Nursing Interventions to Prevent Secondary Injury in Critically Ill Patients with Traumatic Brain Injury: A Scoping Review.

Background: Traumatic brain injury is a prevalent health issue with significant social and economic impacts. Nursing interventions are crucial in preventing secondary injury and improving patient prognosis. This scoping seeks to map and analyze the existing scientific evidence on nursing interventions aimed at preventing secondary injuries in critically ill patients with traumatic brain injury. Methods: The review was conducted according to Arksey and O'Malley's methodological framework. The electronic databases Pubmed, MEDLINE Complete, CINAHL Complete, Nursing & Allied Health Collection: Comprehensive, Cochrane Central Register of Controlled Trials, and Cochrane Clinical Answers were consulted in May 2023. We included articles published in English and Portuguese between 2010 and 2023. Results: From the initial search, 277 articles were identified, with 15 meeting the inclusion criteria for the review. Nursing interventions for TBI patients include neuromonitoring, therapeutics, analytical surveillance, professional training, and family support. Nurses play a crucial role in detecting neurological changes, administering treatments, monitoring metabolic markers, training staff, and involving families. These interventions aim to prevent secondary injury and improve patient outcomes. Conclusions: By prioritizing evidence-based practice and utilizing innovative technologies, nurses enhance TBI patient care and contribute to overall well-being.

Labor induction with a combined method (pharmacologic and mechanical): A randomized controlled trial.

INTRODUCTION: The aim of this study was to compare the effectiveness of a combined misoprostol-Foley catheter induction of labor protocol against the current guidelines of our department. MATERIAL AND METHODS: A randomized trial was conducted comparing two cervical ripening study groups: combined misoprostol-cervical Foley and the current department practice (misoprostol alone or dinoprostone alone). Women were stratified randomly according to parity for the two intervention groups. The primary outcome was defined as time to delivery (in hours). Secondary outcomes were cesarean delivery rate, time to active labor (defined as dilatation 6 cm or greater), delivery within 12 h, delivery within 24 h, maternal length of stay and indication for cesarean delivery. A composite of maternal morbidity and neonatal morbidity were also analyzed. RESULTS: 142 women were randomized into one of the two groups (74 for treatment group and 68 for control group). Demographic and clinical characteristics were similar among the two groups. The primary outcome, the average time to delivery, was faster in the treatment group (22.7 h vs 27.2 h, p = 0.03) and this difference was higher in the nulliparous subgroup (24.2 h vs 29.2 h, p = 0.03). Active phase of labor was achieved faster in the treatment group (17.9 h vs 22.7 h, p = 0.008). The risk for cesarean section was similar in both groups (OR 0.801 (0.527-1.217) vs OR 1.203 (0.871-1.662), p = 0.278). CONCLUSIONS: Our study suggests that the combined method of cervical Foley with vaginal misoprostol for women presenting to induction of labor with unfavorable Bishop scores reduces time to delivery safely. The risk for cesarean section was similar in both groups.

Vulvar High-Grade Squamous Intraepithelial Lesion and the Risk of Recurrence and Progression to Cancer.

OBJECTIVE: This study aimed to analyze which clinical characteristics are associated with recurrence and progression of vulvar high-grade squamous intraepithelial lesion (vHSIL). MATERIALS AND METHODS: This was a retrospective cohort study, including all women with vHSIL followed in 1 center between 2009 and 2021. Women with a concomitant diagnosis of invasive vulvar cancer were excluded. Medical records were reviewed for demographic factors, clinical data, treatment type, histopathologic results, and follow-up information. RESULTS: A total of 30 women were diagnosed with vHSIL. The median follow-up time was 4 years (range = 1-12 years). More than half of the women (56.7% [17/30]) underwent excisional treatment, whereas 26.7% (8/30) underwent combined (excisional plus medical) treatment, and 16.7% (5/30) only had medical treatment (imiquimod). Six women had recurrence of vHSIL (20% [6/30]), with a mean time to recurrence of 4.7 ± 2.88 years. The progression rate to invasive vulvar cancer was 13.3% (4/30), with a mean time to progression of 1.8 ± 0.96 years. Multifocal disease was associated with progression to vulvar cancer ( p = .035). We did not identify other variables associated with progression; no differences were found between women with and without recurrences. CONCLUSIONS: Multifocality of the lesions was the only variable associated with progression to vulvar cancer. This reinforces the idea that these lesions are a challenge in both treatment and surveillance, involving a more difficult therapeutic decision with greater associated morbidity.

