Clinical virtual simulation: predictors of user acceptance in nursing education.

BACKGROUND: Using virtual patients integrated in simulators expands students' training opportunities in healthcare. However, little is known about the usability perceived by students and the factors/determinants that predict the acceptance and use of clinical virtual simulation in nursing education. OBJECTIVES: To identify the factors/determinants that predict the acceptance and use of clinical virtual simulation in learning in nursing education. METHODS: Observational, cross-sectional, analytical study of the use of clinical virtual simulation in nursing to answer the research question: What factors/determinants predict the acceptance and use of a clinical virtual simulator in nursing education? We used a non-probabilistic sampling, more specifically a convenience sample of nursing degree students. The data were collected through a questionnaire adapted from the Technology Acceptance Model 3. In technology and education, the Technology Acceptance Model is a theoretical model that predicts the acceptance of the use of technology by users. RESULTS: The sample comprised 619 nursing students, who revealed mean values of perceived usefulness (M = 5.34; SD = 1.19), ease of use (M = 4.74; SD = 1.07), and intention to use the CVS (M = 5.21; SD = 1.18), in a Likert scale of seven points (1-the worst and 7 the best possible opinion). This study validated the use of Technology Acceptance Model 3 adapted and tested the related hypotheses, showing that the model explains 62% of perceived utility, 32% of ease of use, and 54% of intention to use the clinical virtual simulation in nursing by nursing students. The adequacy of the model was tested by analysis of the direct effects of the relationships between the internal constructs (PU-BI, ß = 0.11, p = 0.012; PEOU-BI, ß = -0.11, p = 0.002) and the direct relations between some of the constructs internal to the Technology Acceptance Model 3 and the external determinants Relevance for learning and Enjoyability. In the proposed model, the external constructs that best predicted perceived usefulness, ease of use, and behaviour intention to use the clinical virtual simulation in nursing were Relevance for learning and Enjoyability. CONCLUSIONS: These study results allowed us to identify relevance for learning and enjoyability as the main factors/determinants that predict the acceptance and use of clinical virtual simulation in learning in nursing.

US for Evaluation of Acute Abdominal Conditions in Neonates.

US is the imaging modality of choice for evaluation of a variety of abdominal conditions, and in recent years it has also become useful and promising as a bedside technique for assessment of acute abdominal conditions in neonates. Bedside US can help, complement, and sometimes replace radiographic or contrast-enhanced studies in critically ill and labile neonates who are difficult to transport to the fluoroscopy suite. Some of the features of bedside US can be applied as point-of-care US (POCUS) of the sick neonate. Some of the abdominal conditions in neonates that can be assessed and monitored with bedside US are necrotizing enterocolitis and its complications, malrotation with a midgut volvulus, segmental volvulus, meconium peritonitis, and complicated inguinal hernia. High-resolution US with the use of 15-MHz and higher-frequency probes allows characterization of the bowel anatomy and features of intestinal abnormalities in neonates in fine detail. Color Doppler US and microvascular imaging improve accuracy in the detection and characterization of bowel vascularity, which is important in the treatment and follow-up of patients with intestinal conditions. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. The slide presentation from the RSNA Annual Meeting is available for this article.

Omphalomesenteric Duct Anomalies in Children: A Multimodality Overview.

The omphalomesenteric duct is an embryologic structure that connects the yolk sac with the primitive midgut of the developing fetus. Omphalomesenteric duct anomalies include a group of entities that result from failed resorption of the omphalomesenteric duct. These anomalies include Meckel diverticulum, omphalomesenteric fistula, fibrous bands, cysts, and umbilical polyps. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually asymptomatic. Symptoms develop when Meckel diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. Hemorrhage is the most common complication of Meckel diverticulum, and technetium 99m-pertechnetate scintigraphy is the imaging modality of choice for detecting acute bleeding. US and CT are commonly used for the evaluation of patients with other complications such as obstruction and inflammation. Nevertheless, the diagnosis of these complications can be challenging, as their clinical manifestations are usually nonspecific and can masquerade as other acute intraabdominal entities such as appendicitis, inflammatory bowel disease, or other causes of bowel obstruction. There are other umbilical disorders, such as urachal remnants and umbilical granuloma, that may present with symptoms and imaging findings similar to those of omphalomesenteric duct anomalies. An accurate preoperative diagnosis of omphalomesenteric duct anomaly is crucial for appropriate management and a better outcome, particularly when these anomalies manifest as a life-threatening condition. The authors review the anatomy, clinical features, and complications of omphalomesenteric duct anomalies in children, describing the relevant differential diagnoses and associated imaging findings seen with different imaging modalities. ©RSNA, 2021.

