Cardiovascular Risk in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review.

Background/Objectives: A comprehensive and up-to-date review on cardiovascular disease (CVD) risk in patients with COPD is needed. Therefore, we aimed to systematically review the risk of a range of CVD in patients with COPD. Methods: We searched three databases (Pubmed, Web of Science, SCOPUS) from inception to September 2023 using terms related to COPD and CVD. Observational studies were included if they (1) were conducted in adults with a diagnosis of COPD based on the GOLD criteria, spirometry, physician diagnosis, or review of electronic health records; (2) reported the risk of CVD, namely of myocardial infarction (MI), ischaemic heart disease (IHD), atrial fibrillation (AF), heart failure, cerebrovascular disease, pulmonary hypertension, and peripheral vascular disease, compared with a control population using a measure of risk. A narrative synthesis was used. Results: Twenty-four studies from 2015 to 2023, mainly from Europe (n = 17), were included. A total of 3,485,392 patients with COPD (43.5-76.0% male; 63.9-73.5 yrs) and 31,480,333 (40.0-55.4% male, 49.3-70.0 yrs) controls were included. A higher risk of CVD in patients with COPD was evident regarding overall CVD, MI, IHD, heart failure, and angina. Higher risks of arrhythmia and AF, stroke, sudden cardiac death/arrest, pulmonary embolism, pulmonary hypertension, and peripheral vascular disease were also found, although based on a small amount of evidence. Conclusions: Patients with COPD have a higher risk of CVD than the general population or matched controls. This review underscores the need for vigilant and close monitoring of cardiovascular risk in individuals with COPD to inform more precise preventive strategies and targeted interventions to enhance their overall management.

[Prehospital Care Times and Interventions for Victims of Major Trauma in the Central Region of Portugal: A Retrospective Study]. / Tempos de Resposta e Intervenções Extra-Hospitalar à Vítima de Trauma Major na Região Centro de Portugal: Um Estudo Retrospetivo.

INTRODUCTION: The quality and promptness of prehospital care for major trauma patients are vital in order to lower their high mortality rate. However, the effectiveness of this response in Portugal is unknown. The objective of this study was to analyze response times and interventions for major trauma patients in the central region of Portugal. METHODS: This was a retrospective, descriptive study, using the 2022 clinical records of the National Institute of Medical Emergency's differentiated resources. Cases of death prior to arrival at the hospital and other non-transport situations were excluded. Five-time intervals were determined, among which are the response time (T1, between activation and arrival at the scene), on-scene time (T2), and transportation time (T5; between the decision to transport and arrival at the emergency service). For each ambulance type, averages and dispersion times were calculated, as well as the proportion of cases in which the nationally and internationally recommended times were met. The frequency of recording six key interventions was also assessed. RESULTS: Of the 3366 records, 602 were eliminated (384 due to death), resulting in 2764 cases: nurse-technician ambulance (SIV) = 36.0%, physician- nurse ambulance (VMER) = 62.2% and physician-nurse helicopter = 1.8%. In a very large number of records, it was not possible to determine prehospital care times: for example, transport time (T5) could be determined in only 29%, 13% and 8% of cases, respectively for SIV, VMER and helicopter. The recommended time for stabilization (T2 ≤ 20 min) was met in 19.8% (SIV), 36.5% (VMER) and 18.2% (helicopter). Time to hospital (T5 ≤ 45 min) was achieved in 80.0% (SIV), 93.1% (VMER) and 75.0% (helicopter) of the records. The administration of analgesia (42% in SIV) and measures to prevent hypothermia (23.5% in SIV) were the most recorded interventions. CONCLUSION: There was substantial missing data on statuses and a lack of information in the records, especially in the VMER and helicopter. According to the records, the time taken to stabilize the victim on-scene often exceeded the recommendations, while the time taken to transport them to the hospital tended to be within the recommendations.