Candidate microRNAs as prognostic biomarkers in heart failure: A systematic review.

BACKGROUND: Heart failure (HF) is a high prevalent syndrome with significant burden worldwide. B-type natriuretic peptide (BNP) and N-terminal proBNP are the gold standard biomarkers in HF management. Although useful in clinical practice, they have limitations as their expression can be influenced by ventricular function, aging, obesity, renal failure and atrial arrhythmias. MicroRNAs have recently emerged as potential diagnostic and prognostic biomarkers, given that they are related to cell growth, proliferation, differentiation, and metabolism. An increasing amount of research has highlighted some microRNAs for their potential as HF biomarkers. However, different study designs, methods and study groups have led to inconsistent results. METHODS AND RESULTS: We performed a systematic search of available literature on Pubmed and Scopus reporting the prognostic value of microRNAs in HF, followed by a review of risk of bias, according to Quadas Group Standards. Simultaneously, microRNAs' potential as differential diagnosis and severity biomarkers was also analyzed. Studies have described circulating microRNA as potential diagnostic, prognostic, and severity markers. Mir-622, -519 and -499 were significantly related to HF with reduced ejection fraction, whereas miR-22-3p revealed greater ability as a severity biomarker. Let-7i-5p, miR-223-5p, miR-423-5p, miR-21, miR-1306-5p and miR-122 serum expressions presented a consistent correlation with HF prognosis. Furthermore, identified miR targets were associated with signaling pathways already known to be involved in HF progression. CONCLUSION: Several miRs were related to HF pathophysiology and demonstrated potential as biomarkers for disease progression. MicroRNAs have a promising role in HF, and although unquestionable, we require a deeper and broader understanding of their role and function for future research.

Predictive Model of the Psychological Well-Being of Nursing Students During the COVID-19 Lockdown.

Introduction: Lockdowns due to the COVID-19 pandemic radically changed nursing education. Along with social isolation, the transition to distance education affected the well-being of students in several countries, particularly Portugal and Spain. Objectives: To identify which variables are predictors of psychological well-being for Portuguese and Spanish nursing students during mandatory lockdowns. Methods: A multicenter, cross-sectional, descriptive, correlational study involving a sample of 1075 students (944 women, mean age 22.46 + /-4.95 years). Data were collected from an online questionnaire which applied the following scales: Perceived Stress Scale (α = .820); Brief COPE-14 Subscales (α = .430 < 0.930); Well-being Manifestations Measure Scale (α = .940); Herth Hope Index (α = .850). A multiple regression model was created to predict the psychological well-being of nursing students. Results: The following predictor variables were identified in the model of the psychological well-being of students during the COVID-19 pandemic: perceived stress (ß = .405; p ≤ .001); hope (ß = .404; p ≤ .001); and the mechanisms of active coping (ß = .405; p ≤ .001), planning (ß = .097; p ≤ .001), and positive reinterpretation (ß = .053; p = .12). These five variables predicted 62.0% of the nursing students' psychological well-being (R 2 = .620; F = 350.82; p ≤ .001). Conclusion: Promoting students' mental health is essential, especially in periods of great adversity, such as a pandemic. Our results lead the way for the design and validation of an intervention program that addresses the five variables identified as predictors of students' psychological well-being.

Prognostic Value of the Malnutrition-inflammation Score in Hospitalization and Mortality on Long-term Hemodialysis.

