Práticas de cuidado e necessidades de saúde de homens em atenção domiciliar / Care practices and health needs of men in home care / Prácticas de cuidado y necesidades de salud de los hombres en el cuidado domiciliario

Objetivo: Analisar as práticas de cuidado desenvolvidas para atender às necessidades de saúde de homens em atenção domiciliar. Métodos: Pesquisa observacional e qualitativa, realizada com 34 cuidadores e 24 homens assistidos pelo serviço de atenção domiciliar do município de João Pessoa. A coleta de dados foi realizada por meio de um roteiro com variáveis sociodemográficas e perguntas abertas. A Análise Crítica do Discurso foi utilizada como método de análise, com destaque para os significados representacional e identificacional dos discursos. Resultados: As práticas de cuidado e necessidades de saúde foram apontadas com base na relação hegemônica entre os atores do cuidado, associação do cuidado ao processo de trabalho informal, atuação da família, da atividade corresponsabilizada, e prática da autonomia e autocuidado. Conclusão: Evidenciou-se um cuidado multifacetado e executado por diversos atores com suporte de equipes multiprofissionais de atenção domiciliar. (AU)

Objective: To analyze the care practices developed to meet the health needs of men in home care. Methods: Observational and qualitative research, carried out with 34 caregivers and 24 men assisted by the home care service in the city of João Pessoa. Data collection was performed through a script with sociodemographic variables and open questions. Critical Discourse Analysis was used as a method of analysis, with emphasis on the representational and identificational meanings of the discourses. The research was approved according to the opinion number 1.829.326. Results: Care practices and health needs were identified based on the hegemonic relationship between the care actors, association of care with the informal work process, family activities and co-responsibility activities, and the practice of autonomy and self-care. Conclusion: There was evidence of a multifaceted care performed by different subjects with the support of multidisciplinary home care teams. (AU)

Objetivo: Analizar las prácticas asistenciales desarrolladas para satisfacer las necesidades de salud de los hombres en la atención domiciliaria. Métodos: Investigación observacional y cualitativa, realizada con 34 cuidadores y 24 hombres asistidos por el servicio de atención domiciliaria en la ciudad de João Pessoa. La recolección de datos se realizó mediante un guión con variables sociodemográficas y preguntas abiertas. Se utilizó el Análisis Crítico del Discurso como método de análisis, con énfasis en los significados representativos e identificativos de los discursos. La investigación fue aprobada de acuerdo al dictamen número 1.829.326. Resultados: Se identificaron prácticas de cuidado y necesidades de salud a partir de la relación hegemónica entre los actores del cuidado, la asociación del cuidado con el proceso de trabajo informal, las actividades familiares y de corresponsabilidad, y la práctica de la autonomía y el autocuidado. Conclusión: Se evidenció una atención multifacética realizada por diferentes sujetos con el apoyo de equipos multidisciplinares de atención domiciliaria. (AU)

Kaplan-Meier Survival Analysis: Practical Insights for Clinicians.

This article aims to provide a guide that will help healthcare professionals and clinical researchers from all fields that deal with Kaplan-Meier curves. Survival analysis methods are among the most frequently used in the medical sciences and in clinical research. Overall survival, progression free survival, time to recurrence, or any other clinically relevant parameter represented by a Kaplan-Meier curve will be discussed. We will present a practical and straightforward interpretation of these curves, setting aside intricate mathematical considerations. Our focus will be on essential concepts that interface with biological sciences and medicine in order to guarantee proficiency in one of the most popular yet frequently misunderstood methods in clinical research. Being familiar with these concepts is not only essential for designing new clinical studies but also for critically assessing and interpreting published data.

Strategies for nursing care of critically ill multicultural patients: A scoping review.

