Perceived barriers and facilitators for the integration of palliative care in intensive care: results from a qualitative study

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Hemothorax After Retroclavicular Approach to the Infraclavicular Region in a Critically Ill Patient: A Case Report

The retroclavicular approach to the infraclavicular region (RAPTIR) is a recently described locoregional technique for upper limb analgesia that offers advantages over the classic infraclavicular block. RAPTIR is considered an effective and easy-to-perform block associated with few complications and better patient comfort. We present a case of a critically ill patient with thoracic and upper limb trauma. Despite multimodal analgesia, the patient developed delirium and experienced suboptimal pain control. An ultrasound-guided continuous RAPTIR block was performed, resulting in improved pain scores and delirium control. Twenty-four hours post block, the patient presented with dyspnea and chest pain, leading to the diagnosis of hemothorax. Chest computed tomography angiography revealed no vascular damage. The perineural catheter was removed 48 hours after its placement and the patient had a satisfactory recovery without long-term complications. The RAPTIR requires the needle to pass underneath the clavicle's acoustic shadow, putting the structures beneath the clavicle at risk of injury. Cadaver studies have raised concerns about potential vascular complications of the RAPTIR in a noncompressible location. This case highlights, for the first time, a rare but serious complication of the RAPTIR, demonstrating the potential risks of passing the needle through a blind spotinfo:eu-repo/semantics/publishedVersio

Burnout in end-of-life care: Results from a multicenter comparative study between intensive and palliative care units

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Key factors of the functional ability of older people to self-manage medications

Funding Information: This work was funded by the 4IE project (0499_4IE_PLUS_4_E) funded by Interreg V-A España-Portugal (POCTEP) 2017/2021 (https://4ie.eu/). Publisher Copyright: © 2021, The Author(s).Daily medication use can be affected by the gradual loss of functional ability. Thus, elderly patients are at risk for nonadherence due to functional decline, namely, decreases in cognitive skills and visual and manual dexterity. The main objective was to assess the ability of older people to self-manage their medication and to identify the main predictors for unintentional nonadherence. A cross-sectional study was conducted (2014–2017) in community centers and pharmacies. Functional assessment was performed with the Portuguese versions of the Drug Regimen Unassisted Grading Scale (DRUGS-PT) and the Self-Medication Assessment Tool (SMAT-PT). A purposive sample including 207 elderly patients was obtained. To identify the main predictors, binary logistic regression was performed. The average DRUGS-PT score was slightly lower than that in other studies. On the SMAT-PT, the greatest challenge for patients was identifying medications by reading labels/prescriptions. The main difficulties identified were medication memorization and correct schedule identification. The scores were higher with the real regimen than with the simulated regimen, underlining the difficulties for patients in receiving new information. Regarding the predictors of an older individual’s ability to self-manage medications, two explanatory models were obtained, with very high areas under the curve (> 90%). The main predictors identified were cognitive ability, level of schooling and daily medication consumption.publishersversionpublishe

Compared to Palliative Care, Working in Intensive Care More than Doubles the Chances of Burnout: Results from a Nationwide Comparative Study

Professionals working in intensive and palliative care units, hence caring for patients at the end-of-life, are at risk of developing burnout. Workplace conditions are determinant factors to develop this syndrome among professionals providing end-of-life care.This study was partially supported by Fundação Grünenthal and Fundação Merck, Sharp and Dohme (2007/2011), which provided financial support during the period of data collectioninfo:eu-repo/semantics/publishedVersio

The burnout of nurses in intensive care units and the impact of the pandemic of SARS-CoV-2: protocol of a scoping review

BackgroundThe SARS-CoV-2 pandemic has brought multiple challenges for health institutions and their professionals. The requirement of this disease forced nurses to confront organizational and clinical challenges to maintain the quality standards of care they provide. These requirements may have contributed to increased burnout symptoms. This study aims to map the scientific evidence related to nurses’ burnout in intensive care units. Methods: A scoping review will be conducted according to the Joanna Briggs Institute methodology. Relevant databases will be used as well as grey literature, where the following words will be used: burnout, nurses, intensive care units and SARS-CoV-2. Results: This scoping review will include all types of studies—quantitative, qualitative and mixed—and all types of reviews that focus on the objective of this review. Conclusions: It is vital to determine the impact of the burnout caused by the pandemic of SARS-CoV-2 to assess amending measures of risk and protection factors. This will help in the implementation of guidelines according to the available evidence. Additionally, this will help to improve the skills of these professionals as well as to reduce their emotional and physical exhaustion. This protocol is registered with the Open Science Framework.info:eu-repo/semantics/publishedVersio

