Ensaios clínicos randomizados sobre procedimentos de enfermagem registrados por enfermeiros no Brasil: estudo bibliométrico / Randomized clinical trials on nursing procedures recorded by nurses in Brazil: bibliometric study

Objetivo: Caracterizar os Ensaios Clínicos Randomizados sobre procedimentos de Enfermagem registrados por enfermeiros no Brasil. Métodos: Estudo bibliométrico, que aconteceu por meio do acesso à plataforma digital de Registro Brasileiro de Ensaios Clínicos entre os anos de 2010 e 2021, no qual foram incluídos 65 ensaios registrados por enfermeiros. A análise dos dados ocorreu com auxílio do software R. Resultados: Constatou-se aumento dos registros acerca dos procedimentos de enfermagem ao longo dos anos, em que a maioria das pesquisas foi oriunda da região Sudeste, por profissionais com titulação de doutor, vinculados a instituições públicas, e sobre a população estudada ocorreu predominância de pacientes. A maior parte dos estudos foi realizada na atenção secundária, com ênfase no procedimento de punção venosa e arterial. Conclusão: A caracterização dos ensaios clínicos randomizados sobre procedimentos de enfermagem pode contribuir para evidenciar os avanços e as lacunas das condutas desses profissionais na assistência à saúde. Verifica-se o crescimento no desenvolvimento de ensaios clínicos randomizados com o passar dos anos, no entanto sua incorporação à prática clínica ainda representa um desafio. Descritores: Ensaios Clínicos Controlados Aleatórios como Assunto; Cuidados de Enfermagem; Pesquisa em Enfermagem Clínica

Objective: To characterize the Randomized Clinical Trials on Nursing procedures registered by nurses in Brazil.Methods: Bibliometric study, which took place through access to the digital platform of the Brazilian Registry of Clinical Trials between the years 2010-2021, in which 65 trials registered by nurses were included. Data analysis occurred with the aid of the software R. Results: There was an increase in records about nursing procedures over the years, in which most of the research came from the southeast region, by professionals with PhD degree, linked to public institutions, and on the population studied there was a predominance of patients. Most studies were conducted in secondary care, with emphasis on venous and arterial puncture. Conclusion: The characterization of randomized clinical trials on nursing procedures can contribute to highlight the advances and gaps in the conduct of these professionals in health care. There is a growth in the development of randomized clinical trials over the years, so its incorporation into clinical practice still represents a challenge. Descriptors: Randomized Controlled Trials as Subject; Nursing care; Clinical Nursing Research

Marine heatwaves can limit the role of surfgrasses as biofilters for wastewaters.

Marine heatwaves (MHWs) can have detrimental effects on seagrasses, but knowledge about the impacts on their ecosystem services remains scarce. This work evaluated Phyllospadix scouleri (surgrass) as a biofilter for wastewater discharges, and how warming associated with MHW may affect this ecological function. The nitrogen uptake kinetics and assimilation abilities for ammonium, nitrate, and urea were examined under two different warming scenarios (single and repeated events) simulated in a mesocosm. N-uptake kinetics were related to urban sewage discharges close to surfgrass meadows. Our results revealed that surfgrasses can serve as effective biofilters because of their high nitrogen uptake rates and above-average canopy biomass. Nonetheless, exposure to both experimental warmings resulted in a significant decline in their ability to incorporate and assimilate nitrogen. Consequently, MHWs may reduce the capacity of surfgrasses to function as nitrogen sinks and green filters for sewage waters, jeopardizing their role as Blue Nitrogen systems.

Effectiveness and Cost of Stenting in Ureteral Injury in Colorectal Surgeries in the US: 2015 - 2019.

Background: Intraoperative ureteral injury (IUI) during colorectal surgery can have devastating consequences. This study aimed to assess the clinical and economic impact of pre-operative ureteral stenting in colorectal surgeries. Methods: A retrospective cohort study was conducted using United States hospital data (October 2015 - December 2019). IUI incidence was examined across selected inpatient surgery types (elective colectomy, enterectomy, proctectomy, enterostomy, other colorectal procedures; emergency colectomy). Stenting effectiveness was evaluated as the difference in IUI and intraoperative detection rates between propensity score-matched groups. The additional hospital cost for stenting was also estimated considering the savings from IUIs that were potentially avoidable or detected by stenting. Results: In total, 283,549 colorectal surgeries were analyzed. Across surgery types, stent use and IUI incidence ranged from 1.47% - 8.86% and from 0.91% - 2.90%, respectively. Stents were used in 6.75% of elective colectomy cases, where they were associated with an absolute reduction of 1.14 percentage points (95% CI: -1.85 to -1.03) in IUI rate and a 21.6 percentage point reduction in the intraoperative detection rate. Additional hospital costs for stenting ranged from $1,464 - $4,436 across surgery types. Additional results varied by case but were consistent with the colectomy example. Conclusions: While effective in limited settings, the IUI reduction attributed to stenting and ability to shift IUI detection to the intraoperative setting could not offset the hospital cost of stent placement during colectomy (and colorectal surgery, in general). There thus remains an ongoing need in colorectal surgery for a universal, cost-effective solution to prevent IUI.

Development of a mobile application for health education about sepsis.

OBJECTIVE: To develop and validate a mobile application for health education about sepsis. METHOD: Methodological study composed of two stages. Firstly, information from the Latin American Sepsis Institute and Global Sepsis Alliance was used, followed by putting together, design and layout of the application, according to the agile development model proposed by Sommerville. In the second stage, content validation occurred with 20 health professionals with expertise in the areas of intensive care and sepsis, from the use of the Instrument for Validation of Educational Content in Health through analyzing objectives, structure and relevance; and it was considered valid the item with a minimum agreement of 80%, by binomial test. RESULTS: The app presents 15 screens that encompass prevention measures, recognition and early identification of sepsis, illustrated by interactive images. Out of the 18 items evaluated in the validation process, the minimum agreement obtained was 0.95 and the average validation index was 0.99. CONCLUSION: The application was developed and considered valid by the referees regarding contents. Thus, it is an important technological resource for health education in prevention and early identification of sepsis.

