Estudio de caso de un adolescente según el Modelo Teórico de Ajuste al Cáncer Parental

Objective: To describe and analyze the experience of an adolescent experiencing parental cancer, based on A Model of Children’s Adjustment to Parental Cancer, and to prescribe nursing interventions in classified language. Method: This is a single case study, qualitative, of a 16-year-old adolescent experiencing maternal cancer. We analyzed a semi-structured interview, based on a script conceptualized by the selected theoretical model. Data processing took place through content analysis. Authorization was obtained from the Research Ethics Committee TI 25/2020. Results: The analysis of the adolescent’s interview allowed identifying categories in agreement with the model variables. Psychosocial adjustment dimensions and stress response symptoms, such as academic performance and somatic symptoms, were recognized in the adolescent’s adjustment process. Nursing interventions will focus on education and support. Conclusion: The theoretical model contributed to assess the needs of adolescents experiencing parental cancer, allowing nursing interventions to be prescribed in classified language that consider moderating and mediating variables, promoting adjustment. The model proved to be suitable for future interventions for adolescents experiencing similar situations.info:eu-repo/semantics/publishedVersio

Detection of anti-infliximab antibodies is impacted by antibody titer, infliximab level and IgG4 antibodies: a systematic comparison of three different assays

Background: There is scant information on the accuracy of different assays used to measure anti-infliximab antibodies (ADAs), especially in the presence of detectable infliximab (IFX). We thus aimed to evaluate and compare three different assays for the detection of IFX and ADAs and to clarify the impact of the presence of circulating IFX on the accuracy of the ADA assays.Methods: Blood samples from 79 ulcerative colitis (UC) patients treated with infliximab were assessed for IFX levels and ADAs using three different assays: an in-house assay and two commercial kits, Immundiagnostik and Theradiag. Sera samples with ADAs and undetectable levels of IFX were spiked with exogenous IFX and analyzed for ADAs.Results: The three assays showed 81-96% agreement for the measured IFX level. However, the in-house assay and Immundiagnostik assays detected ADAs in 34 out of 79 samples, whereas Theradiag only detected ADAs in 24 samples. Samples negative for ADAs with Theradiag, but ADA-positive in both the in-house and Immundiagnostik assays, were positive for IFX or IgG4 ADAs. In spiking experiments, a low concentration of exogenous IFX (5 mu g/ml) hampered ADA detection with Theradiag in sera samples with ADA levels of between 3 and 10 mu g/ml. In the Immundiagnostik assay detection interference was only observed at concentrations of exogenous IFX higher than 30 mu g/ml. However, in samples with high levels of ADAs (> 25 mu g/ml) interference was only observed at IFX concentrations higher than 100 mu g/ml in all three assays. Binary (IFX/ADA) stratification of the results showed that IFX+/ADA and IFX-/ADAs + were less influenced by the assay results than the double-positive (IFX+/ADAs+) and double-negative (IFX-/ADAs-) combination.Conclusions: All three methodologies are equally suitable for measuring IFX levels. However, erroneous therapeutic decisions may occur when patients show double-negative (IFX-/ADAs) or double-positive (IFX+/ADAs+) status, since agreement between assays is significantly lower in these circumstances

Arbustus unedo essence: morphological and genetic characterization of the strawberry tree of Castelo de Paiva

O medronheiro é um arbusto da região mediterrânica que pode ser encontrada por todo o país. Ao contrário do que verifica na região sul do país, no concelho de Castelo de Paiva é atribuída uma reduzida importância económica a esta espécie. Com o intuito de preservar e potenciar a produção desta espécie e contribuir para a dinamização da economia do concelho, procedeu-se à caracterização morfológica e genética de uma amostra da população de medronheiros de Castelo de Paiva. A caracterização morfológica e genética foi realizada para um total de 10 genótipos. Para tal recolheram-se 70 folhas aleatoriamente em cada árvore. Em 40 folhas mediu-se o comprimento, largura, comprimento do pedúnculo, peso fresco, peso seco e determinou-se a área foliar. Dos caracteres morfológicos analisados, aqueles que se revelaram mais úteis na distinção dos vários genótipos foram: comprimento do pedúnculo, peso fresco e peso seco. As restantes 30 folhas foram utilizadas para a caracterização genética. Esta caracterização foi realizada recorrendo a um marcador de DNA, ISSR. Os 5 primeiros exemplaresutilizados na técnica de ISSR demonstraram-se polimórficos. Os resultados da caracterização genética sugerem que a variabilidade genética na população é média a alta.The strawberry tree is a shrub native in the Mediterranean region and it can be found throughout Portugal. Unlike the case in the southern region of the country, in Castelo de Paiva a minor economic importance is given to this species. In order to preserve, to enhance the production of this species and to contribute to the boosting of the economy of the region, we proceeded to the characterization of a small sample population of this fruit tree of Castelo de Paiva in what concerns to its morphology and genetics. The morphological and genetic characterization was performed for a total of 10 genotypes. For this, 70 leaves were randomly collected from each tree. For 40 leaves, it was measured the length, the width, the peduncle length, the wet weight, the dry weight and determined the leaf area. Of the morphological characteristics analyzed, the ones that proved most useful in distinguishing the various genotypes were: the length peduncle, the wet weight and the dry weight. The remaining 30 leaves were used in the genetic characterization. This characterization was performed using a DNA marker, the ISSR. The 5 primers used in the ISSR technique proved to be polymorphic. The results from the genetic characterization suggest that variability in population genetics is medium to high

