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.

Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis.

BACKGROUND: Women of advanced maternal age, defined as ≥ 35 years at delivery, are at increased risk of multiple complications during pregnancy, with perinatal death being one of the most feared. For instance, the risk of stillbirth at term in this subgroup of women is higher than in younger women, and particularly high beyond 39 weeks of gestation. Induction of labor at 39-40 weeks might help prevent some cases of perinatal death, however, the fact that induction of labor has been historically associated with an increased risk of cesarean delivery and the knowledge that advanced maternal age is an independent risk factor for cesarean delivery are some of the major reasons why clinicians are reluctant to offer elective induction of labor in this particular group. OBJECTIVE: The aim of the study was to assess if induction of labor in advanced maternal age was associated with increased rates of cesarean delivery when compared to expectant management. MATERIAL AND METHODS: We performed an electronic search limited to published articles available between January 2000 and March 2020. Randomized clinical trials and retrospective studies with large cohorts comparing induction of labor with expectant management in singleton pregnancies at term, of women aged ≥ 35 years were included. The primary outcome was the rate of cesarean delivery in induction of labor versus expectant management, and secondary outcomes were the occurrence of assisted vaginal delivery and postpartum hemorrhage. RESULTS: Eight studies, including 81151 pregnancies (26,631 in the induction group and 54,520 expectantly managed), were included in the analysis. Six of the included studies were randomized clinical trials with the remaining two being observational and retrospective cohort studies. Induction of labor was not associated with a significant increased risk of cesarean delivery (OR 0.97, 95 % CI 0.86-1.1), assisted vaginal delivery (OR 1.12, 95 % CI 0.96-1.32) or postpartum hemorrhage (OR 1.11, 95 % CI 0.88-1.41). DISCUSSION: The belief that induction of labor is associated with an increased risk of cesarean delivery is based on the results of retrospective studies comparing induction with spontaneous labor at the same gestational age. However, at any point in a pregnancy, the comparison should be between induction of labor and expectant management, with the latter contributing to a pregnancy of greater gestation age and not always leading to spontaneous labor. When comparing induction to expectant management, our study shows no significant increase of cesarean section, assisted vaginal delivery or postpartum hemorrhage. Our study was not powered to assess neonatal outcomes, and additional research is needed to confirm whether induction of labor might have a positive effect in preventing stillbirth. CONCLUSION: Induction of labor at term in advanced maternal age has no significant impact on cesarean delivery rates, assisted vaginal delivery or postpartum hemorrhage, giving additional reassurance to obstetricians who would consider this intervention in this particular subgroup.

Levonorgestrel intrauterine system as a treatment option for severe menorrhagia in adolescent with type III von Willebrand disease.

The authors describe a case of an adolescent with type III von Willebrand disease and severe menorrhagia since menarche. Antifibrinolytic, hormonal (estroprogestative pill in high doses, etonogestrel implant and gonadotropin-releasing hormone agonist goserelin) and Von Willebrand Factor/Factor VIII replacement therapies were prescribed to the patient, but symptomatic control was only obtained with high doses of VWF/FVIII twice a week. In March 2012, a levonorgestrel intrauterine system was inserted in a 14-year-old. At present, the patient is asymptomatic without regular prophylaxis (VWF/FVIII replacement therapy) and has had a remarkable improvement in her quality of life.

Twin pregnancy complicated by vasa previa.

Perinatal morbidity and mortality rates for vasa previa are high when it is not diagnosed antenatally. In this report, a case of vasa previa in a twin pregnancy was diagnosed postnatally, which leads to complications with the first twin. Serial ultrasound during pregnancy did not diagnose a bilobed placenta, a velamentous insertion of the umbilical cord or vasa previa. At 37 weeks, vaginal bleeding was detected in the expulsive stage and vaginal-assisted delivery of both fetuses was undertaken. The first fetus was born pale and anaemic, and required a blood transfusion and therapeutic hypothermia. A high risk of vasa previa is associated with placentas with low-lying insertion, bilobed placentas, velamentous insertions of the umbilical cord, multiple pregnancy and pregnancies conceived after the use of assisted reproductive technologies. Transvaginal ultrasound screening with colour flow Doppler can allow antenatal diagnoses of vasa previa and an improved outcome.