Clinical factors for predicting cardiovascular risk, need for renal replacement therapy, and mortality in patients with non-dialysis-dependent stage 3-5 chronic kidney disease from the Salford Kidney Study.

BACKGROUND: Established cardiovascular risk assessment tools lack chronic kidney disease-specific clinical factors and may underestimate cardiovascular risk in non-dialysis-dependent chronic kidney disease (CKD) patients. METHODS: A retrospective analysis of a cohort of patients with stage 3-5 non-dialysis-dependent chronic kidney disease in the Salford Kidney Study (UK, 2002-2016) was performed. Multivariable Cox regression models with backward selection and repeated measures joint models were used to evaluate clinical risk factors associated with cardiovascular events (individual and composite cardiovascular major adverse cardiovascular events), mortality (all-cause and cardiovascular-specific), and need for renal replacement therapy. Models were established using 70% of the cohort and validated on the remaining 30%. Hazard ratios ([95% CIs]) were reported. RESULTS: Among 2192 patients, mean follow-up was 5.6 years. Cardiovascular major adverse cardiovascular events occurred in 422 (19.3%) patients; predictors included prior history of diabetes (1.39 [1.13-1.71]; P = 0.002) and serum albumin reduction of 5 g/L (1.20 [1.05-1.36]; P = 0.006). All-cause mortality occurred in 740 (33.4%) patients, median time to death was 3.8 years; predictors included reduction of estimated glomerular filtration of 5 mL/min/1.73 m2 (1.05 [1.01-1.08]; P = 0.011) and increase of phosphate of 0.1 mmol/L (1.04 [1.01-1.08]; P = 0.021), whereas a 10 g/L hemoglobin increase was protective (0.90 [0.85-0.95]; P < 0.001). In 394 (18.0%) patients who received renal replacement therapy, median time to event was 2.3 years; predictors included halving of estimated glomerular filtration rate (3.40 [2.65-4.35]; P < 0.001) and antihypertensive use (1.23 [1.12-1.34]; P < 0.001). Increasing age, albumin reduction, and prior history of diabetes or cardiovascular disease were risk factors for all outcomes except renal replacement therapy. CONCLUSIONS: Several chronic kidney disease-specific cardiovascular risk factors were associated with increased mortality and cardiovascular event risk in patients with non-dialysis-dependent chronic kidney disease.

Abdominopelvic Surgery: Intraoperative Ureteral Injury and Prophylaxis in the United States, 2015-2019.

INTRODUCTION: Preoperative ureteral catheterization/stenting (stenting) and intraoperative diagnostic cystoscopy (cystoscopy) may help prevent or identify intraoperative ureteral injuries (IUIs) during abdominopelvic surgery. In order to provide a comprehensive, single source of data for health care decision makers, this study aimed to catalog the incidence of IUI and rates of stenting and cystoscopy across a wide spectrum of abdominopelvic surgeries. METHODS: We conducted a retrospective cohort analysis of United States (US) hospital data (October 2015-December 2019). IUI rates and stenting/cystoscopy use were investigated for gastrointestinal, gynecological, and other abdominopelvic surgeries. IUI risk factors were identified using multivariable logistic regression. RESULTS: Among approximately 2.5 million included surgeries, IUIs occurred in 0.88% of gastrointestinal, 0.29% of gynecological, and 1.17% of other abdominopelvic surgeries. Aggregate rates varied by setting and for some surgery types were higher than previously reported, especially in certain higher-risk colorectal procedures. Prophylactic measures were generally employed at a relatively low frequency, with cystoscopy used in 1.8% of gynecological procedures and stenting used in 5.3% of gastrointestinal and 2.3% of other abdominopelvic surgeries. In multivariate analyses, stenting and cystoscopy use, but not surgical approach, were associated with a higher risk of IUI. Risk factors associated with stenting or cystoscopy, as well as those for IUI, largely mirrored the variables reported in the literature, including patient demographics (older age, non-White race, male sex, higher comorbidity), practice settings, and established IUI risk factors (diverticulitis, endometriosis). CONCLUSION: Use of stenting and cystoscopy largely varied by surgery type, as did rates of IUI. The relatively low use of prophylactic measures suggests there may be an unmet need for a safe, convenient method of injury prophylaxis in abdominopelvic surgeries. Development of new tools, technology, and/or techniques is needed to help surgeons identify the ureter and avoid IUI and the resulting complications.

Pesquisas cadastradas por enfermeiros no registro brasileiro de ensaios clínicos / Research registered by nurses in the brazilian registry of clinical trials / Investigación registrada por enfermeros en el registro brasileño de ensayos clínicos

Objetivo: Caracterizar os estudos de intervenção cadastrados por enfermeiros no Registro Brasileiro de Ensaios Clínicos. Métodos: Estudo descritivo, com abordagem quantitativa, realizado mediante acesso virtual ao Registro Brasileiro de Ensaios Clínicos, para busca dos estudos cadastrados na plataforma. Após leitura dos 3350 resumos disponíveis, os 320 cadastrados por enfermeiros foram selecionados para compor a amostra. Foi realizada a análise descritiva, no software R. Resultados: Foram encontrados estudos registrados entre 2010 e 2019, dos quais 49,7% localizavam-se na região Sudeste, 49,3% cadastrados por doutores, 46,3% filiados a universidades federais. A área da enfermagem mais estudada (18,8%) tratou-se de saúde do adulto, 72,9% possuíam dois braços, 53,1% com recrutamento concluído, 50,3% realizados com cegamento e o tipo de intervenções mais estudado (21,9%) foi a educativa. Conclusão: A maioria dos estudos de intervenção cadastrados por enfermeiros no Registro Brasileiro de Ensaios Clínicos testaram intervenções educativas, em adultos, possuíram cegamento e foram randomizados. (AU)

