Assessment of the accuracy of the CALCULATE scale for pressure injury in critically ill patients.

INTRODUCTION: Pressure injury is damage to the skin and underlying soft tissue that occurs in response to intense and/or prolonged skin pressure. The Braden scale is the most used in health services to assess pressure injury. However, this scale was not specifically developed for critically ill patients. The Critical Care Pressure Ulcer Assessment Tool Made Easy (CALCULATE) scale was developed for patients in intensive care units. OBJECTIVE: The objective of this study was to compare the accuracy of the CALCULATE scale with that of Braden in predicting the risk of pressure injury in critically ill patients. METHODS: This was a prospective cohort study, involving patients who did not have pressure injury on admission to the intensive care unit of a tertiary hospital in the city of Porto Alegre, Brazil. Data collection took place between January and July 2020 using the Braden and CALCULATE scales, in addition to clinical and sociodemographic variables. Patients were followed up until discharge from the intensive care unit or death. RESULTS: Fifty-one patients were included in the study. Of these, 29 (56.9%) developed pressure injury. To predict pressure injury onset, the areas under the receiver operator characteristic curve of the Braden scale on the first day and the lowest score during the first 3 days were 0.71 (0.56-0.86) and 0.70 (0.53-0.87), respectively. The areas under the receiver operator characteristic curve of the CALCULATE scale on the first day and the highest score during the first 3 days were 0.91 (0.82-0.99) and 0.92 (0.85-1.00), respectively. In the logistic regression analysis, the CALCULATE scale on the first day remained an independent predictor of pressure injury onset after controlling for age and length of stay in the intensive care unit. CONCLUSION: We found that the CALCULATE scale may be more accurate than the Braden scale as a tool to assess the risk of developing pressure injury in critically ill patients.

Teaching and learning nursing management in the hospital context: an approach in the light of Pichon-Rivière.

OBJECTIVE: Analyze the articulation of students, professors (supervisors of the undergraduate practicum) and nursing professionals in teaching and learning nursing management at graduation in a public university hospital. METHOD: This is a study of qualitative approach, anchored in the operative group reference of Pichon-Rivière. Data collection was held between October 2013 and September 2014 and consisted of a self-administered questionnaire, participant observation and focus group. The information was submitted to thematic analysis. RESULTS: The thematic analysis of the corpus resulted in four themes: the unknown and the inevitable; in coming and going, attitudes, values and new bonding; the dialogue and ways of acting in the teaching/learning; the emergence of praxis. CONCLUSION: The articulation among students, supervisors and nursing professionals occurring in a coming and going of attitudes, values and new bonding, in which the dialogue enables ways of acting in the teaching/learning of nursing management in graduation, allowing the emergence of praxis.

Perception of users on self-care of lower leg ulcers. / Percepção do usuário no autocuidado de úlcera em membros inferiores.

OBJECTIVE: To know the perception of users on self-care of ulcers in the lower limbs. METHOD: This is a qualitative, exploratory, and descriptive study conducted with 10 users registered in the complementary programme of a wound care clinic in Canoas, RS, Brazil. Data were collected using information from the medical records of the users and semi-structured interviews conducted between October and November 2016. RESULTS: The results were discussed according to thematic content analysis with three thematic categories: self-care and living with the ulcer, self-care deficit and supporting users with ulcer, and self-care and the ulcer care network, based on the Nursing Self-Care Deficit Theory. CONCLUSIONS: Self-care is the result of dialogue between the user/nurse/health workers and the link they establish when they share care. The support of family members and the service can facilitate or limit care.

Subcutaneous perfusion before and during surgery in obese and nonobese patients.

