Non-pharmacological interventions for the prevention of delirium in intensive care unit patients: a systematic review

Enquadramento: O delirium nas Unidades de Cuidados Intensivos, é reconhecido como um problema de saúde que tem impacto a longo prazo não só para o doente, como também, no que respeita a encargos financeiros para os serviços de saúde, razões pelas quais, os enfermeiros assumem um papel preponderante na implementação de medidas preventivas de delirium. Objetivo: Identificar as recomendações da literatura científica para intervenções não farmacológicas preventivas de delirium em doentes adultos internados em Unidades de Cuidados Intensivos. Métodos: Foi realizada uma revisão da literatura em janeiro de 2022, em 11 bases de dados, partindo da questão de investigação “quais as recomendações existentes na evidência científica relativas às intervenções não farmacológicas preventivas do delirium em doentes adultos internados na Unidade de Cuidados Intensivos”? A pesquisa e a documentação foram realizadas de acordo com a metodologia PRISMA. Resultados: Como resultado obtivemos 11 artigos. A prevenção de delirium está associada a intervenções que estão organizadas neste estudo em sete categorias: comunicação, estimulação visual, estimulação auditiva, estimulação cognitiva, preservação do sono noturno, mobilização precoce e inclusão da família nos cuidados de saúde. As intervenções não farmacológicas podem efetivamente diminuir a incidência desta patologia e assim melhorar os resultados clínicos. Conclusões: Das sete categorias representativas das intervenções não farmacológicas preventivas do delirium resultantes desta revisão destacamos duas: a preservação do sono noturno e a estimulação auditiva, uma vez que, estiveram presentes com mais destaque, na quase totalidade dos artigos analisados. As intervenções identificadas neste estudo, revelam-se eficazes na sua maioria, sendo por isso de grande relevância para a prática clínica.Background: In the Intensive Care Unit, delirium is recognized as a health issue with a long term impact, not only for the patient, but also for the Health Service itself because of its financial charges. This is why nurses assume such a major role in the implementation of the delirium preventive ways. Objective: This study was conducted to Identify the recommendations for non-pharmacological interventions the prevention of delirium in adult patients admitted to the Intensive Care Unit in the scientific literature. Methods: A review was held in January 2022, in 11 based on the electronic data, based on the research question "what are the recommendations in the scientific evidence regarding non-pharmacological preventive interventions for delirium in adult patients admitted to the Intensive Care Unit? The research and documentation were carried out in accordance with the PRISMA methodology. Results: As a result, we obtained 11 articles. The prevention of the delirium is associated to measures that are categorized in this study, in seven areas: communication; visual stimulation; hearing stimulation; cognitive stimulation; nocturnal sleep preservation; early mobilization and family inclusion in the care process, which can reduce effectively the occurrence of this pathology, and, with this, improve clinic results. Conclusions: From the seven representative categories of nonpharmacological intervention for the prevention of delirium resulting from this review, we highlight two: night sleep preservation and hearing stimulation, since they were more prominently present in almost all of the articles analyzed. The interventions identified in this study had shown in its majority to be effective, being therefore, of great relevance for the practical clinic.info:eu-repo/semantics/publishedVersio

Selection bias: neighbourhood controls and controls selected from those presenting to a Health Unit in a case control study of efficacy of BCG revaccination.

BACKGROUND: In most case control studies the hardest decision is the choice of the control group, as in the ideal control group the proportion exposed is the same as in the population that produced the cases. METHODS: A comparison of two control groups in a case control study of the efficacy of BCG revaccination. One group was selected from subjects presenting to the heath unit the case attended for routine prevention and care; the second group was selected from the neighbourhood of cases. All Health Units from which controls were selected offered BCG revaccination. Efficacy estimated in a randomized control trial of BCG revaccination was used to establish that the neighbourhood control group was the one that gave unbiased results. RESULTS: The proportion of controls with scars indicating BCG revaccination was higher among the control group selected from Health Unit attenders than among neighbourhood controls. This excess was not removed after control for social variables and history of exposure to tuberculosis, and appears to have resulted from the fact that people attending the Health Unit were more likely to have been revaccinated than neighbourhood controls, although we can not exclude an effect of other unmeasured variables. CONCLUSION: In this study, controls selected from people presenting to a Health Unit overrepresented exposure to BCG revaccination. Had the results from the HU attenders control group been accepted this would have resulted in overestimation of vaccine efficacy. When the exposure of interest is offered in a health facility, selection of controls from attenders at the facility may result in over representation of exposure in controls and selection bias

Rapid Automatized Naming and Explicit Phonological Processing in Children With Developmental Dyslexia: A Study With Portuguese-Speaking Children in Brazil.

peer reviewedMany studies have shown that children with reading difficulties present deficits in rapid automatized naming (RAN) and phonological awareness skills. The aim of this study was to examine RAN and explicit phonological processing in Brazilian Portuguese-speaking children with developmental dyslexia and to explore the ability of RAN to discriminate between children with and without dyslexia. Participants were 30 children with a clinical diagnosis of dyslexia established by the Brazilian Dyslexia Association and 30 children with typical development. Children were aged between 7 and 12, and groups were matched for chronological age and sex. They completed a battery of tests that are commonly used in Brazil for diagnosing dyslexia, consisting of the Wechsler Intelligence Test for Children (WISC-IV) as well as tests of single word and non-word reading, RAN, and the profile of phonological abilities test. Results indicate that the cognitive profile of this group of children, with a clinical diagnosis of dyslexia, showed preserved skills in the four subscales of the WISC-IV (verbal comprehension, perceptual reasoning, working memory, and processing speed) and on the profile of phonological abilities test. Groups significantly differed on the reading tests (word and non-word) and RAN measures, with medium to large effect sizes for RAN. Classification and regression tree analysis revealed that RAN was a good predictor for dyslexia diagnosis, with an overall classification accuracy rate of 88.33%

