Synthesis of superparamagnetic Fe3O4-graphene oxide-based material for the photodegradation of clonazepam.

The global concern over water pollution caused by contaminants of emerging concern has been the subject of several studies due to the complexity of treatment. Here, the synthesis of a graphene oxide-based magnetic material (GO@Fe3O4) produced according to a modified Hummers' method followed by a hydrothermal reaction was proposed; then, its application as a photocatalyst in clonazepam photo-Fenton degradation was investigated. Several characterization analyses were performed to analyze the structure, functionalization and magnetic properties of the composite. A 23 factorial design was used for the optimization procedure to investigate the effect of [H2O2], GO@Fe3O4 dose and pH on clonazepam degradation. Adsorption experiments demonstrated that GO@Fe3O4 could not adsorb clonazepam. Photo-Fenton kinetics showed that total degradation of clonazepam was achieved within 5 min, and the experimental data were better fitted to the PFO model. A comparative study of clonazepam degradation by different processes highlighted that the heterogeneous photo-Fenton process was more efficient than homogeneous processes. The radical scavenging test showed that O 2 · - was the main active free radical in the degradation reaction, followed by hydroxyl radicals (•OH) and holes (h+) in the valence layer; accordingly, a mechanism of degradation was proposed to describe the process.

A Methodology for Shielding-Gas Selection in Wire Arc Additive Manufacturing with Stainless Steel.

The main objective of this work was to propose and evaluate a methodology for shielding-gas selection in additive manufacturing assisted by wire arc additive manufacturing (WAAM) with an austenitic stainless steel as feedstock. To validate the proposed methodology, the impact of multi-component gases was valued using three different Ar-based blends recommended as shielding gas for GMA (gas metal arc) of the target material, using CMT (cold metal transfer) as the process version. This assessment considered features that potentially affect the building of the case study of thin walls, such as metal transfer regularity, deposition time, and geometrical and metallurgical characteristics. Different settings of wire-feed speeds were conceived to maintain a similar mean current (first constraint for comparison's sake) among the three gas blends. This approach implied different mean wire-feed speeds and simultaneously forced a change in the deposition speed to maintain the same amount of material deposited per unit of length (second comparison constraint). The composition of the gases affects the operational performance of the shielding gases. It was concluded that by following this methodology, shielding-gas selection decision-making is possible based on the perceived characteristics of the different commercial blends.

Criação e validação de cenário simulado interprofissional para a pronação de pacientes com SDRA / Creation and validation of an interprofessional simulated scenario for the pronation of patients with ARDS

RESUMO Introdução: Este trabalho versa sobre a construção e validação de um cenário simulado com abordagem interprofissional, que permitirá a utilização no ensino e na educação permanente de profissionais da saúde por meio da metodologia ativa de simulação clínica. Objetivo: Este estudo teve como objetivos construir e validar um cenário simulado para a pronação de pacientes críticos com síndrome do desconforto respiratório agudo. Método: Trata-se de um estudo metodológico desenvolvido durante o ano de 2022 em uma universidade pública do Sul do Brasil e realizado em duas etapas: 1. delineamento do caso clínico e construção do cenário, e 2. validação de conteúdo e de aparência por 11 juízes com expertise em simulação clínica e/ou cuidado destinado ao paciente crítico, que atenderam aos critérios de Fehring. Aplicou-se um questionário do tipo Likert para a avaliação de 37 itens estabelecidos a partir do referencial de Fabri et al. Para medir o percentual de concordância entre os juízes, adotou-se o índice de validade de conteúdo (IVC). Resultado: Para a construção do cenário, desenvolveram-se o roteiro e guia de apoio ao facilitador e ao participante, e o roteiro para o ator simulado; um quadro de ações esperadas para cada participante; a relação de materiais e equipamentos necessários para o desenvolvimento; e o checklist de observação do desenvolvimento de competências e habilidades para cada profissão envolvida no cenário (médico, fisioterapeuta, enfermeiro e técnico de enfermagem). Os juízes eram predominantemente enfermeiros (63,6%), seguidos por fisioterapeutas (18,1%), médico (9%) e docente de enfermagem (9%). Os juízes responderam a um questionário que abordou os seguintes temas: "experiência prévia do participante/briefing", "conteúdo/objetivos", "recursos humanos", "preparo do cenário", "desenvolvimento do cenário" e "avaliação". Todos os itens obtiveram IVC superior ao desejável (0,80) e, portanto, foram considerados válidos. Além disso, os juízes realizaram sugestões de melhorias para o cenário, as quais foram acatadas ou rejeitas e discutidas com a literatura disponível. Conclusão: Este estudo permitiu criar e validar um cenário que reflete a prática real, ao mesmo tempo que oportuniza um ambiente seguro para os participantes e responde aos objetivos da aprendizagem interprofissional.

