Effects of cluster set resistance training on bone mineral density and markers of bone metabolism in older hemodialysis subjects: A pilot study.

Chronic kidney disease (CKD) is associated with a series of mineral bone disturbances due to increased production of parathormone which increases the activity of osteoclasts, removing calcium and phosphorous from the bones. However, the literature lacks investigations on the feasibility of different resistance training (RT) methods, such as cluster-sets, in this population. Thus, the aim of the present study was to compare traditional versus cluster-set RT protocols on bone mineral density (BMD) T-score, BMD Total, femur BMD, L3-L4 BMD, femoral neck BMD, Klotho, FGF23, Klotho - FGF23 ratio, Sclerostin, vitamin D, phosphorous and calcium in older subjects with CKD. Seventy-eight older subjects (age: 57.55 ±â€¯4.06 years, body mass: 72.26 ±â€¯13.96 kg, body mass index: 26.73 ±â€¯2.97 kg/m2) with CKD undergoing maintenance hemodialysis were randomly divided into control group (CG, n = 26), traditional RT (RT, n = 26) and cluster-set RT (RT-CS, n = 26) groups. Subjects completed 24 weeks of RT three times per week, 1 h and 30 min before the hemodialysis session, and each training lasted around 60 to 80 min. There was a group×time interaction for total BMD, femur BMD, L3-L4 BMD, and femoral neck BMD, revealed by improvements for RT and RT-CS groups (pre versus post). Only femur BMD displayed differences as compared with the CG. Minimum clinically important difference (MCID) values revealed more responsive subjects in the RT-CS group for total BMD, femur BMD, klotho, FGF23, sclerostin, Vitamin D and calcium. In conclusion, RT can be used as a non-pharmacological complementary strategy for the treatment of CKD. RT-CS may be useful for these subjects as more responders were found for this type of training.

Exergame-based rehabilitation for cancer patients undergoing abdominal surgery: Effects on pain, anxiety, depression, and fatigue - A pilot study.

PURPOSE: This study aimed to determine the efficacy of an exergame rehabilitation program on pain, anxiety or depression, and fatigue in oncology patients undergoing abdominal surgery. METHODS: The randomized controlled trial evaluated the efficacy of exergame rehabilitation on Pain, Anxiety, Depression, and Fatigue in oncology patients undergoing abdominal surgery. Patients were recruited from October 2022-March 2023 and were randomly assigned to the intervention group (postoperative traditional rehabilitation plus an exergame rehabilitation program) or control group (postoperative traditional rehabilitation). Data were collected at three different times: on admission, in the first 48 h, and on the 7th day after surgery. Primary outcomes were evaluated and monitored with different validated instruments: numeric rating scale (NRS) for pain, Hospital Anxiety and Depression Scale (HADS) to assess the level of anxiety and depression, and the Fatigue Assessment Scale (FAS) to assess physical and psychological fatigue. The length of stay and program completion were secondary outcomes. RESULTS: A total of 128 postoperative patients were recruited. Of these, 58 patients were excluded from the study due to clinical complications related to the surgical procedure (n = 53) or healthcare staff-related reasons (n = 5). Both the control and intervention groups were the same size (n = 35). Lower pain scores were observed on the 7th postoperative day in the group subject to the "exergame rehabilitation program" (p = 0.006). No statistically significant differences were observed for anxiety and depression between the 2 groups. Regarding fatigue, statistically significant differences were observed on admission (p = 0.03), which disappeared 48 h after surgery (p = 0.143). Differences between the groups were observed again on the 7th day after surgery (p = 0.005). CONCLUSIONS: The intervention using exergames was effective in reducing the postoperative pain of the patient undergoing major abdominal surgery and in restoring the levels of fatigue before surgical intervention. However, no differences were observed for anxiety or depression. Future studies with larger samples should be carried out.

Maternal Perception of Pregnancy Loss: Protocol for a Thematic Synthesis.