Síntese e avaliação da atividade antimicrobiana de furanonas halogenadas e de compostos análogos aos nostoclídeos Synthesis and evaluation of antimicrobial activity of halogenated furanones and compounds analogues to nostoclides

<abstract language="eng">Considering the broad spectrum of biological activity of gamma-butyrolactone derivatives, we presented the synthesis of 3,4-dihalo-5-arylidenefuran-2(5H)-ones (17-21) and analogues (24-28) of the natural product nostoclide (7,8). Furanones 17-21 were synthesized from the condensation of aromatic aldehydes with lactones 14 and 15, that were obtained from mucobromic and mucochloric acids. Lactone 15 was converted into the intermediate 23 in 36% overall yield. Compound 23 was then transformed into the nostoclide analogues 24-28. Some of the compounds prepared showed antimicrobial activities against Escherichia coli, Staphylococcus aureus and Bacillus cereus comparable to commercial antibiotics

Peripheral Nerve Injury Treatments and Advances: One Health Perspective

Peripheral nerve injuries (PNI) can have several etiologies, such as trauma and iatrogenic interventions, that can lead to the loss of structure and/or function impairment. These changes can cause partial or complete loss of motor and sensory functions, physical disability, and neuropathic pain, which in turn can affect the quality of life. This review aims to revisit the concepts associated with the PNI and the anatomy of the peripheral nerve is detailed to explain the different types of injury. Then, some of the available therapeutic strategies are explained, including surgical methods, pharmacological therapies, and the use of cell-based therapies alone or in combination with biomaterials in the form of tube guides. Nevertheless, even with the various available treatments, it is difficult to achieve a perfect outcome with complete functional recovery. This review aims to enhance the importance of new therapies, especially in severe lesions, to overcome limitations and achieve better outcomes. The urge for new approaches and the understanding of the different methods to evaluate nerve regeneration is fundamental from a One Health perspective. In vitro models followed by in vivo models are very important to be able to translate the achievements to human medicine

Effects of Olfactory Mucosa Stem/Stromal Cell and Olfactory Ensheating Cells Secretome on Peripheral Nerve Regeneration

Cell secretome has been explored as a cell-free technique with high scientific and medical interest for Regenerative Medicine. In this work, the secretome produced and collected from Olfactory Mucosa Mesenchymal Stem Cells and Olfactory Ensheating Cells was analyzed and therapeutically applied to promote peripheral nerve regeneration. The analysis of the conditioned medium revealed the production and secretion of several factors with immunomodulatory functions, capable of intervening beneficially in the phases of nerve regeneration. Subsequently, the conditioned medium was applied to sciatic nerves of rats after neurotmesis, using Reaxon&reg; as tube-guides. Over 20 weeks, the animals were subjected to periodic functional assessments, and after this period, the sciatic nerves and cranial tibial muscles were evaluated stereologically and histomorphometrically, respectively. The results obtained allowed to confirm the beneficial effects resulting from the application of this therapeutic combination. The administration of conditioned medium from Olfactory Mucosal Mesenchymal Stem Cells led to the best results in motor performance, sensory recovery, and gait patterns. Stereological and histomorphometric evaluation also revealed the ability of this therapeutic combination to promote nervous and muscular histologic reorganization during the regenerative process. The therapeutic combination discussed in this work shows promising results and should be further explored to clarify irregularities found in the outcomes and to allow establishing the use of cell secretome as a new therapeutic field applied in the treatment of peripheral nerves after injury

Variação anual de hormônios tireoideanos e características termorreguladoras de vacas leiteiras em ambiente quente Annual thyroid hormone variation and thermo regulators traits of milk cows in hot environment

Este trabalho foi conduzido com o objetivo de estudar o comportamento anual de características termorreguladoras de 200 vacas leiteiras. Durante dois anos consecutivos, foram registradas a freqüência respiratória (FR) e a temperatura retal (TR), bem como coletada uma amostra de sangue para dosagens de triiodotironina (T3) e tiroxina (T4). Foram também registradas a temperatura e a umidade do ar e calculados o índice de temperatura de globo e umidade (ITGU) e a carga térmica radiante (CTR), nos mesmos dias de coleta. Houve efeito significativo do ano para a maioria das variáveis estudadas, no entanto, os efeitos do mês de coleta e do rebanho foram significativos para todas. Todos os valores de TR estiveram dentro da amplitude de normalidade, indicando homeotermia. A FR foi alterada em todas as épocas do ano e rebanhos, confirmando a necessidade constante de termólise. No rebanho de maior TR e a FR, houve redução da secreção de T3 e T4. Nas épocas de maiores ITGU e CTR, houve aumento da TR, seguido de maiores FR e menores concentrações plasmáticas de T3 e T4.<br>This work was carried out with the objective to study the annual behavior of thermo regulators traits in dairy cows. Two hundred cows were used during two consecutive years and the respiratory rate (RR), rectal temperature (RT), as well as a blood sample was collected for triiodothyronin (T3) and thyroxin (T4) dosages, were recorded. Air temperature and humidity were also recorded and the black globe humidity index (BGHI) and radiant heat load (RHL) were calculated in the same days of data collection. There was no significative effect of the year for the majority of studied variables, however, the effects of month of collection and herd were significative for all variables. All values of RT were inside of the amplitude of normality, indicating homoeothermic condition. The RR was altered in every seasons of the year and herds, showing a constant necessity of thermolisys. In herds with higher RT and RR, there was a reduction T3 and T4 liberation. In seasons of higher BGHI and RHL, there was increase in the RT, followed for higher RR and lower T3 and T4 plasmatic concentrations