Mobile Application as a Learning Aid for Nurses and Nursing Students to Identify and Care for Stroke Patients: Pretest and Posttest Results.

Cerebrovascular accident is a serious public health problem and requires the attention of professionals who can detect, diagnose, and provide care in a timely fashion. A quantitative quasi-experimental study was conducted using a mobile app called mSmartAVC for clinical evaluation of nursing care at the bedside. The study aimed at measuring the knowledge of nurses and nursing students in the detection and care of cerebrovascular accident. In this study, a total of 115 nurses from health services in the South of Brazil and 35 nursing students of a community university participated. The stages focused on development, modeling of clinical cases, problem-based learning, pretest (before) app use, and posttest (after) use of the app. The results of the pretest and posttest corrections showed a substantial statistical difference (P < .001), indicating a significant knowledge gain after the use of the app, particularly in terms of the detection scales and interpretation of the imaging tests. The mSmartAVC app used at the bedside supported decision-making for detection and nursing care. It was possible to confirm that the use of mobile apps plays an essential role as a learning tool for nurses and nursing students.

Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology.

BACKGROUND: We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in 'real-world' settings. METHODS: We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006-2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). RESULTS: We assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54-1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35-0.98; 3500 patients). CONCLUSIONS: The whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI.

Discovering the importance of health informatics education competencies in healthcare practice. A focus group interview.

BACKGROUND: As healthcare and especially health technology evolve rapidly, new challenges require healthcare professionals to take on new roles. Consequently, the demand for health informatics competencies is increasing, and achieving these competencies using frameworks, such as Technology Informatics Guiding Reform (TIGER), is crucial for future healthcare. AIM: The study examines essential health informatics and educational competencies and health informatics challenges based on TIGER Core Competency Areas. Rather than examine each country independently, the focus is on uncovering commonalities and shared experiences across diverse contexts. METHODS: Six focus group interviews were conducted with twenty-one respondents from three different countries (Germany (n = 7), Portugal (n = 6), and Finland (n = 8)). These interviews took place online in respondents' native languages. All interviews were transcribed and then summarized by each country. Braun and Clarke's thematic analysis framework was applied, which included familiarization with the data, generating initial subcategories, identifying, and refining themes, and conducting a final analysis to uncover patterns within the data. RESULTS: Agreed upon by all three countries, competencies in project management, communication, application in direct patient care, digital literacy, ethics in health IT, education, and information and knowledge management were identified as challenges in healthcare. Competencies such as communication, information and communication technology, project management, and education were identified as crucial for inclusion in educational programs, emphasizing their critical role in healthcare education. CONCLUSIONS: Despite working with digital tools daily, there is an urgent need to include health informatics competencies in the education of healthcare professionals. Competencies related to application in direct patient care, IT-background knowledge, IT-supported and IT-related management are critical in educational and professional settings are seen as challenging but critical in healthcare.

Impact of the COVID-19 pandemic on percutaneous coronary interventions in Portugal.

INTRODUCTION: The COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity. OBJECTIVES: To quantify and compare the number of percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years. METHODS: Data on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017-2019). RESULTS: The total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (-36%, p<0.001). The reduction in PCI procedures for STEMI, NSTE-ACS and CCS was, respectively, -25% (p<0.019), -20% (p<0.068) and -59% (p<0.001). CONCLUSIONS: Compared with the corresponding period in the previous three years, the number of PCI procedures performed for STEMI and CCS decreased markedly during the first wave of the COVID-19 pandemic in Portugal.

Terms of specialized nursing language in the care of the newborn with central venous catheter.

OBJECTIVE: To construct and validate a specialized nursing terminology for the care of newborns with peripherally inserted central venous catheters (PICC), based on the Betty Neuman Systems Model. METHODS: Methodological study, carried out in a public maternity hospital, operationalized by the steps: extraction of terms from medical records of neonates using PICC; normalization; cross-mapping with the 2019/2020 version of ICNP®; organization in the Seven Axes; and content validation with nurses using content validity index and kappa coefficient. RESULTS: 1,718 terms were extracted, and 372 relevant terms were normalized, with 265 constants and 107 non-constants. A total of 335 terms were validated, 246 of which were constant and 89 were not constant, which reached an agreement index and kappa ≥ 0.80. CONCLUSION: Relevant terms were identified, which aid newborns using central venous catheters; thus, a terminological subset will be contributed to information in nursing practice.

The eHealth4all@eu Pipeline of Course Development: TIGER Recommendations in Action.