Objective: To characterize the intervention studies registered by nurses in the Brazilian Registry of Clinical Trials. Methods: Descriptive study, with quantitative approach, carried out through virtual access to the Brazilian Registry of Clinical Trials, to search for the studies registered on the platform. After reading the 3350 abstracts available, the 320 registered by nurses were selected to make up the sample. Descriptive analysis was performed in the software R. Results: Studies registered between 2010 and 2019 were found, of which 49.7% were in the Southeast region, 49.3% registered by doctors, 46.3% affiliated to federal universities. The most studied nursing area (18.8%) it was adult health, 72.9% had two arms, 53.1% with completed recruitment, 50.3% performed blinding and the most studied type of interventions (21.9%) was the educational. Conclusion: Most intervention studies registered by nurses in the Brazilian Registry of Clinical Trials tested educational interventions in adults, blinded and randomized. (AU)

Objetivo: Caracterizar los estudios de intervención registrados por enfermeros en el Registro Brasileño de Ensayos Clínicos. Métodos: Estudio descriptivo, con enfoque cuantitativo, realizado a través del acceso virtual al Registro Brasileño de Ensayos Clínicos, para buscar estudios registrados en la plataforma. Después de leer los 3350 resúmenes disponibles, los 320 registrados por enfermeros fueron seleccionados para componer la muestra. Se realizó análisis descriptivo en el software R. Resultados: Se encontraron estudios registrados entre 2010 y 2019, de los cuales el 49,7% se ubicaron en la región Sudeste, el 49,3% fueron registrados por médicos, el 46,3% fueron afiliados a universidades federales. El área de enfermería más estudiada (18,8 %) fue la salud del adulto, el 72,9 % tenía dos brazos, el 53,1 % había completado el reclutamiento, el 50,3 % estaba cegada y el tipo de intervenciones más estudiadas (21,9 %) fue la educativa. Conclusión: La mayoría de los estudios de intervención registrados por enfermeros en el Registro Brasileño de Ensayos Clínicos probaron intervenciones educativas en adultos, fueron ciegos y aleatorizados. (AU)

Preferences for Anaemia Treatment Attributes among Patients with Non-Dialysis-Dependent Chronic Kidney Disease.

INTRODUCTION: Information about patient preferences for the treatment of anaemia associated with chronic kidney disease (CKD) is scarce. Hence, our aim was to examine how patients with non-dialysis-dependent CKD valued attributes of alternative hypothetical anaemia treatments. METHODS: A discrete choice experiment (DCE) was conducted in adult patients who reported a clinical diagnosis of CKD-related anaemia. Treatment attributes included mode and frequency of administration, need for iron supplementation, risk of gastrointestinal side effects, risk of major cardiovascular events and impact on energy levels (as defined by the vitality section of the SF-6D health index). Logit models were used to analyse patients' preferences. RESULTS: The DCE was completed by 200 patients in four countries. Patients preferred an oral mode of administration. Patients were willing to tolerate a 5.1% (95% CI 2.0-8.3%) increase in the risk of a major cardiovascular event and an 11.7% (95% CI 5.0-18.5%) increase in the risk of gastrointestinal side effects to switch from an at-home subcutaneous injection administered once every 2 weeks to an at-home oral pill administered three times a week. Patients were willing to tolerate a 20.3% (95% CI 15.0-25.6%) increase in the risk of gastrointestinal side effects and an 8.9% (95% CI 6.1-11.7%) increase in the risk of a major cardiovascular event to transition from 'Sometimes having a lot of energy' to 'Always having a lot of energy'. CONCLUSIONS: Patients with non-dialysis-dependent CKD-related anaemia demonstrated clear treatment preferences and were willing to accept increased gastrointestinal or cardiovascular risks in exchange for more energy or an oral treatment.

Development of a mobile application for health education about sepsis / Desarrollo de una aplicación móvil para la educación en salud sobre sepsis / Desenvolvimento de aplicativo móvel para educação em saúde sobre sepse

ABSTRACT Objective: To develop and validate a mobile application for health education about sepsis. Method: Methodological study composed of two stages. Firstly, information from the Latin American Sepsis Institute and Global Sepsis Alliance was used, followed by putting together, design and layout of the application, according to the agile development model proposed by Sommerville. In the second stage, content validation occurred with 20 health professionals with expertise in the areas of intensive care and sepsis, from the use of the Instrument for Validation of Educational Content in Health through analyzing objectives, structure and relevance; and it was considered valid the item with a minimum agreement of 80%, by binomial test. Results: The app presents 15 screens that encompass prevention measures, recognition and early identification of sepsis, illustrated by interactive images. Out of the 18 items evaluated in the validation process, the minimum agreement obtained was 0.95 and the average validation index was 0.99. Conclusion: The application was developed and considered valid by the referees regarding contents. Thus, it is an important technological resource for health education in prevention and early identification of sepsis.

