Entrepreneurship and nursing: what reality?

O presente estudo de revisão integrativa da literatura tem como objetivo validar a evidência científica sobre como é efetivado o empreendedorismo pelos enfermeiros. Considerou-se este um tema de relevância, uma vez que ser empreendedor equivale a ideias inovadoras que permitem a identificação da necessidade de se criar algo de novo para preencher lacunas. Assim, num mundo em constante renovação, os enfermeiros avaliam continuamente os problemas a nível de saúde e de ofertas para responder às reais necessidades das comunidades, o que os leva a questionar: Como posso fazer melhor? Os enfermeiros possuem uma perspetiva única sobre o comportamento humano e sobre as perspetivas dos cuidados de saúde, podendo traduzir-se em inovação de oferta de assistência, preenchendo lacunas existentes. Neste sentido, realizou-se uma revisão integrativa da literatura, com pesquisas que incluíram estudos que datam entre 2015 a 2019, em inglês, recorrendo à plataforma eletrónica de bases de dados "Web of Science" no período de 01/05/2020 a 1/06/2020, utilizando os seguintes termos: entrepreneurship; entrepeneur; nursing. O corpus textual ficou constituído por 10 artigos, cuja análise revela que ser enfermeiro empreendedor significa empreender, assumir a responsabilidade e o risco de descobrir ou criar oportunidades para usar talentos pessoais, habilidades e energia, usando de um processo de planeamento para transferir essa oportunidade para um serviço ou produto. Importa ressalvar que assumir riscos é um aspeto fundamental do empreendedorismo, uma vez que, como demonstram os estudos, ser enfermeiro empreendedor, na maioria dos casos, equivale a iniciar o seu próprio negócio e ser trabalhador independente. No entanto, o termo não se deve limitar ao status de emprego, na medida em que o empreendedorismo tem a ver com o espírito de imaginação e de criatividade, e a coragem para desenvolver novas ideias. Um enfermeiro empreendedor é autónomo, diretamente responsável perante o cliente, a quem ou em nome do qual presta serviços de enfermagem.The present study of integrative literature review aims to validate the scientific evidence on how entrepreneurship is carried out by nurses. This was considered a relevant topic, since being an entrepreneur is equivalent to innovative ideas that allow the identification of the need to create something new to fill gaps. Thus, ina world in constant renewal, nurses continually assess problems interms of health and offers to respond to the real needs of communities, which leads them to ask: How can I do better? Nurses have a unique perspective on human behavior and health care perspectives, which can translate into innovation in the provision of care, filling existing gaps. In this sense, an integrative literature review was carried out, with research that included studies dating from 2015 to 2019, in English, using the electronic database platform "Web of Science" inthe period from 01/05/2020 to 01/06/2020, using the following terms: entrepreneurship; entrepreneur; nursing. The textual corpus consistedof 10 articles, whose analysis reveals that being an entrepreneur nurse means to undertake, to assume responsibility and the risk of discovering or creating opportunities to use personal talents, skills and energy, using a planning process to transfer this opportunity to a service or product. It is important to emphasize that taking risks is a fundamental aspect of entrepreneurship, since, as studies show, being an entrepreneur nurse, in most cases, is equivalent to starting your own business and being an independent worker. However, the term should not be limited to employment status, as entrepreneurship has to do with the spirit of imagination and creativity, and the courage to develop new ideas. An entrepreneurial nurse is autonomous, directly responsible to the client, to whom or on behalf of whom he provides nursing services.info:eu-repo/semantics/publishedVersio

Liderança e governação hospitalar: promoção da qualidade de cuidados num país envelhecido

The aging of the population has become a major challenge for most countries worldwide, as well as a focus of research, in the concrete case in the area of nursing. The overall decline in fertility rates and the prolongation of life expectancy per capita in both developed and developing countries since 1996 have led to a resurgence of the elderly population worldwide. Developed countries were the first to experience an aged society and are moving towards hyper-aged societies, as is the Portuguese case. Several population projections also indicate that the aging process of the world's population will accelerate in the coming decades. Through this scenario, this article aims to reflect on hospital leadership and governance in promoting the quality of care in an aging country, based on a literature review methodology.O envelhecimento da população tornou-se um grande desafio para a maioria dos países a nível mundial, bem como um foco de investigação, no caso concreto na área da enfermagem. O declínio geral das taxas de fertilidade e o prolongamento da esperança de vida per capita, tanto nos países desenvolvidos como nos países em desenvolvimento, desde 1996, levaram a um recrudescimento da população idosa em todo o mundo. Os países desenvolvidos foram os primeiros a vivenciar uma sociedade envelhecida e estão a avançar para sociedades hiper-envelhecidas, como é o caso português. Várias projeções populacionais indicam também que o processo de envelhecimento da população mundial irá acelerar nas próximas décadas. Mediante tal cenário, objetiva-se com este artigo refletir sobre a liderança e governação hospitalar na promoção da qualidade de cuidados num país envelhecido, com base numa metodologia de revisão da literatura