ABSTRACT Introduction: This work is focused on the construction and validation of a simulated scenario with an interprofessional approach, which will allow the use in the teaching and continuing education of health professionals through the active methodology of clinical simulation. Objective: To build and validate a simulated scenario for the pronation of critically ill patients with Acute Respiratory Distress Syndrome (ARDS). Method: This is a methodological study developed in 2022 at a public university in Curitiba-PR, which occurred in two stages: 1) delineation of the clinical case and construction of the scenario; 2) content and appearance validation by 11 judges with expertise in clinical simulation and/or critical patient care, who met the Fehring's criteria. A Likert-type questionnaire was applied to evaluate 37 items based on the Fabri's reference. To measure the percentage of agreement among the judges, the Content Validity Index (CVI) was adopted. Results: To build the scenario, the script and support guide for the facilitator, the participant, and the script for the simulated actor; a table of expected actions for each participant; the list of materials and equipment needed for the development; and the checklist for observation of the development of competencies and skills for each profession involved in the scenario (physician, physical therapist, nurse, and nursing technician) were developed. The judges were predominantly nurses (63.6%), followed by physical therapists (18.1%), physicians (9%), and nursing lecturers (9%). The judges responded to a questionnaire that addressed "Prior Participant Experience/Briefing", "Content/Objectives"; "Human Resources"; "Scenario Preparation", "Scenario Development", and "Evaluation". All items scored higher than desirable Content Validity Index (0.80) and were considered valid. In addition, the judges suggested improvements to the scenario, which were accepted or rejected and discussed with the available literature. Conclusion: This study made it possible to create and validate a scenario that reflects actual practice while providing a safe environment for participants and meeting the goals of interprofessional learning.

Conhecimento do cirurgião-dentista sobre as implicações judiciais embutidas na cirurgia estética de bichectomia / Knowledge of the dentist on the judicial implications embedded in aesthetic surgery of bichectomy

Objetivo: Analisar se os cirurgiões-dentistas têm conhecimento das implicações judiciais embutidas na cirurgia estética de bichectomia. Métodos: Trata-se de um estudo descritivo no qual foi aplicado um questionário estruturado aos docentes cirurgiões-dentistas da Faculdade Maria Milza (FAMAM) que realizam bichectomia. Os dados do questionário foram organizados em forma de tabela, apresentando informações sociodemográficas e sobre o conhecimento deles em relação aos aspectos judicias embutidos neste tipo de cirurgia. Resultados: A amostra foi composta por 08 cirurgiões-dentistas, docentes da Faculdade Maria Milza. A maioria era do sexo masculino, com idade entre 29 a 39 anos, com tempo de docência menor igual a 5 anos e atuando em clínica privada. A maioria afirmou estar ciente das possíveis implicações judiciais e se previnir destas, no entanto, grande parte da amostra estudada não tinha conhecimento do Código Civil Brasileiro. Conclusão: A maioria dos dentistas não possuíam conhecimento sobre o Código Civil Brasileiro, mas sabem que podem responder processos movidos pelos pacientes. Frente a isso, eles estão se protegendo de possíveis implicações de ordem judicial relacionados a cirurgia de bichectomia.(AU)

Objective: To analyze whether dentists are aware of the judicial implications embedded in cosmetic surgery for bichectomy. Methods: This is a descriptive study in which a structured questionnaire was applied to the professors-dentists at Faculdade Maria Milza (FAMAM) who perform bichectomy. The questionnaire data were organized in form of a table, presenting sociodemographic information and their knowledge in relation to the judicial aspects embedded in this type of surgery. Results: The sample consisted of 08 dental surgeons, professors at Faculdade Maria Milza. Most were male, aged between 29 and 39 years old, with less than 5 years of teaching experience and working in a private clinic. The majority claimed to be aware of the possible legal implications and to prevent them, however, a large part of the sample studied was not aware of the Brazilian Civil Code. Conclusion: Most surgeons had no knowledge of the Brazilian Civil Code, but they know that they can respond to a lawsuit brought by patients. Faced with this, they are protecting themselves from possible implications of a court order related to bichectomy surgery.(AU)

Adsorption of chloroquine, propranolol, and metformin in aqueous solutions using magnetic graphene oxide nanocomposite.

The work proposes the application of a nanocomposite formed by graphene oxide and magnetite to remove chloroquine, propranolol, and metformin from water. Tests related to adsorption kinetics, equilibrium isotherms and adsorbent reuse were studied, and optimization parameters related to the initial pH of the solution and the adsorbent dosage were defined. For all pharmaceuticals, adsorption tests indicated that removal efficiency was independent of initial pH at adsorbent dosages of 0.4 g L-1 for chloroquine, 1.2 g L-1 for propranolol, and 1.6 g L-1 for metformin. Adsorption equilibrium was reached within the first few minutes, and the pseudo-second-order model represented the experimental data well. While the equilibrium data fit the Sips isotherm model at 298 K, the predicted maximum adsorption capacities for chloroquine, propranolol, and metformin were 44.01, 16.82, and 12.23 mg g-1, respectively. The magnetic nanocomposite can be reused for three consecutive cycles of adsorption-desorption for all pharmaceuticals, being a promising alternative for the removal of different classes of pharmaceuticals in water.