RESUMEN Objetivo: Desarrollar y validar una aplicación móvil para la educación sanitaria sobre la sepsis. Método: Estudio metodológico compuesto por dos etapas. En la primera, se utilizó información del Instituto Latinoamericano de Sepsis y de la Global Sepsis Alliance, seguida del montaje, diseño y diagramación de la aplicación, según el modelo de desarrollo ágil propuesto por Sommerville. En la segunda etapa, se realizó la validación del contenido con 20 profesionales de la salud expertos en las áreas de cuidados intensivos y sepsis, a partir del uso del Instrumento de Validación de Contenidos Educativos en Salud que analiza objetivos, estructura y relevancia y se consideró válido el ítem con un acuerdo mínimo de 80%, mediante prueba binomial. Resultados: La app presenta 15 pantallas que contemplan medidas de prevención, reconocimiento e identificación precoz de la sepsis, ilustradas por imágenes interactivas. De los 18 ítems evaluados en el proceso de validación, el acuerdo mínimo obtenido fue de 0,95 y el índice medio de validación fue de 0,99. Conclusión: La aplicación ha sido desarrollada y considerada válida en lo que respecta al contenido por los jueces. Por lo tanto, es un importante recurso tecnológico para la educación sanitaria en la prevención e identificación precoz de la sepsis.

RESUMO Objetivo: Desenvolver e validar aplicativo móvel para educação em saúde sobre sepse. Método: Estudo metodológico composto por duas etapas. Na primeira, foram utilizadas informações do Instituto Latino-Americano de Sepse e Global Sepsis Alliance, seguidos da montagem, design e layout do aplicativo, conforme modelo de desenvolvimento ágil proposto por Sommerville. Na segunda etapa, ocorreu a validação do conteúdo com 20 profissionais de saúde com expertise nas áreas de terapia intensiva e sepse, a partir da utilização do Instrumento de Validação de Conteúdo Educativo em Saúde que analisa objetivos, estrutura e relevância e foi considerado válido o item com concordância mínima de 80%, por teste binomial. Resultados: O aplicativo apresenta 15 telas que contemplam medidas de prevenção, reconhecimento e identificação precoce de sepse, ilustrados por imagens interativas. Dos 18 itens avaliados no processo de validação, a concordância mínima obtida foi 0,95 e o índice de validação médio foi 0,99. Conclusão: O aplicativo foi desenvolvido e considerado válido pelos juízes quanto ao conteúdo. Assim, consiste em importante recurso tecnológico para educação em saúde que contemple a prevenção e identificação precoce da sepse.

Competência profissional do enfermeiro na unidade de trauma / Professional competence of nurses in the trauma unit

Objetivo: Analizar la competencia profesional del personal de enfermería en la unidad de trauma. Metodología: Investigación cuantitativa, descriptiva y transversal, que fue desarrollada con 47 profesionales de enfermería. Este grupo se desempeñaba en cuatro sectores de riesgo de la unidad de trauma de un hospital público en el noreste de Brasil. Se aplicó un cuestionario validado sobre la competencia profesional del personal de enfermería en emergencias, compuesto por módulos y dominios, entre ellos variables sociodemográficas, formación profesional, caso ficticio y autoevaluación de las acciones diarias correspondientes a la realidad laboral. La recolección de datos se realizó de julio a septiembre de 2019. Para el análisis de datos, se utilizó estadística descriptiva, el software SPSS y la prueba de chi-cuadrado. Para verificar la significancia, se adoptó un valor de p<0.05. Resultados: Se observó que la mayoría de personas participantes eran del sexo femenino, especialistas y tenían más de una relación laboral. En cuanto a los dominios ''relaciones de trabajo'' y ''práctica profesional'', las personas participantes se autoevaluaron como ''muy competentes'' o ''extremadamente competentes'' en todas las acciones que retratan la realidad de trabajo en que están insertas. En el dominio ''excelencia profesional'', la acción ''participa periódicamente en simulación realista en emergencias'' fue la única evaluada como ''poco competente''. En el caso ficticio, en las tres declaraciones, más de la mitad de las personas participantes calificó el comportamiento de la persona profesional en enfermería como ''extremadamente competente'', ''muy competente'' o ''competente''. Conclusión: La mayoría de profesionales en enfermería no juzgaron correctamente las acciones realizadas por la persona enfermera en el caso ficticio, aunque se autoevaluaron como competentes en las acciones que realizan diariamente. Por lo tanto, el estudio plantea la necesidad de que el servicio invierta en educación permanente vinculada al compromiso profesional para garantizar una atención de alta calidad.

Objetivo: Analisar a competência profissional do enfermeiro na unidade de trauma. Metodologia: Pesquisa quantitativa, descritiva e transversal, desenvolvida com 47 enfermeiros que atuavam em quatro setores da unidade de trauma do hospital público no nordeste brasileiro. Aplicou-se questionário validado sobre a competência profissional do enfermeiro em emergências composto por variáveis sociodemográficas, de formação profissional, um caso fictício e autoavaliação das ações diárias correspondente à realidade do trabalho. A coleta de dados foi realizada nos meses de julho a setembro de 2019. Para análise dos dados, utilizou estatísticas descritivas, o software SPSS e teste do qui-quadrado, para verificar significância adotou-se valor de p<0,05. Resultados: Observou-se que a maioria dos enfermeiros eram do sexo feminino, especialistas e possuíam mais de um vínculo empregatício. Referente aos domínios ''Relações de Trabalho'' e ''Prática Profissional'', os enfermeiros se autoavaliaram como ''muito competente'' ou ''extremamente competente'' em todas as ações que retratam a realidade de trabalho na qual estavam inseridos. No domínio ''Excelência profissional'' a ação ''Participa de simulação realística em emergências periodicamente'' foi a única avaliada como ''pouco competente''. No caso fictício, nas três afirmativas, mais da metade dos enfermeiros julgaram como ''extremamente competente'', ''muito competente'' ou ''competente'' a conduta do enfermeiro no caso. Conclusão: A maioria dos enfermeiros não julgaram corretamente as ações realizadas pelo enfermeiro no caso fictício, mesmo se autoavaliando como competentes nas ações que desempenham diariamente. Sendo assim, o estudo levanta a necessidade do serviço de investir em educação permanente atrelado ao empenho profissional para garantir cuidados de alta qualidade.

