Evidence-based instruction strategies to improve Drug Calculation Skills

Introduction: Medication errors and insecure practices harm healthcare systems worldwide. Each year, around 7,000 to 9,000 people in the United States die due to medication errors. (Tariq et al., 2023). There is no standardized method of educating healthcare providers on medication calculations. Objectives: Identify evidence-based instruction strategies for drug calculation skills development and describe the strategies based on the research-based principles for smart teaching. Methods: Through an evidence-based systematic review, we followed Whittemore and Knalf (2005) steps to assess the level and quality of evidence. The research process involved five steps: (1) defining the research question, (2) conducting a literature review, (3) gathering data from primary sources, (4) analyzing data, and (5) presenting findings. An electronic search of CINAHL, PubMed, and PsycINFO was conducted using the search terms “students,” “nursing,” “education,” “drug dosage calculations,” and “mathematics.” To qualify for inclusion in the review, the studies had to include nursing students or nurses, be written in English, and not restricted in regards of the country. Articles were not restricted to any one country because medication calculation errors related to patient safety remain a significant global issue. From 2014 to 2020, a total of 1793 articles were retrieved. Results: For this review, we found 51 studies that met the eligibility criteria. Most of these studies reported results based on evidence levels III (23.5%) and V (41.2%). The majority of the information quality was from Level B (82.4%). Table 1 summarizes the level of evidence, quality of evidence, role of evidence in learning and teaching, and the research-based principles addressed in the studies reviewed. The major teaching strategies were early diagnostic assessments of students' knowledge, anxiety, and self-confidence; stimulate self-directed learning, and working on knowledge organization by scaffolding complex tasks, and being explicit about objectives and expectations. The use of e-learning has become increasingly popular since 2018. Discussion: Utilizing technology can greatly benefit education by complementing in-class practice and providing students with opportunities for creative, autonomous, collaborative, and interactive learning. In recent years, there has been an increase in publications utilizing e-learning, smartphone apps, and web pages to improve drug calculation skills (for example: https://www.safemedicate.net/ and https://testandcalc.com/index.html). However, due to the low levels and quality of evidence, we recommend that future studies use research designs that produce higher levels of evidence. For instance, randomizing teaching methods per semester allows for a standardized approach to data gathering in nursing programs, which enhances consistency in monitoring student progress and evaluating teaching effectiveness. Implementing web-based software can also support effective research-based approaches. We recommend that teaching approaches address cognitive, motivational, and developmental goals to ensure student success. Future trends are adaptive web-based technology aiming at improving the learning of medication calculation skills (Ravik & Andresen, 2023).<p/

Análise da contribuição do inflamassoma na heterogeneidade clínica de pacientes com doença falciforme

