Future perspectives of Smartphone applications for rheumatic diseases self-management.

Rheumatic diseases (RD) self-management interventions are designed to improve health-related quality of life, health care utilization, and perceived self-efficacy. Despite these demonstrated good results, there are several issues that hinder or render less appealing these interventions. One economically and socially viable solution is exploiting the potential of Smartphone technology. This potential comes from Smartphones pervasive presence in actual society, combined with the advantages of being personal, intuitive, and computationally powerful, with capability to support applications and assist its user throughout different activities of daily living and environments persistently. With their global acceptance increasing quickly, there is a great opportunity for mobile health in using Smartphone applications for RD self-management. Besides the potential of such applications, research on the development and evaluation of such applications is in the early stages. Therefore, it is important to foresee its future applicability in order to meet the needs of the twenty-first century.

Medical Grade Honey as a Promising Treatment to Improve Ovarian Tissue Transplantation.

Ovarian tissue cryopreservation is a female fertility preservation technique that presents major challenges for the maintenance of follicular viability after transplantation. The aim of this study was to evaluate and compare the application of L-Mesitran Soft®, a product containing 40% medical grade honey (MGH), with other strategies to improve ovarian grafts' viability. For this purpose, bovine ovarian tissue was vitrified, warmed and randomly assigned to culture groups: (1) control, (2) MGH 0.2% in vitro, (3) MGH in vivo (direct application in the xenotransplantation), (4) vascular endothelial growth factor (VEGF 50 ng/mL) and (5) vitamin D (100 Nm), during a 48 h period. A sixth group (6) of fragments was thawed on transplantation day and was not cultured. The tissue was xenotransplanted into immunodeficient (Rowett nude homozygous) ovariectomized rats. Grafts were analyzed 48 h after culture, and 7 and 28 days after transplantation. The tissue was subjected to histological and immunohistochemical analysis. Treatments using MGH showed the highest angiogenic and cell proliferation stimulation, with cellular apoptosis, within a healthy cellular turnover pathway. In conclusion, MGH should be considered as a potentially effective and less expensive strategy to improve ovarian tissue transplantation.

Factors that interfere in maternal perception of security at postpartum / Fatores que interferem na percepção de segurança materna no pós-parto

Abstract Objectives: to identify the factors and variables that interfere with the maternal perception of security at postpartum. Methods: a cross-sectional study, carried out in three Portuguese hospital units, with a non-probabilistic sample of 352 puerperal women, recruited from the postpartum units on the day of hospital discharge after delivery. Maternal sociodemographic and obstetric characteristics, as well as data on monitored pregnancy, childbirth and infant feeding, were collected through the application of a questionnaire developed by the researchers. For the analysis of maternal perception of security, the instrument "Parents' postnatal sense of security" (PPSS) was used. Descriptive and inferential statistics were used for data analysis. Results: women who lived with their partner (t (349) = - 2.34, p=0.020), were multiparous (t (349) = - 2.26, p=0.025), had pregnancy monitored (t (349) = -3.25, p=0.001), had a positive childbirth experience (F (1, 351) = 7.07, p=0.008) and those who exclusively breastfed during hospitalization (F (2, 351) = 11,43, p<0.001), presented greater perception of security at postpartum. Conclusions: the factors that affect the maternal perception of security at postpartum are cohabitation with a partner, parity, monitored pregnancy, childbirth experience and infant feeding. Defining which factors interfere with maternal security at postpartum may contribute to the construction of intervention programs that promote the maternal perception of security at the time of hospital discharge after delivery.

Resumo Objetivos: identificar os fatores que interferem na percepção de segurança materna no pós-parto. Métodos: estudo transversal, realizado em três unidades hospitalares portuguesas, com uma amostra não probabilística de 352 puérperas recrutadas nos serviços de internamento, no dia da alta hospitalar após o parto. As caraterísticas sociodemográficas e obstétricas maternas, assim como os dados relativos aos cuidados pré-natais, ao parto e ao tipo de aleitamento, foram recolhidos através da aplicação de um questionário desenvolvido pelas investigadoras. Para a análise da percepção de segurança materna foi usado o instrumento "Parents' Postnatal Sense of Security" (PPSS). Foi utilizada estatística descritiva e inferencial para a análise de dados. Resultados: as mulheres que viviam com o companheiro [t (349) = - 2,34, p=0,020], as multíparas (t (349) = - 2,26, p=0,025), as que vigiaram a gravidez [t (349) = -3,25, p=0,001], as que tiveram uma experiência de parto positiva [F (1, 351) = 7,07, p=0,008] e as que amamentaram em exclusivo durante o internamento [F (2, 351) = 11,43, p<0,001], apresentaram maior percepção de segurança no pós-parto. Conclusões: os fatores que interferem na percepção de segurança materna no pós-parto são a coabitação com o companheiro, a paridade, a vigilância da gravidez, a experiência de parto e o tipo de aleitamento. Determinar os fatores que interferem com a segurança materna no pós-parto pode contribuir para a construção de programas de intervenção promotores da percepção de segurança materna no momento da alta hospitalar após o parto.

Optic neuritis in an adult patient with chickenpox.

Central nervous system involvement in a patient with primary infection with Varicella zoster virus is rare, especially in the immunocompetent adult. In particular, isolated optic neuritis has been described in a small number of cases. The authors present a case of optic neuritis in an immunocompetent patient. A 28-year-old woman presented to the emergency room with a history of headaches during the previous week, without visual symptoms. The examination was unremarkable, except for a rash suggestive of chickenpox and hyperemic and edematous optic disc, bilaterally. Visual acuity and neurological examination were normal. Two days later, she complained of pain on eye movement and decreased visual acuity, which was 20/32 in her right eye and 20/60 in her left eye. Four days after admission, her visual acuity started to improve, and two months later, she had 20/20 visual acuity in both eyes. To our knowledge, this is the first reported case of an immunocompetent adult in which a Varicella zoster virus associated optic neuritis presented with fundoscopic changes before decreased visual acuity. This suggests that this condition may be underdiagnosed in asymptomatic patients.