BACKGROUND: In society, people live in a social reality where multiculturalism is an increasingly relevant and prevalent topic in their contexts. Facing this, caring for multicultural patients in an emergency service or intensive care unit setting requires a high level of cultural competence due to the complexity, vulnerability of the patient, rapid changes in hemodynamic status, involvement of the family, their informational needs. OBJECTIVE: To map the strategies for nursing care of critically ill multicultural patients. METHOD: A Scoping Review was conducted following the Joanna Briggs Institute's recommendations, with the research question: What are the strategies for nursing care of critically ill multicultural patients? The study was guided by PRISMA. The research was conducted through the EBSCOHost platform, SciELO, Portugal's Open Access Scientific Repository, the Virtual Health Library and a search in grey literature. This was achieved by combining the descriptors DECS/MESH: cultural competence; critical care; emergency room; intensive care; and natural words: cultural care; nurs* interventions; nurs* strategies; within the time frame from 2012 to 2024. The study screening was performed by three independent reviewers through the reading of titles, abstracts and full texts, applying exclusion criteria. The study results were then subjected to content analysis, from which categories emerged. RESULTS: The selected articles highlight various strategies that contribute to the improvement of nursing care for critically ill multicultural patients, focusing on care practice and cultural diversity training for both nurses and nursing students. CONCLUSION: Nurses with cultural competence possess more knowledge and strategies to provide tailored care for multicultural critically ill patients, thereby enhancing the quality of care delivered and contributing to the humanization of healthcare. RELEVANCE TO CLINICAL PRACTICE: Nurses need to have knowledge of existing strategies for caring for multicultural critically ill patients. PATIENT OR PUBLIC CONTRIBUTION: No direct patient or public contribution to the review.

ISBAR: A Handover Nursing Strategy in Emergency Departments, Scoping Review.

The present work aims to map the available scientific evidence on the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients' handover in an emergency department context. To this end, a scoping review was conducted, according to the guidelines proposed by the Joanna Briggs Institute (JBI), to answer the following research question: "What are the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients' handover in an emergency department context?" The bibliographic search was carried out during August and September 2023 in the following electronic databases: CINAHL Complete; MEDLINE Complete; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; and Cochrane Methodology Register. Only works published between 2013 and 2023 were deemed fit for inclusion. All the included studies (9) show that ISBAR methodology, as a standardized tool for transferring nursing care in the emergency service, allows for a safe, clear, and concise transition of nursing care. The benefits relate to patient and professional safety, continuity, and quality of care, as well as patient and professional comfort, with health gains.

A satisfação dos estudantes de enfermagem com as práticas clínicas simuladas / Nursing students' satisfaction with simulated clinical experiences / Satisfacción de los estudiantes de enfermería con las prácticas clínicas simuladas

Resumo Enquadramento: As práticas clínicas simuladas, designadas por experiências clínicas simuladas ou simulação, são um processo formativo dinâmico e desafiador que decorre em ambiente controlado com recurso a cenários que recriam a realidade clínica. Objetivo: Estudar a satisfação dos estudantes de enfermagem com as práticas clínicas simuladas. Metodologia: Estudo descritivo-correlacional de abordagem quantitativa, com uma amostra de 223 estudantes de enfermagem. Aplicada a Escala de Satisfação com as Experiências Clínicas Simuladas (ESECS), constituída pelas dimensões: prática, cognitiva e realismo. Resultados: A satisfação média global com as práticas clínicas simuladas, foi de 7,501 na escala de 1-10. As características sociodemográficas, ano curricular e conteúdos, não foram preditivos da satisfação. Os estudantes apresentam-se em média mais satisfeitos na dimensão cognitiva e menos satisfeitos na dimensão realismo. Conclusão: Os estudantes apresentam-se satisfeitos com as práticas clínicas simuladas percecionando a sua importância para a aprendizagem, na aquisição de competências e maior capacidade de resposta no ensino clínico em contexto real. Tal reforça a pertinência do investimento, teórico, científico e prático, nesta estratégia de ensino.

Abstract Background: Simulated clinical experiences, also known as simulated clinical practices or simulation, are dynamic and challenging training activities that occur in a controlled environment using scenarios that recreate real-life clinical practice. Objective: To examine nursing students' satisfaction with simulated clinical experiences. Methodology: This quantitative descriptive-correlational study was conducted with 223 nursing students, using the Escala de Satisfação com as Experiências Clínicas Simuladas (ESECS; Satisfaction with Simulated Clinical Experiences Scale), which includes the Practical, Cognitive, and Realism dimensions. Results: The total mean of global satisfaction with the simulated clinical experiences was 7.501 on a scale of 1 to 10. The socio-demographic characteristics and course year and contents were not predictors of satisfaction. On average, students were more satisfied with the Cognitive dimension and less satisfied with the Realism dimension. Conclusion: Students are satisfied with simulated clinical experiences and understand their importance for acquiring skills and improving their ability to respond during clinical teachings in real-life contexts. For this reason, the theoretical, scientific, and practical investment in this teaching strategy is highly relevant.