In spite of having a molecular basis, Sickle cell disease (SCD) is an inflammatory state with abnormal cell activation. Physiopathological factors are not completely understood, but it is known that interleukins plays an important role in inflammation. Inflammasome complex is an innate immune pathway involved in the production of active IL-1β and IL-18. The participation of this complex in sickle cell disease is still not clear. Polymorphisms of inflammasome are simple amino acid substitution that can lead to a loss or gain of function and may be associated with clinical manifestations. NLRP3 is the most studied and well-known inflammasome, associated especially to auto-inflammatory diseases. Aim: To analyze the contribution of inflammasome to the clinical heterogeneity of SCD. To this, the association of inflammasome gene polymorphisms and a functional in vitro study were performed. Methods: In the association study 161 patients were included. Retrospective data were collected to fill clinical and laboratorial information. Patients were classified in two different groups: mild (0-1) or severe (> 2 organ damage). DNA samples were collected from 88 patients and 73 were used from a biorepository (BR- 116). Minor allelic frequency and literature information were used to choose 10 SNPs. Real-time PCR technique with allele and specific probes was used in TaqMan® assays (Applied Biosystms, Thermo Fisher Scientific). To functional study (n=7), PBMC and monocytes from healthy patients and controls were challenged with LPS and / or ATP, with subsequent IL-1β dosage by the ELISA method. All volunteers received a free and informed consent form. Multivariate analysis were performed by the software R Studio 3.5.3 (www.r-project.org), SNP association package. Mann-Whitney test was applied to group comparison. Results: The gain-offunction polymorphism rs16944 has resulted in a significant protection factor for SCD severity. The loss of function variant in the IL18 gene (rs1834481) was associated to high count of monocytes and leucocytes. In the functional test, patients with SCD tend to have less inflammasome activation when compared to controls. Conclusion: The promoter variant -511 C>T in IL1β resulted significantly associated to mild presentation in SCD patients (padj=0.001). PBM analysis showed that SCD cells seems to be less prone to activate inflammasome than HD.Introdução: A doença falcifome (DF) é causada por uma simples mudança de base (adenina por timina, c.20A>T) no gene da cadeia da ß-globina, com produção de hemoglobina S. Os principais mecanismos fisiopatológicos da DF envolvem anemia hemolítica e eventos vaso-oclusivos. Apesar da patogênese comum, os pacientes com DF apresentam quadros clínicos variados e diferentes graus de gravidade. A inflamação é uma caraterística frequente e vários padrões moleculares associados ao dano (DAMPs), como a própria hemoglobina falciforme, podem ativar o complexo inflamassoma com consequente produção das citocinas pró-inflamatórias IL-1ß e IL- 18. Variantes genéticas nos componentes do inflamassoma foram previamente associadas a manifestações clínicas que também ocorrem nos pacientes com DF. Portanto, levantamos a hipótese de que o inflamassoma possa contribuir na patogênese da DF e explicar, pelo menos em parte, a heterogeneidade clínica da doença. Objetivos: Avaliar a distribuição de polimorfismos nos principais genes do inflamassoma de acordo com a gravidade da DF e analisar a ativação do complexo em monócitos e PBMC dos pacientes. Material e métodos: Foram analisadas 10 variantes gênicas funcionais nos principais componentes do inflamassoma em uma coorte de 161 pacientes com DF (SS/Sβ) através de ensaios alelo-especificos e qPCR. A distribuição dos polimorfismos foi avaliada através de análise multivariada, de acordo com a gravidade da DF e de dados clínicos e laboratoriais. A ativação do inflamassoma em monócitos e PBMC isolados de sangue periférico foi comparada entre pacientes (n=10) e controles (n=9), através de dosagem de IL1-β pelo método de ELISA. Resultados: O polimorfismo ganho-de função rs16944 no gene IL1β resultou em um fator protetor para gravidade da DF. A variante perda-de-função no gene IL18 (rs1834481) associou-se com valores mais altos de monócitos e leucócitos. No teste funcional, pacientes com AF tendem a ativar menos o inflamassoma quando comparados aos controles. Conclusão: O polimorfismo da IL1β (-511C>T) pode contribuir na heterogeneidade clínica da DF, além de que, quando comparados a controles normais, os monócitos e PBMC desses pacientes tendem a produzir menos IL1β.Dados abertos - Sucupira - Teses e dissertações (2019

Avaliação dos efeitos da transfusão de sanguínea na saturação venosa mista e nos níveis de lactato em pacientes com SIRS/sepse