OBJECTIVE: Since its development, cumulative evidence has accumulated regarding the prognostic value of the Malnutrition-Inflammation Score (MIS/Kalantar score) prognostic value; however, there is a shortage of recent and large studies with comprehensive statistical methodologies that contribute to support a higher level of evidence and a consensual cutoff. The aim of this study was to assess the strength of MIS association with hospitalization and mortality in a nationwide cohort. METHODS: This was a historical cohort study of hemodialysis patients from 25 outpatient centers followed up for 48 months. Univariable and multivariable Cox additive regression models were used to analyze the data. The C-index was estimated to assess the performance of the final model. RESULTS: Two thousand four hundred forty-four patients were analyzed, 59.0% males, 32.0% diabetic, and median age of 71 years (P25 = 60, P75 = 79). During a median period of 45-month follow-up, with a maximum of 48 months (P25 = 31; P75 = 48), 875 patients presented an MIS <5 (35.8%) and 860 patients (35.2%) died. The proportion of deaths was 23.1% for patients with the MIS <5 and 41.9% if the MIS ≥5 (P < .001). A total of 1,528 patients (62.5%) were hospitalized with a median time to the first hospitalization of 26 months (P25 = 9; P75 = 45). A new cutoff point regarding the risk of death, MIS ≥6, was identified for this study data set. In multivariable analysis for hospitalization risk, a higher MIS, higher comorbidity index, and arteriovenous graft or catheter increased the risk, whereas higher Kt/V and higher albumin had a protective effect. In multivariable analysis for mortality risk, adjusting for age, albumin, normalized protein catabolic rate, Charlson comorbidity index, interdialytic weight gain, Kt/V, diabetes, hematocrit, and vascular access, patients with the MIS ≥6 showed a hazard ratio of 1.469 (95% confidence interval: 1.262-1.711; P < .001). Higher age, higher interdialytic weight gain, higher comorbidity index, and catheter increased significantly the risk, whereas higher Kt/V, higher albumin, and higher normalized protein catabolic rate (≥1.05 g/kg/d) reduced the risk. CONCLUSION: The MIS maintains its relevant and significant association with hospitalization and mortality.

Cerebral venous thrombosis in adolescence: Looking beyond the obvious.

Behçet's disease (BD) is a rare systemic vasculitis with multisystemic involvement. Neurological involvement, called neuro-Behçet's disease (NBD), mostly involves the central nervous system and cerebral venous thrombosis (CVT) is the predominant neurological manifestation in the pediatric age. A 12-year-old female with a past medical history of a CVT, without an identifiable etiology, was admitted with a five-day right fronto-orbital headache. Neuroimage showed a subacute thrombosis of a right superficial sylvian vein, with indirect signs of intracranial hypertension and no imaging signs of vasculitis. Prothrombotic screening and immunologic study were normal. She was started on acetazolamide and hypocoagulation with progressively improving. She had a history of frequent oral aphthae and an episode of a genital ulcer three months before admission. Pathergy test was negative. HLA-B51 was positive. She was diagnosed with NBD and started therapy with colchicine and infliximab. After discharge, the patient remains without symptoms, hypocoagulated, and on infliximab regimen, without complications to report. This case, only diagnosed in the second episode of CVT, is paradigmatic of the difficulty in establishing the diagnosis of BD.

Diagnosis of bacterial vaginosis: Clinical or microscopic? A cross-sectional study.

OBJECTIVE: To compare the performance of the Amsel criteria, culture of Gardnerella spp., and wet mount microscopy (WMM) in the diagnosis of bacterial vaginosis. METHODS: A cross-sectional cohort study was conducted, consisting of evaluating 749 consecutive women, regardless of symptoms. The Amsel criteria were evaluated, WMM microscopy and Gram staining were performed, and a swab was collected for culture. The gold standard for diagnosis was the Nugent score. RESULTS: The sensitivity and specificity for the different approaches were: Amsel criteria 41.3% (95% confidence interval [CI] 33.76-49.18) and 97.8% (95% CI 96.21-98.81); cultures 59.9% (95% CI 51.47-67.85) and 99.0% (95% CI 97.76-99.69); WMM 82.6% (95% CI 76.02-88.05) and 92.4% (95% CI 89.98-94.45), respectively. WMM performed equally well in symptomatic and asymptomatic women. Amsel criteria in scenarios where there is no use of a microscope had very poor sensitivity (22.8% [CI 16.63-29.87%]). CONCLUSION: The Amsel criteria have a poor performance for the diagnosis of bacterial vaginosis. WMM performs well but is not routinely used and should be the first approach for the diagnosis of vaginitis.