Aim: To analyze the professional competence of nurses in trauma units. Methods: This was a quantitative, descriptive and cross-sectional study developed with 47 nurses who work in four areas of the trauma unit of a public hospital in the Northeast of Brazil. A validated Likert Scale questionnaire was applied to evaluate the professional competence of nurses during emergencies; this scale included sociodemographic variables, professional training, a fictitious case, and a self-assessment of daily activities related to the reality of work. The data collection was carried out from July to September 2019. To analyze the data, the researchers employed descriptive statistics or the SPSS software and a qui-square test to verify the significance using a p value of <0.05. Results: It was observed that the majority of the nurses were female specialists who had more than one employment relationship. Regarding the domains ''Work Relations'' and ''Professional Practice'', the nurses assessed themselves as ''highly competent'' or ''extremely competent'' in all the actions that portray the reality of work in which they are immersed. In the ''Professional Excellence'' domain, the action ''periodically participates in realistic simulation in emergencies'' was the only one evaluated as ''little competent''. In the fictitious case, across all three statements, more than half of the nurses rated the nurse's behavior in the case as ''extremely competent'', ''very competent'', or ''competent''. Conclusion: Most of the nurses do not correctly judge the actions performed by the nurse in a fictitious case, even when they self-assess themselves as competent in the actions they perform daily. The study also raises the need for the service to invest in permanent professional training endeavor to guarantee competent labor and high-quality care.

Posição prona: efetividade da intervenção educativa no processo assistencial intensivo / Prone position: effectiveness of educational intervention in the intensive care process / Posición prona: efectividad de la intervención educativa en el proceso de cuidados intensivos

Objetivo: avaliar a efetividade da intervenção educativa no processo assistencial intensivo, no nível de conhecimento da equipe de enfermagem acerca do posicionamento prono em pacientes com síndrome do desconforto respiratório agudo. Método: trata-se de um estudo quantitativo do tipo quase experimental, com amostragem de 62 profissionais de setor intensivo. Coletaram-se dados relativos à variável conhecimento dos profissionais durante fase pré e pós-intervenção educativa, durante uma semana, através da aplicação de formulários de múltipla escolha. Para análise dos dados e avaliação da efetividade de intervenção educativa utilizou-se estatística descritiva e testes de Kolmogorov-Smirnova e Shapiro Wilk para prova de normalidade e o teste T de student para comparação das médias obtidas. Resultados: nas fases de pré e pós-intervenção educativa, observou-se que a média de acertos pré-intervenção foi de 6,12 (dp= 2,15), t(61)=11,31 e p=0,000, enquanto na fase pós-intervenção 9,43 (dp= 0,76), t(61)=11,31 e p=0,000. Conclusão: constatou-se efetividade da intervenção educativa no processo assistencial intensivo a cerca do conhecimento dos profissionais de enfermagem sobre o posicionamento prono, visto significativo aumento do escore de acertos obtidos na fase de pós-intervenção. Sendo assim, a educação continuada em setores intensivos, torna-se essencial para fins de aperfeiçoamento dos profissionais. (AU)

Objective: To evaluate the effectiveness of educational intervention in the intensive care process, at the level of knowledge of the nursing team about the prone position in patients with acute respiratory distress syndrome. Methods: This is a quasi-experimental quantitative study, with a sample of 62 professionals from the intensive sector. Data was collected on the variable knowledge of professionals during the pre- and post-educational intervention phase, for a week, through the application of multiple choice forms. For data analysis and evaluation of the effectiveness of educational intervention, descriptive statistics and Kolmogorov-Smirnova and Shapiro Wilk tests were used to prove normality and the Student T test to compare the averages obtained. Results: When comparing the averages obtained in the pre and post educational intervention phases, it was observed that the average of correct answers before intervention was 6.12, while in the post intervention 9.43. Conclusion: The effectiveness of the educational intervention in the intensive care process was found to be about the knowledge of nursing professionals about the prone position, considering a significant increase in the score of correct answers obtained in the post intervention phase. Thus, continuing education in intensive sectors, becomes essential for the purposes of professional development. (AU)

Objetivo: Evaluar la efectividad de la intervención educativa en el proceso de cuidados intensivos, a nivel de conocimiento del equipo de enfermería sobre la posición prona en pacientes con síndrome de dificultad respiratoria aguda. Métodos: Se trata de un estudio cuantitativo cuasi-experimental, con una muestra de 62 profesionales del sector intensivo. Se recogieron datos sobre la variable conocimiento de los profesionales durante la fase de intervención pre y poseducativa, durante una semana, mediante la aplicación de formularios de opción múltiple. Para el análisis de datos y evaluación de la efectividad de la intervención educativa se utilizó estadística descriptiva y pruebas de Kolmogorov-Smirnova y Shapiro Wilk para comprobar la normalidad y la prueba T de Student para comparar los promedios obtenidos. Resultados: Al comparar los promedios obtenidos en las fases de intervención pre y poseducativa, se observó que el promedio de aciertos antes de la intervención fue de 6,12, mientras que en la intervención pos fue de 9,43. Conclusión: Se encontró que la efectividad de la intervención educativa en el proceso de cuidados intensivos se basa en el conocimiento de los profesionales de enfermería sobre la posición prona, considerando un aumento significativo en la puntuación de aciertos obtenidos en la fase posintervención. Así, la formación continua en sectores intensivos, se vuelve fundamental para los fines del desarrollo profesional. (AU)

Risk of suicide among nursing students.