Introdução: A qualidade e rapidez do socorro pré-hospitalar à pessoa vítima de trauma major é vital para diminuir a sua elevada mortalidade. Contudo, desconhece-se a efetividade desta resposta em Portugal. O objetivo deste estudo foi analisar os tempos de resposta e as intervenções realizadas às vítimas de trauma major na região centro de Portugal. Métodos: Estudo retrospetivo, descritivo, utilizando os registos clínicos de 2022 dos meios diferenciados do Instituto Nacional de Emergência Médica. Casos de óbito pré-chegada ao hospital e outras situações de não transporte foram excluídos. Determinaram-se cinco tempos, entre os quais o tempo de resposta (T1, decorrente entre acionamento e chegada ao local), o tempo no local (T2) e o tempo de transporte (T5, intervalo entre a decisão de transporte e a chegada ao serviço de urgência). Foram calculadas médias e medidas de dispersão para cada meio, bem como a proporção de casos em que foram cumpridos os tempos recomendados nacional e internacionalmente. Avaliou-se também a frequência de registo de seis intervenções chave. Resultados: Dos 3366 registos, eliminaram-se 602 (384 por óbito), resultando em 2764 casos [suporte imediato de vida (SIV) = 36,0%, viaturas médicas de emergência e reanimação (VMER) = 62,2%, helicóptero de emergência médica (HEM) = 1,8%]. Num elevado número de registos não foi possível determinar tempos de socorro: por exemplo, o tempo de transporte (T5) foi determinável em apenas 29%, 13%, e 8% dos casos, respetivamente para SIV, VMER e HEM. O tempo recomendado para a estabilização (T2 ≤ 20 min), foi cumprido em 19,8% (SIV), 36,5% (VMER), e 18,2% (HEM) dos regis- tos. Já o tempo de transporte (T5 ≤ 45 min) foi cumprido em 80,0% (SIV), 93,1% (VMER) e 75,0% (HEM) dos registos (avaliáveis). A administração de analgesia (42% na SIV) e as medidas de prevenção de hipotermia (23,5% na SIV) foram as intervenções mais registadas. Conclusão: Observaram-se muitos status omissos e falta de informação nos registos, sobretudo na VMER e HEM. De acordo com os registos, o tempo no local superou frequentemente as recomendações, enquanto o tempo de transporte tende a estar dentro das normas.

Beyond clinical trials - The cost saving associated with dapagliflozin use in Portugal hospital clinical practice.

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is a clinical syndrome associated with substantial morbidity, mortality, and healthcare costs. Dapagliflozin has proven efficacy in reducing the risk of death and hospitalization in HF patients, regardless of left ventricular ejection fraction (LVEF). This paper aimed to project the potential impact of dapagliflozin on healthcare costs related to HF subsequent hospitalizations (HFHs) in Portuguese hospitals. METHODS: The total number of HF-related hospitalizations (hHF), HFHs, and the average length of stay for patients with a primary diagnosis of HF from six Portuguese hospitals, between January 2019 and December 2021, were collected and aggregated by hospital classification. Costs associated with HFHs were calculated according to Portuguese legislation and considering conservative, average, and complex approaches. Cost-saving projections were based on extrapolations from hHF risk reductions reported in dapagliflozin clinical trials. RESULTS: Considering a 26% risk reduction in hHF reported on pooled-analysis of DAPA-HF and DELIVER as the expected reduction in HFHs, the use of dapagliflozin would be associated with cost savings ranging from EUR 1612851.54 up to EUR 6587360.09, when considering all hospitals and the different approaches, between 2019 and 2021. A similar projection is observed based on 24% RRR derived by weighting DAPA-HF and DELIVER sub-analyses and PORTHOS epidemiological data. CONCLUSIONS: In this projection, dapagliflozin use in all eligible hHF patients is associated with a significant reduction in direct costs. Our data support that, in addition to the improvements in HF-related outcomes, dapagliflozin may have a significant economic impact on healthcare costs in Portuguese hospitals.

General nurse competencies in disaster: A delphi study.

