Patient satisfaction in ambulatory anesthesia assessed by the Heidelberg Peri-anaesthetic Questionnaire: a cross-sectional study

Abstract Background: Service quality in anesthesiology has been frequently measured by morbidity and mortality. This measure increasingly considers patient satisfaction, which is the result of care from the client's perspective. Therefore, anesthesiologists must be able to build relationships with patients, provide understandable information and involve them in decisions about their anesthesia. This study aimed to evaluate the peri-anesthetic care provided by the anesthesia service in an ambulatory surgery unit using the Heidelberg Peri-anaesthetic Questionnaire. Methods: This cross-sectional study used the Heidelberg Peri-anaesthetic Questionnaire to evaluate 1211 patients undergoing ambulatory surgery. We selected questions that showed a greater degree of dissatisfaction and correlated them with patient characterization data (age, sex, education, and ASA physical status), anesthesia data (type, time, and prior experience), and surgical specialty. Results: Questions in which patients tended to show dissatisfaction involved fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain. Conclusion: The Heidelberg Peri-anaesthetic Questionnaire proved to be a useful tool in identifying points of dissatisfaction, mainly fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain in the population studied. These were correlated with patient, anesthesia, and surgical variables. This allows the establishment of priorities at the different points of care, with the ultimate goal of improving patient satisfaction regarding anesthesia care.

Patient satisfaction in ambulatory anesthesia assessed by the Heidelberg Peri-anaesthetic Questionnaire: a cross-sectional study.

BACKGROUND: Service quality in anesthesiology has been frequently measured by morbidity and mortality. This measure increasingly considers patient satisfaction, which is the result of care from the client's perspective. Therefore, anesthesiologists must be able to build relationships with patients, provide understandable information and involve them in decisions about their anesthesia. This study aimed to evaluate the peri-anesthetic care provided by the anesthesia service in an ambulatory surgery unit using the Heidelberg Peri-anaesthetic Questionnaire. METHODS: This cross-sectional study used the Heidelberg Peri-anaesthetic Questionnaire to evaluate 1211 patients undergoing ambulatory surgery. We selected questions that showed a greater degree of dissatisfaction and correlated them with patient characterization data (age, sex, education, and ASA physical status), anesthesia data (type, time, and prior experience), and surgical specialty. RESULTS: Questions in which patients tended to show dissatisfaction involved fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain. CONCLUSION: The Heidelberg Peri-anaesthetic Questionnaire proved to be a useful tool in identifying points of dissatisfaction, mainly fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain in the population studied. These were correlated with patient, anesthesia, and surgical variables. This allows the establishment of priorities at the different points of care, with the ultimate goal of improving patient satisfaction regarding anesthesia care.

Two Sides of a Coin: a Zika Virus Mutation Selected in Pregnant Rhesus Macaques Promotes Fetal Infection in Mice but at a Cost of Reduced Fitness in Nonpregnant Macaques and Diminished Transmissibility by Vectors.

Although fetal death is now understood to be a severe outcome of congenital Zika syndrome, the role of viral genetics is still unclear. We sequenced Zika virus (ZIKV) from a rhesus macaque fetus that died after inoculation and identified a single intrahost substitution, M1404I, in the ZIKV polyprotein, located in nonstructural protein 2B (NS2B). Targeted sequencing flanking position 1404 in 9 additional macaque mothers and their fetuses identified M1404I at a subconsensus frequency in the majority (5 of 9, 56%) of animals and some of their fetuses. Despite its repeated presence in pregnant macaques, M1404I has occurred rarely in humans since 2015. Since the primary ZIKV transmission cycle is human-mosquito-human, mutations in one host must be retained in the alternate host to be perpetuated. We hypothesized that ZIKV I1404 increases viral fitness in nonpregnant macaques and pregnant mice but is less efficiently transmitted by vectors, explaining its low frequency in humans during outbreaks. By examining competitive fitness relative to that of ZIKV M1404, we observed that ZIKV I1404 produced lower viremias in nonpregnant macaques and was a weaker competitor in tissues. In pregnant wild-type mice, ZIKV I1404 increased the magnitude and rate of placental infection and conferred fetal infection, in contrast to ZIKV M1404, which was not detected in fetuses. Although infection and dissemination rates were not different, Aedes aegypti mosquitoes transmitted ZIKV I1404 more poorly than ZIKV M1404. Our data highlight the complexity of arbovirus mutation-fitness dynamics and suggest that intrahost ZIKV mutations capable of augmenting fitness in pregnant vertebrates may not necessarily spread efficiently via mosquitoes during epidemics.IMPORTANCE Although Zika virus infection of pregnant women can result in congenital Zika syndrome, the factors that cause the syndrome in some but not all infected mothers are still unclear. We identified a mutation that was present in some ZIKV genomes in experimentally inoculated pregnant rhesus macaques and their fetuses. Although we did not find an association between the presence of the mutation and fetal death, we performed additional studies with ZIKV with the mutation in nonpregnant macaques, pregnant mice, and mosquitoes. We observed that the mutation increased the ability of the virus to infect mouse fetuses but decreased its capacity to produce high levels of virus in the blood of nonpregnant macaques and to be transmitted by mosquitoes. This study shows that mutations in mosquito-borne viruses like ZIKV that increase fitness in pregnant vertebrates may not spread in outbreaks when they compromise transmission via mosquitoes and fitness in nonpregnant hosts.

DNA vaccination before conception protects Zika virus-exposed pregnant macaques against prolonged viremia and improves fetal outcomes.