Hypoxia at the surgical site impairs wound healing and oxidative killing of microbes. Surgical site infections are more common in obese patients. We hypothesized that subcutaneous oxygen tension (Psq O2) would decrease substantially in both obese and non-obese patients following induction of anesthesia and after surgical incision. We performed a prospective observational study that enrolled obese and non-obese surgical patients and measured serial Psq O2 before and during surgery. Seven morbidly obese and seven non-obese patients were enrolled. At baseline breathing room air, Psq O2 values were not significantly different (p = 0.66) between obese (6.8 kPa) and non-obese (6.5 kPa) patients. The targeted arterial oxygen tension (40 kPa) was successfully achieved in both groups with an expected significant increase in Psq O2 (obese 16.1 kPa and non-obese 13.4 kPa; p = 0.001). After induction of anesthesia and endotracheal intubation, Psq O2 did not change significantly in either cohort in comparison to levels right before induction (obese 15.5, non-obese 13.5 kPa; p = 0.95), but decreased significantly during surgery (obese 10.1, non-obese 9.3 kPa; p = 0.01). In both morbidly obese and non-obese patients, Psq O2 does not decrease appreciably following induction of anesthesia, but decreases markedly (∼33%) after commencement of surgery. Given the theoretical risks associated with low Psq O2 , future research should investigate how Psq O2 can be maintained after surgical incision.

[Offshore work and the work of nurses on board: an integrative review]. / Trabalho offshore e a atuação do enfermeiro embarcado: uma revisão integrative.

OBJECTIVE: To know the production of theoretical approaches on issues related to offshore work and the work of offshore nurses. METHOD: Integrative literature review conducted in the databases of LILACS, BDENF, MEDLINE, SciELO and Index PSI. RESULTS: We selected 33 studies published in national and international journals between 1997 and 2014. The thematic analysis corpus resulted in four central themes: offshore work environment; amid work adversities, an escape; structuring of offshore health and safety services; in search of safe practices. CONCLUSION: This study contributes to the offshore work of nurses in relation to the nature of work, acting amid adversities and the restless search for safe practices in the open sea.

Potentialities and difficulties in nursing education during the COVID-19 pandemic.

OBJECTIVE: To know the potentialities and difficulties in Nursing teaching during the COVID-19 pandemic, in Rio Grande do Sul (RS). METHOD: Cross-sectional study carried out with coordinators of 48 undergraduate Nursing courses in the state of RS, Brazil, between October 2020 and January 2021, using an electronic questionnaire sent to participants by email. Data analysis was performed using descriptive and inferential statistics. RESULTS: It was highlighted, as potentialities, the expansion in handling information and communication technologies (87.5%), increased creativity (79.2%) and diversification of methodologies (77.1%). As difficulties, the reduction of skills training (75.0%), less student/professor/colleagues interaction (70.8%) and reduction of interpersonal relationships (64.6%). CONCLUSION: If, on the one hand, difficulties were identified, such as the reduction of skills training and interpersonal relationships, on the other hand, potentialities related to new technologies and teaching methods signal disruptive and irreversible changes in Nursing education.

[Search by specialized training in occupational health nursing by nurses]. / A busca pela formação especializada em enfermagem do trabalho por enfermeiros.

This article examines and discusses the search for specialized formation in Occupational Health Nursing for nurses. This is an exploratory descriptive qualitative study whose data were analyzed using content analysis. Data collection took place in May, 2010 with nine students from a specialization course that agreed to participate. All participants signed a free and informed consent term. The search for specialized formation is governed by the perspective for professional practice in Occupational Health Nursing and specificity of the curriculum in occupational health. Interfaces of the educational process confirm important contributions to a solid formation, projects nursing to theorical/academic levels and sets a path for the Stricto Sensu formation. Expectations, motivations and potentialities contributes to a contextualized governance of the educational process and the contemporary demands for Occupational Health Nursing.

[Autonomy and the work of the nurse]. / Autonomia e trabalho do enfermeiro.

This is a qualitative, exploratory and descriptive study that aimed to describe nurses'perceptions on the autonomy they hold in the practice they work in. Ten nurses working in the hospital or primary care centers participated in the study. A semistructured interview was used to gather data. The data were analyzed using content analysis, which led to three thematic areas: nursing education, nursing work processes and interpersonal relations. The study highlights the importance that nurses and their personal stories have in organizing and directing nursing work processes, especially decision-making in a responsible autonomous action.

Performance of nurses/nursing team in the dispensing of materials for users of home care services.