Bem-estar psicológico e coping em estudantes de enfermagem durante a quarentena pela COVID-19 / Nursing students' psychological well-being and coping during the COVID-19 quarantine / Bienestar psicológico y afrontamiento (coping) en estudiantes de enfermería durante la cuarentena por la COVID-19

Resumo Enquadramento: A crise pandémica da COVID-19 acarretou mudanças na vida académica dos estudantes do ensino superior, o que poderá afetar o seu bem-estar psicológico. Objetivo: Analisar a relação entre estratégias de coping utilizadas e o bem-estar psicológico em estudantes de enfermagem durante a quarentena pela COVID-19. Metodologia: Estudo transversal, descritivo-correlacional, utilizando uma amostra de 136 estudantes. Colheita de dados online, com recurso à Escala de Medida de Manifestação de Bem-estar Psicológico e à Brief COPE. Resultados: Os estudantes dos últimos anos de curso utilizam mais frequentemente a estratégia de coping suporte instrumental (p = 0,015) e emocional (p = 0,009), apresentam ainda, maiores níveis de bem-estar psicológico (p = 0,012). As alterações no rendimento familiar estão associadas ao bem-estar psicológico (p = 0,024), assim como as estratégias de coping religião (r = 0,36; p ≤ 0,01), reinterpretação positiva (r = 0,47; p ≤ 0,01) e humor (r = 0,37; p ≤ 0,01). Conclusão: As estratégias de coping adotadas pelos estudantes parecem estar relacionadas com o bem-estar psicológico durante a quarentena.

Abstract Background: The COVID-19 pandemic crisis has brought about changes in the lives of higher education students that may influence their psychological well-being. Objective: To analyze the association between nursing students' coping strategies and their psychological well-being during the COVID-19 quarantine. Methodology: Cross-sectional, descriptive-correlational study using a convenience sample of 136 students. Data were collected online using the Portuguese version of the Échelle de Mesure des Manifestations du Bien-être Psychologique and the Brief COPE. Results: Students in the last years of their undergraduate studies used the instrumental support (p = 0.015) and emotional support (p = 0.009) coping strategies more often and had higher levels of psychological well-being (p = 0.012). Psychological well-being is associated with household income changes (p = 0.024), as well as with religion (r = 0.36; p ≤ 0.01), positive reframing (r = 0.47; p ≤ 0.01), and humor (r = 0.37; p ≤ 0.01) coping strategies. Conclusion: Students' coping strategies seem to be associated with their psychological well-being during the COVID-19 quarantine.

Resumen Marco contextual: La crisis provocada por la pandemia de la COVID-19 produjo cambios en la vida académica de los estudiantes de educación superior, que pueden afectar su bienestar psicológico. Objetivo: Analizar la relación entre las estrategias de afrontamiento utilizadas y el bienestar psicológico en estudiantes de enfermería durante la cuarentena por la COVID-19. Metodología: Estudio transversal, descriptivo-correlacional, con una muestra de 136 estudiantes. La recopilación de datos se realizó en línea mediante la Escala de Medición de la Manifestación del Bienestar Psicológico y el Brief COPE. Resultados: Los estudiantes de los últimos cursos utilizan con más frecuencia la estrategia de afrontamiento apoyo instrumental (p = 0,015) y emocional (p = 0,009), y también tienen mayores niveles de bienestar psicológico (p = 0,012). Los cambios en los ingresos familiares se asocian con el bienestar psicológico (p = 0,024), así como con las estrategias de afrontamiento religión (r = 0,36; p ≤ 0,01), reinterpretación positiva (r = 0,47; p ≤ 0,01) y estado de ánimo (r = 0,37; p ≤ 0,01). Conclusión: Las estrategias de afrontamiento adoptadas por los estudiantes parecen estar relacionadas con el bienestar psicológico durante la cuarentena.