AIM: The aim of this study is to understand the significance of a disaster-related competence framework for Portuguese general nurses and identify from ICN - Core Competencies in Disaster Nursing version 2.0 core competencies description, those that are considered crucial for a competent preparedness and response in disaster scenarios. BACKGROUND: Research suggests that the occurrence of disasters will be more recurrent, requiring that nurses, pillars of any health system, have knowledge, skills and preparedness to face these events. DESIGN: An exploratory, cross-sectional qualitative study was carried out. Delphi method was used for data collection. METHODS: The study group consisted of technical-scientific council's presidents or coordinators/directors of nursing courses, nurses integrated in the Portuguese Council of Nurses and National Nursing Specialty Colleges and nurses with experience in the field of disasters. RESULTS: Findings revealed that there is consensus on sixteen competencies, considered relevant for developing general nurse knowledge and competence, both at a national or international level, in the field of disasters. CONCLUSIONS: The development of these competencies which establishes practice standards, building nurses skills and knowledge and ultimately, influencing nursing level-entry curricula's, conferring professional autonomy and self-regulation, in the field of disaster are fundamental. Furthermore, this study may serve as a reference for future alignment of competency frameworks between European Union countries or others.

Cognitive maturity of Portuguese nursing students to intervene in disasters: initial training contribution.

OBJECTIVE: To understand whether, from the perspective of coordinators/directors of nursing courses and nurses with skills in the field of disasters, nursing students have the necessary cognitive maturity to articulate the various dimensions inherent to the area of disasters, allowing efficient performance. METHOD: A study with a qualitative methodological approach, based on inductive reasoning and rigorous phenomenon description, based on exploratory research. RESULTS: Given the specificity and complexity of these phenomena, the inclusion of the disaster domain in the teaching-learning process, supporting valid knowledge construction and allowing the development and maturity of nursing students' cognitive processes, is crucial. CONCLUSION: Currently, reduced technical-scientific training in the field of disasters in Portugal constitutes a barrier in the development of nursing students' cognitive maturity, impeding their ability to respond when faced with phenomena of this complexity.

Heart failure management with ß-blockers: can we do better?

Heart failure (HF) is associated with disabling symptoms, poor quality of life, and a poor prognosis with substantial excess mortality in the years following diagnosis. Overactivation of the sympathetic nervous system is a key feature of the pathophysiology of HF and is an important driver of the process of adverse remodelling of the left ventricular wall that contributes to cardiac failure. Drugs which suppress the activity of the renin-angiotensin-aldosterone system, including ß-blockers, are foundation therapies for the management of heart failure with reduced ejection fraction (HFrEF) and despite a lack of specific outcomes trials, are also widely used by cardiologist in patients with HF with preserved ejection fraction (HFpEF). Today, expert opinion has moved away from recommending that treatment for HF should be guided solely by the LVEF and interventions should rather address signs and symptoms of HF (e.g. oedema and tachycardia), the severity of HF, and concomitant conditions. ß-blockers improve HF symptoms and functional status in HF and these agents have demonstrated improved survival, as well as a reduced risk of other important clinical outcomes such as hospitalisation for heart failure, in randomised, placebo-controlled outcomes trials. In HFpEF, ß-blockers are anti-ischemic and lower blood pressure and heart rate. Moreover, ß-blockers also reduce mortality in the setting of HF occurring alongside common comorbid conditions, such as diabetes, CKD (of any severity), and COPD. Higher doses of ß-blockers are associated with better clinical outcomes in populations with HF, so that ensuring adequate titration of therapy to their maximal (or maximally tolerated) doses is important for ensuring optimal outcomes for people with HF. In principle, a patient with HF could have combined treatment with a ß-blocker, renin-angiotensin-aldosterone system inhibitor/neprilysin inhibitor, mineralocorticoid receptor antagonist, and a SGLT2 inhibitor, according to tolerability.

Unstable Angina: Risk Stratification for Significant Coronary Artery Disease in The Era of High-Sensitivity Cardiac Troponin.