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

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

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Formação dos enfermeiros das unidades de cuidados continuados de longa duração do distrito de Viseu em cuidados paliativos

Enquadramento: Cuidar de doentes com necessidades de cuidados paliativos envolve a prevenção e o tratamento/controlo dos sintomas e do sofrimento. Como os enfermeiros desempenham um papel fundamental nesta área, a preparação adequada em todas as esferas dos cuidados paliativos é crucial. Por conseguinte, procurou-se estudar os determinantes que influenciam a formação dos enfermeiros das Unidades de Cuidados Continuados Integrados de Longa Duração (UCCILD) do Distrito de Viseu. Objetivos: Conhecer a perceção dos enfermeiros que trabalham em UCCILD sobre a sua formação em cuidados paliativos; Identificar os determinantes que influenciam a formação em cuidados paliativos dos enfermeiros das UCCILD do Distrito de Viseu; descrever a relação das variáveis de caracterização sociodemográfica com a formação em cuidados paliativos dos enfermeiros das UCCILD do Distrito de Viseu Métodos: Estudo de natureza quantitativa, com corte transversal, descritivo-analítico numa amostra não probabilística por conveniência constituída por 93 enfermeiros a trabalhar em Unidades de Cuidados Continuados de Longa Duração do Distrito de Viseu, sendo a maioria do género feminino (81,7%), com uma média de idades de 30,90 anos (±5,95 anos). O instrumento de recolha de dados, elaborado ad hoc, inclui um questionário com questões de caracterização sociodemográfica e profissional, questões relativas à formação em cuidados paliativos, às principais necessidades que o doente apresenta em fim de vida, questões referentes à importância da intervenção do Enfermeiro em cuidados paliativos e à formação sobre cuidados paliativos. Resultados: A maioria dos enfermeiros (44,1%) tem a perceção que a sua formação como suficiente e 25,8% considera-a insuficiente. Quase a totalidade da amostra assumiu como importante desenvolver mais os conteúdos e aumentar a carga horária sobre cuidados paliativos no curso de licenciatura em enfermagem (95,7%); 78,5% receberam, durante o curso, informação sobre cuidados a doentes em situação terminal; 55,9% referem que depois de terminarem o curso frequentaram formação na área dos cuidados paliativos; 64,5% sentem-se preparados para cuidar doentes paliativos; 60,2% consideram que os enfermeiros da sua Instituição/unidade/serviço estão preparados para cuidar destes doentes. Enquanto profissionais frequentaram acções de formação em cuidados paliativos com uma média de 40,65±46,63 horas de formação; 83,3% dos enfermeiros a referirem que essa formação não teve componente prática (estágio). A falta de tempo (61,0%), a pouca oferta formativa na área e a falta de conhecimento de formação na área (31,7%), foram apontados como principais motivos pelos quais 44,1% dos enfermeiros nunca frequentaram formação extracurricular na área dos cuidados paliativos; 88,2% gostariam de frequentar formação específica na área, com a maioria (60,0%) a referir que gostaria de tirar uma Pós-graduação. Quer os Enfermeiros (88,2%) quer as Enfermeiras (72,3%) expressam que gostariam de frequentar formação na área. O controlo de sintomas (72,0%), a comunicação em cuidados paliativos (67,0%), o apoio à família e cuidador (66,0%), doente em situação terminal/processo de morrer (63,0%) e apoio no processo de perda e luto (60%) são as áreas que mais gostariam de ver aprofundadas. Maioritariamente, os enfermeiros (64,5%) consideram estar reparados para cuidar doentes paliativos (82,4% Enfermeiros vs. 60,5% Enfermeiras), tendo 92,5% atribuído um grau de muita importância à intervenção do Enfermeiro em cuidados paliativos. As necessidades percepcionadas pelos enfermeiros como mais importantes num doente em fim de vida foram “Alívio do sofrimentos (sintomas)” (M=1,72) e “ser tratado como um ser humano” (M=2,99). Conclusões: Apesar da maioria dos enfermeiros considerarem estar preparada para cuidar doentes com necessidades paliativas os resultados revelam que a grande maioria gostaria de frequentar formação específica na área. Surge, assim, a necessidade de se investir mais sobre aspetos específicos de intervenção paliativa na formação os enfermeiros das Unidades de Cuidados Continuados Integrados de Longa Duração, capacitando-os para o desempenho de boas práticas. As situações com que lidam no dia-a-dia são de grande complexidade com doenças/processos crónicos e vários níveis de incapacidade, exigindo prestação de cuidados que satisfaçam as suas necessidades globais, numa visão holística e de acordo com os princípios que regem os cuidados paliativos.Abstract