Resumen Marco contextual: Las prácticas clínicas simuladas, denominadas experiencias clínicas simuladas o simulación, son un proceso de formación dinámico y desafiante que tiene lugar en un entorno controlado y que utiliza escenarios que recrean la realidad clínica. Objetivo: Estudiar la satisfacción de los estudiantes de enfermería con las prácticas clínicas simuladas. Metodología: Estudio descriptivo-correlacional con enfoque cuantitativo, con una muestra de 223 estudiantes de enfermería. Se aplicó la Escala de Satisfacción con las Experiencias Clínicas Simuladas (ESECS), que consta de las siguientes dimensiones: práctica, cognitiva y realismo. Resultados: La satisfacción global media con las prácticas clínicas simuladas fue de 7,501 en una escala del 1 al 10. Las características sociodemográficas, el año de estudio y los contenidos no predijeron la satisfacción. De media, los estudiantes se mostraron más satisfechos en la dimensión cognitiva y menos satisfechos en la dimensión realismo. Conclusión: Los estudiantes se muestran satisfechos con las prácticas clínicas simuladas y son conscientes de su importancia para el aprendizaje, la adquisición de habilidades y una mayor capacidad de respuesta en la enseñanza clínica en un contexto real. Esto refuerza la pertinencia de la inversión teórica, científica y práctica en esta estrategia pedagógica.

Exploring Bioactivities and Peptide Content of Body Mucus from the Lusitanian Toadfish Halobatrachus didactylus.

Identifying bioactive molecules from marine organisms is still vastly understudied. Fish remain an untapped source of bioactive molecules, even when considering species whose toxicity to other fish species has been noticed before. We assessed potential applications of crude body mucus of the Lusitanian toadfish (Halobratachus didactylus) and characterized its peptide fraction composition. Mucus samples from three individuals (two wild and one captive) revealed potential antioxidant, antihypertensive, and antimicrobial activities. For antioxidant activity, the best results of 2371 ± 97 µmol Trolox Equivalent/g protein for ORAC and 154 ± 6 µmol Trolox Equivalent/g protein for ABTS were obtained. For antihypertensive activity, the relevant inhibitory activity of ACE resulted in IC50 of 60 ± 7 µg protein/mL. Antimicrobial activity was also identified against the pathogenic bacteria Escherichia coli and Listeria monocytogenes. The peptide profile of the crude body mucus was obtained through size exclusion chromatography, with a conspicuous peak at ca. 800 Da. LC-MS/MS allowed the detection of the most probable peptide sequences of this dominant peptide. This is the first study where the bioactive potential of mucus from the Lusitanian toadfish is demonstrated. Peptides with such properties can be applied in the food and pharmaceutical industries.

Buerger's Disease - A Clinical Case.

Buerger's disease is a distal segmental nonatherosclerotic vasculopathy that involves the inferior and superior limbs of smoker males younger than 45 years old. This article aims to describe a clinical case and revise the literature about Buerger's disease. A 45-year-old smoker male repeatedly visited the emergency department for refractory pain and inflammatory signs in the right hallux. After developing ulcers in the right foot, Doppler ultrasonography revealed segmental occlusion of distal arteries of that limb. It was also observed in arteriography "corkscrew" collaterals. Autoimmune, thrombophilic and cardiovascular diseases were excluded. Analgesia, antibiotics and alprostadil were implemented. As a result, the patient stopped smoking and was submitted to minor amputation with complete healing, after which he remained asymptomatic. Buerger's disease is a diagnosis of exclusion. Therefore, smoking cessation is the most effective treatment and is crucial to prevent disease progression.

Breast cancer in young women: a rising threat: A 5-year follow-up comparative study.

Introduction: Breast cancer in young women is usually considered as breast cancer occurring in women younger than 40 years and is the most frequent cancer-related cause of death in these patients. In the past few years, there seems to be an increasing trend in the prevalence of breast cancer in young women, which, associated with poorer prognosis, more aggressive histologic features, and more frequent recurrence rates, makes it a rising threat to young women. This study aimed to evaluate the biological behavior of breast cancer in young women in our institution. Material and methods: A retrospective, unicentric, cohort study was conducted between 2012 and 2016. All consecutive patients with breast cancer were enrolled in the study. Cases were divided into two groups: case group, those younger than 40 years, and control group, those 40 years or older. The exclusion criterion was nonoperative treatment. Several clinical and pathologic parameters were evaluated, as well as were overall survival time and disease-free survival time. Results: The incidence of breast cancer in young women presented a rising tendency over the study period. Significant differences were observed in the comparison of the groups according to body mass index, age at menarche, age at birth of the first child, and proliferation rate. There were no differences in overall survival and disease-free survival rates between the groups. Conclusions: Young women had a more symptomatic presentation, a greater tumor proliferation rate, but similar outcomes compared with older patients. Greater multicentric studies are needed to confirm or refute these results.