Introduction: High-sensitivity troponin (hsTn) has a very high diagnostic accuracy for myocardial infarction (MI), and patients who were formerly diagnosed with unstable angina (UA) are being reclassified as having NSTEMI in the era of hsTn. This paradigm shift has changed the clinical features of UA, which remain poorly characterized, specifically the occurrence of obstructive coronary artery disease (CAD) and the need for myocardial revascularization. The main purpose of this study was to clinically characterize contemporary UA patients, assess predictors of obstructive CAD, and develop a risk model to predict significant CAD in this population. Methods: We conducted a retrospective cohort study of 742 patients admitted to the hospital with UA. All patients underwent coronary angiography. The endpoint of the study was the presence of obstructive CAD on angiography. The cohort was divided into two groups: patients with significant coronary artery disease (CAD+) and those without CAD (CAD-). We developed a score (UA CAD Risk) based on the multivariate model and compared it with the GRACE, ESC, and TIMI risk scores using ROC analysis. Results: Obstructive CAD was observed on angiography in 53% of the patients. Age, dyslipidemia, troponin level, male sex, ST-segment depression, and wall motion abnormalities on echocardiography were independent predictors of obstructive CAD. hsTn levels (undetectable vs. nonsignificant detection) had a negative predictive value of 81% to exclude obstructive CAD. We developed a prediction model with obstructive CAD as the outcome (AUC: 0.60). Conclusions: In a contemporary UA cohort, approximately 50% of the patients did not have obstructive CAD on angiography. Commonly available cardiac tests at hospital admission show limited discrimination power in identifying patients at risk of obstructive CAD. A revised diagnostic and etiology algorithm for patients with UA is warranted.

Cognitive maturity of Portuguese nursing students to intervene in disasters: initial training contribution / Madurez cognitiva de estudiantes Portugueses de enfermería para intervenir en desastres: contribución de la formación inicial / Maturidade cognitiva do estudante de enfermagem Português para intervir em desastres: contribuição da formação inicial

ABSTRACT Objective: To understand whether, from the perspective of coordinators/directors of nursing courses and nurses with skills in the field of disasters, nursing students have the necessary cognitive maturity to articulate the various dimensions inherent to the area of disasters, allowing efficient performance. Method: A study with a qualitative methodological approach, based on inductive reasoning and rigorous phenomenon description, based on exploratory research. Results: Given the specificity and complexity of these phenomena, the inclusion of the disaster domain in the teaching-learning process, supporting valid knowledge construction and allowing the development and maturity of nursing students' cognitive processes, is crucial. Conclusion: Currently, reduced technical-scientific training in the field of disasters in Portugal constitutes a barrier in the development of nursing students' cognitive maturity, impeding their ability to respond when faced with phenomena of this complexity.

RESUMEN Objetivo: Comprender si, desde la perspectiva de los coordinadores/directores de carreras de enfermería y enfermeros con competencias en el área de desastres, el estudiante de enfermería tiene la madurez cognitiva necesaria para articular las diversas dimensiones inherentes al área de desastres, permitiendo desempeño eficiente. Método: Estudio con enfoque metodológico cualitativo, basado en razonamientos inductivos y descripción rigurosa de los fenómenos, basado en investigación exploratoria. Resultados: Dada la especificidad y complejidad de estos fenómenos, la inclusión del dominio de desastres en el proceso de enseñanza-aprendizaje, para apoyar la construcción de conocimientos válidos y permitir el desarrollo y madurez de los procesos cognitivos del estudiante de enfermería, es crucial. Conclusión: Actualmente, la reducida formación técnico-científica en el campo de los desastres en Portugal constituye una barrera en el desarrollo de la madurez cognitiva de los estudiantes de enfermería, impidiendo su capacidad de respuesta ante fenómenos de esta complejidad.