Transcriptome characterization by RNA sequencing identifies a major molecular and clinical subdivision in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) has heterogeneous clinical and biological behavior. Whole-genome and -exome sequencing has contributed to the characterization of the mutational spectrum of the disease, but the underlying transcriptional profile is still poorly understood. We have performed deep RNA sequencing in different subpopulations of normal B-lymphocytes and CLL cells from a cohort of 98 patients, and characterized the CLL transcriptional landscape with unprecedented resolution. We detected thousands of transcriptional elements differentially expressed between the CLL and normal B cells, including protein-coding genes, noncoding RNAs, and pseudogenes. Transposable elements are globally derepressed in CLL cells. In addition, two thousand genes-most of which are not differentially expressed-exhibit CLL-specific splicing patterns. Genes involved in metabolic pathways showed higher expression in CLL, while genes related to spliceosome, proteasome, and ribosome were among the most down-regulated in CLL. Clustering of the CLL samples according to RNA-seq derived gene expression levels unveiled two robust molecular subgroups, C1 and C2. C1/C2 subgroups and the mutational status of the immunoglobulin heavy variable (IGHV) region were the only independent variables in predicting time to treatment in a multivariate analysis with main clinico-biological features. This subdivision was validated in an independent cohort of patients monitored through DNA microarrays. Further analysis shows that B-cell receptor (BCR) activation in the microenvironment of the lymph node may be at the origin of the C1/C2 differences

Factorial validity of the Toronto Alexithymia Scale (TAS-20) in clinical samples: A critical examination of the literature and a psychometric study in anorexia nervosa

There is extensive use of the 20-item Toronto Alexithymia Scale (TAS-20) in research and clinical practice in anorexia nervosa (AN), though it is not empirically established in this population. This study aims to examine the factorial validity of the TAS-20 in a Portuguese AN sample (N = 125), testing four different models (ranging from 1 to 4 factors) that were identified in critical examination of existing factor analytic studies. Results of confirmatory factor analysis (CFA) suggested that the three-factor solution, measuring difficulty identifying (DIF) and describing feelings (DDF), and externally oriented thinking (EOT), was the best fitting model. The quality of measurement improves if two EOT items (16 and 18) are eliminated. Internal consistency of EOT was low and decreased with age. The results provide support for the factorial validity of the TAS-20 in AN. Nevertheless, the measurement of EOT requires some caution and may be problematic in AN adolescents.Center for Psychology at the University of Porto, Portuguese Science Foundation (FCT UID/PSI/00050/2013) and EU FEDER through COMPETE 2020 program (POCI-01-0145-FEDER-007294info:eu-repo/semantics/acceptedVersio

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Prognostic Value of Dobutamine Stress Echocardiography With Early Injection of Atropine With Versus Without Chronic Beta-Blocker Therapy in Patients With Known or Suspected Coronary Heart Disease

Although a new protocol of dobutamine stress echocardiography with the early injection of atropine (EA-DSE) has been demonstrated to be useful in reducing adverse effects and increasing the number of effective tests and to have similar accuracy for detecting coronary artery disease (CAD) compared with conventional protocols, no data exist regarding its ability to predict long-term events. The aim of this study was to determine the prognostic value of EA-DSE and the effects of the long-term use of beta blockers on it. A retrospective evaluation of 844 patients who underwent EA-DSE for known or suspected CAD was performed; 309 (37%) were receiving beta blockers. During a median follow-up period of 24 months, 102 events (12%) occurred. On univariate analysis, predictors of events were the ejection fraction (p <0.001), male gender (p <0.001), previous myocardial infarction (p <0.001), angiotensin-converting enzyme inhibitor therapy (p = 0.021), calcium channel blocker therapy (p = 0.034), and abnormal results on EA-DSE (p <0.001). On multivariate analysis, the independent predictors of events were male gender (relative risk [RR] 1.78, 95% confidence interval [CI] 1.13 to 2.81, p = 0.013) and abnormal results on EA-DSE (RR 4.45, 95% CI 2.84 to 7.01, p <0.0001). Normal results on EA-DSE with P blockers were associated with a nonsignificant higher incidence of events than normal results on EA-DSE without beta blockers (RR 1.29, 95% CI 0.58 to 2.87, p = 0.54). Abnormal results on EA-DSE with beta blockers had an RR of 4.97 (95% CI 2.79 to 8.87, p <0.001) compared with normal results, while abnormal results on EA-DSE without beta blockers had an RR of 5.96 (95% CI 3.41 to 10.44, p <0.001) for events, with no difference between groups (p = 0.36). In conclusion, the detection of fixed or inducible wall motion abnormalities during EA-DSE was an independent predictor of long-term events in patients with known or suspected CAD. The prognostic value of EA-DSE was not affected by the long-term use of beta blockers. (C) 2008 Elsevier Inc. All rights reserved. (Am J Cardiol 2008;102:1291-1295