Zika virus (ZIKV) infection of pregnant women is associated with congenital Zika syndrome (CZS) and no vaccine is available, although several are being tested in clinical trials. We tested the efficacy of ZIKV DNA vaccine VRC5283 in a rhesus macaque model of congenital ZIKV infection. Most animal vaccine experiments have a set pathogen exposure several weeks or months after vaccination. In the real world, people encounter pathogens years or decades after vaccination, or may be repeatedly exposed if the virus is endemic. To more accurately mimic how this vaccine would be used, we immunized macaques before conception and then exposed them repeatedly to ZIKV during early and mid-gestation. In comparison to unimmunized animals, vaccinated animals had a significant reduction in peak magnitude and duration of maternal viremia, early fetal loss, fetal infection, and placental and fetal brain pathology. Vaccine-induced neutralizing antibody titers on the day of first ZIKV exposure were negatively associated with the magnitude of maternal viremia, and the absence of prolonged viremia was associated with better fetal outcomes. These data support further clinical development of ZIKV vaccine strategies to protect against negative fetal outcomes.

Psicologia, políticas públicas e participação social: diálogos com a Multidão / Psychology, public policies and social participation: dialogues with the multitude

Este artigo se destina a discutir os caminhos trilhados pela Psicologia na história das políticas públicas no Brasil. Num resgate histórico sobre como os saberes-psi constituíram as lutas pela redemocratização da sociedade e a garantia de direitos, lançaremos mão de conceitos criados por Michel Foucault, fazendo-os dialogar com os dispositivos de participação social e com o conceito de Multidão, criado por Michael Hardt e Toni Negri. Dessa forma, faz-se possível pensar como as práticas em psicologia têm operado nos equipamentos das políticas públicas. Priorizaremos três eixos principais na escrita deste texto - eixos que, atrelados, culminarão numa proposta para o leitor -, trazendo elementos para debatermos a composição das políticas de Saúde, Educação e Assistência Social. Concluímos como estratégia do trabalho em psicologia o fortalecimento da aliança ética com o projeto da Multidão por meio de ações de cunho micropolítico

This article aims to discuss the trodden paths by (trajectory of) Psychology in the history of public policies in Brazil. In a historical review about how psychology’s knowledge has constituted the struggles (efforts) for democratization of society and guarantee of rights, we will use concepts created by Michel Foucault making the dialogue with social participation devices and the concept of Multitude, created by Michael Hardt and Toni Negri. Thereby, it makes possible to think about how practices in psychology have operated in public policy establishment. We focused on three main axes while we wrote this text - axes that together that will culminate in a proposal for you, our reader - bringing elements to discuss the composition of health policies, Education and Social Work. We conclude as strategy of the work in psychology the strengthening of the ethical alliance with the project of the Multitude through actions of a micropolitical nature

Teratogenic effects of Mimosa tenuiflora in a rat model and possible role of N-methyl- and N,N-dimethyltryptamine.

Mimosa tenuiflora is a shrub/tree found in northeastern Brazil sometimes eaten by livestock and believed to be responsible for malformations observed in many animals from that region. The teratogenic compounds in M. tenuiflora are not known. This study used pregnant rats fed M. tenuiflora and components therefrom for bioassay and fractionation of possible teratogenic compounds. Rat pups were examined for cranial-facial defects and skeletal malformations. Experimental diets included M. tenuiflora leaf and seed material, extracts of leaf and seed, alkaloid extracts of leaf and seed, and N-methyltryptamine and N,N-dimethyltryptamine. Pups from mothers who received M. tenuiflora plant material, methanol extracts, alkaloid extracts, and purified N-methyltryptamines had a higher incidence of soft tissue cleft palate and skeletal malformations. Results are summarized as to the frequency of observed cleft palate and other noted malformations for each diet versus control.

Mechanism for the uncoupling of oxidative phosphorylation by juliprosopine on rat brain mitochondria.

Prosopis juliflora, popularly known as Algaroba, is a major problem because the lack of food during the driest times of the year and its high palatability and nutritional value make its fruits (pods) much appreciated by cattle, goats, sheep and other animals. However, the consumption of this plant for long periods can cause a disease called cara-torta (pie face), which is characterized by cranial nerve dysfunction, mainly due to the degeneration and disappearance of neurons in the trigeminal motor nucleus. Algaroba contains piperidine alkaloids that have been suggested as being responsible for its toxicity; one of these alkaloids is juliprosopine. This study was conducted to evaluate the mechanisms of action of juliprosopine in isolated rat brain mitochondria to evaluate the potential mechanisms that lead to neurotoxicity in animals intoxicated by algaroba. Juliprosopine stimulated state-4 respiration at concentrations of 10-25 µM, affected the membrane potential at all concentrations studied (5-25 µM) and affected ATP production only at higher concentrations (15 and 25 µM). Juliprosopine cannot be classified as a member of the protonophoric class of uncouplers, such as 2,4-dinitrophenol or CCCP (m-chlorophenylhydrazone), due to its inability to promote mitochondrial swelling in the hyposmotic medium of potassium acetate. In addition, carboxyatractyloside, Mg(2+), cyclosporine A and dithiothreitol did not protect the uncoupling induced by juliprosopine. Because juliprosopine increased the fluorescence responses of mitochondria labeled with 1-aniline-8-naphthalene sulfonate (ANS) and DPH (1,6-diphenyl-1,3,5-hexatriene), we suggested that its uncoupling action must be attributed to a modification of the arrangement of the inner mitochondrial membrane.