Background: Caring for patients with palliative care needs involves the prevention and treatment / control of symptoms and suffering. As nurses play a key role in this area, adequate preparation in all spheres of palliative care is crucial. Therefore, we sought to study the determinants that influence the training of nurses in the Integrated Long-term Care Units (UCCILD) of the District of Viseu. Objectives: To know the perception of the nurses working in UCCILD about their training in palliative care; To identify the determinants that influence the training in palliative care of UCCILD nurses from the District of Viseu; to describe the relationship of variables of sociodemographic characterization with the training in palliative care of UCCILD nurses from the District of Viseu Methods: A quantitative, cross-sectional, descriptive-analytical study in a non-probabilistic sample for the convenience of 93 nurses working in Long-term Care Units of the District of Viseu, most of them female (81.7% ), with a mean age of 30.90 years (± 5.95 years). The data collection instrument, developed ad hoc, includes a questionnaire with questions of sociodemographic and professional characterization, questions related to training in palliative care, the main needs that the patient presents at the end of life, questions concerning the importance of the intervention of the Nurse in palliative care and in palliative care training. Results: Most nurses (44.1%) perceived their training as sufficient and 25.8% considered it insufficient. Almost all of the sample assumed as important to further develop the contents and increase the workload on palliative care in the degree course in nursing (95.7%); 78.5% received information during the course on care for terminally ill patients; 55.9% reported that after completing the course they attended training in palliative care; 64.5% feel prepared to care for palliative patients; 60.2% consider that the nurses of their Institution / unit / service are prepared to take care of these patients. While professionals attended training courses in palliative care with an average of 40.65 ± 46.63 hours of training; 83.3% of the nurses mentioned that this training had no practical component (stage). The lack of time (61.0%), the lack of training in the area and the lack of training knowledge in the area (31.7%) were pointed out as the main reasons why 44.1% of the nurses never attended extracurricular training in the field of palliative care; 88.2% would like to attend specific training in the area, with the majority (60.0%) mentioning that they would like to take a Postgraduate Degree. Both nurses (88.2%) and nurses (72.3%) expressed that they would like to attend training in the area. Control of symptoms (72.0%), communication in palliative care (67.0%), support to the family and caregiver (66.0%), terminally ill / dying process (63.0%), and support in the process of loss and mourning (60%) are the areas they would most like to see in depth. The majority of nurses (64.5%) consider being repaired to care for palliative patients (82.4% Nurses vs. 60.5% Nurses), and 92.5% assigned a very important degree to the nurse's intervention in palliative care . The needs perceived by nurses as most important in an end-of-life patient were "Relief of suffering (symptoms)" (M = 1.72) and "being treated as a human being" (M = 2.99). Conclusions: Although the majority of nurses consider being prepared to care for patients with palliative needs, the results reveal that the vast majority would like to attend specific training in the area. Thus, the need to invest more on specific aspects of palliative intervention in the training of the nurses of Integrated Long-term Integrated Care Units, enabling them to perform good practices. The situations they deal with on a day-to-day basis are highly complex with chronic diseases / processes and various levels of disability, requiring care that meets their global needs, in a holistic view and in accordance with the principles governing care palliative measures

Trabalho Livre nº 15 - Qualidade de Vida de Doente Oncológico de Tecidos Moles em Tratamento à Ferida Cirúrgica com Processo de Cicatrização por Segunda Intenção

A avaliação da Qualidade de Vida (QV) é utilizada como indicador de resposta ao tratamento das pessoas com feridas, em que são analisados os aspectos físicos, psicológicos, sociais, o estado funcional e a visão da vida. Pessoas com feridas com cicatrização demorada enfrentam alterações na imagem corporal, prejuízos na mobilidade, deficit no auto-cuidado, incapacidade para a realização das atividades de vida diária, presença de dor e de desconforto que acarretam impactos negativos na QV, devendo ser uma preocupação do enfermeiro.N/