PURPOSE: To evaluate the effects of red blood cell transfusion in patients with SIRS/sepsis who presented hemoglobin levels under 9.0 g/dL at intensive care unit admission, using two parameters of organ perfusion: mixed venous oxygen saturation and serum lactate levels. METHODS: All patients admitted to the intensive care unit with SIRS/sepsis, as defined by Consensus Conference in 1992, and hemoglobin levels under 9.0 g/dL were included. Hemoglobin levels, mixed venous oxygen saturation, and lactate levels were collected before red blood cell transfusion (pre-T) and up to 1 hour after transfusion (post-T). These variables were analyzed through a paired t test, and results were considered significant if P < .05. RESULTS: Twenty-nine patients (17 male, 12 female) with ages of 61.9 ± 15.1 (mean ± SD) years (range, 21-85 years) and a mean APACHE II score of 12.5 ± 3.75 (7-21) were transfused with a mean of 1.41 packed red cell units. A significant increase in hemoglobin levels was reached by blood transfusion, from 8.14 ± 0.64 g/dL (pre-T) to 9.4 ± 0.33 g/dL (post-T), with POBJETIVOS: Avaliar o efeito da transfusão de hemáceas em pacientes com SIRS/sepse que apresentaram níveis de hemoglobina abaixo de 9,0g/dL durante internação em unidade de terapia intensiva, usando dois parâmetros de perfusão orgânica, a saturação venosa mista de oxigênio e os níveis de lactato sérico. MÉTODOS: Todos os pacientes admitidos na Unidade de Terapia Intensiva com SIRS/sepse, como definido pela Conferência de Consenso de 1992, e níveis de hemoglobina abaixo de 9,0g/dL foram incluídos. Os níveis de hemoglobina, saturação venosa mista de oxigênio e lactato sérico foram coletados antes (pré-T) e após uma hora da transfusão de hemáceas (pós-T). Essas variáveis foram analisadas através do teste T de Student pareado e os resultados considerados significativos se

Premature Infant Gut Microbiome relationships with childhood behavioral scales: preliminary insights

IntroductionVery Low Birth Weight (VLBW) infants, born weighing less than 1,500 grams, are at risk for both gut dysbiosis and later neuropsychological developmental deficits. Behavioral effects, while related to neurodevelopment, are often more subtle and difficult to measure. The extent of later neurobehavioral consequences associated with such microbial dysbiosis has yet to be determined. We explored associations between the infants’ gut microbiome and early childhood behavior at 4 years of age and identified the bacterial taxa through a multivariate analysis by linear models.MethodsParents completed the Child Behavior Checklist (CBCL) focused on different DSM diagnostic categories: affective, anxiety, pervasive developmental, attention deficit/hyperactivity, and oppositional defiant. All the CBCL scores were corrected for gender, delivery method, gestational age, infant birth weight, occurrence of sepsis, and days on antibiotics prior statistical analyses. Canonical correlation analysis (CCA) was performed to determine the relationship between early life gut microbiome and the adjusted CBCL scores. The association of bacterial Amplicon sequence Variants (ASVs) to the CBCL scores were tested with multivariate analysis by linear models (MaAsLin).ResultsNineteen children who were previously born with very low birth weight and studied while hospitalized in the Neonatal Intensive Care Unit (NICU) were included in this study. Statistically significant associations were observed between early life gut bacteria such as Veillonella dispar, Enterococcus, Escherichia coli, and Rumincococcus to later behavior at 4 years. No significant association could be observed with early-life gut microbiome alpha diversity and behavioral measures at 4 years.DiscussionThese preliminary observational data provide insight into the relationships between VLBW gut microbiome dysbiosis and childhood behavior. This study contributes to the literature on gut microbiome analysis by examining various behavioral domains using a standardized tool linked to the Diagnostic and Statistical Manual of Mental Disorders (DSM)

Growth of tamarind seedlings using pre-germinative treatments and different substrates