OBJECTIVE: To contextualize the performance of nurses/nursing team in the dispensing of materials to assist users in home visits, in primary care. METHODS: Dialectical qualitative study conducted between March and April 2018 in which 24 nurses from primary health care units in the Gloria/Cruzeiro/Cristal District of Porto Alegre, Rio Grande do Sul, completed the self-administered questionnaire, whose data were treated by thematic content analysis. The study was approved by the Research Ethics Committee. RESULTS: Two categories emerged from the empirical corpus: logistic chain of material management for home user assistance; production of services and capacity of the team. CONCLUSION: The work processes related to materials management for home user assistance and the resulting health services production require a look at specificities such as workload and technologies involved, as they move the performance of the nurse/nursing staff.

Crossover comparison of the laryngeal mask supreme and the i-gel in simulated difficult airway scenario in anesthetized patients.

BACKGROUND: The single-use supraglottic airway devices LMA-Supreme (LMA-S; Laryngeal Mask Company, Henley-on-Thames, United Kingdom) and i-gel (Intersurgical Ltd, Wokingham, Berkshire, United Kingdom) have a second tube for gastric tube insertion. Only the LMA-S has an inflatable cuff. They have the same clinical indications and might be useful for difficult airway management. This prospective, crossover, randomized controlled trial was performed in a simulated difficult airway scenario using an extrication collar limiting mouth opening and neck movement. METHODS: Sixty patients were included. Both devices were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, and adverse events. RESULTS: Success rate for the LMA-S was 95% versus 93% for the i-gel (P = 1.000). LMA-S needed shorter insertion time (34 +/- 12 s vs. 42 +/- 23 s, P = 0.024). Tidal volumes and airway leak pressure were similar (LMA-S 26 +/- 8 cm H20; i-gel 27 +/- 9 cm H20; P = 0.441). Fiberoptic view through the i-gel showed less epiglottic downfolding. Overall agreement in insertion outcome was 54 (successes) and 1 (failure) or 55 (92%) of 60 patients. The difference in success rate was 1.7% (95% CI -11.3% to 7.6%). CONCLUSIONS: Both airway devices had similar insertion success and clinical performance in the simulated difficult airway situation. The authors found less epiglottic downfolding and better fiberoptic view but longer insertion time with the i-gel. Our study shows that both devices are feasible for emergency airway management in patients with reduced neck movement and limited mouth opening.

Long-term cognitive decline in older subjects was not attributable to noncardiac surgery or major illness.

BACKGROUND: Persistent postoperative cognitive decline is thought to be a public health problem, but its severity may have been overestimated because of limitations in statistical methodology. This study assessed whether long-term cognitive decline occurred after surgery or illness by using an innovative approach and including participants with early Alzheimer disease to overcome some limitations. METHODS: In this retrospective cohort study, three groups were identified from participants tested annually at the Washington University Alzheimer's Disease Research Center in St. Louis, Missouri: those with noncardiac surgery, illness, or neither. This enabled long-term tracking of cognitive function before and after surgery and illness. The effect of surgery and illness on longitudinal cognitive course was analyzed using a general linear mixed effects model. For participants without initial dementia, time to dementia onset was analyzed using sequential Cox proportional hazards regression. RESULTS: Of the 575 participants, 214 were nondemented and 361 had very mild or mild dementia at enrollment. Cognitive trajectories did not differ among the three groups (surgery, illness, control), although demented participants declined more markedly than nondemented participants. Of the initially nondemented participants, 23% progressed to a clinical dementia rating greater than zero, but this was not more common after surgery or illness. CONCLUSIONS: The study did not detect long-term cognitive decline independently attributable to surgery or illness, nor were these events associated with accelerated progression to dementia. The decision to proceed with surgery in elderly people, including those with early Alzheimer disease, may be made without factoring in the specter of persistent cognitive deterioration.

[National curriculum guidelines: perceptions of academics about their training in nursing]. / Diretrizes curriculares nacionais: percepções de acadêmicos sobre a sua formação em enfermagem.

The objective was to study the perceptions of nursing students about their education considering the National Curriculum Guidelines. This is an exploratory study with a qualitative approach, data were collected in March 2007 through semistructured interviews with ten senior students of the undergraduate course at the Federal University of Rio Grande do Sul, Brazil, and all study participants signed an Informed Consent. The data were analyzed using content analysis. The results showed an understanding of the students for their training and their close relationship as study participants with higher education, national curriculum guidelines for nursing, teaching project of the course, the profile of the egress and the curriculum. We conclude with an emphasis on curriculum and pedagogical project of the course as relevant to proper training, integrated and harmonized with the National Curricular Guidelines for Nursing.

