Theoretical reflections of Leininger's cross-cultural care in the context of Covid-19.

OBJECTIVE: To reflect on cross-cultural care for the population based on the theoretical assumptions and concepts of Leininger's Transcultural Theory, related to the recommendations for combating the Covid-19 pandemic. METHOD: Reflective theoretical study based on culturally competent care, related to the Brazilian reality, using the conceptual attributes of care, culture, and worldview. Critically articulated the reasonings about the guidelines for preserving, accommodating, and repatterning actions for the care of people. RESULTS: The nurse must know cross-cultural care in order to consider individual and/or collective treatment and respect the existing differences in beliefs and values. This premise corroborates the adherence to Covid-19 prevention and treatment recommendations. The lack of knowledge about the transmissibility and invisibility of the virus and the risk factors, combined with the cultural diversity of the population, can make it difficult to adhere to health recommendations. FINAL CONSIDERATIONS: Cross-cultural care favors the practice of health education and can provide conditions for greater adherence of the population to nursing actions.

Can Serum be a Match for Urine in the Regulatory Analysis of Boldenone in Cattle? A Systematic Comparison Between Detection Window, Stability, and Enzymatic Hydrolysis.

This work involved a systematic comparison between serum and urine for the monitoring of anabolic androgenic steroids in livestock. Incurred samples were collected over 120 days from crossbred steers treated with intramuscular injections containing boldenone undecylenate. Independent high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) methods were used for the assessment of the respective detection windows, which were larger for serum samples. Both matrices presented adequate performance in terms of long-term stability, assessed using an isochronous approach during 196 days at -20 °C and for five freeze-thaw cycles. The effectiveness of the enzymatic hydrolysis reaction using Helix pomatia juice was also compared. The calculated concentrations in serum samples were not statistically influenced by the deconjugation reaction. On the other hand, urine hydrolysis conditions were studied using a 33 Box-Behnken Design, in which a central point condition led to a satisfactory deconjugation performance. It could be observed that serum exhibited equivalent or better performance than urine for most of the evaluated criteria; thus, its inclusion in the regulatory analysis of boldenone in cattle is supported.

Coronavirus infections: health care planning based on Orem's Nursing Theory.

OBJECTIVE: to report the experience of professors and students of a graduate course on nursing care in coping with the new coronavirus (COVID-19) based on Self-Care Theory. METHOD: the active methodologies used were a literature search and seminar presentations, with an understanding of Orem's theoretical concepts: health; man; self-care; universal, developmental and health deviation requirements; self-care activities; self-care deficits; the required therapeutic demand; nursing systems. The pandemic was considered a health deviation that requires critical thinking and nursing care planning. Methodological frameworks to classify nursing diagnoses, interventions, and outcomes were used. RESULTS: for each health deviation, nursing systems were identified; self-care deficits, diagnoses; actions, interventions; and the form of assessment, outcomes. FINAL CONSIDERATIONS: theoretical-practical reflections of the academic context support nursing care planning.

Coronavirus infections: health care planning based on Orem's Nursing Theory / Infecciones por coronavirus: planificación de la atención basada en la Teoría de Enfermería de Orem / Infecções por coronavírus: planejamento da assistência fundamentado na Teoria de Enfermagem de Orem

ABSTRACT Objective: to report the experience of professors and students of a graduate course on nursing care in coping with the new coronavirus (COVID-19) based on Self-Care Theory. Method: the active methodologies used were a literature search and seminar presentations, with an understanding of Orem's theoretical concepts: health; man; self-care; universal, developmental and health deviation requirements; self-care activities; self-care deficits; the required therapeutic demand; nursing systems. The pandemic was considered a health deviation that requires critical thinking and nursing care planning. Methodological frameworks to classify nursing diagnoses, interventions, and outcomes were used. Results: for each health deviation, nursing systems were identified; self-care deficits, diagnoses; actions, interventions; and the form of assessment, outcomes. Final considerations: theoretical-practical reflections of the academic context support nursing care planning.

RESUMEN Objetivo: reportar la experiencia de docentes y estudiantes de un curso de posgrado en cuidados de enfermería en la lucha contra el nuevo coronavirus basado en la Teoría del Autocuidado. Método: las metodologías activas utilizadas fueron: búsqueda de literatura y presentaciones en seminarios, con conocimiento de los conceptos teóricos de Orem: salud; hombre; cuidados personales; requisitos universales, de desarrollo y de desviación de la salud; actividades de autocuidado; déficit de autocuidado; la demanda terapéutica requerida; sistemas de enfermería. La pandemia se consideró una desviación de la salud que requiere pensamiento crítico y planificación de la atención de enfermería. Se utilizaron marcos metodológicos para la clasificación de diagnósticos, intervenciones y resultados de enfermería. Resultados: para cada desviación de salud, se identificaron sistemas de enfermería; déficit de autocuidado, diagnósticos; acciones, intervenciones; y la forma de evaluación, los resultados. Consideraciones finales: reflexiones teórico-prácticas del contexto académico corroboran la planificación del cuidado de enfermería.