Introduction: The number of women who present this perineal loss is high. Identifying the existing knowledge about the women's experiences and perceptions of pregnancy loss is essential to understand the impact of the phenomenon on women. This identification is also crucial to adapt and improve the healthcare provided. Subjects and Methods: A systematic literature review, meta-synthesis, of qualitative studies will be developed with the goal of obtaining a comprehensive understanding of mothers' perception of pregnancy loss and identifying their specific support needs. Inclusion Criteria: This review will consider qualitative investigations that study the perceptions or experiences of adult women who have suffered prenatal loss. All studies published in English, Spanish or Portuguese between January 1, 2012, and December 31, 2022 will be considered. This systematic review will follow the Joanna Briggs Institute statement for systematic reviews of qualitative design. The Psychology and Behavioral Sciences Collection, Scopus, CINAHL®, MEDLINE® and Cochrane Database of Systematic Reviews (CDRS) databases will be utilized for research. Data extraction will be performed in-peers by the researchers, using the Joanna Briggs Institute model. Finally, the available data will be analysed using a meta-aggregation approach. Conclusion: A better understanding of this phenomenon will be useful, identifying, on the one hand, the support needs of women who have suffered fetal loss and, on the other hand, also identifying the support and interventions that can be implemented by health professionals. Systematic Review Registration Number: PROSPERO® (CRD42023407314).

Exploring Vitamin B12 Supplementation in the Vegan Population: A Scoping Review of the Evidence.

With a significant portion of the population adopting veganism and conflicting views among nutrition professionals regarding the necessity of vitamin B12 supplementation, this review aims to explore existing studies evaluating interventions through food supplementation. It focuses on the impact of vitamin B12 deficiency across different demographics. The present study seeks to understand how research has addressed the relationship between the rise in veganism and vitamin B12 deficiency over the past decade. A scoping review was conducted following the PRISMA flow diagram. Studies from 2010 to 2023 were identified using Boolean operators and key terms in electronic databases such as PubMed/MEDLINE, Web of Science, and EBSCO (Library, Information Science & Technology Abstracts, and Academic Search Complete). Out of 217 articles identified, 70 studies were included. The topical analysis categorized the studies into three groups: those associating vitamin B12 deficiency with diseases (n = 14), those analyzing the dietary habits of vegetarian individuals (vegan or not) without a specific focus on vitamin B12 (n = 49), and those addressing food guides and nutrition institution positions (n = 7). The authors concluded that vitamin B12 deficiency is prevalent among vegans due to limited consumption of animal products. For vegetarians, supplementation is an efficient means of treating and preventing deficiency; a daily dose of 50 to 100 micrograms is advised. There are still significant gaps in the research, nevertheless, such as the absence of randomized controlled trials evaluating various forms or dosages of vitamin B12 among vegetarians and the requirement for more information and awareness of the vitamin's significance in vegan diets.

Aqueous phase recycling: impact on microalgal lipid accumulation and biomass quality.

The potential success of microalgal biofuels greatly depends on the sustainability of the chosen pathway to produce them. Hydrothermal liquefaction (HTL) is a promising route to convert wet algal biomass into biocrude. Recycling the resulting HTL aqueous phase (AP) aims not only to recover nutrients from this effluent but also to use it as a substrate to close the photosynthetic loop and produce algal biomass again and process this biomass again into new biocrude. With that purpose, the response to AP recycling of five Chlorellaceae strains was monitored over five cultivation cycles. After four successive cycles of dynamic growth under nutrient-replete conditions, the microalgae were cultivated for a prolonged fifth cycle of 18 days in order to assess the impact of the AP on lipid and biomass accumulation under nutrient-limited conditions. Using AP as a substrate reduced the demand for external sources of N, S, and P while producing a significant amount of biomass (2.95-4.27 g/L) among the strains, with a lipid content ranging from 16 to 36%. However, the presence of the AP resulted in biomass with suboptimal properties, as it slowed down the accumulation of lipids and thus reduced the overall energy content of the biomass in all strains. Although Chlorella vulgaris NIES 227 did not have the best growth on AP, it did maintain the best lipid productivity of all the tested strains. Understanding the impact of AP on microalgal cultivation is essential for further optimizing biofuel production via the HTL process.

Impact of Exergames on the Rehabilitation of Cancer Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial.