[Violence and health professionals in primary health care]. / A violência e os profissionais da saúde na atenção primária.

The professionals who work on primary health care are affected by violence as they deal with very diverse patients. This exploratory descriptive study, with a qualitative approach, aimed at determining the situations in which primary health care professionals suffer aggressions. Data were collected in 2007, and included all members of a primary health care unit. Content analysis revealed seven categories of answers: work process in primary health care; health needs of the population; the risk of exposure to aggression, the aggressor; the types of aggression suffered; and the role of health management and health professionals in the primary health care context. The study showed the factors associated to risk of exposure to violence and its consequences, contributing with information and knowledge that may mitigate these events.

Potentialities and difficulties in nursing education during the COVID-19 pandemic / Potencialidades y dificultades en la educación de enfermería durante la pandemia de COVID-19 / Potencialidades e dificuldades na educação em enfermagem durante a pandemia de COVID-19

ABSTRACT Objective To know the potentialities and difficulties in Nursing teaching during the COVID-19 pandemic, in Rio Grande do Sul (RS). Method Cross-sectional study carried out with coordinators of 48 undergraduate Nursing courses in the state of RS, Brazil, between October 2020 and January 2021, using an electronic questionnaire sent to participants by email. Data analysis was performed using descriptive and inferential statistics. Results It was highlighted, as potentialities, the expansion in handling information and communication technologies (87.5%), increased creativity (79.2%) and diversification of methodologies (77.1%). As difficulties, the reduction of skills training (75.0%), less student/professor/colleagues interaction (70.8%) and reduction of interpersonal relationships (64.6%). Conclusion If, on the one hand, difficulties were identified, such as the reduction of skills training and interpersonal relationships, on the other hand, potentialities related to new technologies and teaching methods signal disruptive and irreversible changes in Nursing education.

RESUMEN Objetivo Conocer el potencial y las dificultades en la enseñanza de Enfermería durante la pandemia de COVID-19 en Rio Grande do Sul (RS). Método Estudio transversal realizado con coordinadores de 48 cursos de pregrado en enfermería en el estado de RS, Brasil, entre octubre de 2020 y enero de 2021, a través de un cuestionario electrónico enviado a los participantes vía correo electrónico. El análisis de los datos se realizó mediante estadística descriptiva e inferencial. Resultados Se destacó, como potencial, la expansión en la gestión de las tecnologías de la información y la comunicación (87,5%), el aumento de la creatividad (79,2%) y la diversificación de metodologías (77,1%). Como dificultades, la reducción de la formación de habilidades (75,0%), menor interacción alumno/profesor/compañeros (70,8%) y reducción de las relaciones interpersonales (64,6%). Conclusión Si por un lado se identificaron dificultades, como la reducción de la formación de habilidades y las relaciones interpersonales, por otro lado, las potencialidades relacionadas con las nuevas tecnologías y métodos de enseñanza señalan cambios disruptivos e irreversibles en la formación en enfermería.

RESUMO Objetivo Conhecer as potencialidades e dificuldades no ensino de Enfermagem durante a pandemia de COVID-19, no Rio Grande do Sul (RS). Método Estudo transversal, realizado junto a coordenadores de 48 cursos de graduação em Enfermagem do estado do RS, Brasil, entre outubro de 2020 e janeiro de 2021, por meio de questionário eletrônico, enviado aos participantes via e-mail. A análise dos dados ocorreu por meio de estatística descritiva e inferencial. Resultados Destacaram-se, como potencialidades, a ampliação no manejo das tecnologias de informação e comunicação (87,5%), aumento da criatividade (79,2%) e diversificação de metodologias (77,1%). Como dificuldades, a redução do treino de habilidades (75,0%), menor interação aluno/professor/colegas (70,8%) e redução das relações interpessoais (64,6%). Conclusão Se, por um lado, foram identificadas dificuldades, como a redução do treino de habilidades e das relações interpessoais, por outro, potencialidades relacionadas a novas tecnologias e métodos de ensino sinalizam alterações disruptivas e irreversíveis para o ensino de Enfermagem.