This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.

Nursing knowledge of people with paresis of voluntary muscles: a living scoping review protocol.

OBJECTIVE: This review aims to continuously map the nursing knowledge about people with paresis of voluntary muscles in any context of care. INTRODUCTION: Muscle paresis is a condition that significantly impacts quality of life. Nurses have a crucial role in managing this condition, particularly paresis of voluntary movement muscles. However, nursing knowledge about patients with paresis of voluntary muscles is dispersed, hampering the integration of evidence within the structure of information systems. Mapping how the nursing process components are identified is the first step in creating a Nursing Clinical Information Model for this condition, capable of integrating evidence into information systems. INCLUSION CRITERIA: This scoping review will consider studies focusing on the nursing process regarding people with paresis of voluntary muscles in all care contexts. The review will include quantitative, qualitative, and mixed-methods study designs, systematic reviews, clinical guidelines, dissertations, and theses. METHODS: The review process will follow JBI's scoping review guidance, as well as the Cochrane Collaboration's guidance on living reviews. Screening of new literature will be performed regularly, with the review being updated according to new findings. The search strategy will map published and unpublished studies. The databases to be searched will include MEDLINE, CINAHL, Scopus, JBI Evidence Synthesis , and the Cochrane Central Register of Controlled Trials. Searches for unpublished studies will include OpenGrey and Repositorios Científicos de Acesso Aberto de Portugal. Studies published in English and Portuguese from 1975 will be considered for inclusion. REGISTRATION: Open Science Framework: https://osf.io/d7c9g/.

Nursing knowledge on skin ulcer healing: a living scoping review protocol.

OBJECTIVE: This review aims to continuously map the nursing knowledge on skin ulcer healing in any context of care. INTRODUCTION: Chronic wounds are an increasing concern for society and health care providers. Pressure ulcers and venous ulcers, among others, have devastating effects on morbidity and quality of life and require a systematic approach. The nursing process is an important method that allows a better organization and overall care quality for a systematic and continuous professional approach to nursing management of skin ulcers. The integration of this nursing knowledge in informatics systems creates an opportunity to embed decision-support models in clinical activity, promoting evidence-based practice. INCLUSION CRITERIA: This scoping review will consider articles on nursing data, diagnosis, interventions, and outcomes focused on people with skin ulcers in all contexts of care. This review will include quantitative, qualitative, and mixed methods study designs as well as systematic reviews and dissertations. METHODS: JBI's scoping review guidance, as well as the Cochrane Collaboration's guidance on living reviews, will be followed to meet the review's objective. Screening of new literature will be performed regularly, with the review updated according to new findings. The search strategy will map published and unpublished studies. The databases to be searched include MEDLINE, CINAHL, Scopus, JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PEDro. Searches for unpublished studies will include OpenGrey and Repositórios Científicos de Acesso Aberto de Portugal. Studies published in English and Portuguese since 2010 will be considered for inclusion. SCOPING REVIEW PROTOCOL REGISTRATION: Open Science Framework: https://osf.io/f6s4e/.

Representation of Diagnosis and Nursing Interventions in OpenEHR Archetypes.

OBJECTIVE: The study aimed to represent the content of nursing diagnosis and interventions in the openEHR standard. METHODS: This is a developmental study with the models developed according to ISO 18104: 2014. The Ocean Archetype Editor tool from the openEHR Foundation was used. RESULTS: Two archetypes were created; one to represent the nursing diagnosis concept and the other the nursing intervention concept. Existing archetypes available in the Clinical Knowledge Manager were reused in modeling. CONCLUSION: The representation of nursing diagnosis and interventions based on the openEHR standard contributes to representing nursing care phenomena and needs in health information systems.

Terminological subset of the International Classification for Nursing Practice for patients hospitalized due to burns.

OBJECTIVE: To develop a proposal of a terminological subset of the International Classification for Nursing Practice for burned patients. METHOD: This is a methodological study following the steps: identification of clinical findings; mapping of terms; construction of statements of diagnoses/results and nursing interventions; content validation of statements; and structuring of the subset with the theoretical model of Basic Human Needs. Content validation was performed by 26 specialist nurses, through the Content Validity Index, with statements ≥ 0.80 being considered validated. RESULTS: A total of 36 diagnoses/results and 119 interventions were validated. Among these, the ones with the highest index were: Respiratory System Function, Impaired/Respiratory System Function, Effective; Volume of Fluids, Impaired/Volume of Fluids, Effective; Burn Wound/Wound Healing, Effective; Pain, Acute/Pain, Absent, and as interventions: To Monitor Vital Signs; to Monitor Fluid Balance; to Treat Skin Condition; to Assess Response to Pain Management (Control). CONCLUSION: The validated statements depict the burned people basic human needs, with the psychobiological ones being the most prevalent.