An Unusual Case of Hemophagocytic Lymphohistiocytosis Associated with Mycobacterium chimaera or Large-Cell Neuroendocrine Carcinoma.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and very dangerous condition characterized by abnormal activation of the immune system, causing hemophagocytosis, inflammation, and potentially widespread organ damage. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity, is most commonly seen in children. Secondary HLH is commonly associated with infections, malignancies, and rheumatologic disorders. Most current information on diagnosis and treatment is based on pediatric populations. HLH is a disease that should be diagnosed and treated promptly, otherwise it is fatal. Treatment is directed at treating the triggering disorder, along with symptomatic treatment with dexamethasone and etoposide. We present a 56-year-old patient who was admitted with worsening weakness, exertional dyspnea, dry and nonproductive cough, and a 5-pound weight loss associated with loss of appetite. This is among the rare disorders that are not commonly encountered in day-to-day practice. Our differential diagnoses were broad, including infection, such as visceral leishmaniasis, atypical/tuberculous mycobacteria, histoplasmosis, Ehrlichia, Bartonella, Brucella, Adenovirus, disseminated herpes simplex virus (HSV), hematological-like Langerhans cell histiocytosis, or multicentric Castleman disease; drug reaction, such as drug rash with eosinophilia and systemic symptoms (DRESS); and metabolic disorder, including Wolman's disease (infantile lysosomal acid lipase deficiency) or Gaucher's disease. Based on our investigations as described in our case report, it was narrowed down to hemophagocytic lymphohistiocytosis and COVID-19. Two COVID-19 tests were negative. His lab abnormalities and diagnostic testing revealed hemophagocytic lymphohistiocytosis. He was empirically started on antibiotics and dexamethasone, to be continued for 2 weeks then tapered if the patient showed continued improvement. Dexamethasone was tapered over 8 weeks. He improved on just one of the Food and Drug Administration (FDA)-approved medications, proving that treatment should be tailored to the patient. In addition, in this case study, we included the background, etiology, pathogenesis, diagnosis, management, and prognosis of HLH.

Fatores estressores de estudantes de enfermagem em diferentes cenários simulados

Objetivo: Comparar a percepção de fatores estressores de estudantes de enfermagem antes e após sua experiência em cinco cenários diferentes de simulação. Material e Método: Pesquisa de intervenção, longitudinal e quantitativa, realizado com uma amostra por conveniência de 35 estudantes de enfermagem de uma universidade do sul do Brasil. O critério de inclusão foi estar matriculado no curso Saúde do Adulto e do Idoso do sexto semestre do programa de Enfermagem, que tem duração de 10 semestres. O critério de exclusão foi ter formação prévia em um programa com competências em exame clínico. O critério de descontinuidade foi a ausência de pelo menos uma experiência simulada. O questionário KEZKAK, validado em português e adaptado com 31 itens para estudos de simulação, foi utilizado para avaliar a percepção de fatores estressores durante cinco cenários simulados sobre suporte básico e avançado de vida. Resultados: Após experiência dos estudantes em cinco diferentes cenários de simulação, observou-se uma redução significativa na percepção dos seguintes estressores: falta de competência (p= 0,0329); contato com o sofrimento (p= 0,0279); relacionamento com tutores e companheiros (p= 0,4699 / p= 0,0135 respectivamente); e ser magoado no relacionamento com o paciente (p= 0,0110). Conclusões: A execução de cenários variados e com nível progressivo de complexidade, pode ajudar a reduzir os fatores de estresse percebidos pelos estudantes de enfermagem durante as atividades de simulação clínica.

Objective: To compare the perception of nursing students before and after their experience in five different simulation scenarios. Materials and Methods: Interventional, longitudinal and quantitative research, conducted with a convenience sample of 35 nursing students from a university in the south of Brazil. The inclusion criterion was to be enrolled in the course Adult and Elderly Health of the sixth semester of the graduate Nursing program, which has a duration of 10 semesters. The exclusion criterion was having previous training in a program with competencies in clinical examination. The discontinuity criterion was the absence of at least one simulated experience. To assess the perception of stressors during simulated scenarios in basic and advanced life support, the KEZKAK questionnaire, validated in Portuguese and adapted with 31 items for simulation studies, was used. Results: After experiencing five different simulation scenarios, there was a significant reduction in the perception of the following stressors: lack of competence (p= 0.0329); contact with suffering (p= 0.0279); relationship with tutors and peers (p= 0.4699 / p= 0.0135 respectively); and hurt feelings in the relationship with the patient (p= 0.0110). Conclusions: Performing varied scenarios with increasing levels of complexity may help to reduce the stressors perceived by nursing students during clinical simulation activities.

Objetivo: Comparar la percepción de factores estresantes en estudiantes de enfermería antes y después de su experiencia en cinco escenarios diferentes de simulación. Material y Método: Investigación de intervención, longitudinal y cuantitativa, realizada con una muestra por conveniencia de 35 estudiantes de enfermería de una Universidad del Sur de Brasil. El criterio de inclusión fue estar matriculado en la asignatura de Salud del Adulto y Adulto Mayor del sexto semestre de la carrera de Enfermería que tiene un total de 10 semestres de formación. El criterio de exclusión fue tener formación previa em una carrera com competencias en examen clínico. El criterio de discontinuidad fue la ausencia en al menos una experiencia simulada. Para evaluar la percepción de estresores durante los escenarios simulados en soporte vital básico y avanzado, se utilizó el cuestionario KEZKAK validado en lengua portuguesa, adaptado com 31 ítems para estudios en el ámbito de la simulación. Resultados: Después de la experiencia en cinco escenarios diferentes de simulación, hubo una reducción significativa en la percepción de los siguientes factores estresantes: falta de competencia (p= 0,0329); contacto con el sufrimiento (p= 0,0279); relación con tutores y compañeros (p= 0,4699 / p=0,0135); y sentirse herido en la relación con el paciente (p= 0,0110). Conclusiones: La ejecución de escenarios variados y con un nivel de complejidad progresivo, puede ayudar a reducir los estresores que perciben los estudiantes de enfermería durante las actividades de simulación clínica.