Educação permanente em lesões crônicas de pele: relato de experiência / Educación permanente en lesiones crónicas de la piel: relato de experiencia / Permanent education in chronic skin injuries: experience report

RESUMO Objetivo: relatar a experiência de Educação Permanente em Saúde, realizada por meio de ações de extensão por profissionais, docentes e estudantes de Enfermagem, sobre lesões crônicas de pele, de 2017 a 2020, com profissionais de Enfermagem em uma parceria entre a Escola de Enfermagem da Universidade Federal do Rio Grande do Sul e a Secretaria Municipal de Saúde de Porto Alegre, Rio Grande do Sul, Brasil. Método: relato de experiência que descreve quatro ações extensionistas. Os resultados foram correlacionados à política pública de Educação Permanente em Saúde. Resultados: ações desenvolvidas por meio de extensão universitária proveram a elaboração e a edição de cartilha de autocuidado das pessoas com úlceras de perna e de orientações sobre lesões de pele aos profissionais de Enfermagem. As cartilhas foram impressas e divulgadas em oficinas educativas, constituindo-se em forma de Educação Permanente em Saúde na Atenção Primária à Saúde, contemplando 64 trabalhadores, em 2018, e 171, em 2019. Em 2020, em função da pandemia, o curso foi ofertado de forma virtual, na plataforma Moodle, por meio de webconferências e postagem de trabalhos, abrangendo 135 profissionais de Enfermagem. Considerações Finais: as experiências relatadas e a lacuna de desenvolvimento informada como necessária à qualificação dos profissionais de Enfermagem destacaram a necessidade de Educação Permanente em Saúde para potencializar a autonomia dos profissionais de Enfermagem no cuidado de pessoas com lesões crônicas de pele na medida em que eles se constituem protagonistas do cuidado.

RESUMEN Objetivo: relatar la experiencia de Educación Permanente en Salud, realizada por medio de acciones de extensión por profesionales, docentes y estudiantes de Enfermería, sobre lesiones crónicas de la piel, de 2017 a 2020, con profesionales de Enfermería en una asociación entre la Escuela de Enfermería de la Universidad Federal de Rio Grande do Sul y la Secretaría Municipal de Salud de Porto Alegre, Rio Grande do Sul, Brasil. Método: relato de experiencia que describe cuatro acciones extensionistas. Los resultados fueron correlacionados a la política pública de Educación Permanente en Salud. Resultados: acciones desarrolladas por medio de extensión universitaria proporcionaron la elaboración y la edición de cartilla de autocuidado de las personas con úlceras de pierna y de orientaciones sobre lesiones de piel a los profesionales de Enfermería. Las cartillas fueron impresas y divulgadas en talleres educativos, constituyéndose en forma de Educación Permanente en Salud en la Atención Primaria a la Salud, contemplando 64 trabajadores, en 2018, y 171, en 2019. En 2020, por cuenta de la pandemia, el curso fue ofrecido de forma virtual, en la plataforma Moodle, por medio de webconferencias y publicación de trabajos, abarcando 135 profesionales de Enfermería. Consideraciones Finales: las experiencias relatadas y la laguna de desarrollo informada como necesaria para la cualificación de los profesionales de Enfermería destacaron la necesidad de Educación Permanente en Salud para potenciar la autonomía de los profesionales de Enfermería en el cuidado de personas con lesiones crónicas de la piel en la medida en que se constituyen protagonistas del cuidado.

ABSTRACT Objective: to report the experience of Continuing Education in Health carried out through extension actions by nursing professionals, professors, and students, on chronic skin lesions, from 2017 to 2020, with nursing professionals in a partnership between the School of Nursing of the Federal University of Rio Grande do Sul and Porto Alegre Municipal Health Department, Rio Grande do Sul, Brazil. Method: experience report that describes four extension actions. The results were correlated to the public policy of Permanent Education in Health Results: actions developed through university extension provided the elaboration and edition of a self-care booklet for people with leg ulcers and guidance on skin lesions for nursing professionals. The booklets were printed and disseminated in educational workshops, constituting the form of Permanent Health Education in Primary Health Care, covering 64 workers in 2018 and 171 in 2019. In 2020, due to the pandemic, the course was offered from virtual form, on the Moodle platform, through web conferences and posting of works, covering 135 nursing professionals. Final Considerations: the experiences reported, and the development gap reported as necessary for the qualification of nursing professionals highlighted the need for Permanent Education in Health to enhance the autonomy of nursing professionals in the care of people with chronic skin lesions, as they become protagonists of care.