Fournier Gangrene Management: Is a Stoma Mandatory?

Fournier gangrene is a rare life-threatening surgical emergency mainly due to a polymicrobial infection of the perineal, genital, or perianal region. It is characterized by rapid tissue destruction and systemic signs of toxicity. It is more frequent in males and immunocompromised patients, such as patients with poorly controlled diabetes, alcoholism, or human immunodeficiency virus (HIV) infection. Treatment often involves surgical intervention, broad-spectrum antibiotic therapy, fecal diversion surgery, and negative pressure wound therapy (NPWT). Delays in diagnosis are associated with high mortality due to rapid progression to septic shock.

Prostate-specific antigen response after Abiraterone treatment in mCRPC: PSA as a predictor of overall survival.

OBJECTIVES: Abiraterone Acetate (AA) is an important agent in the treatment of advanced prostate cancer. It was primarily approved for the treatment of metastatic castration-resistant prostate cancer (mCRPC) after failure of androgen deprivation therapy. There is still no available strong data regarding the impact of early decline of prostate-specific antigen (PSA) in the overall survival. The aim of this study was to evaluate the clinical efficacy of an early prostate-specific antigen response as a predictor of overall survival (OS) in metastatic castration-resistant prostate cancer when treated with Abiraterone Acetate. MATERIALS AND METHODS: A dual center, retrospective, cohort study on patients diagnosed with mCRPC treated with abiraterone between 2013 and 2020 was performed. Primary end-point was to demonstrate the efficacy of AA, with the analysis of PSA decline, and the correlation with overall survival. RESULTS: The cohort analysis consisted of 84 patients with a median age of 71 ± 9 years. A PSA response of > 30% and > 50% at 60 and 90 days was associated with improved OS. Multivariate analysis revealed that a 60 day PSA decline of > 30% was predictive of overall survival. Median OS of diag-nosed mCRPC patients was 28 months. Docetaxel pre-treatment was not associated with longer OS. The median duration of drug exposure for patients submitted to AA was found to be 14 months. CONCLUSIONS: Early PSA response rate can offer clinically meaningful information and can be considered a surrogate of longer OS. A > 30% or > 50% prostate-specific antigen decline at 60 and 90 days provided an important low-cost clinical tool to predict subsequent events in mCRPC patients treated with abiraterone.

Production of Bi-Compartmental Tablets by FDM 3D Printing for the Withdrawal of Diazepam.

Diazepam (DZP) is a long-acting benzodiazepine to treat anxiety or acute alcohol withdrawal. Although this class of drugs should be taken for a short period of time, many patients take them for longer than recommended, which has been linked to an increased risk of dementia and dependence. The present work aimed at using the dual-nozzle system of fused deposition modeling (FDM) 3D printers to prepare tablets with gradual doses of DZP with constant mass and size. Placebo and DZP-loaded filaments were prepared by hot-melt extrusion and used to print the bi-compartmental tablets. Thermal processing allowed the conversion of crystalline DZP to its amorphous counterpart. Tablets with different DZP contents were effectively printed with a mass, thickness and diameter average of 111.6 mg, 3.1 mm, and 6.4 mm, respectively. Microscopic data showed good adhesion between the different layers in the printed tablets. The desired drug contents were successfully achieved and were within the acceptance criteria (European Pharmacopeia). The combination of a placebo and drug-loaded extrudates proved to be beneficial in the production of tablets by FDM for patients in need of drug withdrawal.

Grass xylan structural variation suggests functional specialization and distinctive interaction with cellulose and lignin.