OBJECTIVES: to identify the risk and degree of risk of suicide in nursing students of a public institution in the countryside of Pernambuco, Brazil. METHODS: this was a cross-sectional, quantitative research conducted with 150 students. For data collection, a sociodemographic questionnaire and the instrument, M.I.N.I. - Brazilian version 5.0.0 - Module C - Risk of suicide were used. Statistical analyses were performed with IBM(® )SPSS(®), version 23. RESULTS: 53.3% of nursing students had a risk of suicide, of which 20.7% had a high risk. Moreover, 22.67% reported previous suicide attempt. It is noteworthy that students without a partner have a higher risk of suicide (56.8%) than those with a partner (29.4%). CONCLUSIONS: it is perceived the need to develop programs that identify students at risk of suicide in higher education institutions, in order to raise awareness of the problem and implement policies to promote mental health in the academia.

Construction and validation of checklist for disinfecting ambulances to transport Covid-19 patients.

OBJECTIVE: To build and validate a checklist for disinfecting ambulances transporting patients with Covid-19. METHOD: Methodological study composed by the construction of a checklist and validation by 42 professionals, of which 35 professionals had expertise in patient transport/transfer and seven in hospital infection control. The item with a minimum agreement of 80% was considered valid, based on the Content Validation Index and binomial test. RESULTS: The checklist had the steps performed for terminal disinfection of ambulances. It had 54 items, which included the personal protective equipment and used materials, disinfection of the driver's cabin, equipment, and the patient care cabin. The minimum agreement obtained was 85% and the mean of the Content Validation Index was 0.96. CONCLUSION: The checklist was considered valid in terms of content and can be used to disinfect ambulances transporting patients with Covid-19.

The takeover of Thalassia testudinum by Anadyomene sp. at Biscayne Bay, USA, cannot be simply explained by competition for nitrogen and phosphorous.

Apart from direct light effects, we tested whether the takeover of the seagrass Thalassia testudinum by the seaweed Anadyomene sp. in high nutrient areas of Biscayne Bay, Florida, USA, is related to a faster nutrient surge uptake capacity of the seaweed and/or a negative effect on the seagrass uptake rates. Anadyomene sp. and T. testudinum showed a similar ammonium surge uptake capacity, but the seagrass performed better than the seaweed in mixed incubations at high ammonium concentrations. T. testudinum was faster than Anadyomene sp. at taking up pulses of phosphate, but the uptake rates of the seagrass were significantly decreased in the presence of the seaweed. The takeover of T. testudinum by Anadyomene sp. at Biscayne Bay is likely dominated by light and cannot be simply explained by their single or mixed nutrient surge uptake rates, but the phosphate availability and the seagrass uptake inhibition by the seaweed may also play a key role in the process.

Fatores associados aos óbitos e ataques de tubarão: um estudo transversal / Factors associated with shark attacks and deaths: a crosssectional study / Factores asociados con las muertes y los ataques de tiburones: estudio transversal

OBJETIVO: avaliar os fatores associados aos óbitos e ataques de tubarão no Brasil. MÉTODO: trata-se de um estudo transversal, quantitativo, realizado mediante acesso virtual ao website do Global Shark Attack File. A análise foi realizada no programa R, a partir de estatística descritiva e dos testes de Qui-quadrado de Pearson e Teste Exato de Fisher. RESULTADOS: ocorreram 86 ataques, dos quais 26 (30,2%) resultaram em óbito. Foi encontrada associação entre a ocorrência de ataque com o ano, estado, região, dia da semana, turno e espécie do tubarão, além da faixa etária, sexo da vítima e local do corpo acometido. Nenhuma variável apresentou associação com o óbito. O estado de Pernambuco computou o maior número de ataques (83,7%) e óbitos (96,2%). CONCLUSÃO: os ataques de tubarão estiveram associados com nove variáveis: três de caracterização da vítima e seis do perfil do acidente. Os óbitos não apresentaram associação significativa. Pernambuco sobressaiu como estado com maior ocorrência de ataque e óbitos.

OBJECTIVE: to evaluate the factors associated with shark attacks and deaths in Brazil. METHOD: this is a cross-sectional and quantitative study, carried out through virtual access to the Global Shark Attack File website. The analysis was performed in the R program, using descriptive statistics and the Pearson's chi-square and Fisher's exact tests. RESULTS: there were 86 attacks, of which 26 (30.2%) resulted in deaths. An association was found between occurrence of the attacks and year, state, region, day of the week, shift and shark species, in addition to the victim's age group and gender and to the part of the body affected. No variable was associated with death as outcome. The state of Pernambuco accounted for the largest number of attacks (83.7%) and deaths (96.2%). CONCLUSION: shark attacks were associated with nine variables: three related to the victim's characterization and six to the profile of the accident. The deaths did not present a significant association. Pernambuco stood out as the state with the highest occurrence of attacks and deaths.

OBJETIVO: evaluar los factores asociados con las muertes y los ataques de tiburones en Brasil. MÉTODO: se trata de un estudio transversal, cuantitativo, realizado a través del acceso virtual al sitio web Global Shark Attack File. El análisis se realizó mediante el programa R, utilizando estadística descriptiva y chi-cuadrado de Pearson y prueba exacta de Fisher. RESULTADOS: hubo 86 ataques, de los cuales 26 (30,2%) resultaron en muerte. Se encontró que hay asociación entre el ataque y el año, estado, región, día de la semana, turno y especie de tiburón, además del rango etario, sexo de la víctima y parte del cuerpo afectada. Ninguna variable se asoció con la muerte. El estado de Pernambuco tuvo el mayor número de ataques (83,7%) y muertes (96,2%). CONCLUSIÓN: los ataques de tiburones se asociaron con nueve variables: tres de la caracterización de la víctima y seis del perfil del accidente. Las muertes no mostraron una asociación significativa. Pernambuco se destacó como el estado con mayor número de ataques y muertes.