RESUMO Objetivo: relatar a experiência de docente e discentes de uma disciplina de pós-graduação sobre assistência de enfermagem no combate ao novo coronavírus (COVID-19) fundamentada na Teoria do Autocuidado. Método: as metodologias ativas utilizadas foram a busca na literatura e apresentações de seminários, com apreensão dos conceitos teóricos de Orem: saúde; homem; o autocuidado; os requisitos universais, desenvolvimentais e de desvios de saúde; as atividades de autocuidado; os déficits de autocuidado; a demanda terapêutica requerida; e os sistemas de enfermagem. A pandemia foi considerada um desvio de saúde que demanda pensamento crítico e planejamento da assistência de enfermagem. Foram utilizados referenciais metodológicos das classificações de diagnósticos, intervenções e resultados de enfermagem. Resultados: para cada desvio de saúde, foram identificados sistemas de enfermagem; déficits de autocuidado, os diagnósticos; as ações, intervenções; e a forma de avaliação, os resultados. Considerações finais: reflexões teórico-práticas do contexto acadêmico corroboram o planejamento da assistência de enfermagem.

Theoretical reflections of Leininger's cross-cultural care in the context of Covid-19 / Reflexiones teóricas del cuidado transcultural de Leininger en el contexto de Covid-19 / Reflexões teóricas do cuidado transcultural de Leininger no contexto da Covid-19

ABSTRACT Objective To reflect on cross-cultural care for the population based on the theoretical assumptions and concepts of Leininger's Transcultural Theory, related to the recommendations for combating the Covid-19 pandemic. Method Reflective theoretical study based on culturally competent care, related to the Brazilian reality, using the conceptual attributes of care, culture, and worldview. Critically articulated the reasonings about the guidelines for preserving, accommodating, and repatterning actions for the care of people. Results The nurse must know cross-cultural care in order to consider individual and/or collective treatment and respect the existing differences in beliefs and values. This premise corroborates the adherence to Covid-19 prevention and treatment recommendations. The lack of knowledge about the transmissibility and invisibility of the virus and the risk factors, combined with the cultural diversity of the population, can make it difficult to adhere to health recommendations. Final considerations Cross-cultural care favors the practice of health education and can provide conditions for greater adherence of the population to nursing actions.

RESUMEN Objetivo Reflexionar sobre la atención intercultural para la población a partir de los supuestos y conceptos teóricos de la teoría transcultural de Leininger, relacionados con las recomendaciones para combatir la pandemia de Covid-19. Método Estudio teórico reflexivo basado en el cuidado culturalmente competente, relacionado con la realidad brasileña, utilizando los atributos conceptuales del cuidado, la cultura y la cosmovisión. Se articuló críticamente el razonamiento sobre las directrices para preservar, acomodar y repotenciar las acciones de atención a las personas. Resultados La enfermera debe conocer los cuidados interculturales para considerar el tratamiento individual y/o colectivo y respetar las diferencias existentes en cuanto a creencias y valores. Esta premisa apoya la adhesión a las recomendaciones de prevención y tratamiento de Covid-19. El desconocimiento de la transmisibilidad y la invisibilidad del virus y de los factores de riesgo, junto con la diversidad cultural de la población, pueden dificultar el cumplimiento de las recomendaciones sanitarias. Consideraciones finales La atención transcultural favorece la práctica de la educación para la salud y puede proporcionar condiciones para una mayor adhesión de la población a las acciones de enfermería.

RESUMO Objetivo Refletir sobre o cuidado transcultural à população a partir dos pressupostos teóricos e conceitos da Teoria Transcultural de Leininger, relacionados às recomendações para o combate da pandemia da Covid-19. Método Estudo teórico reflexivo baseado no cuidado cultural competente, relacionado à realidade brasileira, utilizando-se os atributos conceituais de cuidado, cultura e visão de mundo. Articularam-se de modo crítico os raciocínios sobre a orientações de preservar, acomodar e repadronizar ações para o cuidado das pessoas. Resultados O enfermeiro deve conhecer o cuidado transcultural para considerar o tratamento individual e ou coletivo e respeitar as diferenças existentes sobre as crenças e valores. Essa premissa corrobora para a adesão às recomendações de prevenção e tratamento da Covid-19. O desconhecimento sobre a transmissibilidade e invisibilidade do vírus e dos fatores de risco, aliados à diversidade cultural da população, podem dificultar a adesão às recomendações sanitárias. Considerações finais: O cuidado transcultural favorece a prática da educação em saúde e pode proporcionar condições para maior adesão da população às ações de enfermagem.