Validation of Nursing Diagnoses for people with chronic kidney conditions on conservative treatment.

OBJECTIVE: To develop and validate Nursing Diagnoses statements of the International Classification for Nursing Practice (ICNP®) aimed at the care of people with chronic kidney conditions undergoing conservative treatment. METHOD: This is a methodological research structured in sequenced construction stages, cross-mapping, content validation by the Delphi Technique by specialist nurses, and categorization of Nursing Diagnoses. RESULTS: Forty-two specialist nurses participated in the first round and 34 in the second. A total of 179 Nursing Diagnoses statements were prepared, categorized according to Roy's adaptation model, of which 160 were validated for content, with Content Validity Index ≥ 0.80. CONCLUSION: The Diagnoses developed and validated show the modes of adaptation to health of people with chronic kidney conditions undergoing conservative treatment, influenced by biological, psychological, social, and cultural needs, with the Physiological Mode being the most prevalent.

Nursing diagnoses, results, and interventions in the care for Covid-19 patients in critical condition.

OBJECTIVE: To develop and validate a terminological subset of the International Classification for Nursing Practice for COVID-19 patients in critical care. METHOD: This is a methodological study, which followed the guidelines of the Brazilian method, using the Basic Human Needs as a theoretical model. Content validation was performed by 25 specialist nurses using the Delphi technique. RESULTS: A total of 73 diagnoses and their respective nursing results were prepared. Of these, 62 statements had a Content Validity Index ≥ 0.80, with the need for oxygenation having the highest number of statements. Of the 210 nursing interventions developed, and after suggestions from experts, 150 interventions reached an index ≥ 0.80 and comprised the terminological subset. CONCLUSION: The terminological subset developed showed statements that were validated by specialist nurses and, therefore, are relevant to the nurse's clinic in the critical care scenario associated with Covid-19.

Validation of nursing diagnosis for nursing consultation on home visit to adults.

OBJECTIVES: to identify and confirm the priority nursing diagnosis of International Classification for Nursing Practice® for home nursing consultation to adults in Primary Health Care. METHODS: qualitative study, of methodological and validation type. The 5-point Likert scale was used, with a minimum Content Validity Index of 80% consensus among judges., considering the answers "priority" or "very priority" for the list of nursing diagnoses presented. 23 expert judges participated in this survey. RESULTS: a hundred and eleven nursing diagnoses of prepared statements lists have been grouped by human systems and sociodemographic characteristics. were grouped by human systems and sociodemographic characteristics. Eighty-three of them (74.77%) had a Content Validity Index equal or higher to 0.8; and 27 (32.5%) had an index of 1.0 (100%) among judges. CONCLUSIONS: nursing diagnosis validated can be used to assist clients in home nursing consultations in Primary Health Care.

Initial experience with the Presillion stent in an unselected population: immediate and six-month outcomes.

INTRODUCTION: The release of a new bare metal stent (BMS), the Presillion stent, whose main innovative feature is its reduced strut thickness, has created expectations that it may reduce neointimal proliferation and consequently lower the restenosis rate. OBJECTIVE: To evaluate the efficacy and safety profile of Presillion stent implantation in an unselected population referred for coronary revascularization with BMS. METHODS: This was a prospective study of the first 20 consecutive patients undergoing implantation of at least one Presillion stent. We performed a descriptive analysis of the study population in terms of demographics, clinical context, angiographic characteristics of coronary lesions before and after angioplasty, and clinical outcome. After discharge, patients were followed up and assessed clinically at 3 and 6 months for the occurrence of MACE (cardiovascular death, myocardial infarction, stroke or revascularization). The statistical analysis consisted of calculation of means and standard deviation for continuous variables and relative proportions for categorical variables. RESULTS: The study population was predominantly male (65%), with a mean age of 68.8 years. The indication for cardiac catheterization was acute coronary syndrome in 90% and heart failure in 10% of cases. Half the patients had multivessel disease, and 34 stents, of which 26 were Presillion stents, were implanted in 29 coronary lesions. According to the ACC/AHA classification, the coronary lesions treated with Presillion stents were classified as type A in 0% of cases, type B1 in 27% and type B2 or C in 73%; 27% of these had moderate to severe calcification. The percentage of stenosis and minimal luminal diameter (MLD) before and after angioplasty were respectively 88.5 +/- 9.7% (MLD = 0.65 +/- 0.40 mm) and 10.6 +/- 4.3% (MLD = 2.58 +/- 0.36 mm). The success rate of Presillion implantation was 100%, with no significant drop in hemoglobin, additional elevation of cardiac biomarkers or deterioration in renal function after the procedure. No MACE occurred before hospital discharge. At 6-month follow-up all patients were alive, none had had stroke, two patients (10%) had had acute myocardial infarction in territories not dependent on previously treated arteries and two patients had undergone a new revascularization, but not of the target vessel. CONCLUSION: This initial experience with Presillion stents showed a high efficacy rate and an excellent safety profile that was maintained over 6 months of follow-up. Their effectiveness compared to other BMS should be demonstrated in larger-scale comparative studies.