BACKGROUND: Exergames can be an appealing strategy that is integrated into post-abdominal surgery rehabilitation. OBJECTIVE: The aim of this study was to assess the effectiveness of exergame rehabilitation in improving independence in activities of daily living (ADLs) and patient balance after abdominal cancer surgery. METHODS: A randomized control-group study was carried out in an oncological hospital in Portugal. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcomes were the Barthel and Berg scales, and data collection occurred at 3 different time points: admission, 48 hours postoperatively, and on the seventh day after surgery. RESULTS: At the third assessment, a statistically significant difference was observed between the 2 groups for both indicators, ADLs and balance. CONCLUSIONS: There was an improvement in ADLs and balance in the exergames group. By the seventh day after surgery, the intervention group showed improvement in balance and ADLs compared with the control group. IMPLICATIONS FOR PRACTICE: The use of exergames can be a solution to the challenges of traditional rehabilitation methods after abdominal surgery for cancer for postoperative patients. This is the first study carried out in this specific population.

Changes in mortality by tuberculosis in non-industrialized Coimbra (Portugal): Trends between 1861 and 1914.

Considering that before antibiotics and vaccination the course of tuberculosis depended mostly on the patient's immune response, this study tested the hypothesis that the mortality profile remained similar during the transition from the 19th to 20th century. The biographical data of the individuals buried in the Coimbra Municipal Cemetery of Conchada were analysed, and the records of those who were born in the city and had tuberculosis registered as the cause of death were analysed using SPSS. The years of death were grouped: 1861-1870 (n = 124, 22.5%), 1871-1880 (n = 234, 42.4%), and 1910-1914 (5 years, n = 194, 35.1%). Mortality by tuberculosis has increased over the years. A total of 552 individuals, 242 females (43.8%) and 310 males (56.2%) died of tuberculosis (p < 0.05). The mean age at death (min = 11 days, max = 86 years) decreased over time, respectively 51.8, 53.1, and 35.8 years-old for individuals >20. Deaths by pulmonary tuberculosis (n = 38, 1861-1870; n = 115, 1910-1914) and meningeal tuberculosis (n = 0, 1861-1870; n = 48, 1910-1914) increased over time, whereas scrofula decreased (n = 23, 1861-1870; n = 3, 1910-1914). Only a 12 years-old male (0.2%) died of bone tuberculosis. Infant (0-3 years-old) mortality occurred mainly (50.5%,48/95) between July and October. The hypothesis tested was not confirmed. Death by tuberculosis has increased, which may be a consequence of population growth, deterioration of the living conditions, and/or changes in bacterial virulence and/or in the host immune system.

Characterization and monitoring of nutritional risk and nutritional status in oncological patients admitted to an oncological surgery unit: A longitudinal study.

BACKGROUND AND AIMS: malnutrition is a common phenomenon in people with cancer and can occur at all stages of the disease trajectory. Prevention, early identification of patients at risk of malnutrition, nutritional diagnosis, and personalized intervention, monitoring and follow-up are essential measures to minimize the occurrence of malnutrition and its consequences. This study aims to evaluate if current institutional practices regarding nutritional intervention guarantees nutritional/dietary care for cancer patients. METHODS: adescriptive, analytical and longitudinal study was carried out, lasting five months, in a hospital inpatient surgical oncology unit. All patients admitted to the unit in the period between 1 March and 31 July 2022, who underwent nutritional screening at the time of admission to the service, were included. During hospitalization, they were subjected to periodic assessments of weight, body mass index and nutritional screening every 7 days until discharge. RESULTS: a total of 659 patients were admitted to the inpatient unit. The highest prevalence of malnutrition was observed in Head and Neck (37.6%), Genitourinary (30.8%) and Digestive (27.7%) cancers. Weight loss was especially significant in digestive, skin and sarcoma cancers, as well as genitourinary cancers, but not in breast cancer patients. During the hospitalization period, 14.0% of the hospitalized patients received nutrition-related nursing intervention, and 21.5% were referred for clinical dietetic intervention (by a registered dietitian). CONCLUSION: this work reinforces the high prevalence of malnutrition in oncological patients and the need to systematically track cancer patients throughout their disease/treatment trajectory, from admission to the hospital, to the day of admission to inpatient unit, and subsequent follow-up. We also propose expedited referrals to different specialized centres in nutritional support for cancer patients from the first day of hospitalization. Assessment of patients should always be accompanied by active referral capacity to a specialized and duly trained nutritional care team that is quick, proactive, and responsive.