Debriefing virtual: uma análise da percepção dos estudantes de enfermagem sobre sua utilização* / Debriefing virtual: un análisis de la percepción de los estudiantes de enfermería sobre su utilización / Virtual debriefing: an analysis of nursing students' perception of its use

Objetivo: avaliar o debriefing virtual, realizado com estudantes de enfermagem que participaram como observadores em um cenário de simulação, gravado, sobre rebaixamento do nível de consciência por hipoglicemia. Método: estudo com delineamento transversal descritivo na fase quantitativa, e exploratório-descritivo na fase qualitativa entre 2020 e 2021, com 60 estudantes de graduação em enfermagem que assistiram a um cenário gravado e vivenciaram um debriefing virtual. Foram aplicados dois instrumentos de avaliação do debriefing, e na abordagem qualitativa utilizou-se análise pelo Iramuteq. Resultados: na Escala de Avaliação do Debriefing Associada à Simulação, a média geral de avaliação foi 4,25, mostrando que os participantes tiveram uma percepção positiva. Na Escala de Experiência com o Debriefing, a avaliação geral foi 4,38 sugerindo que foi uma estratégia útil. Conclusão: os estudantes apontaram o debriefing virtual como uma estratégia positiva para o aprendizado.

Objective: to evaluate the virtual debriefing, performed with nursing students who participated as observers in a simulation scenario, recorded, on lowering the level of consciousness by hypoglycemia. Method: study with descriptive cross-sectional design in the quantitative phase, and exploratory-descriptive in the qualitative phase between 2020 and 2021, with 60 nursing graduate students who attended a recorded scenario and, after, experienced a virtual debriefing. Two instruments were applied to evaluate the debriefing, and the qualitative approach used analysis by Iramuteq. Results: on the Simulation-Associated Debriefing Evaluation Scale, the overall mean of evaluation was 4.25, showing that the participants had a positive perception. And in the Debriefing Experience Scale, the overall assessment was 4.38, suggesting that debriefing was a useful strategy. Conclusion: students pointed to virtual debriefing as a positive strategy for learning.

Objetivo: evaluar el debriefing virtual, realizado con estudiantes de enfermería que participaron como observadores en un escenario de simulación, grabado, sobre descenso del nivel de conciencia por hipoglucemia. Método: estudio con delineamiento transversal descriptivo en la fase cuantitativa, y exploratorio-descriptivo en la fase cualitativa entre 2020 y 2021, con 60 estudiantes de graduación en enfermería que asistieron a un escenario grabado y, después, experimentaron un debriefing virtual. Se aplicaron dos instrumentos de evaluación del debriefing, y en el enfoque cualitativo se utilizó el análisis del Iramuteq. Resultados: en la Escala de Evaluación del Debriefing Asociada a la Simulación, la media general de evaluación fue 4,25, mostrando que los participantes tuvieron una percepción positiva. En la Escala de Experiencia con Debriefing, la evaluación general fue 4,38 sugiriendo que fue una estrategia útil. Conclusión: los estudiantes señalaron el debriefing virtual como una estrategia positiva para el aprendizaje.

Hope and depression in Brazilian head and neck cancer patients during the COVID-19 pandemic.

Introduction: Head and neck cancer is characterised as traumatic, when compared to other types of cancer, due to the physical, physiological and social impact it has on the patient. Objective: To evaluate hope and severe depression in patients with head and neck cancer during the COVID-19 pandemic. Method: Quantitative, observational, and analytical; conducted in the outpatient department of the head and neck department of an oncological hospital in the city of Curitiba, Paraná, Brazil, with 60 patients with head and neck cancer being treated with chemotherapy and radiotherapy. Data collection took place between May and September 2020, with the application of three questionnaires: socio-demographic and clinical; Patient Health Questionnaire-9 (PHQ-9), to evaluate severe depression; and the Herth hope scale. Data analysis was through descriptive statistics and non-parametric Mann- Whitney, Kruskal-Wallis and Spearman correlation tests. Results: The age of participants ranged from 34 to 85 years, with 61.7% being male. The diagnosis of cancer occurred in the oral cavity (53.3%) and larynx (33.3%); 28.3% (n = 1 7) presented with a diagnosis of depression; 8.6% (n = 5) are in treatment with psychology; and 10.3% (n = 6) are in treatment with psychotropic drugs. The analysis of the association of the PHQ-9 score with sex showed a mean score of 7.7 ± 6.2, with a higher level of depression in women. The mean hope score was 41.3 ± 3.1; however, during the pandemic, 35% (n = 21) reported feelings of anguish, anxiety and fear, with the latter being predominant and in association with the PHQ-9 score showing a mean of 8.2 ± 6.2 (p = 0.123). The association of hope with the number of children was statistically significant (p = 0.034) and in the education variable with the PHQ-9 score (p = 0.019). Conclusion: The use of tools that assess both levels of hope and depression in patients undergoing chemotherapy and radiotherapy provides health professionals with support for the implementation of targeted actions to cope with the disease.