Computer Vision Challenges for Chronic Wounds Assessment.

Chronic wound assessment and wound healing are important for diagnostic, follow up and wound treatment. However, this growing disease affecting nearly 2 thousand million and 5.7 million people in the USA and Europe, costing around $20 billion and $8 thousand million USD per year, still relies on subjective human assessment of wounds. A scoping review allowed us to identify 109 articles that map the literature on the topic of computer vision for chronic wound assessment and healing. These results were carefully analyzed and mapped into relevant clinical challenges associated with this field, identifying the maturity of each different computer vision challenge that needs addressing. Results show that wound size and tissue type classification already have interesting work, but various other clinical areas are in need of larger datasets and computer vision research efforts for achieving a relevant impact in today's clinical routine.

Clinical Decision Support Systems for Pressure Ulcer Management: Systematic Review.

BACKGROUND: The clinical decision-making process in pressure ulcer management is complex, and its quality depends on both the nurse's experience and the availability of scientific knowledge. This process should follow evidence-based practices incorporating health information technologies to assist health care professionals, such as the use of clinical decision support systems. These systems, in addition to increasing the quality of care provided, can reduce errors and costs in health care. However, the widespread use of clinical decision support systems still has limited evidence, indicating the need to identify and evaluate its effects on nursing clinical practice. OBJECTIVE: The goal of the review was to identify the effects of nurses using clinical decision support systems on clinical decision making for pressure ulcer management. METHODS: The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. The search was conducted in April 2019 on 5 electronic databases: MEDLINE, SCOPUS, Web of Science, Cochrane, and CINAHL, without publication date or study design restrictions. Articles that addressed the use of computerized clinical decision support systems in pressure ulcer care applied in clinical practice were included. The reference lists of eligible articles were searched manually. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. RESULTS: The search strategy resulted in 998 articles, 16 of which were included. The year of publication ranged from 1995 to 2017, with 45% of studies conducted in the United States. Most addressed the use of clinical decision support systems by nurses in pressure ulcers prevention in inpatient units. All studies described knowledge-based systems that assessed the effects on clinical decision making, clinical effects secondary to clinical decision support system use, or factors that influenced the use or intention to use clinical decision support systems by health professionals and the success of their implementation in nursing practice. CONCLUSIONS: The evidence in the available literature about the effects of clinical decision support systems (used by nurses) on decision making for pressure ulcer prevention and treatment is still insufficient. No significant effects were found on nurses' knowledge following the integration of clinical decision support systems into the workflow, with assessments made for a brief period of up to 6 months. Clinical effects, such as outcomes in the incidence and prevalence of pressure ulcers, remain limited in the studies, and most found clinically but nonstatistically significant results in decreasing pressure ulcers. It is necessary to carry out studies that prioritize better adoption and interaction of nurses with clinical decision support systems, as well as studies with a representative sample of health care professionals, randomized study designs, and application of assessment instruments appropriate to the professional and institutional profile. In addition, long-term follow-up is necessary to assess the effects of clinical decision support systems that can demonstrate a more real, measurable, and significant effect on clinical decision making. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42019127663; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127663.

ICNP® terminology subset to infants in Primary Health Care.

OBJECTIVES: to describe the development of an ICNP® terminology subset for Nursing Consultation to infants in Primary Health Care. METHODS: a methodological study, described in five stages, carried out from May to September 2018 with 15 nurses who identified diagnoses, results, interventions, and validated the subset content. RESULTS: the subset developed consists of 86 nursing diagnoses and results and 178 interventions, organized in the fields of Theory of Basic Human Needs. FINAL CONSIDERATIONS: the subset contributed to implement the systematized Nursing Consultation, assisting nurses in decision making. Construction and validation consolidate evidence-based practice, bringing the subset closer to practical reality, in addition to contributing to infant health care qualification.