DNA methylation as a triage marker for colposcopy referral in HPV-based cervical cancer screening: a systematic review and meta-analysis.

BACKGROUND: Screening plays a key role in secondary prevention of cervical cancer. High-risk human papillomavirus (hrHPV) testing, a highly sensitive test but with limited specificity, has become the gold standard frontline for screening programs. Thus, the importance of effective triage strategies, including DNA methylation markers, has been emphasized. Despite the potential reported in individual studies, methylation markers still require validation before being recommended for clinical practice. This systematic review and meta-analysis aimed to evaluate the performance of DNA methylation-based biomarkers for detecting high-grade intraepithelial lesions (HSIL) in hrHPV-positive women. METHODS: Hence, PubMed, Scopus, and Cochrane databases were searched for studies that assessed methylation in hrHPV-positive women in cervical scrapes. Histologically confirmed HSIL was used as endpoint and QUADAS-2 tool enabled assessment of study quality. A bivariate random-effect model was employed to pool the estimated sensitivity and specificity as well as positive (PPV) and negative (NPV) predictive values. RESULTS: Twenty-three studies were included in this meta-analysis, from which cohort and referral population-based studies corresponded to nearly 65%. Most of the women analyzed were Dutch, and CADM1, FAM19A4, MAL, and miR124-2 were the most studied genes. Pooled sensitivity and specificity were 0.68 (CI 95% 0.63-0.72) and 0.75 (CI 95% 0.71-0.80) for cervical intraepithelial neoplasia (CIN) 2+ detection, respectively. For CIN3+ detection, pooled sensitivity and specificity were 0.78 (CI 95% 0.74-0.82) and 0.74 (CI 95% 0.69-0.78), respectively. For pooled prevalence, PPV for CIN2+ and CIN3+ detection were 0.514 and 0.392, respectively. Furthermore, NPV for CIN2+ and CIN3+ detection were 0.857 and 0.938, respectively. CONCLUSIONS: This meta-analysis confirmed the great potential of DNA methylation-based biomarkers as triage tool for hrHPV-positive women in cervical cancer screening. Standardization and improved validation are, however, required. Nevertheless, these markers might represent an excellent alternative to cytology and genotyping for colposcopy referral of hrHPV-positive women, allowing for more cost-effective screening programs.

A scoping review of mobile apps for use with palliative patients in the context of home care.

CONTEXT: Progress in mobile technology, especially the use of applications for mobile devices, can support the process of monitoring patients in palliative care (therapeutics), controlling symptoms, or providing self-care guidelines for the user, namely patients or caregivers. OBJECTIVES: To map the available knowledge regarding the use of applications for mobile devices to support adult patients in palliative care at home. METHODS: Literature review, based on the Joanna Briggs Institute model(s) for Scoping Review. All articles published until October 27, 2022, were identified in the electronic databases MEDLINE®, CINAHL®, Psychology and Behavioral Sciences Collection, Cochrane Library, and Scopus using the respective Boolean logical operators and key terms. RESULTS: A total of 634 articles were identified, and a final 24 studies were included. Eleven mobile device applications were identified, demonstrating different aspects of design, use, and technological development. These have incorporated the most recent technology in their functionalities. CONCLUSION: Mobile applications can be considered a viable and effective means of monitoring patients in palliative care. However, these applications must go beyond the academic scenario in which they were developed and move toward widespread use in practice, allowing the evaluation of the impact of this "new" intervention modality to understand their effectiveness and the application of best practices.

Neoadjuvant Gastric Cancer Treatment and Associated Nutritional Critical Domains for the Optimization of Care Pathways: A Systematic Review.

(1) Background: Gastric cancer patients are known to be at a high risk of malnutrition, sarcopenia, and cachexia, and the latter impairs the patient's nutritional status during their clinical course and also treatment response. A clearer identification of nutrition-related critical points during neoadjuvant treatment for gastric cancer is relevant to managing patient care and predicting clinical outcomes. The aim of this systematic review was to identify and describe nutrition-related critical domains associated with clinical outcomes. (2) Methods: We performed a systematic review (PROSPERO ID:CRD42021266760); (3) Results: This review included 14 studies compiled into three critical domains: patient-related, clinical-related (disease and treatment), and healthcare-related. Body composition changes during neoadjuvant chemotherapy (NAC) accounted for the early termination of chemotherapy and reduced overall survival. Sarcopenia was confirmed to have an independent prognostic value. The role of nutritional interventions during NAC has not been fully explored. (4) Conclusions: Understanding critical domain exposures affecting nutritional status will enable better clinical approaches to optimize care plans. It may also provide an opportunity for the mitigation of poor nutritional status and sarcopenia and their deleterious clinical consequences.