The Burnout of Nurses in Intensive Care Units and the Impact of the SARS-CoV-2 Pandemic: A Scoping Review

Background: The world’s population changed with the emergence of the SARS-CoV-2 pandemic. Burnout arises due to overwork, prolonged work periods, a lack of human and material resources, etc. Several studies have reported the incidence of burnout syndrome in nurses that work in intensive care units (ICUs). The aim was to map the scientific evidence related to nurses’ burnout in the ICU, namely the repercussions of SARS-CoV-2 in terms of burnout among nurses. Methods: A scoping review followed the Joanna Briggs Institute methodology guidelines to search for and synthesise studies published between 2019 and 2022. The databases searched were MEDLINE, CINAHL, LILACS, SCOPUS, PsycINFO and OPEN GREY. A total of fourteen articles were eligible to be included. Results: A content analysis of the selected articles was carried out, and three categories emerged that corresponded to the dimensions of burnout according to Maslach and Leiter: emotional exhaustion, depersonalisation dimension and a lack of personal accomplishment. It was evident that nurses who worked in the ICU during the pandemic showed high levels of burnout. Conclusions: It is recommended that hospital administrations hire health professionals, namely nurses, as a strategic and operational management strategy to reduce the risk of increased burnout during pandemic outbreaks.info:eu-repo/semantics/publishedVersio

Pullulan hydrogels as drug release platforms in biomedicine

It is increasingly urgent to develop new therapeutic systems to combat the spreading and evolution of various pathologies globally. Nonspecific therapies and/or insufficient medication biodistribution might hinder the patient's recovery. In this sense, a targeted and controlled delivery of various biomolecules allows overcoming the limitations of conventional delivery systems, taking the user one step closer to the successful treatment of a disease. Hydrogels have been highlighted for their drug delivery abilities, particularly for their tunable properties, like hydration capacity, biodegradability, release kinetics, etc., that can be adjusted to the desired needs. Additionally, they can be produced from either natural and/or synthetic polymers, with natural-origin sources providing exceptional features like biodegradation and acceptable integration in biological systems. One of those polymers is pullulan, a biodegradable, biocompatible and hemocompatible material, with multiple uses in biomedicine. Investigations into pullulan-based hydrogels have progressively increased over the last few decades. This review addresses the uses of pullulan in biomedical engineering, emphasizing its exceptional properties for drug delivery and its processing into hydrogel systems, either in its original or derivative forms.Authors acknowledge the Portuguese Foundation for Science and Technology (FCT), FEDER funds by means of Portugal 2020 Competitive Factors Operational Program (POCI) and the Portuguese Government (OE) for funding the project PEPTEX with reference PTDC/CTM-TEX/28074/2017 (POCI-01-0145-FEDER-028074) and 2C2T Strategic project UIDP/00264/2020. M.O.T. and H.P.F. also acknowledge FCT for funding PhD scholarship with reference 2021.06906.BD and auxiliary researcher contract via 2021.02720. CEEIND, respectively

Formulation, characterization, and cytotoxicity evaluation of lactoferrin functionalized lipid nanoparticles for riluzole delivery to the brain

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a very poor prognosis. Its treatment is hindered by a lack of new therapeutic alternatives and the existence of the blood–brain barrier (BBB), which restricts the access of drugs commonly used in ALS, such as riluzole, to the brain. To overcome these limitations and increase brain targeting, riluzole-loaded nanostructured lipid carriers (NLC) were prepared and functionalized with lactoferrin (Lf), facilitating transport across the BBB by interacting with Lf receptors expressed in the brain endothelium. NLC were characterized with respect to their physicochemical properties (size, zeta potential, polydispersity index) as well as their stability, encapsulation efficiency, morphology, in vitro release profile, and biocompatibility. Moreover, crystallinity and melting behavior were assessed by DSC and PXRD. Nanoparticles exhibited initial mean diameters between 180 and 220 nm and a polydispersity index below 0.3, indicating a narrow size distribution. NLC remained stable over at least 3 months. Riluzole encapsulation efficiency was very high, around 94–98%. FTIR and protein quantification studies confirmed the conjugation of Lf on the surface of the nanocarriers, with TEM images showing that the functionalized NLC presented a smooth surface and uniform spherical shape. An MTT assay revealed that the nanocarriers developed in this study did not cause a substantial reduction in the viability of NSC-34 and hCMEC/D3 cells at a riluzole concentration up to 10 μM, being therefore biocompatible. The results suggest that Lf-functionalized NLC are a suitable and promising delivery system to target riluzole to the brain.info:eu-repo/semantics/publishedVersio