RESUMO Objetivo: Compreender se, na perspectiva dos coordenadores/diretores dos cursos de licenciatura em enfermagem e enfermeiros com competências no domínio de desastres, o estudante de enfermagem apresenta a necessária maturidade cognitiva para articular as diversas dimensões inerentes à área de desastres, permitindo um desempenho eficiente. Método: Estudo de abordagem metodológica qualitativa, sustentado no raciocínio indutivo e na descrição rigorosa dos fenômenos, alicerçado na pesquisa exploratória. Resultados: Diante da especificidade e da complexidade desses fenômenos, a inclusão do domínio de desastres no processo de ensino-aprendizagem, para subsidiar a construção de conhecimento válido e permitir o desenvolvimento e maturidade dos processos cognitivos do estudante de licenciatura em enfermagem, é determinante. Conclusão: Atualmente, a redutora formação técnico-científica no domínio de desastres em Portugal constitui uma barreira no desenvolvimento da maturidade cognitiva do estudante de enfermagem, impedindo a sua capacidade de resposta quando confrontado com fenômenos dessa complexidade.

Portuguese Heart Failure Prevalence Observational Study (PORTHOS) rationale and design - A population-based study.

INTRODUCTION AND OBJECTIVES: Current epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. METHODS: The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. CONCLUSIONS: Through the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life.

Effect of video on satisfaction and self-confidence in simulation training: a randomized clinical trial.

OBJECTIVES: to identify the effect on satisfaction and self-confidence of undergraduate nursing students after using a validated bed bath video during the simulation. METHODS: blinded parallel randomized clinical trial. Participants were allocated to the control group (simulation with tutor) or intervention (simulation with video). After the interventions, the Student Satisfaction and Self Confidence with Learning Scale was used to assess satisfaction and self-confidence. The study was approved by the Ethics Committee and Brazilian Registry of Clinical Trials. Mann Whitney, Fisher Exact and Student t statistical tests were used. A significance level of 5% was adopted. Results: fifty eight students (30, control; and 28, intervention) were evaluated. There was no significant difference between the groups regarding satisfaction (p=0.832) and self-confidence (p>0.999). CONCLUSIONS: satisfaction and self-confidence were similar between the groups, and the two strategies could be used in the simulated practice of bed bathing.

Practical approach to referral from primary health care to a cardiology hospital consultation in 2022.

In Portugal, up to 38% of the population has cardiovascular disease, which highlights the importance of primary health care (PHC) in its management. Adequate management of people with cardiovascular disease often requires hospital referral for a cardiology consultation. However, it is not always easy to ascertain which situations should be referred, especially given that PHC does not have access to all diagnostic exams recommended by international guidelines, such as natriuretic peptides in heart failure or computed tomography coronary angiogram in chronic coronary syndromes, among others. The aim of this document is to describe a practical approach to the most frequent heart diseases that may require a referral for a hospital cardiology consultation. Thus, in the different chapters, the recommendations for referral are highlighted generically according to group of disease, as well as, albeit briefly, the initial clinical approach within the scope of PHC for a differential diagnosis and more efficient follow-up. A modified Metaplan methodology was used. A panel of 4 cardiology specialists and 3 specialists in General and Family Medicine developed this document, which should not be taken as an official guideline, but as additional guidance for the correct referral of patients. It is therefore advisable to validate these recommendations locally with the referral hospital, as well as to be aware of the respective international and national guidelines.

Incidence of Bloodstream Infection in Patients with Pulmonary Hypertension under Intravenous Epoprostenol or Iloprost-A Multicentre, Retrospective Study.