Iniciação científica e formação de professores: um estudo sobre os trabalhos de conclusão de curso de licenciatura em Educação Física da Universidade de Brasíli / Scientific initiation and teacher education: a study about final monographs of the graduation course in Physical Education at the University of Brasília / Iniciación científica y formación de profesores: unestudio sobre lastesis de graduación de lacarrera de Educación Física enlaUniversidad de Brasilia

Inspirado pelo debate da formação em educação física e diante da necessidade de apresentar parte da realidadedo curso de licenciatura da Universidade de Brasília, o artigo teve como objetivo levantar dados acerca dos Trabalhos de Conclusão de Curso (TCC). Procurou-se selecioná-los entre 2016 e 2019, período que abarca a totalidade dos TCC produzidos no curso. Foram encontrados 116 trabalhos, sendo que 55,2% correspondem à temática da educação física escolar. Classificados segundo as categorias da fundamentação, intervenção e diagnóstico/descrição, os trabalhos relacionados à educação física escolar se apresentam desequilibrados, de forma que aproximadamente 70% correspondem a trabalhos de diagnóstico/descrição da realidade. Tal desequilíbrio e o pouco interesse dos estudantes no desenvolvimento por trabalhos de fundamentação teórica e de intervenção pedagógicaconflitua com a tradição científica da educação física escolar de forma que tais resultados põem dúvidas sobre os vínculos dos estudantes com o foco de atuação requerido pela licenciatura.

Inspired by the discussion on physical education scientific and because the necessity to present part of the reality of the graduate course at the University of Brasília, the article aimed to raise data about the Final Monograph (TCC). We tried to select them between 2016 and 2019, a period that covers all the TCC produced in the course. 116 studies were found, and 55.2% correspond to the topic of school physical education. It's classified according to the categories of theoretical foundation, intervention and diagnosis/description. These studies related to school physical education are unbalanced.Approximately 70% correspond to studies of diagnosis/description of reality. Such unbalance and the few interest of students in the development of studies of theoretical foundation and pedagogical intervention conflicts with the scientific tradition of school physical education, so that such results cast doubts on the students' links with the focus of action required by the degree.

Inspirado en el debate sobre la formación en educación física y dada la necesidad de presentar la realidad del curso de pregradoenlaUniversidad de Brasilia, el artículo tuvo como objetivo analizar datos sobre las tesis de graduación. Fueron seleccionados trabajos entre 2016 y 2019, período que reúne la producción total de tesis de graduación delcurso. Se encontraron 116 trabajos y el 55,2% corresponden a la temática de educación física escolar. Clasificado ssegún las categorías de fundamento, intervención y diagnóstico/descripción, enlostrabajos relacionados con la educación física escolar se encontró un cierto desequilibrio, de manera que aproximadamente el 70% corresponde a trabajos de diagnóstico/descripción. Tal desequilibrio y eles caso interés de los estudiantes por el desarrollo de trabajos de fundamentación teórica e intervención pedagógica opuesto a la tradición científica del área, fragiliza la necesaria vinculación de lo estudiantes con el enfoque de acción que requiere latitulación.

The Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols.

OBJECTIVES: to identify, classify, and analyze modes of failure in the medication process. METHODS: evaluative research that used the Healthcare Failure Mode and Effect Analysis (HFMEA) in a service of bone marrow transplant from June to September 2018, with the participation of 35 health workers. RESULTS: 207 modes of failure were identified and classified as mistakes in verification (14%), scheduling (25.6%), administration (29%), dilution (16.4%), prescription (2.4%), and identification (12.6%). The analysis of risk showed a moderate (51.7%) and high (30.9%) need of intervention, leading to the creation of an internal quality assurance group and of continued education activities. CONCLUSIONS: the Healthcare Failure Mode and Effect Analysis showed itself to be a tool to actively identify, classify, and analyze failures in the process of medication, contributing for the proposal of actions aimed at patient safety.

Coping Religioso/Espiritual e Qualidade de Vida dos Sobreviventes de Câncer Cinco Anos após o Transplante de Células-Tronco Hematopoiéticas / Religious/Spiritual Coping and Quality of Life of 5-Years Cancer Survivors After Hematopoietic Stem Cell Transplantation Afrontamiento / Religioso/Espiritual y Calidad de Vida de Sobrevivientes de Cáncer Cinco Años después del Trasplante de Células Madre Hematopoyéticas