Cell-targeted PD-1 agonists that mimic PD-L1 are potent T cell inhibitors.

The PD-1/PD-L1 pathway is a key immune checkpoint that regulates T cell activation. There is strong rationale to develop PD-1 agonists as therapeutics against autoimmunity, but progress in this area has been limited. Here, we generated T cell receptor (TCR) targeting, PD-1 agonist bispecifics called ImmTAAI molecules that mimic the ability of PD-L1 to facilitate the colocalization of PD-1 with the TCR complex at the target cell-T cell interface. PD-1 agonist ImmTAAI molecules specifically bound to target cells and were highly effective in activating the PD-1 receptor on interacting T cells to achieve immune suppression. Potent PD-1 antibody ImmTAAI molecules closely mimicked the mechanism of action of endogenously expressed PD-L1 in their localization to the target cell-T cell interface, inhibition of proximal TCR signaling events, and suppression of T cell function. At picomolar concentrations, these bispecifics suppressed cytokine production and inhibited CD8+ T cell-mediated cytotoxicity in vitro. Crucially, in soluble form, the PD-1 ImmTAAI molecules were inactive and, hence, could avoid systemic immunosuppression. This study outlines a promising new route to generate more effective, potent, tissue-targeted PD-1 agonists that can inhibit T cell function locally with the potential to treat autoimmune and chronic inflammatory diseases of high unmet need.

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.

In vitro anticoagulant activity of selected medicinal plants: potential interactions with warfarin and development of new anticoagulants.

OBJECTIVES: Warfarin is the most widely used anticoagulant in the world, but it has several limitations including its narrow therapeutic range, need for dose adjustment and high potential for interactions. The simultaneous use of other drugs or even medicinal plants and certain foods could interfere with its therapeutic activity. In this context, this study aims to investigate the in vitro anticoagulant potential and phytochemical constitution of 17 plants selected from a previous clinical cross-sectional study (2014), that investigated the habits of plant utilization among patients taking warfarin. METHODS: Ethanol extracts and essential oils were evaluated, in vitro, as to their effect in the prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests. Four species that presented aPTT >50 s were selected for phytochemical evaluation. RESULTS: Thirteen of the 17 plants selected demonstrated a significant anticoagulant effect in at least one of the evaluated parameters. Citrus sinensis (PT=14.75 and aPTT=53.15), Mentha crispa (aPTT=51.25), Mikania laevigata (PT=14.90 and aPTT=52.10), and Nasturtium officinale (aPTT=50.55) showed greater anticoagulant potential compared to normal plasma pool (PT=12.25 and aPTT=37.73). Chemical profiles of these four species were obtained, and certain compounds were identified: rosmarinic acid from M. crispa and isoorientin from N. officinale. CONCLUSIONS: Thus, the results of this study could be a useful indicator for clinical practice towards the possibility of interaction between these plants and anticoagulants, although further clinical research is needed taking into consideration the limitations of in vitro studies. These findings also suggest that further research into the action of these plants could be of real clinical value in identifying potential alternative anticoagulant therapies.

COVID-19 pandemic and its psychological impact among healthy Portuguese and Spanish nursing students.