Intravenous synthetic prostacyclin analogs (iPCAs), such as epoprostenol, treprostinil and iloprost have been widely used for the treatment of pulmonary arterial hypertension (PAH). Despite having good outcomes, continuous infusion of iPCAs has been associated with some adverse effects. Bloodstream infection (BSI) is one of the most severe complications, although poorly recognized, especially under iloprost administration, which few studies have addressed. This study aimed to compare the BSI incidence rates between intravenous iloprost and epoprostenol administration. Patients with pulmonary hypertension (PH) functional class III or IV receiving intravenous iloprost or epoprostenol through Hickman catheter, between 2004 and 2019, were retrospectively selected from two PH treatment centers. From a total of 36 patients (13 for iloprost and 23 for epoprostenol), 75% (n = 27) fulfilled the PAH criteria, mainly belonging to the idiopathic group. Overall BSI rate was 1.5/1000 days of treatment (3.38 and 0.09/1000 days for iloprost and epoprostenol, respectively). Patients receiving iloprost were at a higher risk of developing BSI than those receiving epoprostenol (HR: 12.5; 95% CI: 1.569-99.092). A higher mortality rate from BSI was also identified in the iloprost group (p = 0.04). Twenty-seven patients developed BSI, with 92% of them requiring hospitalization. A total of 29 agents were found, 10 Gram-positive (mainly Staphylococcus aureus; n = 5) and 19 Gram-negative (mainly Pseudomonas aeruginosa; n = 6) bacteria. Iloprost administration was linked to a significantly higher incidence of BSI, worse prognosis, and more BSI-related deaths than epoprostenol. BSI due to Gram-negative, commensal, low-virulence bacteria was also higher in the iloprost group. In short, physicians should be aware when prescribing iPCA to guarantee their patients' safety and best medical care.

Development of educational videos about bathing in bed newborns admitted to a neonatal unit.

OBJECTIVE: to develop and analyze evidence of content validity of educational videos about bathing newborns in bed in a neonatal unit. METHOD: applied and methodological research, carried out from December/2020 to February/2022, in three phases: pre-production, production, post-production. Validity was carried out by nurses specializing in social communication and nursing professionals, including the Brazilian Sign Language and assessment by nursing students. The Content Validity Index and Cronbach's alpha above 0.8 were considered for analysis. RESULTS: the videos were entitled "Best practices: bathing newborns in the heated crib" and "Best practices: bathing newborns in the incubator", lasting seven minutes each, divided into six scenes that demonstrated the approach to parents, environment and material organization, preparing newborns, bathing and after-bath care. CONCLUSION: the videos will support permanent education processes, academic training and professional training in nursing.

Effect of video on satisfaction and self-confidence in simulation training: a randomized clinical trial / Efecto del vídeo en la satisfacción y autoconfianza en el entrenamiento simulado: estudio clínico randomizado / Efeito do vídeo na satisfação e autoconfiança no treinamento por simulação: estudo clínico randomizado

ABSTRACT Objectives: to identify the effect on satisfaction and self-confidence of undergraduate nursing students after using a validated bed bath video during the simulation. Methods: blinded parallel randomized clinical trial. Participants were allocated to the control group (simulation with tutor) or intervention (simulation with video). After the interventions, the Student Satisfaction and Self Confidence with Learning Scale was used to assess satisfaction and self-confidence. The study was approved by the Ethics Committee and Brazilian Registry of Clinical Trials. Mann Whitney, Fisher Exact and Student t statistical tests were used. A significance level of 5% was adopted. Results: fifty eight students (30, control; and 28, intervention) were evaluated. There was no significant difference between the groups regarding satisfaction (p=0.832) and self-confidence (p>0.999). Conclusions: satisfaction and self-confidence were similar between the groups, and the two strategies could be used in the simulated practice of bed bathing.

RESUMEN Objetivos: identificar efecto en la satisfacción y autoconfianza de estudiantes del curso de grado en Enfermería tras uso de video validado sobre baño en el lecho durante el simulado. Métodos: estudio clínico randomizado paralelo y ciego. Los participantes fueron ubicados en grupo control (simulado con tutor) o intervención (simulado con vídeo). Tras intervenciones, utilizado la Escala de Satisfacción de Estudiantes y Autoconfianza con el Aprendizaje para evaluar satisfacción y autoconfianza. El estudio aprobado por el Comité de Ética y Registro Brasileño de Ensayos Clínicos. Utilizadas pruebas estadísticas Mann Whitney, Exacta de Fisher y t Student. Adoptado nivel de significación de 5%. Resultados: evaluados 58 estudiantes (30, control; y 28, intervención). No hubo diferencia significante entre los grupos cuanto a la satisfacción (p=0,832) y autoconfianza (p>0,999). Conclusiones: satisfacción y autoconfianza fueron similares entre los grupos, y las dos estratégias podrán ser utilizadas en la práctica simulada del baño en el lecho.