Introdução: O transplante de células-tronco hematopoiéticas é um tratamento complexo, com potencial de cura, no entanto, apresenta risco significativo de complicações graves e consequente comprometimento na qualidade de vida relacionada à saúde. Diante desse cenário, é necessário que a equipe de saúde reconheça as demandas a que os pacientes estão expostos, e as estratégias de enfrentamento utilizadas, a fim de promover intervenções que objetivem a melhora da qualidade de vida relacionada à saúde e a diminuição dos desconfortos decorrentes do diagnóstico e tratamento. Objetivo: Correlacionar o uso do coping religioso/espiritual com a qualidade de vida após cinco anos da realização do transplante de células-tronco hematopoiéticas. Método: Estudo analítico e longitudinal, com 55 pacientes em um hospital de referência para o procedimento na América Latina. Coleta de dados de 2013 até 2021, com os questionários Functional Assessment of Cancer Therapy ­ Bone Marrow Transplantation e Religious/Spiritual Coping Scale. Correlações entre as variáveis pelo coeficiente de correlação de Spearman. Resultados: Trinta pacientes foram a óbito antes de completar cinco anos de tratamento. A qualidade de vida apresentou melhores índices no quinto ano (116,1/148). Houve maior uso do coping religioso/espiritual positivo (3,15/5,00). Observou-se correlação significativa negativa entre os escores de qualidade de vida (-0,624/p<0,00) e coping/religioso espiritual negativo. Conclusão: Reconhecer a multidimensionalidade do constructo qualidade de vida, incluindo o domínio espiritual, poderá auxiliar o paciente no enfrentamento da doença e do tratamento

Introduction: Hematopoietic stem cell transplantation is a complex treatment, with healing potential, however, it presents a significant risk of serious complications and consequent impairment in health-related quality of life. Given this scenario, it is necessary for the health team to recognize the demands that patients are exposed to, and the coping strategies used, in order to promote interventions that aim to improve health-related quality of life, and decrease the discomforts resulting from the diagnosis and treatment. Objective: To correlate the use of religious/spiritual coping with quality of life after five years of hematopoietic stem cell transplantation. Method: Analytical and longitudinal study, with 55 patients in a referral hospital for the procedure in Latin America. Data were collected from 2013 to 2021, with the Functional Assessment of Cancer Therapy ­ Bone Marrow Transplantation and Religious/Spiritual Coping Scale questionnaires. Correlations between variables by the Spearman's correlation coefficient. Results: 30 patients died before completing five years of treatment. Quality of life showed better rates in the fifth year (116.1/148). There was greater use of positive religious/spiritual coping (3.15/5.00). A significant negative correlation between quality-of-life scores (-0.624/p<0.00) and negative religious/spiritual coping was found. Conclusion: Recognizing the multidimensionality of the quality of life construct, including the spiritual domain, can help the patient to cope with the disease and treatment

Introducción: El trasplante de progenitores hematopoyéticos es un tratamiento complejo, con potencial curativo, sin embargo, presenta un riesgo importante de complicaciones graves y consecuente deterioro de la calidad de vida relacionada con la salud. Ante este escenario, es necesario que el equipo de salud reconozca las demandas a las que se exponen los pacientes y las estrategias de enfrentamiento utilizadas, a fin de promover intervenciones que apunten a mejorar la calidad de vida relacionada con la salud y disminuir los malestares derivados del diagnóstico y tratamiento. Objetivo: Correlacionar el uso del afrontamiento religioso/espiritual con la calidad de vida después de cinco años del trasplante de células progenitoras hematopoyéticas. Método: Estudio analítico y longitudinal, con 55 pacientes en un hospital de referencia para el procedimiento en América Latina. Recopilación de datos de 2013 a 2021, con los cuestionarios Functional Assessment of Cancer Therapy ­ Bone Marrow Transplantation y Religious/Spiritual Coping Scale. Correlaciones entre variables por el coeficiente de correlación de Spearman. Resultados: Treinta pacientes fallecieron antes de completar cinco años de tratamiento. La calidad de vida mostró mejores índices en el quinto año (116,1/148). Hubo un mayor uso del afrontamiento religioso/espiritual positivo (3,15/5,00). Hubo una correlación negativa significativa entre las puntuaciones de calidad de vida (-0,624/p<0,00) y el afrontamiento religioso/espiritual negativo. Conclusión: Reconocer la multidimensionalidad del constructo calidad de vida, incluyendo el dominio espiritual, puede ayudar al paciente a enfrentar la enfermedad y el tratamiento

The Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols / El Healthcare Failure Mode and Effect Analysis como herramienta de evaluación de protocolos asistenciales / O Healthcare Failure Mode and Effect Analysis como ferramenta de avaliação de protocolos assistenciais

ABSTRACT Objectives: to identify, classify, and analyze modes of failure in the medication process. Methods: evaluative research that used the Healthcare Failure Mode and Effect Analysis (HFMEA) in a service of bone marrow transplant from June to September 2018, with the participation of 35 health workers. Results: 207 modes of failure were identified and classified as mistakes in verification (14%), scheduling (25.6%), administration (29%), dilution (16.4%), prescription (2.4%), and identification (12.6%). The analysis of risk showed a moderate (51.7%) and high (30.9%) need of intervention, leading to the creation of an internal quality assurance group and of continued education activities. Conclusions: the Healthcare Failure Mode and Effect Analysis showed itself to be a tool to actively identify, classify, and analyze failures in the process of medication, contributing for the proposal of actions aimed at patient safety.