Paragem cardiorrespiratória no serviço de ortopedia / Cardiorespiratory arrest in the orthopedic service

A Paragem Cardiorrespiratória (PCR) é um evento que pode ocorrer no meio intra-hospitalar, geralmente de forma inesperada. Os enfermeiros, profissionais da equipa multidisciplinar, que se encontram na primeira linha de cuidado à pessoa internada, têm o dever de detetar precocemente a PCR para poderem atuar de forma rápida e eficiente para uma possível reversão do evento crítico. A PCR é um momento que origina elevados níveis de tensão, uma vez que, a sua ocorrência no internamento é pouco frequente o que gera baixos níveis de confiança e destreza na atuação perante a mesma. O objetivo geral do presente estudo consiste em perceber quais as experiências dos enfermeiros, do serviço de Ortopedia de um Hospital Central da Zona Norte, na intervenção face à pessoa em paragem cardiorrespiratória. Mais especificamente pretende-se: identificar os fatores dificultadores e potenciadores na intervenção da equipa de enfermagem, face à pessoa em situação de PCR e identificar que competências são necessárias mobilizar para a intervenção face à pessoa em situação de PCR. Este é um estudo qualitativo de natureza exploratória descritiva, no qual se recorreu à entrevista semiestruturada para realizar a colheita de dados junto de nove enfermeiros que trabalham no serviço de ortopedia de um Hospital Central da Zona Norte. Os discursos obtidos foram submetidos à análise de conteúdo segundo Bardin (2009). Os resultados obtidos mostram que as competências mobilizadas pelos enfermeiros numa situação de PCR se prendem com competências técnico-científicas, capacidade de decisão para a ação, capacidade de controlo das emoções, capacidade física, competências comunicacionais bem como a capacidade de liderança. Como fatores dificultadores da intervenção da equipa de enfermagem face à pessoa com PCR, os enfermeiros identificaram a inexperiência na prática da ressuscitação cardiopulmonar (RCP), a articulação das equipas, o défice de rácios enfermeiro-doente, a utilização do carro de emergência, a gestão do stress, o dilema ético que a RCP envolve e a estrutura física. Como aspetos potenciadores da intervenção da equipa de enfermagem face à pessoa com PCR houve destaque para a formação, a experiência em situações de PCR, a capacidade para a gestão do stress, o trabalho em equipa, a concentração, o rácio adequado enfermeiro-doente e a estrutura organizacional. Na ótica dos enfermeiros estes são os fatores que potenciam a sua intervenção nas situações de PCR. Por fim, os enfermeiros constataram que os fatores quelhes permitiam uma atuação eficaz perante uma pessoa em PCR eram então o conhecimento, o treino, o saber agir, a disponibilidade de materiais e a comunicação. Estes resultados sugerem que é necessário implementar uma política de formação e treino com menos tempo de intervalo para que o conhecimento não se degrade, sugerem ainda que a criação de espaços de reflexam seriam uma mais valia para a equipa de enfermagem e que um programa de estágios periódicos dos profissionais do internamento na equipa de emergência e/ou unidade de cuidados intensivos polivalentes poderia ter vantagens ao nível da experiência para atuação perante pessoas em PCR.

The Cardiopulmonary stop (PCR) is an event that may occur in the intra-hospital environment, often unexpectedly. Nurses, professionals of the multidisciplinary team, which are the first line of care to the hospitalized person, have a duty to detect early PCR in order to act quickly and efficiently to make a possible reversal of the critical event. PCR is a time which gives high levels of tension, since its occurrence is infrequent during hospitalization which generates low levels of confidence and dexterity during such event. The overall objective of this study is to understand what are the experiences of nurses of the Orthopedics Service of a Central Hospital of Northern Zone in intervention against the person in cardiac arrest. More specifically, the aim is to: identify the factors hindering and enhancing the intervention of the nursing team, when faced with the person in a PCR situation and identify what are the skills needed to mobilize for the intervention in the PCR situation. This is a qualitative study of exploratory nature, in which it was used the semi-structured interview to make the data collection with nine nurses working in the orthopedic service of a Central Hospital of the Northern Zone. The records obtained were subjected to content analysis according to Bardin (2009). The results shown demonstrate the skills mobilized by nurses in a PCR situation are related to technical and scientific skills, decision-making capacity for action, ability to control emotions, physical ability, communication skills and leadership ability. As limiting factors of the nursing team intervention against the person with PCR, nurses identified the inexperience in the practice of cardiopulmonary resuscitation (CPR), the articulation of teams, the shortage in nurse-patient ratios, the use of the emergency car, stress management, the ethical dilemma that CPR involves and physical structure. As positive aspects of the nursing team intervention against the person with PCR, there was emphasis on the training, experience in PCR situations, the ability to manage stress, teamwork, concentration, proper nurse-patient ratio and the organizational structure. In the view of nurses these are the factors that enhance their intervention in PCR situations. Finally, the nurses found that the factors that allow them to effectively interact with a person in PCR were the knowledge, training, knowing how to act, the availability of materials and communication.These results suggest that it is necessary to implement training policies with less time interval so that knowledge does not degrade, also, i tis suggested that the creation of reflection spaces would be an asset to the nursing team and a periodical internship program of hospital workers in the emergency team and / or polyvalent intensive care unit could have advantages in terms of experience to interact with people in PCR.