A cultura do tamarindo vem ganhando destaque em consequência da adaptabilidade à região nordeste e das diversas finalidades que o seu fruto pode proporcionar. Porém, seu cultivo possui ainda restrita especificidade para os tratos culturais, fundamental para maximizar a exploração comercial desta espécie, como o processo de produção de mudas, que é primordial para se alcançar alta produtividade, principalmente em espécies frutíferas. Portanto, objetivou-se avaliar o crescimento em mudas de tamarindeiro sob a influência de tratamentos pré-germinativos e diferentes substratos. A pesquisa foi conduzida em ambiente protegido, nas dependências da Universidade Federal de Campina Grande, campus Pombal. O delineamento experimental adotado foi em blocos casualizados em esquema fatorial 5 x 4, cujo primeiro fator equivale aos tratamentos pré-germinativos (escarificação mecânica com a lixa e embebição em água por 24 horas; corte do tegumento e embebição em água por 24 horas; embebição em água por 24 horas; semente embebida em água com Trichoderma harzianum por 24 horas; e &nbsp;semente embebida em água contendo Trichoderma longibrachiatum por 24 horas) e o segundo fator aos substratos (100% solo; solo + substrato comercial basaplant Solaris® (3:2); solo + esterco bovino (3:2);e, &nbsp;solo + esterco caprino (3:2)), com 6 repetições. O crescimento das mudas de Tamarindus indica L. obteve os melhores índices de crescimento com os substratos formulados da mistura de esterco caprino e solo, sendo assim o mais a fonte mais viável. O uso dos tratamentos pré-germinativos com embebição da semente em Trichoderma ssp. estimulou crescimento das mudas. Palavras-chaves: desenvolvimento vegetativo, embebição de sementes, insumo orgânico, Tamarindus indica L. &nbsp

Analytical Processing Over XML and XLink

Current commercial and academic OLAP tools do not process XML data that contains XLink. Aiming at overcoming this issue, this paper proposes an analytical system composed by LMDQL, an analytical query language. Also, the XLDM metamodel is given to model cubes of XML documents with XLink and to deal with syntactic, semantic and structural heterogeneities commonly found in XML documents. As current W3C query languages for navigating in XML documents do not support XLink, XLPath is discussed in this article to provide features for the LMDQL query processing. A prototype system enabling the analytical processing of XML documents that use XLink is also detailed. This prototype includes a driver, named sql2xquery, which performs the mapping of SQL queries into XQuery. To validate the proposed system, a case study and its performance evaluation are presented to analyze the impact of analytical processing over XML/XLink documents.FAPESPFACEPECAPESCNPqINEPFINE

Homicides and social vulnerability.

O objetivo deste estudo foi analisar a distribui??o espacial das taxas de homic?dios (H) segundo os ?ndices de vulnerabilidade social (IVS) e de qualidade de vida urbana (IQVU), em Betim/ MG, de 2006 a 2011. Foram feitas an?lise descritiva, an?lise de correla??o espacial utilizando o ?ndice de Moran e an?lise espacial de H, IV e IQVU. Ocorreram no per?odo, 1.383 ?bitos, com predom?nio de homens (91,9%), de 15 a 24 anos (46,9%), pardos/pretos (76,9%), com ensino m?dio (51,1%) e solteiros (83,9%). N?o se verificou autocorrela??o espacial, indicando que a distribui??o das taxas de homic?dio ? aleat?ria, o mesmo ocorrendo com o IVS e com o IQVU. Em conjunto, no entanto, houve sobreposi??o de H, IVS, IQV, o que foi analisado ? luz de diferentes teorias explicativas do crime, desde as que abordam a desigualdade social, passando pelas que pautam o tr?fico de armas e drogas at? chegar ?s teorias de Durkheim e Habermas, respectivamente, anomia e coloniza??o do mundo da vida. Conclus?o: tanto do ponto de vista emp?rico como te?rico, vulnerabilidade social e homic?dio se mostram associados.The goal of this study was to analyze the spatial distribution of homicide rates (H) according to the social vulnerability index (SVI) and the quality of urban life index (QUL) in Betim, State of Minas Gerais, from 2006 to 2011. Descriptive analysis was performed using Moran?s spatial correlation analysis, and the H, SVI and QUL spatial analyses. During this period there were 1,383 deaths, mostly of males (91.9%), aged 15-24 years (46.9%), brown/black (76.9%), with secondary education (51.1%), and single (83.9%). No spatial autocorrelation was revealed, indicating that the distribution of homicide rates is random; the same occurred with the SVI and the QUL index. Taken together, however, the H, SVI and QUL index overlapped, which was analyzed using different theories of crime, such as those addressing socioeconomic issues, arms of drugs dealing and Durkheim?s and Habermas? theories, namely anomie and colonization of the lifeworld. Conclusion: social vulnerability and homicide are associated from both empirical and theoretical perspectives