Developing a Card Game for Assessment and Intervention in the Person and the Family in Palliative Care: "Pallium Game".

Communication between the multidisciplinary team, the person, and the family in palliative and end-of-life situations implies, in most situations, a high negative emotional burden. Therefore, innovative strategies are needed to reduce it. The goal of this study is to describe the various stages of development and validation of a collaborative card game for people in palliative care and their families. Phase one is an exploratory study, Phase two is a Delphi study, and Phase three is a multiple case study. Participants for phases 2 and 3 were recruited using a convenience sampling method. The results demonstrate in an organized and structured way the different phases required to build a collaborative card game. The use of the game was found to be useful and effective. Four categories emerged from the content analysis of the open-ended responses: usability, evaluation tool, communication and therapeutic relationship, and meaning when using the game. A collaborative game in palliative care helps to create a space for individuals and families to express feelings and experiences, meeting the myriad of physical, psychosocial, and spiritual needs. The "Pallium game" is a useful and impactful approach to discussing sensitive topics in palliative care.

The role of spirituality in people with amyotrophic lateral sclerosis and their caregivers: Scoping review.

BACKGROUND: There are few studies evaluating the role of spirituality and the role of spiritually integrated interventions in people with amyotrophic lateral sclerosis (PALS) and their caregivers. OBJECTIVES: A scoping review was conducted to examine the nature and breadth of peer-reviewed literature on the role of spirituality, interventions integrating spirituality, and outcomes for PALS and their caregivers. METHODS: A literature review was performed, following the methods from the Joanna Briggs Institute Reviewers, based on all articles published between January 2006 and April 2022, identified in the CINAHL Complete, MEDLINE Complete, MedicLatina, Psychology and Behavioral Sciences Collection, and SPORTDiscus with full-text databases using key terms. Extracted data included research aims, study design, population and characteristics, theme description, and measures or type of intervention. RESULTS: A total of 18 articles were included in this study: 14 qualitative, 3 quantitative, and 1 protocol of a quantitative study. Eight studies were based in Europe. The search identified different main themes related to spirituality for caregivers and patients, 2 spiritual measure scales, and one intervention. However, many studies were limited in sample size, generalizability, and transferability and used less sophisticated research designs. SIGNIFICANCE OF THE RESULTS: This scoping review illustrates the importance given to spirituality by caregivers and PALS and reveals a very heterogeneous response. Thus, experimental studies in the area of spirituality are needed to systematically explore the impact of spiritual interventions, and the results of these studies could advance practice and policy by enhancing the quality of life for PALS and their caregivers.

Impact of Exergames on the Mental Health of Older Adults: A Systematic Review and GRADE Evidence Synthesis.

Exergames, which combine digital games and physical exercise, have become a popular alternative to traditional exercise programs and are increasingly used in the health domains. This study aimed to provide a systematic review to synthesize existing studies on the use of exergames for the mental wellbeing of healthy older adults, aggregating the collected data to identify effect size. We performed a Systematic Review and Grading of Recommendations, Assessment, Development, and Assessment (GRADE) evidence synthesis. We performed the search in the following databases: MEDLINE®, CINAHL®, SPORTDiscus, SCOPUS, SciELO, Psychology and Behavioral Sciences Collection, and Cochrane® Central Register of Controlled Trials from the first record until October 2021. Randomized controlled trials using exergames as an intervention were included. A total of 10 articles published between 2009 and 2021 were selected. Most studies used the Nintendo Wii® as the exergame in the intervention program. Interventions ranged from 6 to 12 weeks, with 8-week programs being most frequent. It was possible to observe a positive effect on mood, the reduction of apathy, anxiety and depression, self-esteem, and affection.

Exergames to Improve Rehabilitation for Shoulder Injury: Systematic Review and GRADE Evidence Synthesis.