Xylan is the most abundant non-cellulosic polysaccharide in grass cell walls, and it has important structural roles. The name glucuronoarabinoxylan (GAX) is used to describe this variable hemicellulose. It has a linear backbone of ß-1,4-xylose (Xyl) residues that may be substituted with α-1,2-linked (4-O-methyl)-glucuronic acid (GlcA), α-1,3-linked arabinofuranose (Araf), and sometimes acetylation at the O-2 and/or O-3 positions. The role of these substitutions remains unclear, although there is increasing evidence that they affect the way xylan interacts with other cell wall components, particularly cellulose and lignin. Here, we used substitution-dependent endo-xylanase enzymes to investigate the variability of xylan substitution in grass culm cell walls. We show that there are at least three different types of xylan: (i) an arabinoxylan with evenly distributed Araf substitutions without GlcA (AXe); (ii) a glucuronoarabinoxylan with clustered GlcA modifications (GAXc); and (iii) a highly substituted glucuronoarabinoxylan (hsGAX). Immunolocalization of AXe and GAXc in Brachypodium distachyon culms revealed that these xylan types are not restricted to a few cell types but are instead widely detected in Brachypodium cell walls. We hypothesize that there are functionally specialized xylan types within the grass cell wall. The even substitutions of AXe may permit folding and binding on the surface of cellulose fibrils, whereas the more complex substitutions of the other xylans may support a role in the matrix and interaction with other cell wall components.

O conforto em contexto de urgência: A experiência da família da pessoa em situação crítica / Comfort in the emergency service: The experience of families of critically ill patients / El bienestar en el contexto de urgencias: La experiencia de la familia de la persona en estado crítico

Resumo Enquadramento: Perante a vivência de uma doença crítica, o conforto enquanto necessidade acontece tanto na pessoa que vivencia a doença, como nos seus familiares. Objetivo: Compreender a experiência do conforto da família da pessoa em situação crítica (PSC) em contexto de urgência. Metodologia: Estudo exploratório descritivo misto recorrendo-se à entrevista semi-estruturada, numa amostragem não probabilística acidental de 10 familiares da pessoa em situação crítica num serviço de urgência. Resultados: O significado de conforto expressou-se por um estado/perceção de segurança destacando-se a dimensão psico-espiritual e física. Os fatores promotores de conforto relacionaram-se com atitudes/interações positivas, competências técnico-científicas e relacionais dos enfermeiros, com enfoque na dimensão psico-espiritual. As sugestões para um cuidado confortador centraram-se no desenvolvimento de competências relacionais e de comunicação. Conclusão: A perceção de conforto relaciona-se com a situação/circunstância vivida e assume um carácter transitório. No serviço de urgência, o conforto surge como uma dimensão que o enfermeiro pode ajustar, compatibilizando interesses e realizando determinadas atividades promotoras da capacitação da família da PSC.

Abstract Background: When facing a critical illness, patients and their families need comfort. Objective: To understand how families of critically ill patients experience comfort in emergency settings. Methodology: This exploratory descriptive mixed-method study uses semi-structured interviews in a non-probability convenience sample of ten family members of critically ill patients in emergency services. Results: Comfort was described as a state/perception of security, with emphasis on psychospiritual and physical dimensions. Comfort-promoting factors were related to nurses' positive attitudes/interactions and technical-scientific and relational skills, with emphasis on the psychospiritual dimension. Suggestions for comfort promotion focused on the development of relational and communication skills. Conclusion: Comfort is associated with the situation/circumstance experienced and is transitory. In emergency services, comfort emerges as a dimension that nurses can adjust by harmonizing interests and performing specific actions that empower the families of critically ill patients.

Resumen Marco contextual: Ante la experiencia de una enfermedad crítica, el bienestar como necesidad se da tanto en la persona que experimenta la enfermedad como en sus familiares. Objetivo: Comprender la experiencia de bienestar de la familia de la persona en situación crítica (PSC) en el contexto de urgencias. Metodología: Estudio exploratorio descriptivo mixto, para el que se utilizaron entrevistas semiestructuradas en una muestra accidental no probabilística de 10 familiares del enfermo crítico en un servicio de urgencias. Resultados: El significado de bienestar se expresó mediante un estado/percepción de seguridad y se centró en las dimensiones psicoespiritual y física. Los factores que promovieron el bienestar estaban relacionados con las actitudes/interacciones positivas, las competencias técnico-científicas y las relacionales de los enfermeros, con especial énfasis en la dimensión psicoespiritual. Las sugerencias para una atención reconfortante se centraron en el desarrollo de las competencias relacionales y comunicativas. Conclusión: La percepción del bienestar está relacionada con la situación/circunstancia vivida y tiene un carácter transitorio. En el servicio de urgencias, el bienestar emerge como una dimensión que los enfermeros pueden ajustar, al coincidir con los intereses y realizar ciertas actividades que promueven el empoderamiento de la familia del PSC.