Few studies have explored the impacts of COVID-19 and lockdown on the mental health of undergraduate nursing students. This study aimed: a) to explore perceived stress among undergraduate nursing students in Portugal and Spain during the COVID-19 pandemic outbreak; and b) to analyze several COVID-19 related factors and psychological issues that may be associated with perceived stress. A cross-sectional study was conducted with a convenience sample of Portuguese and Spanish undergraduate nursing students (n=1075). The data gathered included demographic information, questions about COVID-19 related factors, and psychological issues. Data were analyzed using multiple logistic regression with a degree of significance at p<0.05. High perceived stress scores were found in 558 participants (51.9%). Students with high perceived stress most likely had a COVID-19 diagnosis in their household; their household income had been affected by the COVID-19 pandemic; experienced difficulty falling asleep or sleeping all night; consumed junk food in excess; neglected their appearance; felt headaches, stomach aches, and back pain; and lacked the patience or desire to exercise. Additionally, high perceived stress was negatively associated with life satisfaction. The results provide evidence that infectious diseases, such as COVID-19, may significantly influence mental health. Further research should explore the long-term psychological effects of the COVID-19 pandemic among nursing students.

Erosive Vulvar Lichen Planus and Risk of Vulvar Neoplasia.

OBJECTIVE: The aim of the study was to assess the risk of vulvar cancer and precursors in a cohort of women with vulvar lichen planus (LP) and the clinical and therapeutic features of these patients. MATERIALS AND METHODS: A retrospective cohort study, including all the women with the diagnosis of vulvar LP, followed in one institution during a period of 11 years, was performed. Demographic and clinical data, as well as treatment, follow-up, and histology results, were evaluated. RESULTS: A total of 127 women were diagnosed with vulvar LP. The mean follow-up time was 3.9 ± 0.5 years (range = 1-11 years). Ultrapotent topical corticosteroids were first-line treatment in 91.8% (n = 112), with 32 cases (25.2%) needing an alternative treatment. Overall, 30 biopsies were performed in 19 women (15%). Vulvar high-grade squamous intraepithelial lesion was diagnosed in 3 women (2.4%), 2 (1.6%) of whom were later diagnosed with vulvar squamous cell carcinoma. No cases of differentiated vulvar intraepithelial neoplasia were observed. CONCLUSIONS: Premalignant/malignant transformation in women with vulvar LP under surveillance and compliant with treatment is low. A close follow-up seems to be crucial to prevent future malignancy. Biopsies should be performed whenever a suspicious lesion seems during follow-up.

Clinical validation of the nanda-i "caregiver role strain" nursing diagnosis in the context of palliative care / Validación clínica del diagnóstico de enfermería nanda-i "cansancio del rol de cuidador" en el contexto de los cuidados paliativos / Validação clínica do diagnóstico de enfermagem nanda-i "tensão do papel de cuidador" em contexto de cuidados paliativos

ABSTRACT Objective: to clinically validate the defining characteristics of the "Caregiver Role Strain" Nursing diagnosis for caregivers of people in a palliative care situation. Method: a cross-sectional, quantitative, descriptive and analytical study. It was developed based on Fehring's Clinical Validation Model and on the diagnostic accuracy measures (sensitivity, specificity, predictive values and Receiver Operating Characteristic curve). The data collection instrument used was a form, applied in 2017 by two nurses to a sample of 111 caregivers of people in a palliative care situation, in Portugal. The caregivers were divided into two groups (with and without the diagnosis), being identified by the simultaneity of three criteria, namely: Zarit Burden Interview values greater than 56; agreement of two nurses about the diagnosis; and caregiver's perception of the presence of signs and symptoms. The defining characteristics were classified as major, secondary and irrelevant, according to the models used. Results: the prevalence of diagnosis was 42.3%. Of the 29 characteristics subjected to the validation process, 9 were considered major, 13 secondary and 7 irrelevant. Ineffective coping, depressive mood, frustration, worsening of previous diseases, stress and fatigue were the characteristics which proved to be more associated with the diagnosis in both analyses. The overall score of the diagnosis was 0.68. Conclusion: the study results contribute to the improvement of the diagnosis, making it more accurate. In addition, they enable better clinical decision in Nursing, allowing nurses to make a diagnostic judgment supported by scientific evidence.