Adalimumabe no manejo da retocolite ulcerativa inespecífica: resultados de um estudo multicêntrico observacional brasileiro / Adalimumab for ulcerative colitis: results of a brazilian multicenter observational study

ABSTRACT BACKGROUND: Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα) inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce. OBJECTIVE: To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis. METHODS: Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score) at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF) and Non responder imputation (NRI) analysis were used. RESULTS: Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively. CONCLUSION: Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.

RESUMO CONTEXTO: O adalimumabe é um anticorpo monoclonal, inibidor do TNF alfa, que tem eficácia comprovada na indução e manutenção da remissão na retocolite ulcerativa inespecífica moderada à severa. Há escassez de dados sobre o uso do adalimumabe na retocolite ulcerativa inespecífica em pacientes latino-americanos. OBJETIVO: Analisar as taxas de remissão clínica na indução e manutenção do tratamento da retocolite ulcerativa inespecífica com adalimumabe. MÉTODOS: Estudo observacional, multicêntrico e retrospectivo de uma série de casos de portadores de retocolite ulcerativa inespecífica moderada à grave que utilizaram adalimumabe. Variáveis analisadas: dados demográficos, uso prévio de infliximabe, medicações concomitantes, Classificação de Montreal, atividade da doença (escore parcial de Mayo) nas semanas 0, 8, 26 e 52, ou até o maior tempo de seguimento atingido. Remissão clínica foi definida como escore parcial de Mayo ≤2 e foi avaliada pelos métodos. Abordagem com base na observação mais recente (LOCF) e Imputação de não respondedores (NRI). RESULTADOS: Trinta e seis pacientes foram incluídos no estudo. Pela análise LOCF, as taxas de remissão nas semanas 8, 26 e 52 foram de 41,7%, 47,2% e 47,2%, respectivamente. Pela análise NRI, as taxas nas semanas 8, 26 e 52 foram de 41,7%, 41,7% e 27,8%, respectivamente. CONCLUSÃO: Adalimumabe foi eficaz no manejo da retocolite ulcerativa inespecífica moderada a grave. A remissão clínica foi observada em cerca de 40% dos pacientes nas semanas 8 e 26, e em cerca de 1/4 dos pacientes após 1 ano de seguimento.

ADALIMUMAB FOR ULCERATIVE COLITIS: RESULTS OF A BRAZILIAN MULTICENTER OBSERVATIONAL STUDY.

BACKGROUND: Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα) inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce. OBJECTIVE: To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis. METHODS: Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score) at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF) and Non responder imputation (NRI) analysis were used. RESULTS: Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively. CONCLUSION: Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.

Early postmarket experience after US Food and Drug Administration approval with the Trevo device for thrombectomy for acute ischemic stroke.

BACKGROUND: TREVO 2 showed the Trevo stent retriever to be more successful for revascularization than Merci for acute stroke intervention in patients treated within 8 hours of symptom onset. These results led to US Food and Drug Administration approval of Trevo. OBJECTIVE: To report the first postmarket experience with Trevo since US Food and Drug Administration approval at a single high-volume comprehensive stroke center in the United States. METHODS: A retrospective analysis of prospectively collected data was conducted in patients who underwent intervention for ischemic stroke with the Trevo device. Trevo was used alone or in conjunction with other intra-arterial devices. Two groups of patients were identified: those with symptom onset within (group 1) and those with symptom onset beyond (group 2) 8 hours. Recanalization, outcome, symptomatic intracranial hemorrhage, and in-hospital and 90-day mortality were assessed. RESULTS: Fifty-two patients were identified, 27 in group 1 and 25 in group 2. Thrombolysis in Cerebral Infarction grade 2 to 3 revascularization was achieved in 93% of group 1 and 84% of group 2 patients. In-hospital mortality and symptomatic intracranial hemorrhage rates were 3.8% and 12% for groups 1 and 2, respectively. Ninety-day mortality was 15% and 24% for groups 1 and 2, respectively. In groups 1 and 2, 48% and 42% of patients, respectively, had good outcomes (modified Rankin Scale score, 0-2), and 50% in both groups of patients achieved Thrombolysis in Cerebral Infarction grade 3 revascularization. Group 2 had longer revascularization times and required adjuvant devices more frequently. CONCLUSION: Our postmarket experience shows that in highly selected patients Trevo is safe and effective, even beyond 8 hours, despite longer procedure times and the need for adjuvant devices.