RESUMO Objetivos: identificar o efeito na satisfação e autoconfiança de estudantes do curso de graduação em Enfermagem após uso de um vídeo validado sobre o banho no leito durante a simulação. Métodos: estudo clínico randomizado paralelo e cego. Os participantes foram alocados no grupo-controle (simulação com tutor) ou intervenção (simulação com vídeo). Após as intervenções, utilizou-se a Escala de Satisfação dos Estudantes e Autoconfiança com a Aprendizagem para avaliar a satisfação e autoconfiança. O estudo foi aprovado pelo Comitê de Ética e Registro Brasileiro de Ensaios Clínicos. Foram utilizados os testes estatísticos Mann Whitney, Exato de Fisher e t Student. Adotou-se nível de significância de 5%. Resultados: avaliaram-se 58 estudantes (30, controle; e 28, intervenção). Não houve diferença significante entre os grupos quanto à satisfação (p=0,832) e autoconfiança (p>0,999). Conclusões: satisfação e autoconfiança foram similares entre os grupos, e as duas estratégias poderão ser utilizadas na prática simulada do banho no leito.

Development of educational videos about bathing in bed newborns admitted to a neonatal unit / Desarrollo de videos educativos sobre el baño en la cama de recién nacidos internados en unidad neonatal / Desenvolvimento de vídeos educativos sobre o banho no leito de recém-nascidos internados em unidade neonatal

ABSTRACT Objective: to develop and analyze evidence of content validity of educational videos about bathing newborns in bed in a neonatal unit. Method: applied and methodological research, carried out from December/2020 to February/2022, in three phases: pre-production, production, post-production. Validity was carried out by nurses specializing in social communication and nursing professionals, including the Brazilian Sign Language and assessment by nursing students. The Content Validity Index and Cronbach's alpha above 0.8 were considered for analysis. Results: the videos were entitled "Best practices: bathing newborns in the heated crib" and "Best practices: bathing newborns in the incubator", lasting seven minutes each, divided into six scenes that demonstrated the approach to parents, environment and material organization, preparing newborns, bathing and after-bath care. Conclusion: the videos will support permanent education processes, academic training and professional training in nursing.

RESUMEN Objetivo: desarrollar y analizar evidencias de validez de contenido de videos educativos sobre el baño de recién nacidos en la cama en una unidad neonatal. Método: investigación aplicada y metodológica, realizada de diciembre/2020 a febrero/2022, en tres fases: preproducción, producción, postproducción. La validación fue realizada por enfermeros especialistas en el área de comunicación social y profesionales de enfermería, incluyendo la Lengua de Signos Brasileña y evaluación por estudiantes de enfermería. Se consideró para el análisis el Índice de Validez de Contenido y el alfa de Cronbach superior a 0,8. Resultados: los videos se titularon "Buenas prácticas: bañar al recién nacido en la cuna caliente" y "Buenas prácticas: bañar al recién nacido en la incubadora", con una duración de siete minutos cada una, dividida en seis escenas que mostraban el acercamiento de los padres, organización del ambiente y materiales, preparación del recién nacido, baño y cuidados posteriores al baño. Conclusión: los videos apoyarán procesos de educación permanente, formación académica y formación profesional en enfermería.

RESUMO Objetivo: desenvolver e analisar evidências de validade de conteúdo de vídeos educativos sobre o banho do recém-nascido no leito em unidade neonatal. Método: pesquisa aplicada e metodológica, desenvolvida de dezembro/2020 a fevereiro/2022, em três fases: pré-produção, produção, pós-produção. A validação foi realizada por enfermeiros doutores especialistas na área da comunicação social e profissionais da enfermagem, incluindo-se a Língua Brasileira de Sinais e avaliação por estudantes de enfermagem. O Índice de Validade de Conteúdo e do alfa de Cronbach acima de 0,8 foram considerados para análise. Resultados: os vídeos intitularam-se "Boas práticas: banho do recém-nascido no berço aquecido" e "Boas práticas: banho do recém-nascido na incubadora", com duração de sete minutos cada, dividido em seis cenas que demonstraram abordagem dos pais, organização do ambiente e materiais, preparo do recém-nascido, banho e cuidados após o banho. Conclusão: os vídeos subsidiarão processos de educação permanente, formação acadêmica e capacitação profissional em enfermagem.