RESUMEN Objetivo: validar clínicamente las características definitorias del diagnóstico de Enfermería "Cansancio del rol de Cuidador de personas en situación de cuidados paliativos". Método: estudio descriptivo y analítico de tipo transversal y naturaleza cuantitativa. Se desarrolló sobre la base del Modelo de Validación Clínica de Fehring y de las medidas de exactitud diagnóstica (sensibilidad, especificidad, valores predictivos y curva Receiver Operating Characteristic). El instrumento para la recolección de dados utilizado fue un formulario, aplicado en el año 2017 por dos enfermeras a una muestra de 111 cuidadores de personas en situación de cuidados paliativos en Portugal. Se dividió a los cuidadores en dos grupos (con y sin el diagnóstico), identificados por la simultaneidad de tres criterios: valores de la escala de Zarit de sobrecarga del cuidador superiores a 56; acuerdo de dos enfermeras acerca del diagnóstico; y percepción del cuidador con respecto a la presencia de señales y síntomas. Las características definitorias se clasificaron como principales, secundarias e irrelevantes, mediante los modelos utilizados. Resultados: la prevalencia del diagnóstico fue del 42,3%. De las 29 características sujetas al proceso de validación, 9 fueron consideradas como principales, 13 como secundarias y 7 como irrelevantes. Afrontamiento poco eficaz, estado de ánimo depresivo, frustración, deterioro de enfermedades previas, estrés y fatiga fueron las características que demostraron mayor asociación con el diagnóstico en ambos análisis. El score global del diagnóstico fue 0,68. Conclusión: los resultados del estudio son útiles para mejorar el diagnóstico, aumentando su exactitud. También hacen posible tomar mejores decisiones clínicas en Enfermería, permitiendo así que los enfermeros tomen determinaciones diagnósticas sobre la base de evidencias científicas.

RESUMO Objetivo: validar clinicamente as características definidoras do diagnóstico de enfermagem "Tensão do Papel de Cuidador da pessoa em situação paliativa". Método: estudo do tipo transversal, de natureza quantitativa, descritivo e analítico. Desenrolou-se ancorado no Modelo de Validação Clínica de Fehring e nas medidas de acurácia diagnóstica (sensibilidade, especificidade, valores preditivos e curva Receiver Operating Characteristic). O instrumento de coleta de dados utilizado foi um formulário, aplicado por duas enfermeiras, a uma amostra de 111 cuidadores de pessoas em situação paliativa, em Portugal, em 2017. Os cuidadores foram divididos em dois grupos (com e sem diagnóstico), sendo identificados pela simultaneidade de três critérios: valores da escala de sobrecarga do cuidador de Zarit superiores a 56; concordância de duas enfermeiras acerca do diagnóstico; e a percepção do cuidador quanto à presença de sinais e sintomas. Classificaram-se as caraterísticas definidoras em principais, secundárias e irrelevantes, mediante os modelos utilizados. Resultados: a prevalência do diagnóstico foi de 42,3%. Das 29 características sujeitas ao processo de validação, 9 foram consideradas principais, 13 secundárias e 7 irrelevantes. O enfrentamento ineficaz, o humor depressivo, a frustração, o agravamento de doenças prévias, o estresse e a fadiga foram as características que se revelaram mais associadas ao diagnóstico em ambas as análises. O score global do diagnóstico foi de 0,68. Conclusão: os resultados do estudo contribuem para o aprimoramento do diagnóstico, tornando-o mais acurado. Ademais, possibilitam melhor decisão clínica em enfermagem, permitindo aos enfermeiros um juízo diagnóstico apoiado em evidências científicas.