The neurological emergency room and prehospital stroke alert: the whole is greater than the sum of its parts.

BACKGROUND: Emergency medical services (EMS) prenotification to hospitals regarding the arrival of patients who have had a stroke is recommended to facilitate the workup once the patient arrives. Most hospitals have the patient enter the emergency department (ED) before obtaining a head computed tomography (CT) scan. At Capital Health, prehospital stroke-alert patients are delivered directly to CT and met by a neurological emergency team. The goal of bypassing the ED is to reduce the time to treatment. OBJECTIVE: To evaluate (1) door-to-CT and door-to-needle time in patients with an acute stroke who arrive as prehospital stroke alerts and (2) the accuracy of EMS assessment. METHODS: A prospective database of all prehospital stroke alert patients was kept and data retrospectively reviewed for patients who were seen between July 2012 and July 2013. RESULTS: Between July 2012 and July 2013, 141 prehospital stroke alerts were called to our emergency department, and the patients were stable enough to bypass the ED and go directly to CT. EMS assessment of stroke was accurate 66% of the time, and the diagnosis was neurological 89% of the time. The average time between patient arrival and acquisition of CT imaging was 11.8 minutes. Twenty-six of the 141 patients (18%) received intravenous tissue plasminogen activator. The median time from arrival to intravenous tissue plasminogen activator bolus was 44 minutes. CONCLUSION: Trained EMS responders are able to correctly identify patients who are experiencing neurological/neurosurgical emergencies and deliver patients to our comprehensive stroke center in a timely fashion after prenotification. The prehospital stroke alert protocol bypasses the ED, allowing the patient to be met in CT by the neurological ED team, which has proven to decrease door-to-CT and door-to-needle times from our historical means. ABBREVIATIONS: ASLS, Advanced Stroke Life SupportDTN, door-to-needleED, emergency departmentEMS, emergency medical servicesEMT, emergency medical technicianIV, intravenousMEND, Miami Emergency Neurological DeficitPHSA, prehospital stroke alerttPA, tissue plasminogen activator.

Prevalência e impacto da incontinência urinária na qualidade de vida de idosas institucionalizadas / Prevalence and impact of urinary incontinence on the quality of life of institutionalized elderly women

A incontinência urinária (IU) é definida como qualquer perda involuntária de urina. Acomete mulheres de várias faixas etárias e apresenta alta incidência em idosas, afetando de forma significativa a qualidade de vida. O objetivo deste estudo foi determinar a prevalência de IU em idosas institucionalizadas e verificar sua influência na qualidade de vida. A amostra foi composta por 40 idosas institucionalizadas dos municípios de Petrolina e Juazeiro que tinham idade igual ou superior a 60 anos. Inicialmente, foram coletadas informações sociodemográficas, ginecológicas e sobre a presença de IU. Em seguida, as idosas que relataram perda de urina responderam ao questionário específico King's Health Questionnaire (KHQ). A análise de dados foi feita por meio de estatística descritiva. A presença de IU foi referida por 47,50% das idosas. O domínio do KHQ que sofreu maior interferência na qualidade de vida foi o de percepção de saúde com 51,31%; nos outros domínios, o impacto da IU foi considerado baixo, mas na escala de sintomas as idosas relataram que a IU afeta mais ou menos ou muito sua vida. Foi possível concluir que é elevada a prevalência de IU em idosas institucionalizadas, e observar que muitas vezes essas mulheres convivem com estes sintomas como algo intrínseco ao envelhecimento, não percebendo o quanto afetam sua qualidade de vida.

Urinary incontinence(UI) is defined as anyinvoluntary loss ofurine.It affectswomenof all agesandhas high incidencein elderly women,significantly affectingthe qualityof life.Thisstudy aimed to determinethe prevalence ofUI ininstitutionalized elderly womenandverifytheir influence on the qualityof life.Thesample consisted of40institutionalized elderlywomen in the municipalities ofPetrolinaand Juazeirowho wereaged60 or more years. Initially,sociodemographic andgynecological information, and about the presenceof UI was collected.Then theelderlywomen who reportedloss of urineanswered thespecific King's HealthQuestionnaire (KHQ). Data analysiswas performed usingdescriptive statistics.The presenceof urinary incontinencewas reported by47.50% of the elderly women. The domainof the KHQthatsuffered the greatestinterfering withthe quality of lifewas theperceptionof health (51.31%); in the other domainsthe impact ofUIwas considered low, however in the scale ofsymptomspatients reportedthatUIaffects moreor lessor verymuch their lives. Itispossible to conclude thatthe prevalence ofUI ininstitutionalized elderly womenis high,and to observe thatoften these womenlive withsuch symptomsas intrinsicto aging,not realizinghow much their quality of life is affected.