A psicologia na atenção básica: fortalecendo o vínculo com a comunidade / Psychology in primary care: strengthening the bond with the community / Psicología en atención primaria: fortalecer el vínculo con la comunidad

RESUMO A atenção básica é um conjunto de ações e intervenções de saúde realizadas por uma equipe multiprofissional que atua nas Unidades Básicas de Saúde (UBS) no contexto do Sistema Único de Saúde. Nesse sentido, relatou-se a experiência de práticas desenvolvidas pela Psicologia em uma UBS, durante o período de estágio curricular obrigatório, destacando as principais atividades realizadas. Como resultados, foram narradas as vivências com os grupos de cuidadores e de gestantes, sendo o último de maior adesão; a ação da campanha de prevenção ao suicídio e valorização da vida; e a realização do plantão psicológico que atendeu alguns usuários da Unidade. Por fim, destacou-se que é possível atuar com diferentes modalidades de ações que funcionam como dispositivos para a prevenção e a promoção de saúde da comunidade; e que as práticas da Psicologia precisam de consolidação no espaço da atenção básica, pois ainda caracterizam-se enquanto desafiadoras para os (futuros) profissionais.

ABSTRACT The primary health care is a set of actions and health interventions carried out by a multiprofessional team that works in the Health Certers (HC) in the context of the Unified Health System. Thus, the experience of practices developed by the Psychology in a HC, during the period of required curricular traineeship, highlighting the main activities performed. As results, the experiences with the groups of caregivers and expecting mothers were narrated, being the last one of greater adhesion; the action of the campaign of prevention to the suicide and valorization of the life; and the accomplishment of the psychological attendance that attended some users of the Unit. Finally, it was pointed out that it is possible to act with different modalities of actions that function as devices for the prevention and promotion of community health; and that the practices of Psychology need consolidation in the primary health care space, since they are still characterized as challenging for the (future) professionals.

RESUMEN La atención primaria es un conjunto de acciones e intervenciones de salud realizadas por un equipo multiprofesional que opera en las Unidades Básicas de Salud (UBS) en el contexto del Sistema Único de Salud. En este sentido, la experiencia de las prácticas desarrolladas por la Psicología en un UBS, durante el período de prácticas obligatorias, destacando las principales actividades realizadas. Como resultado, se narraron las experiencias con los grupos de cuidadores y mujeres embarazadas, siendo la última con la mayor adherencia; la acción de la campaña de prevención del suicidio y valorización de la vida; y el cumplimiento del deber psicológico que ayudó a algunos usuarios de la Unidad. Finalmente, se destacó que es posible actuar con diferentes modalidades de acciones que actúan como dispositivos para la prevención y promoción de la salud de la comunidad; y que las prácticas de Psicología necesitan consolidación en el espacio de la atención primaria, ya que todavía se caracterizan por ser un desafío para los (futuros) profesionales.

Risk of suicide among nursing students / Riesgo de suicidio entre estudiantes de enfermeira / Risco de suicídio entre estudantes de enfermagem

ABSTRACT Objectives: to identify the risk and degree of risk of suicide in nursing students of a public institution in the countryside of Pernambuco, Brazil. Methods: this was a cross-sectional, quantitative research conducted with 150 students. For data collection, a sociodemographic questionnaire and the instrument, M.I.N.I. - Brazilian version 5.0.0 - Module C - Risk of suicide were used. Statistical analyses were performed with IBM(® )SPSS(®), version 23. Results: 53.3% of nursing students had a risk of suicide, of which 20.7% had a high risk. Moreover, 22.67% reported previous suicide attempt. It is noteworthy that students without a partner have a higher risk of suicide (56.8%) than those with a partner (29.4%). Conclusions: it is perceived the need to develop programs that identify students at risk of suicide in higher education institutions, in order to raise awareness of the problem and implement policies to promote mental health in the academia.

RESUMEN Objetivos: identificar el riesgo y el grado de riesgo de suicidio en estudiantes de enfermería de una institución pública del interior de Pernambuco, Brasil. Métodos: una investigación transversal, cuantitativa, realizada con 150 estudiantes. Para la recolección de datos, un cuestionario sociodemográfico y el M.I.N.I. - versión brasileña 5.0.0 - Módulo C - Riesgo de suicidio. Los análisis estadísticos se realizaron en IBM (®) SPSS (®) , versión 23. Resultados: el 53,3% de los estudiantes de enfermería tenían riesgo de suicidio; de estos, el 20,7% estaban en alto riesgo. Además, el 22,67% informó de un intento de suicidio previo. Es de destacar que los estudiantes sin pareja tienen un mayor porcentaje de riesgo de suicidio (56,8%) que los que tienen pareja (29,4%). Conclusiones: existe la necesidad de desarrollar programas que identifiquen a los estudiantes en riesgo de suicidio en las instituciones de educación superior para generar conciencia sobre el problema e implementar políticas para promover la salud mental en la academia.

RESUMO Objetivos: identificar o risco e o grau de risco de suicídio em estudantes de enfermagem de uma instituição pública do interior de Pernambuco, Brasil. Métodos: tratou-se de uma pesquisa transversal, quantitativa, realizada com 150 estudantes. Para a coleta de dados utilizou-seum questionário sociodemográfico e o instrumento, M.I.N.I. - versão brasileira 5.0.0- Módulo C - Risco de Suicídio. As análises estatísticasforam realizadas no IBM® SPSS®, versão 23. Resultados: 53,3% dos estudantes de enfermagem apresentaram risco de suicídio; desses, 20,7% tinham alto risco. Ademais, 22,67% relataram tentativa de suicídio anterior. Destaca-se que os estudantes sem companheiro apresentam maior percentual de risco de suicídio (56,8%) do que os com companheiro (29,4%). Conclusões: percebe-se a necessidade do desenvolvimento de programas que identifiquem estudantes com risco de suicídio nas instituições de ensino superior, para a conscientização do problema e a implementação de políticas de promoção da saúde mental no meio acadêmico.