Esperança e bem-estar psicológico durante a crise sanitária pela COVID-19: estudo com estudantes de enfermagem / Hope and psychological well-being during the sanitary crisis by COVID-19: a study with nursing students / Esperanza y bienestar psicológico durante la crisis sanitaria por COVID-19: estudio con estudiantes de enfermería

Objetivo: analisar as relações entre a esperança e o bem-estar psicológico de estudantes de enfermagem portugueses durante a crise pandêmica pela COVID-19. Método: estudo descritivo-correlacional, com recurso a questionário online para coleta de dados. Participaram 705 estudantes de enfermagem com idade média de 21,74 anos (DP=4,44). Os instrumentos de coleta de dados utilizados foram a Escala de Esperança de Herth (HHI-PT) e a Escala de Medida de Manifestação de Bem-Estar Psicológico (EMMBEP). Foi utilizada a estatística descritiva e inferencial. Resultados: na HHI-PT, o domínio afectivo-comportamental obteve a pontuação média mais alta, 3,30 (DP=0,45); no EMMBEP, foi o domínio sociabilidade, 3,64 (DP=0,77). Havia correlações moderadas a fortes (0,383

Aim: to analyze the relationship between hope and the psychological well-being of Portuguese nursing students during the COVID-19 pandemic crisis. Method: this is a descriptive-correlational study using an online questionnaire for data collection. 705 nursing students participated, with a mean age of 21.74 years (SD=4.44). The data collection instruments used were the Herth Hope Index (HHI-PT) and the Well-Being Manifestations Measure Scale (WBMMS). Descriptive and inferential statistics were used. Results: in the HHI-PT, the affective-behavioral domain had the highest mean score (3.30; SD=0.45), while in the WBMMS, it was the sociability domain, 3.64 (SD=0.77). There were moderate to strong correlations (0.383

Objetivo: analizar la relación entre la esperanza y el bienestar psicológico de los estudiantes portugueses de enfermería durante la crisis pandémica por COVID-19. Método: estudio descriptivo-correlacional mediante cuestionario online para la recogida de datos. Participaron 705 estudiantes de enfermería, con una edad promedio de 21,74 años (DE=4,44). Los instrumentos de recolección de datos utilizados fueron la Escala de Esperanza de Herth (HHI-PT) y la Escala de Medida de Manifestación de Bienestar Psicológico (EMMBEP). Se utilizó estadística descriptiva e inferencial. Resultados: en HHI-PT, fue el dominio afectivoconductual el que obtuvo la puntuación promedio más alta, 3.30 (DE=0.45), en EMMBEP, fue el dominio de sociabilidad, 3.64 (DE=0.77). Hubo correlaciones de moderadas a fuertes (0.383

Review of nursing diagnosis validation studies: caregiver role strain.

OBJECTIVE: To analyze the nursing diagnosis NANDA-I - Caregiver Role Strain validation studies. METHODS: Integrative literature review. Research of studies carried out between 2000 and 2018 with the descriptors: caregivers, nursing diagnosis and validation study in the following databases: Web of Science, EBESCOhost, Scielo Brasil and Portugal, LILACS, RCAAP, CAPES, NANDA-I website, and in the bibliographic references of the articles. Articles in Portuguese, English or Spanish were included. RESULTS: The sample consisted of seven validation studies, with heterogeneity in the methodologies used. The populations where the diagnosis was clinically validated focused on caregivers for the elderly and people with chronic illness. The most prevalent defining characteristics were Stress and Apprehension related to the future. CONCLUSIONS: This diagnosis requires further validation studies among different populations in search of greater accuracy and a reduction in the number of defining characteristics, facilitating the use of taxonomy.

Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery in a Portuguese maternity.

Objectives The burden of undocumented SARS-Cov-2 infections in Portuguese pregnant women is unknown. At our institution, routine COVID-19 testing was implemented from 19th of March on to all pregnant women who were admitted for delivery. The purpose of the study was to estimate the SARS-CoV-2 infection rate in our obstetric population admitted for delivery. Mathods Between 19th March and May 4th, 184 pregnant women were screened for SARS-CoV-2 infection upon admission. Results Eleven women were positive for SARS-CoV-2, corresponding to a global prevalence of 6.0%. Of these, only two reported symptoms at admission. The prevalence of asymptomatic infection was 4.9%. We report a lower rate of positive cass than other studies. Eighty-two percent of our cases had no symptoms at admission. Conclusions The proportion of asymptomatic infection highlights the importance of universal laboratory screening for all women admitted for delivery as opposed to symptom-based screening.