Chronic thromboembolic pulmonary hypertension: A 10-year analysis from a Portuguese referral center.

INTRODUCTION AND OBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive, but potentially curable, form of pulmonary hypertension. Pulmonary endarterectomy (PEA) is a complex surgery that frequently achieves hemodynamic normalization and symptom resolution, although not all patients are suitable for the procedure. We aimed to assess long-term outcomes of CTEPH, namely all-cause mortality and hospital admission for decompensated heart failure, according to treatment modalities in patients who underwent PEA or non-surgical therapy. METHODS: A 10-year retrospective study of patients with CTEPH at a referral center was conducted. Forty-five patients were included and median follow-up time was 57 (IQR 24-93) months. Survival analysis was performed and a multivariate Cox regression model was used to identify independent predictors of outcomes. RESULTS: Patients were mostly female (59%) and mean age was 63±16 years. Two-thirds were severely symptomatic at diagnosis, with 62.2% of patients presenting in WHO functional class (WHO FC) III or IV. One-, two- and three-year survival was 93.3%, 82.4% and 75.9%, respectively. Serum BNP (HR 1.003; 95% CI: 1.001-1.005; p=0.003) and creatinine (HR 12.092; 95% CI: 1.121-130.390; p=0.040) were predictors of death. Mortality was numerically lower in those who underwent PEA (p=0.135). PEA was associated with decreased risk of the combined endpoint of all-cause mortality and hospital admission for decompensated heart failure (HR 0.198; 95% CI: 0.040-0.982; p=0.047), as were lower serum BNP (HR 1.003; 95% CI: 1.001-1.005; p=0.008) and mPAP (HR 1.073; 95% CI: 1.022-1.128; p=0.005) at diagnosis. Most patients who underwent PEA presented improved WHO FC (92.9%) and post-surgical residual pulmonary hypertension was identified in only 21.4%. CONCLUSION: PEA provided a better overall prognosis than non-surgical therapy, improving symptoms and frequently achieving hemodynamic normalization, with a numerical trend for lower mortality. Higher serum BNP, creatinine and mPAP at diagnosis were independently associated with worse outcomes.

Face mask use during the COVID-19 pandemic: how risk perception, experience with COVID-19, and attitude towards government interact with country-wide policy stringency.

BACKGROUND: During the 2020 COVID-19 pandemic, governments imposed numerous regulations to protect public health, particularly the (mandatory) use of face masks. However, the appropriateness and effectiveness of face mask regulations have been widely discussed, as is apparent from the divergent measures taken across and within countries over time, including mandating, recommending, and discouraging their use. In this study, we analyse how country-level policy stringency and individual-level predictors associate with face mask use during the early stages of the global COVID-19 pandemic. METHOD: First, we study how (self and other-related) risk perception, (direct and indirect) experience with COVID-19, attitude towards government and policy stringency shape face mask use. Second, we study whether there is an interaction between policy stringency and the individual-level variables. We conduct multilevel analyses exploiting variation in face mask regulations across countries and using data from approximately 7000 students collected in the beginning of the pandemic (weeks 17 through 19, 2020). RESULTS: We show that policy stringency is strongly positively associated with face mask use. We find a positive association between self-related risk perception and mask use, but no relationship of mask use with experience with COVID-19 and attitudes towards government. However, in the interaction analyses, we find that government trust and perceived clarity of communication moderate the link between stringency and mask use, with positive government perceptions relating to higher use in countries with regulations and to lower use in countries without regulations. CONCLUSIONS: We highlight that those countries that aim for widespread use of face masks should set strict measures, stress self-related risks of COVID-19, and use clear communication.