INTRODUCTION: The use of exergames has become an increasingly frequent intervention in rehabilitation, referred to as a fun and motivating activity that involves patients. This systematic review aimed to evaluate the effectiveness of exergames in the rehabilitation of the shoulder joint compared to other types of care. METHODS: We performed a systematic review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) evidence synthesis. The search was conducted using the following databases: MEDLINE, CINAHL, SPORTDiscus, SCOPUS, SciELO, Psychology and Behavioral Sciences Collection, Cochrane Central Register of Controlled Trials, and PEDRo. Databases were searched from the first record until July 2021. Randomized controlled trials using exergames as an intervention were included. RESULTS: The search resulted in 1,048 records. A total of 10 articles published between 2013 and 2020 met inclusion criteria and were reviewed for this study. A positive impact was observed in using exergames to increase shoulders' range of motion, namely, extension, flexion, abduction, internal and external rotation, and functionality postinjury. CONCLUSIONS: The results of this review provide evidence of the benefits of exergames in shoulder joint rehabilitation. However, more robust clinical trials need to be developed that assess the effectiveness of using exergames as a complement to traditional rehabilitation and assess participants' degree of satisfaction, motivation, and adherence.

Changes in mortality in a non-industrialized Portugal: Coimbra Municipal Cemetery records (1861-1914) and identified osteological collections.

OBJECTIVE: To investigate if there were changes in mortality knowing that industrialization was a slow and late process in Portugal. MATERIALS: The biographic information (1) of the individuals buried at the Coimbra Municipal Cemetery, considering three quinquennia: 1861-1865 (n = 1111, 18.3%), 1870-1974 (n = 2602, 42.7%), 1910-1914 (n = 2374, 39.0%), related to the periods before, during and at the end of the second industrialization and (2) of the Coimbra identified osteological collections (CIOC, N = 1796) composed of individuals who were born and died in the city. METHODS: Excel databases with the biographic information were analyzed with SPSS. RESULTS: Data from the cemetery show statistically significant differences between sexes and age-at-death mortalities. Non-adult mortality (higher in the age range from 1 to 7 years) has decreased over time which has increased mean age-at-death. The main adult occupations are domestic work (females) and craft activities (males). Child labor is common after the age of 14. The main causes of death (in both cemetery and CIOC records) were infections, respiratory diseases, heart disease, and malignant neoplasm. Among the communicable diseases, tuberculosis accounted for the highest number of deaths. The identified individuals have lesions compatible with tuberculosis and sinusitis while malignant neoplasms are more difficult to identify. The high prevalence of heart disease can overshadow other causes of death. CONCLUSIONS: In the absence of industrialization, tuberculosis, heart disease, and malignant neoplasms increased over time, while respiratory diseases decreased. SIGNIFICANCE: Mortality profile changed between 1861-1864 and 1910-1914 in Coimbra. LIMITATIONS: The causes of death were studied, but not all diseases. SUGGESTIONS FOR FURTHER RESEARCH: Study of other cemetery records for further comparison.

Insight into the cryptic diversity and phylogeography of the peculiar fried egg jellyfish Phacellophora (Cnidaria, Scyphozoa, Ulmaridae).