RESUMEN Objetivos: identificar, clasificar y analizar modos de fallos en el proceso de medicación. Métodos: investigación evaluativa que utilizó el Healthcare Failure Mode and Effect Analysis (HFMEA) en Servicio de Trasplante de Médula Ósea, de junio a septiembre de 2018, con la participación de 35 profesionales de salud. Resultados: han sido identificados 207 modos de fallos, clasificados en errores de chequeo (14%); aplazamiento (25,6%); administración (29%); dilución (16,4%); prescripción (2,4%) e identificación (12,6%). El análisis del riesgo evidenció la necesidad de intervención moderada (51,7%) y alta (30,9%), resultando en la creación del equipo interno de calidad y actividades de educación continua. Conclusiones: el Healthcare Failure Mode and Effect Analysis demostró ser herramienta para identificar, clasificar y analizar, activamente, fallos en el proceso de medicación, contribuyendo para la proposición de acciones con objetivo de seguridad del paciente.

RESUMO Objetivos: identificar, classificar e analisar modos de falhas no processo de medicação. Métodos: pesquisa avaliativa que utilizou o Healthcare Failure Mode and Effect Analysis (HFMEA) em Serviço de Transplante de Medula Óssea, de junho a setembro de 2018, com a participação de 35 profissionais de saúde. Resultados: foram identificados 207 modos de falhas, classificados em erros de checagem (14%); aprazamento (25,6%); administração (29%); diluição (16,4%); prescrição (2,4%) e identificação (12,6%). A análise do risco evidenciou a necessidade de intervenção moderada (51,7%) e alta (30,9%), resultando na criação do grupo interno de qualidade e atividades de educação continuada. Conclusões: o Healthcare Failure Mode and Effect Analysis demonstrou ser ferramenta para identificar, classificar e analisar, ativamente, falhas no processo de medicação, contribuindo para a proposição de ações com vistas à segurança do paciente.

Falsely positive heparin-induced thrombocytopenia antibody testing in severe hyperbilirubinemia.

Heparin-induced thrombocytopenia (HIT) is a life-threatening pathologic reaction to heparin-based products. Diagnosis of this condition can be confounded by other comorbidities or by acute illness-oftentimes presenting challenging clinical dilemmas, particularly in critically ill patients. A 67-year-old woman was admitted with liver failure and severe hyperbilirubinemia. She developed thrombocytopenia after prophylactic heparin exposure. Subsequent quantitative latex immunoturbidimetric assay (LIA) HIT antibody testing was intermediately positive. Confirmatory serotonin release assay testing subsequently returned negative. Platelet factor4-dependent P-selectin expression assay also returned negative, suggesting false positivity of the initial LIA tests. Concern was raised that hyperbilirubinemia (total bilirubin, 55.5 mg/dL) interfered with the original assay. Further testing with a separate HIT ELISA assay, which includes multiple washes and dilutions of the serum in order to effectively remove bilirubin, returned negative. Medical providers must consider the possibility of false-positive LIA testing when evaluating for HIT in the setting of severe hyperbilirubinemia.

Assessment of quality of life three years from hematopoietic stem cell transplant.

OBJECTIVE: To assess the domains of quality of life related to hematologic cancer patient health in the first three years from autologous and allogeneic hematopoietic stem cell transplantation. METHOD: A prospective cohort from September 2013 to February 2019 at a reference service in Latin America with 55 patients. The instruments Quality of Life Questionnaire Core C30 and Functional Assessment Cancer Therapy - Bone Marrow Transplantation were used. For data analysis, Generalized Linear Mixed Model was used. RESULTS: The domains global and overall quality of life presented the lowest scores in the pancytopenia phase: 59.3 and 91.4 in autologous, 55.3 and 90.3 in allogeneic. The mixed method analysis has shown that there was a significant change in scores between the phases throughout the treatment (p< 0.05). CONCLUSION: Health-related quality of life presented significant changes in the domains between the phases throughout time. Understanding these results enables nursing interventions directed at the domains which were damaged during treatment.

Guided imagery relaxation in quality of life of patients undergoing hematopoietic stem cell transplantation: a quasi-experiment.

OBJECTIVE: The aim of this study was to evaluate the effects of the relaxation technique with guided imagery by means of virtual reality on health-related quality of life in patients undergoing hematopoietic stem cell transplantation. METHODS: A quasi-experiment conducted in a Bone Marrow Transplantation Service of a public hospital in southern Brazil. From October 2019 to October 2020, forty-two adult participants who underwent transplantation were included, 35 in the intervention group and seven in the control group. A guided imagery intervention, with audio guiding the relaxation associated with nature images in 360º, was performed during the hospitalization period. Data were collected on the first day of hospitalization, on the transplantation day, during the neutropenia stage, and at pre-hospital discharge. The Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) and Functional Assessment of Cancer Therapy-Neutropenia (FACT-N) were used to assess health-related quality of life, fatigue and neutropenia. Data were analyzed using the Generalized Linear Mixed Model for the evolution of the health-related quality of life assessments over time, considering the groups and stages. Pearson's correlation coefficient was adopted for the correlation analyses. RESULTS: Allogeneic transplantation was predominant: 28 (80%) in the intervention group and 5 (71.43%) in the control group. There were improvements in the health-related quality of life scores, although not significant. A significant difference was found among the stages (p <0.050) and a significant positive correlation (p <0.000) among the variables on general quality of life, additional concerns, fatigue and neutropenia in all stages. CONCLUSION: Patients undergoing hematopoietic stem cell transplantation suffer changes in their quality of life. Interventions based on integrative practices emerge as an option to minimize them. 
.