Reflections on comprehensive care in the ethnic-racial context: an integrating review. / Reflexões sobre o cuidado integral no contexto étnico-racial: uma revisão integrativa.

The objective of this article is to identify in the scientific literature affirmative care actions for the black population. This is an integrative review of the literature carried out in April 2017 at the Virtual Health Library (BVS), using LILACS (Latin American and Caribbean Literature in Health Sciences) and the Nursing Database (BDENF). Ten papers explored and shown in synoptic tables were used and analyzed through an instrument after taking into account the inclusion and exclusion criteria. Nine affirmative actions were listed to promote healthcare for the black population following the study of the papers. It is necessary, in both care and training spaces, to question the main demands against the context in which the black population is inserted, as well as the affirmative care actions for the black population to implement the principles of universality and integrality in health services to their full extent.

O objetivo deste artigo é identificar na literatura científica, as ações afirmativas de cuidado para população negra. Trata-se de uma revisão integrativa da literatura, realizada no mês de abril de 2017, na Biblioteca Virtual em Saúde, tendo como base de dados a LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e a Base de Dados de Enfermagem (BDENF). Após levar em consideração os critérios de inclusão e exclusão, foram utilizados e analisados através de um instrumento, dez artigos explorados e demonstrados em quadros sinópticos. Após o estudo dos artigos, foram elencadas nove ações afirmativas para promoção do cuidado à população negra no âmbito da saúde. Faz-se necessário, tanto nos espaços de cuidado, como nos de formação, problematizar sobre as principais demandas frente ao contexto em que a população negra está inserida, bem como as ações afirmativas de cuidado para população negra, de modo a efetivar os princípios da universalidade e da integralidade nos serviços de saúde em sua plenitude.

O acolhimento na rede de atenção psicossocial: estudo descritivo-exploratório / El acogimiento en la red de atención psicosocial: estudio descriptivo- exploratorio / Welcoming in the psychosocial care network: a descriptive-exploratory study

OBJETIVO: Descrever as práticas e estratégias de acolhimento aos usuários em processo de adoecimento mental desenvolvidas na Rede de Atenção Psicossocial. MÉTODO: Estudo descritivo, exploratório, qualitativo, realizado no período de dezembro de 2017 a fevereiro de 2018 com 10 profissionais de saúde dos serviços da Rede de Atenção Psicossocial de um município do Estado de Pernambuco. Os dados foram coletados através de entrevistas semiestruturadas, observação não participante e registros em diário de campo e analisados segundo a análise textual discursiva. RESULTADOS: As práticas de acolhimento predominantes foram a escuta qualificada, o estabelecimento de vínculo e o diálogo. Evidenciou-se consonância com a Política Nacional de Humanização e com o modelo de atenção psicossocial. CONCLUSÃO: A formação permanente permite que não sejam reproduzidas práticas vinculadas ao modelo biomédico. As ferramentas de escuta qualificada e diálogo são primordiais para conhecer a trajetória do usuário e, com isso, estabelecer um vínculo com o mesmo.

OBJETIVO: Describir las prácticas y estrategias del acogimiento a los usuarios con enfermedad mental, desarrolladas en la Red de Atención Psicosocial. MÉTODO: Estudio descriptivo, exploratorio, cualitativo, realizado en el período de diciembre de 2017 a febrero de 2018 con 10 profesionales de la salud, de los servicios de la Red de Atención Psicosocial de un municipio del estado de Pernambuco. Los datos fueron colectados a través de entrevistas semiestructuradas, observación no participativa y registros en diario de campo, analizados según un análisis textual discursivo. RESULTADOS: Las prácticas del acogimiento fueron: la escucha calificada, el establecimiento de un vínculo y un diálogo. Se demostró consonancia con la Política Nacional de Humanización y con el Modelo de Atención Psicosocial. CONCLUSIÓN: La formación permanente permite que no sean reproducidas practicas del modelo biomédico. La escucha calificada y el diálogo son primordiales para conocer la trayectoria del usuario y establecer un vínculo con él mismo.

OBJECTIVE To describe the welcoming practices and strategies implemented in the Psychosocial Care Network to individuals experiencing the process of mental illness. METHOD: A descriptive, exploratory, and qualitative study conducted from December 2017 to February 2018, with 10 healthcare professionals from the Psychosocial Care Network of a city in the State of Pernambuco. The data were collected by means of a semi-structured interviews, non-participating observation and field diary records, and analyzed according to discursive textual analysis. RESULTS: The predominant welcoming practices were qualified listening, bonding and dialogue. Consonance with the National Policy of Humanization and with the model of psychosocial attention was identified. CONCLUSION: Permanent education enables that practices related to the biomedical model are not reproduced. Qualified listening and dialogue are essential to know the patient's history and to establish a connection with him/her.

Nutrition of the seagrass Cymodocea nodosa: Pulses of ammonium but not of phosphate are crucial to sustain the species growth.

We investigated the nutrient acquisition of the seagrass Cymodocea nodosa and the importance of sediment to water column nutrient pulses, which regularly occur in coastal lagoons forced by incoming flood tides. Ammonium was preferentially taken up and accounted for 60-90% of the total daily N acquisition, whereas amino acid acquisition through belowground plant parts represented the second most important source of N, accounting 8-34%. The uptake of ammonium pulses increased dramatically the daily N acquisition from 9.5 mmol m-2 day-1 to 1.33 mmol m-2 day-1 at ambient nutrient concentrations, enabling the species to meet its N demand. Roots accounted for 96% of the total phosphate acquisition, with no evidence for P limitation. The ability of seagrasses to adapt to nutrient pulses may be an overlooked nutrition strategy common to many ecosystems where nutrient availability in the water column is low but nutrient pulses occur.