A prática interprofissional e a formação dos profissionais de saúde: uma revisão integrativa / Interprofessional practice and training of health professionals: an integrative review

Objetivo: conhecer o que vem sendo escrito sobre a vivência prática e a formação, na atenção primária brasileira, sobre interprofissionalidade. Método: revisão integrativa de literatura a partir das bases de dados: LILACS, BDENF e BBO. Os descritores utilizados foram "educação interprofissional", "relações interprofissionais", "comportamento cooperativo", "equipe de saúde" e "educação profissional" combinados com o operador booleano 'AND'. O período de busca foi de janeiro de 2015 até dezembro de 2019. Resultados: selecionados 31 artigos que apresentam a Educação Interprofissional nas vivências de práticas e formação em saúde. Conclusão: o ensino interprofissional e o trabalho colaborativo rompem o ensino e a prática instituída em nossa realidade e busca novos modos de atenção e formação em saúde. Entretanto, para essas mudanças, novas iniciativas curriculares devem ser pensadas e, pelo que se constatou, o processo de ensino colaborativo deve ser feito do início ao fim da formação acadêmica. Nos serviços, a realização de espaços de diálogo e reflexão precisa ser estabelecido, não por decisões legais, mas por espaços de integração e compartilhamento. As experiências apresentadas apontam iniciativas e avaliações positivas, entre elas as mais citadas são as Residências Multiprofissionais e o PET-Saúde, entretanto, revelam fragilidades na formação docente e nas preceptorias dos serviços e em sua estrutura, apontando caminhos a seguir. Os usuários foram pouco investigados nos estudos. A lógica colaborativa certamente se fortalece a partir do Sistema Único de Saúde, das universidades, dos estudantes e dos usuários e, consequentemente, fortificam um país.

Formação de enfermeiros durante a pandemia de COVID-19 no extremo sul do Brasil: estudo transversal / Training of nurses during the COVID-19 pandemic in southernmost Brazil: a cross-sectional study / Formación de enfermeras durante la pandemia de COVID-19 en el extremo sur de Brasil: estudio transversal / Training of nurses during the COVID-19 pandemic in southernmost Brazil: a cross-sectional study

Objetivos: identificar as estratégias adotadas para a continuidade da formação de enfermeiros durante a pandemia de COVID-19. Métodos: estudo transversal, realizado com coordenadores de curso de graduação em Enfermagem do Rio Grande do Sul, Brasil, e coleta de dados on-line, entre novembro de 2020 e março de 2021. Resultados: participaram 48 coordenadores; as Instituições de Ensino Superior adotaram o Ensino Remoto Emergencial no tempo médio de 26,9 dias após a determinação do distanciamento social e a mediana 45 dias em relação aos Estágios Obrigatórios, sendo que em 2020/1 81,3% das instituições mantiveram alunos nesta atividade e em 2020/2 o número passou para 85,4%. A supervisão direta, nos estágios, foi realizada em 50% das instituições. Como auxílio aos estudantes, destacaram-se o acesso a plataformas e biblioteca digital, e acesso assíncrono ao conteúdo. Conclusão e implicações para a prática: as estratégias para a continuidade do ensino incluíram a adoção de estratégia on-line, a retomada de estágios curriculares, a redução do número de alunos por grupo nas aulas práticas e a disponibilização de auxílio aos estudantes. O presente estudo identificou iniciativas que garantiram o ensino de Enfermagem no contexto pandêmico; há necessidade de novas investigações que avaliem o impacto de tais medidas na qualidade do ensino