Cytokine Production but Lack of Proliferation in Peripheral Blood Mononuclear Cells from Chronic Chagas' Disease Cardiomyopathy Patients in Response to T. cruzi Ribosomal P Proteins

Background:Trypanosoma cruzi ribosomal P proteins, P2β and P0, induce high levels of antibodies in patients with chronic Chagas' disease Cardiomyopathy (CCC). It is well known that these antibodies alter the beating rate of cardiomyocytes and provoke apoptosis by their interaction with β1-adrenergic and M2-muscarinic cardiac receptors. Based on these findings, we decided to study the cellular immune response to these proteins in CCC patients compared to non-infected individuals.Methodology/Principal findings:We evaluated proliferation, presence of surface activation markers and cytokine production in peripheral blood mononuclear cells (PBMC) stimulated with P2β, the C-terminal portion of P0 (CP0) proteins and T. cruzi lysate from CCC patients predominantly infected with TcVI lineage. PBMC from CCC patients cultured with P2β or CP0 proteins, failed to proliferate and express CD25 and HLA-DR on T cell populations. However, multiplex cytokine assays showed that these antigens triggered higher secretion of IL-10, TNF-α and GM-CSF by PBMC as well as both CD4+ and CD8+ T cells subsets of CCC subjects. Upon T. cruzi lysate stimulation, PBMC from CCC patients not only proliferated but also became activated within the context of Th1 response. Interestingly, T. cruzi lysate was also able to induce the secretion of GM-CSF by CD4+ or CD8+ T cells.Conclusions/Significance:Our results showed that although the lack of PBMC proliferation in CCC patients in response to ribosomal P proteins, the detection of IL-10, TNF-α and GM-CSF suggests that specific T cells could have both immunoregulatory and pro-inflammatory potential, which might modulate the immune response in Chagas' disease. Furthermore, it was possible to demonstrate for the first time that GM-CSF was produced by PBMC of CCC patients in response not only to recombinant ribosomal P proteins but also to parasite lysate, suggesting the value of this cytokine to evaluate T cells responses in T. cruzi infection.Fil: Longhi, Silvia Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Atienza, Augusto. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Perez Prados, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Buying, Alcinette. Torrey Pines Institute for Molecular Studies; Estados UnidosFil: Balouz, Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Biotecnológicas. Universidad Nacional de San Martín. Instituto de Investigaciones Biotecnológicas; ArgentinaFil: Buscaglia, Carlos Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Biotecnológicas. Universidad Nacional de San Martín. Instituto de Investigaciones Biotecnológicas; ArgentinaFil: Santos, Radleigh. Torrey Pines Institute for Molecular Studies; Estados UnidosFil: Tasso, Laura Mónica. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Bonato, Ricardo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Chiale, Pablo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Pinilla, Clemencia. Torrey Pines Institute for Molecular Studies; Estados UnidosFil: Judkowski, Valeria A.. Torrey Pines Institute for Molecular Studies; Estados UnidosFil: Gomez, Karina Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentin

Primeiro registro de Cryptococcus neoformans em excretas de pombos provenientes de locais públicos e residenciais de área metropolitana de Cuiabá, Estado do Mato Grosso, Brasil