O enfermeiro-mor nas Santas Casas da província de Minas Gerais: entre a administração e a assistência / The enfermeiro-mor (head-nurse) in Santas Casas in the province of Minas Gerais: between care and administration

Resumo Este artigo trata da percepção da enfermagem como uma ocupação de baixo prestígio no século XIX. A história da enfermagem produzida pelos profissionais da área reforçou essa concepção. No entanto, o perfil do cargo de enfermeiro-mor, presente nas Santas Casas, indica um espectro social mais amplo para a profissão de enfermagem. As autoras defendem a hipótese de que essa avaliação negativa se baseia apenas em atividades de cuidado ao paciente que eram mais visíveis. A presença do enfermeiro-mor exemplifica os limites de uma generalização da desvalorização social da enfermagem. A conclusão é que a suposição generalizada de que a enfermagem se limitava a cuidados básicos de saúde não se sustenta.

Abstract This article focuses on the perception of nursing as a low-prestige occupation in the 19th century. The history of nursing produced by professionals in the area supported this understanding. However, the profile of the enfermeiro-mor (head nurse), a position in the Santas Casas, demonstrates that the nursing profession was present throughout a broader social spectrum. The authors support the hypothesis that the typical negative assessment is based only on the more visible patient care activities. The presence of the enfermeiro-mor exemplifies the limits of a generalization of the social undervaluation of nursing. The conclusion is that the generalized assumption that nursing was only about basic health care is not acceptable.

Internal Ribosome Entry Site (IRES)-Mediated Translation and Its Potential for Novel mRNA-Based Therapy Development.

Many conditions can benefit from RNA-based therapies, namely, those targeting internal ribosome entry sites (IRESs) and their regulatory proteins, the IRES trans-acting factors (ITAFs). IRES-mediated translation is an alternative mechanism of translation initiation, known for maintaining protein synthesis when canonical translation is impaired. During a stress response, it contributes to cell reprogramming and adaptation to the new environment. The relationship between IRESs and ITAFs with tumorigenesis and resistance to therapy has been studied in recent years, proposing new therapeutic targets and treatments. In addition, IRES-dependent translation initiation dysregulation is also related to neurological and cardiovascular diseases, muscular atrophies, or other syndromes. The participation of these structures in the development of such pathologies has been studied, yet to a far lesser extent than in cancer. Strategies involving the disruption of IRES-ITAF interactions or the modification of ITAF expression levels may be used with great impact in the development of new therapeutics. In this review, we aim to comprehend the current data on groups of human pathologies associated with IRES and/or ITAF dysregulation and their application in the designing of new therapeutic approaches using them as targets or tools. Thus, we wish to summarise the evidence in the field hoping to open new promising lines of investigation toward personalised treatments.

The enfermeiro-mor (head-nurse) in Santas Casas in the province of Minas Gerais: between care and administration. / O enfermeiro-mor nas Santas Casas da província de Minas Gerais: entre a administração e a assistência.

This article focuses on the perception of nursing as a low-prestige occupation in the 19th century. The history of nursing produced by professionals in the area supported this understanding. However, the profile of the enfermeiro-mor (head nurse), a position in the Santas Casas, demonstrates that the nursing profession was present throughout a broader social spectrum. The authors support the hypothesis that the typical negative assessment is based only on the more visible patient care activities. The presence of the enfermeiro-mor exemplifies the limits of a generalization of the social undervaluation of nursing. The conclusion is that the generalized assumption that nursing was only about basic health care is not acceptable.

Este artigo trata da percepção da enfermagem como uma ocupação de baixo prestígio no século XIX. A história da enfermagem produzida pelos profissionais da área reforçou essa concepção. No entanto, o perfil do cargo de enfermeiro-mor, presente nas Santas Casas, indica um espectro social mais amplo para a profissão de enfermagem. As autoras defendem a hipótese de que essa avaliação negativa se baseia apenas em atividades de cuidado ao paciente que eram mais visíveis. A presença do enfermeiro-mor exemplifica os limites de uma generalização da desvalorização social da enfermagem. A conclusão é que a suposição generalizada de que a enfermagem se limitava a cuidados básicos de saúde não se sustenta.

Validation Testing of the European Portuguese Critical-Care Pain Observation Tool.