Juvenile cystic adenomyoma.

The purpose of this paper is to describe a case of juvenile cystic adenomyoma in a 17 year-old female patient with severe dysmenorrhoea unresponsive to non-steroidal anti-inflammatory drugs. The patient presents progressively worsening dysmenorrhoea that started 2 years after menarche and a cystic uterine lesion in MRI. The cyclic nature of symptoms, the similarity of the lesion and endometrium in MRI signal intensity and response to hormone suppression are consistent with juvenile cystic adenomyoma. The treatment depends on the age of the patient, severity of her symptoms and size and localisation of the cyst. This is a rare condition in young nulliparous women with a challenging differential diagnosis. This case highlights the relevance of MRI in the patient's study, featuring important characteristics of the lesion that disclosed the final diagnosis.

[Chorionicity and perinatal complications in twin pregnancy: a 10 years case series]. / Corionicidade e complicações perinatais na gravidez gemelar: casuística de 10 anos.

UNLABELLED: OVERVIEW AND AIMS: Multiple pregnancy accounts for about 3% of all pregnancies. The monochorionic pregnancy presents a relatively constant incidence (1:250 pregnancies) unlike the dichorionic, which is influenced by race, heredity, maternal age, parity and medically assisted procreation. The purpose of this work was to evaluate the impact of chorionicity on perinatal morbidity of twin pregnancy. POPULATION AND METHODS: Retrospective, longitudinal, descriptive and analytical study of women with twin pregnancy whose birth occurred in our maternity hospital since January/1999 until December/2008. INCLUSION CRITERIA: monochorionic and dichorionic twin pregnancies confirmed by ultrasound. EXCLUSION CRITERIA: monochorionic monoamniotic gestation. Demographic data, delivery variables and perinatal morbidity and mortality were studied. Data were evaluated using the χ2 test (qualitative variables), t-Student (continuous quantitative variables) and Mann-Whitney test (quantitative discrete variables). RESULTS: We studied 504 pregnancies (356 dichorionic diamniotic and 148 monochorionic diamniotic). The monochorionic pregnancy had a higher incidence of threatened preterm labor (43,9% vs 31,5%, p<0,05), of oligohydramnios/hydramnios (9,8% vs 3,3%, p<0,001), discordant fetal growth (26,8% vs 14,8%, p<0,001) and intrauterine growth restriction (7,4% vs 3,7%, p<0,05). Prematurity was more common in the monochorionic group (p<0,001). The cesarean delivery rate was higher in monochorionic pregnancy (58,8% vs 50,3%, p<0,05) and the average weight of newborns was lower in monochorionic pregnancies (1983g vs 2233g, p<0,001). Newborns in the monochorionic group had higher incidence of hyaline membrane disease (5,8% vs 2,8%, p<0,05) and intraventricular haemorrhage (2,1% vs 0,4%, p<0,05). The perinatal mortality was higher in the monochorionic group (7,8% vs 1,8%, p<0,001). CONCLUSIONS: As the morbidity and mortality associated with monochorionic pregnancies are higher, it is essential to perform an early detection of chorionicity by ultrasound (11-13 weeks) in order to place differentiated prenatal and appropriate peripartum surveillance.

Lessons from monochorionic twin delivery.

The presence of acute peripartum anaemia in a monochorionic twin pregnancy represents a clinical challenge requiring prompt recognition and management. Twin-to-twin transfusion syndrome (TTTS) is a major complication of these pregnancies and a medical emergency in its acute form. Acute intrapartum fetoplacental transfusion (AIFT) has been reported infrequently. The authors present a case of a probable acute TTTS in an uneventful monochorionic monoamnionic twin pregnancy, where typical ultrasound criteria for long-standing TTTS were absent. The first twin was born pale, hypotonic and developed hypovolemic shock due to acute anaemia. Soon after birth, she presented with seizures and a cerebral ultrasound detected a large parieto-occipital infarction. The second twin, although plethoric, was clinically well. The risk of acute TTTS and AIFT, although infrequent and unpredictable, should be kept in mind when planning delivery of monochorionic twins, because the consequences for one or both twins can be disastrous.