Objectives: To identify the strategies adopted to proceed to education nursing during the COVID-19 pandemic. Methods: A cross-sectional study was carried out with coordinators of undergraduate nursing programs in the Rio Grande do Sul, Brazil. Data collection was carried out online between November 2020 and March 2021. Results: A total of 48 coordinators participated. Higher Education Institutions adopted Emergency Remote Education in an average time of 26.9 days after determining social distance and the median of 45 days concerning mandatory internships. In 2020/1, 81.3% of institutions kept students in this activity, and in 2020/2, the number increased to 85.4%. Direct supervision was carried out in 50% of institutions in internships. Access to platforms and digital libraries and asynchronous access to content stood out as an aid to students. Conclusion and implications for practice: Strategies for continuity of teaching included adopting an online strategy, resumption of curricular internships, reducing the number of students per class in practical classes, and student aid. The present study involved the identification of initiatives that ensured nursing education in the context of the pandemic, encouraging the need for new investigations that focus on assessing the impact of such measures on education quality

Objetivos: identificar las estrategias adoptadas para continuar la formación de enfermeras durante la pandemia de COVID-19. Métodos: estudio transversal, realizado con coordinadores de cursos de pregrado en Enfermería en Rio Grande do Sul, Brasil, y recolección de datos en línea, entre noviembre de 2020 y marzo de 2021. Resultados: de un total de 48 coordinadores participantes, se identificó que las Instituciones de Educación Superior adoptaron Educación Remota de Emergencia en un tiempo promedio de 26,9 días después de la determinación del distanciamiento social y la mediana de 45 días en relación a las Pasantías Obligatorias. En 2020/1, el 81,3% de las instituciones tenían alumnos en esta actividad y, en 2020/2, el 85,4%. La supervisión directa, en pasantías, se realizó en el 50% de las instituiciones. Como ayuda a los estudiantes se destacó el acceso a plataformas y biblioteca digital, y el acceso asincrónico a contenidos. Conclusión e implicaciones para la práctica: Las estrategias para la continuidad de la docencia incluyeron la adopción del formato enlínea, la reanudación de las prácticas curriculares, la reducción del número de alumnos por clase en las clases prácticas y la asistencia al alumno. El presente estudio implicó la identificación de iniciativas que garantizaron la formación en Enfermería en el contexto de la pandemia, incentivando la necesidad de nuevas investigaciones que se centren en evaluar el impacto de tales medidas en la calidad de la educación.

Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study.

BACKGROUND: Many orthopaedic surgical procedures can be performed with either regional or general anesthesia. We hypothesized that total hip arthroplasty with regional anesthesia is associated with less postoperative morbidity and mortality than total hip arthroplasty with general anesthesia. METHODS: This retrospective propensity-matched cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database included patients who had undergone total hip arthroplasty from 2007 through 2011. After matching, logistic regression was used to determine the association between the type of anesthesia and deep surgical site infections, hospital length of stay, thirty-day mortality, and cardiovascular and pulmonary complications. RESULTS: Of 12,929 surgical procedures, 5103 (39.5%) were performed with regional anesthesia. The adjusted odds for deep surgical site infections were significantly lower in the regional anesthesia group than in the general anesthesia group (odds ratio [OR] = 0.38; 95% confidence interval [CI] = 0.20 to 0.72; p < 0.01). The hospital length of stay (geometric mean) was decreased by 5% (95% CI = 3% to 7%; p < 0.001) with regional anesthesia, which translates to 0.17 day for each total hip arthroplasty. Regional anesthesia was also associated with a 27% decrease in the odds of prolonged hospitalization (OR = 0.73; 95% CI = 0.68 to 0.89; p < 0.001). The mortality rate was not significantly lower with regional anesthesia (OR = 0.78; 95% CI = 0.43 to 1.42; p > 0.05). The adjusted odds for cardiovascular complications (OR = 0.61; 95% CI = 0.44 to 0.85) and respiratory complications (OR = 0.51; 95% CI = 0.33 to 0.81) were all lower in the regional anesthesia group. CONCLUSIONS: Compared with general anesthesia, regional anesthesia for total hip arthroplasty was associated with a reduction in deep surgical site infection rates, hospital length of stay, and rates of postoperative cardiovascular and pulmonary complications. These findings could have an important medical and economic impact on health-care practice.