Aim. The study aim was to validate the Portuguese version of the Critical-Care Pain Observation Tool (CPOT) in the critically ill adult population of Portugal. Methods. A prospective, observational cohort study was conducted to evaluate the CPOT in mechanically ventilated patients who were admitted to an intensive care unit. A consecutive sample of 110 patients was observed at rest pre-procedure, during a nociceptive procedure (NP) which includes turning/positioning and endotracheal or tracheal suctioning and 20 min post-procedure. Two raters participated in the data collection. The discriminative validity, criterion validity, convergent validity and inter-rater reliability of the CPOT were examined. Results. The inter-rater reliability was excellent (0.93 ≤ α ≤ 1.00) at rest and fair to moderate (0.39 ≤ α ≤ 0.60) during the NP. The CPOT could discriminate between conditions with higher scores during the NP when compared to CPOT scores at rest (p < 0.001). The optimal CPOT cut-off score was >2, with a sensitivity of 71% and a specificity of 80%, and self-reported pain was the gold standard criterion. Significant correlations (<0.40) were found between CPOT scores, the heart rate and the respiratory rate during the nociceptive procedure. Conclusions. The CPOT appears to be a valid alternative for both ventilated and non-ventilated patients who are unable to communicate.

Targeted Axillary Dissection after Chemotherapy: Feasibility Study with Clip and Carbon Dye Tattoo - Neotarget Trial.

Background: Axillary staging in patients with complete response after neoadjuvant chemotherapy (NAC) is still controversial. Our objective was to test tattoo alone and subsequentially tattoo plus clip as markers in the targeted axillary dissection of ycN0 patients. Methods: Prospective cohort of cT1-T3, cN1 (proven histologically), M0 patients scheduled to receive NAC. Exclusion criteria were lobular histology, prior axillary surgery, and clinical N2/3. In cohort 1 this positive node (Neotarget node) was tattooed at diagnosis. If ycN0, a targeted axillary dissection was performed. After an interim analysis with negative results we changed the protocol in order to do a double marking procedure (Cohort 2): the positive node was clipped at diagnosis and after NAC a tattoo was done before surgery. Results: Thirteen patients in Cohort 1 and 18 patients in Cohort 2. Failure to identify the Neotarget node with multiple nodes retrieved in 9/13 (69%) of Cohort 1 patients. Also in 5/13 (38%) of Cohort 1 patients and 3/18 (17%) of Cohort 2 there was a failure to clearly identify tattooed nodes. In Cohort 2, clip identification by surgical specimen radiography allowed the identification of the tagged node in 17/18 (94,4%) of cases. The concordance between the clipped node and sentinel nodes was 16/18 (89%). Conclusions: The introduction of double marking by clipping the metastatic node and verifying their removal by surgical specimen radiography, using carbon ink as a tracer, allowed the identification of the metastatic node in 94% of cases, with a simple, reproducible, and easy-to-implement targeted axillary dissection procedure.

O papel do enfermeiro na prevenção do delirium no paciente adulto/idoso crítico / The nurse's role in preventing delirium in critically ill adult/elderly patients

Introdução: Delirium é uma disfunção cerebral aguda, associado ao aumento da mortalidade e morbilidade, que atinge frequentemente o paciente adulto/idoso crítico. O enfermeiro tem um papel determinante na prevenção/controlo do delirium, através da implementação de intervenções não farmacológicas. Objetivo: Conhecer as intervenções de enfermagem na identificação, prevenção e controlo do delirium no paciente adulto/idoso crítico. Materiais e métodos: Realizada uma Revisão Integrativa da Literatura de artigos publicados entre 2014 e 2018, que identificaram intervenções de enfermagem dirigidas à prevenção e controlo do delirium no paciente adulto/idoso crítico. Foram realizadas quatro pesquisas, nas bases de dados electrónicas da EBSCOhost e na B-on. Resultados: Identificaram-se 13 estudos, que apresentam intervenções de enfermagem, maioritariamente não farmacológicas, para prevenção e controlo do delirium no paciente adulto/idoso crítico. Destas, evidenciam-se intervenções relacionadas com o ambiente, promoção do sono, intervenção terapêutica precoce, avaliação cognitiva e orientação dos pacientes, intervenções sistematizadas em protocolos, bem como intervenções direcionadas à participação dos familiares, à formação dos enfermeiros e ao ensino dos pacientes. Foram também identificados fatores de risco para o desenvolvimento do delirium e instrumentos de avaliação. Discussão: A prevenção do delirium é importante e imperativa, já que nos pacientes críticos a sua ocorrência está associada ao aumento da mortalidade, morbilidade, do tempo de internamento e a um elevado custo hospitalar. A identificação dos fatores de risco para a ocorrência do delirium devem estar incluídos nos protocolos de abordagem do delirium. Conclusão: As evidências demonstraram que o enfermeiro é fundamental na identificação precoce, prevenção e controlo do delirium, evitando a progressão da doença, contribuindo para a diminuição da morbilidade e mortalidade. A intervenção de enfermagem deve incluir a identificação de fatores predisponentes e/ou precipitantes de modo a contribuir para a diminuição da ocorrência e/ou resolução do quadro de delirium.