RESUMO A criptococose é micose sistêmica potencialmente grave causada por duas espécies do gênero Cryptococcus que acometem tanto homens como animais: Cryptococcus neoformans e C. gattii. São infecções cosmopolitas e emergentes, resultantes da interação do hospedeiro - humano e animal versus meio ambiente. A proposta deste trabalho foi avaliar a ocorrência de C. neoformans em 122 amostras de excretas secas de pombos coletadas em 49 locais na cidade de Cuiabá, Estado do Mato Grosso, Brasil, incluindo: praças públicas (n = 5), igrejas (n = 4), instituições de ensino (n = 3), unidades de saúde (n = 8), áreas abertas exibindo cobertura de amianto (n = 4), conjuntos residenciais domiciliares (n = 23), uma fábrica (n = 1) e um presídio (n = 1). Semeadura de suspensão de amostras em meio ágar niger (NSA), identificação fenotípica por provas bioquímicas e teste em meio de canavanina-glicina-azul de bromotimol, das colônias isoladas com pigmentação marrom escura. Foi também utilizada a técnica da reação em cadeia da polimerase com pares de iniciadores específicos para identificação de C. neoformans. As amostras foram coletadas de julho a dezembro de 2010. Cryptococcus neoformans foi isolado em oito (6,6%) de 122 amostras correspondendo a seis (12,2%) dos 49 sítios analisados. Cryptococcus neoformans associado a excretas de pombos ocorre em áreas de Cuiabá, predominando em residências nas amostras analisadas, constituindo fator de risco potencial para aquisição da doença tanto para indivíduos imunocomprometidos como imunocompetentes.SUMMARY Cryptococcosis is a severe systemic mycosis caused by two species of Cryptococcus that affect humans and animals: C. neoformans and C. gattii. Cosmopolitan and emergent, the mycosis results from the interaction between a susceptible host and the environment. The occurrence of C. neoformans was evaluated in 122 samples of dried pigeon excreta collected in 49 locations in the City of Cuiabá, State of Mato Grosso, Brazil, including public squares (n = 5), churches (n = 4), educational institutions (n = 3), health units (n = 8), open areas covered with asbestos (n = 4), residences (n = 23), factory (n = 1) and a prison (n = 1). Samples collected from July to December of 2010 were seeded on Niger seed agar (NSA). Dark brown colonies were identified by urease test, carbon source assimilation tests and canavanine-glycine-bromothymol blue medium. Polymerase chain reaction primer pairs specific for C. neoformans were also used for identification. Cryptococcus neoformans associated to pigeon excreta was isolated from eight (6.6%) samples corresponding to six (12.2%) locations. Cryptococcus neoformans was isolated from urban areas, predominantly in residences, constituting a risk of acquiring the disease by immunocompromised and immunocompetent individuals

A rastreabilidade de dispositivos médicos implantáveis e o sistema único de identificação de dispositivos: um estudo bibliométrico

The aim was to systematize and analyze the national and international scientific production on the traceability of implantable medical devices and the use of the Unique Device Identification System in 126 academic articles. Data were retrieved from the Scopus database and analyzed using inferential statistics to reach conclusions about a larger group. Thus, the coefficient of determination and the chi-square test of adherence were adopted, using the Microsoft Excel® software and the R statistical program to assess the scientific production activity related to the terms’ traceability and unique identification of the device. A map was generated in the VOS software, which provided the analysis of the behavior parameters and some presentations of the results in the form of tables and graphs, examined according to descriptive statistics. It was found that there was theoretical and empirical growth in the field of traceability of implantable medical devices and in the use of the Unique Device Identification System.Objetivou-se sistematizar e analisar a produção científica nacional e internacional sobre a rastreabilidade de dispositivos médicos implantáveis ​​e a utilização do Sistema Único de Identificação de Dispositivos em 126 artigos acadêmicos. Os dados foram recuperados da base de dados Scopus e analisados ​​à luz da estatística inferencial, a fim de se chegar a conclusões sobre um grupo maior. Assim, foram adotados o coeficiente de determinação e o teste de aderência do qui-quadrado, utilizando o software Microsoft Excel® e o programa estatístico R para avaliar a atividade de produção científica relacionada com os termos rastreabilidade e identificação única do dispositivo. Foi gerado um mapa no software VOS, que proporcionou a análise dos parâmetros de comportamento e algumas apresentações dos resultados em forma de tabelas e gráficos, examinados de acordo com a estatística descritiva. Verificou-se que houve crescimento teórico e empírico no campo da rastreabilidade de dispositivos médicos implantáveis ​​e na utilização do Sistema Único de Identificação de Dispositivos