The fried egg jellyfish Phacellophora camtschatica (senso lato) is a morphologically peculiar and conspicuous species occurring mostly in the cold waters of the North Pacific. It is less common in the cold waters of the NW Atlantic, and occasionally has been reported in the Mediterranean, Arctic, East and South Pacific, and E, SW and NE Atlantic. However, sightings of this scyphozoan jellyfish have intensified during the past two to three decades in Macaronesia, the Iberian Peninsula and the Mediterranean. These jellyfish are known to be voracious predators of other jellies, but also of other taxa, including fish of commercial interest. Therefore, Phacellophora aggregations may threaten local fisheries, aquaculture, and local biodiversity structuring. We report the first known occurrences of Phacellophora in the Azores Islands, which apparently become more frequent in recent years of the past decade. We confirm, through DNA barcoding of COI and 16S mitochondrial markers, the genetic identity of Phacellophora occurring in the Azores (NE Atlantic). We reveal, with COI sequence data, three (potentially four) cryptic species within the Phacellophora camtschatica complex. Two Phacellophora species co-occur in the North Pacific. In the North Atlantic (and possibly in the Mediterranean) one or two distinct species exist. Three nominal species of the genus that are currently synonymized, with type localities in the N Pacific, NW Atlantic, and the Mediterranean, need reassessment. The morphotypes previously defined for the four putative species names given for Phacellophora might be eventually differentiated by the number and disposition of the marginal lappets of umbrellae. This morphologic character has to be further inspected in vouchers of the four genetic lineages of Phacellophora, to decide between the description of new species, and the resurrection of junior synonyms through the designation of neotypes with DNA Barcodes, to validate the identity of the cryptic taxa detected. More haplotype sampling is necessary across the distribution of the genus to further investigate the genetic diversity and phylogeographic history of Phacellophora. The high genetic relatedness of Phacellophora from the cold NW Atlantic and the sub-tropical shores of the Azores, revealed by 16S and COI sequence data, suggests a recent invasion, in terms of geologic time, of the temperate waters of the NE Atlantic (and possibly of the Mediterranean). The medusivorous habits of Phacellophora, and especially its predation on the mauve stinger (Pelagia spp.) which frequently blooms in Macaronesia and Mediterranean waters, could relate to the recent reports of Phacellophora in the Azores, Madeira, Canary Islands, and the Mediterranean. More investment, including on scientific staff, is necessary to catalog, DNA barcode and monitor jellyfish dynamics more accurately worldwide.

Exergames to improve Rehabilitation after Anterior Cruciate Ligament Injury: Systematic review and GRADE evidence synthesis.

INTRODUCTION: Exergames are a fun, engaging, and interactive form of exercise that has been used in rehabilitation. This systematic review aimed to evaluate the effectiveness of exergames compared to usual rehabilitation after anterior cruciate ligament reconstruction. METHOD: We performed a Systematic Review and GRADE evidence synthesis. The PRISMA guidelines for systematic reviews were followed. MEDLINE® (Medical Literature Analysis and Retrieval System Online), CINAHL® (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, SCOPUS, SciELO (Scientific Electronic Library Online), Cochrane Central Register of Controlled Trials, and PEDro (Physiotherapy Evidence Database) were searched from their first record to May 2021. Randomised controlled trials using exergames as an intervention were included. RESULTS: Initial literature searches yielded 794 non-duplicated records. After exclusion based on title, abstract, and full text review, five articles were included for analysis. Compared with the control group, the participants in the exergames group showed differences in proprioception and flexion angle difference. CONCLUSION: Although there is no conclusive evidence that favours exergames over traditional rehabilitation, they did not aggravate the effects of rehabilitation. Nonetheless, exergames can be safe and motivating.

(Re)'Thinking' family in nursing care in pandemic times.

AIM: This study aimed to identify which strategies are being adopted to deal with family restrictions in health units and assess nurses' perceptions of including families in nursing care during the current pandemic. BACKGROUND: Due to the COVID-19 pandemic, health organisations limited access for visitors. INTRODUCTION: Family centred care needs to be guaranteed, and alternatives for face-to-face interaction should be fostered. Therefore, there is an urgent need to rethink the family in nursing care during a pandemic. METHODS: We conducted a descriptive exploratory mixed-method study in Portugal using an electronic questionnaire. The study included 192 nurses recruited using a non-probabilistic convenience sample. The study was reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS: A total of 41.1% of participants (n = 79) reported that visits to their services were not authorised, and 66.7% (n = 128) reported resorting to video calls because of the restrictions imposed. Regarding attitude assessment, the average score of the scale was 77.9 (SD = 10.0), ranging between 26 and 98. When analysing the different dimensions of the 'Families' Importance in Nursing Care - Nurses Attitudes' scale, family data stand out as a burden. CONCLUSION: Although a large percentage of participants had a positive attitude towards families and tried to find strategies to maintain family centred care, many nurses still considered the family as a burden. The current COVID-19 pandemic may have aggravated this perception. IMPLICATIONS FOR NURSING PRACTICE, NURSING POLICY AND HEALTH POLICY: The continued implementation of family centred nursing practice is essential for child-well-being, including during the current pandemic. Therefore, having intervention policies with alternative forms of care is highly recommended.