Introduction: Delirium is an acute brain dysfunction, associated with increased mortality and morbidity, which often affects critically ill adult/elderly patients. Nurses have a crucial role in the prevention/control of delirium, through the implementation of non-pharmacological interventions. Objective: To know the nursing interventions in the identification, prevention and control of delirium in adult/critical elderly patients. Materials and Methods: An Integrative Literature Review of articles published between 2014 and 2018 was carried out, which identified nursing interventions aimed at the prevention and control of delirium in adult/critical elderly patients. Four searches were carried out, in the electronic databases of EBSCOhost and B-on. Results: 13 studies were identified, which present nursing interventions, mostly non-pharmacological, for the prevention and control of delirium in adult/critical elderly patients. Of these, interventions related to the environment, sleep promotion, early therapeutic intervention, cognitive assessment and patient orientation, interventions systematized in protocols, as well as interventions aimed at the participation of family members, the training of nurses and the teaching of patients are evident. Risk factors for the development of delirium and assessment tools were also identified. Discussion: The prevention of delirium is important and imperative, since its occurrence in critically ill patients is associated with increased mortality, morbidity, length of stay and a high hospital cost. The identification of risk factors for the occurrence of delirium should be included in delirium management protocols. Conclusions: Evidence has shown that nurses are essential in the early identification, prevention and control of delirium, preventing the progression of the disease, contributing to the reduction of morbidity and mortality. The nursing intervention must include the identification of predisposing and/or precipitating factors to contribute to the reduction of the occurrence and/or resolution of delirium.

Introducción: El delirio es una disfunción cerebral aguda, asociada con un aumento de la mortalidad y la morbilidad, que afecta con frecuencia a pacientes adultos/ancianos críticamente enfermos. Las enfermeras tienen un papel crucial en la prevención/control del delirio, a través de la implementación de intervenciones no farmacológicas. Objetivo: Conocer las intervenciones de enfermería en la identificación, prevención y control del delirio en pacientes adultos/ancianos críticos. Materiales y métodos: Se realizó una Revisión Integrativa de la Literatura de artículos publicados entre 2014 y 2018, que identificaron intervenciones de enfermería dirigidas a la prevención y control del delirio en pacientes adultos/ancianos críticos. Se realizaron cuatro búsquedas, en las bases de datos electrónicas de EBSCOhost y B-on. Resultados: Se identificaron 13 estudios que presentan intervenciones de enfermería, en su mayoría no farmacológicas, para la prevención y control del delirio en pacientes adultos/ancianos críticos. De estas, se evidencian intervenciones relacionadas con el medio ambiente, la promoción del sueño, la intervención terapéutica temprana, la evaluación cognitiva y la orientación del paciente, intervenciones sistematizadas en protocolos, así como intervenciones dirigidas a la participación de los familiares, la formación de enfermeras y la enseñanza de los pacientes. También se identificaron factores de riesgo para el desarrollo de delirio y herramientas de evaluación. Discusión: La prevención del delirio es importante e imperativa, ya que su ocurrencia en pacientes críticos se asocia con aumento de la mortalidad, morbilidad, estancia hospitalaria y alto costo hospitalario. La identificación de factores de riesgo para la aparición de delirio debe incluirse en los protocolos de manejo del delirio. Conclusión: La evidencia ha demostrado que los enfermeros son esenciales en la identificación temprana, prevención y control del delirio, previniendo la progresión de la enfermedad, contribuyendo para la reducción de la morbimortalidad. La intervención de enfermería debe incluir la identificación de factores predisponentes y/o precipitantes para contribuir a la reducción de la ocurrencia y/o resolución del delirio.