Um estudo bibliométrico da produção científica: a interface entre a educação especial e a fonoaudiologia nas bases de dados da Biblioteca Virtual em Saúde (BVS) / A bibliometric study on scientific production: interface between Special Education and speech pathology in the Virtual Health Library (VHL) databases

A interdisciplinaridade compõe-se da relação de duas ou mais ciências que levam a um novo conhecimento, sendo assim, a intercecção da Educação Especial com a Fonoaudiologia torna-se relevante à medida que vislumbra um processo salutar de reflexão e avaliação do conhecimento produzido. A proposta do presente artigo implica em apresentar os resultados de uma pesquisa que objetivou uma análise da produção científica focada na interface entre a Educação Especial e a Fonoaudiologia por meio da análise bibliométrica. As unidades de análise contituíram-se pelas bases de dados da Biblioteca Virtual em Saúde. Os registros foram selecionados por um sistema de busca utilizando as palavras chaves Educação Especial e Fonoterapia, entendida aqui como intervenção da Fonoaudiologia, pontuada no campo de descritor de assunto e foram recuperados 140 registros. O estudo bibliométrico permite ressaltar que a interface entre a Educação Especial e a Fonoterapia, ocorre com maior freqüência nos Estados Unidos do que nos países da América Latina e do Caribe. Além de outros apontamentos, a interdisciplinaridade foi observada pela multiplicidade de enfoques ocorridos ao analisar as palavras-chave, que embora demarquem que a ciência fonoaudiológica também interage com as outras ciências.

Estomas: uma abordagem interdisciplinar / Stomas: a multidisciplinary approach

Desconhece-se no Brasil o número de pessoas portadoras de estomas, menos ainda, a repercussäo psico-social imputada a essses pacientes por näo terem acesso a um atendimento global de uma equipe interdisciplinar. Entende-se por atendimento global a orientaçäo recebida no período pré, per e pós operatório. Esta deve iniciar-se no pré-operatório afim de preparar o paciente fisica e emocionalmente para receber um estoma. No per operatório deve-se confeccionar um estoma ideal e posicionado adequadamente na parede abdominal. A orientaçäo no pós operatório imediato e mediato tem como objetivo preparar o paciente para o uso apropriado dos equipamentos e acessórios proporcionando a independência do paciente em seu auto-cuidado. O trabalho interdisciplinar, indispensável no atendimento do estomizado, deve a nosso ver buscar entre os membros das diversas equipes; médica, de enfermagem, de assistência social, nutricionista e de psicologia, coerência, coesäo, entendimento e um respeito profundo entre todos da equipe, pois participam com igual intensidade e importância nos diversos passos do atendimento global do estomizado. Com um atendimento global efetuado por uma equipe interdisciplinar preparada pode-se amenizar ou mesmo abolir os sofrimentos advindos das inabilidades decorrentes dos estomas. Cremos que a reintegraçäo física, sexual e social do portador de estoma depende diretamente do preparo da equipe e da convicçäo de que o estomizado pode ter uma vida normal e feliz...

Contribuiçäo da escova endocervical para a acuidade do teste de Papanicolaou: estudo em 26.519 pacientes / Contribution of the use of the cytobrush to the acuity of Papanicolaou tests: a study of 25.519 patients

O uso da escova para obtençäo de esfregaços citológicos em 26.519 pacientes revelou que 29 por cento das neoplasias cervicais intra-epiteliais situaram-se apenas ao nível do canal endocervical. Nestes casos, os elementos celulares diagnósticos näo foram detectados nos esfregaços escolhidos com a espátula de Ayre na ectocérvice. Na quase totalidade dos casos (90 por cento) em que a endocérvice e ectocérvice exibiram pré-neoplasias de graduaçäo diferente, os processos de maior gravidade foram diagnosticados na colheita endocervical com escova. Estes achados demonstram que a colheita com escova é imprescindível e necessariamente deve ser associada à espátula de Ayre na amostragem citológica do colo uterino