Quality of life and changes in the social dimension of hematopoietic stem cell transplants recipients.

OBJECTIVES: to assess/correlate health-related quality of life with the social dimension of hematopoietic, autologous and allogeneic stem cell transplant patients in the three years post-transplant. METHODS: longitudinal, observational study with 55 patients, in a reference hospital in Latin America, from September 2013 to February 2019, using the Quality of Life Questionnaire-Core and Functional Assessment Cancer Therapy Bone Marrow Transplantation. RESULTS: A total of 71% underwent allogeneic transplantation. The social dimension had low averages since the baseline stage (55, 21) and low scores (56) for quality of life in pancytopenia. There was a significant positive correlation between social dimension, quality of life in pancytopenia (p<0.01) and follow-up after hospital discharge (p<0.00). There is a significant difference (p<0.00) throughout the stages, however, not in terms of the type of transplant (p>0.36/0.86). CONCLUSIONS: patients with better assessments in the social dimension have a better quality of life. Interventions focusing on the multidimensionality of the quality of life construct are necessary.

Adsorptive and photocatalytic activity of Fe3O4-functionalized multilayer graphene oxide in the treatment of industrial textile wastewater.

Multilayer graphene oxide (mGO) was synthesized and functionalized via co-precipitation method to produce magnetic Fe3O4-functionalized multilayer graphene oxide nanocomposite (MmGO). Photocatalytic properties of MmGO were investigated in the photodegradation of raw textile wastewater samples. Fourier-transformed infrared spectroscopy revealed Fe-O vibrations, characterized by the band shift from 636.27 to 587.25 cm-1 on MmGO. X-ray diffraction confirmed the successful oxidation of graphite by the (002) peak at 10° and indicated the presence of Fe3O4 on MmGO surface by the peaks at 2θ 35.8° (311), 42.71° (400), 54.09° (511), and 62.8° (440). There was no detection of coercivity field and remnant magnetization, evidencing a material with superparamagnetic properties. Then, the textile effluent was treated by heterogeneous photo-Fenton (HPF) reaction. A 22 factorial design was conducted to evaluate the effects of MmGO dosage and H2O2 concentration on HPF, with color and turbidity removal as response variables. The kinetic behavior of the adsorption and HPF processes was investigated separately, in which, the equilibrium was reached within 60 and 120 min, for adsorption and HPF, respectively. Pseudo-second-order model exhibited the best fit, with COD uptake capacity at equilibrium of 4094.94 mg g-1, for chemical oxygen demand. The modeling of kinetics data showed that the Chan and Chu model was the most representative for HPF, with initial removal rate of 95.52 min-1. The removal of organic matter was 76.36% greater than that reached by conventional treatment at textile mills. The presence of Fe3O4 nanoparticles attached to MmGO surface was responsible for the increase of electron mobility and the enhancement of its photocatalytic properties. Finally, MmGO presented low phytotoxic to Cucumis sativus L. with a RGI of 0.53. These results bring satisfactory perspectives regarding further employment, on large scale, of MmGO as nanocatalyst of textile pollutants.

In-depth investigation of Sodium percarbonate as oxidant of PAHs from soil contaminated with diesel oil.

Sodium percarbonate (SPC, 2Na2CO3∙3H2O2), is a compound that can be used under multiple environmental applications. In this work, SPC was employed as oxidant in the treatment of soil contaminated with diesel oil. The soil samples were collected during the earthmoving stage of RNEST Oil Refinery (Petrobras), Brazil. Then, the samples were air-dried, mixed and characterized. Subsequently, raw soil was contaminated with diesel and treated by photo-Fenton reaction (H2O2/Fe2+/UV). SPC played a significant role in the generation of hydroxyl radicals under the catalytic effect of ferrous ions (Fe2+), hydrogen peroxide (H2O2) and radiation. These radicals provoked the photodegradation of polycyclic aromatic hydrocarbons (PAHs), in the soil remediation. A factorial design 33 was carried out to assess the variables which most influenced the decrease in total organic carbon (TOC). The study was performed with the following variables: initial concentration of [H2O2] and [Fe2+], between 190.0 and 950.0 mmol L-1 and 0.0-14.4 mmol L-1, respectively. UV radiation was supplied from sunlight, blacklight lamps, and system without radiation. All experiments were performed with 5.0 g of contaminated soil in 50.0 mL of solution. The initial concentration of Fe2+ showed the statistically most significant effect. The oxidation efficiency evaluated in the best condition showed a decrease from 34,765 mg kg-1 to 15,801 mg kg-1 in TOC and from 85.750 mg kg-1 to 20.770 mg kg-1 in PAHs content. Moreover, the sums of low and high molecular weight polycyclic aromatic hydrocarbons (LMW-PAHs and HMW-PAHs) were 19.537 mg kg-1 and 1.233 mg kg-1, respectively. Both values are within the limits recommended by the United Sates Environmental Protection Agency (USEPA) and evidenced the satisfactory removal of PAHs from contaminated soil, being an alternative to classic oxidation protocols.