Intervenções para ansiedade que podem ser utilizadas por enfermeiros: revisão de escopo / Intervenciones para la ansiedad que pueden ser utilizadas por enfermeros: revisión de alcance / Interventions for anxiety that can be used by nurses: a scoping review

Resumo Objetivo Mapear as intervenções que podem ser realizadas por enfermeiros nos diversos serviços de atenção à saúde para o manejo dos sintomas de ansiedade em adultos durante a COVID-19. Métodos A revisão de escopo foi conduzida conforme o manual do Joanna Briggs Institute (JBI). A pergunta de revisão foi "Qual o conhecimento disponível na literatura sobre as intervenções de manejo dos sintomas de ansiedade que podem ser utilizadas por enfermeiros nos diversos serviços de atenção à saúde, na população adulta, durante a COVID-19?". As fontes de dados pesquisadas foram: Biblioteca Virtual em Saúde (BVS), EMBASE, PUBMED, CINAHL, PsycINFo, SCOPUS e Web of Science. Não houve limitação de ano ou idioma de publicação. Resultados Foram analisados 85 artigos. Os estudos mostraram que, em geral, toda a população adulta apresentou mudanças nos níveis de ansiedade durante a pandemia. Entre as intervenções identificadas, que podem ser realizadas por enfermeiros para o manejo dos sintomas de ansiedade, houve singular destaque para as variadas formas de intervenções online , com frequência de 21,4% nos estudos, seguida pelas atividades físicas, com frequência de 13,3%. Conclusão Foi possível mapear as intervenções que podem reduzir os sintomas de ansiedade na população adulta, assim como delimitar as que podem ser aplicadas por enfermeiros, aumentando a visibilidade dessa categoria como protagonista do cuidado nos diversos setores de serviço de saúde. Dentre as intervenções sintetizadas, destacaram-se o teleatendimento, atividade física, exercícios cognitivos e intervenções não farmacológicas.Protocolo de registro do Artigo de Revisão: o protocolo de revisão está registrado no Open Science Framework (OSF), sob o número: https://doi.org/10.17605/OSF.IO/3Q2VT.

Resumen Objetivo Mapear las intervenciones que pueden ser realizadas por enfermeros en los diferentes servicios de atención a la salud para el manejo de los síntomas de ansiedad en adultos durante el COVID-19. Métodos La revisión de alcance fue realizada de acuerdo con el manual del Joanna Briggs Institute (JBI). La pregunta de revisión fue "¿Cuál es el conocimiento disponible en la literatura sobre las intervenciones de manejo de los síntomas de ansiedad que pueden ser utilizadas por enfermeros en los diferentes centros de atención a la salud, en la población adulta, durante el COVID-19?". Las fuentes de datos investigadas fueron: Biblioteca Virtual em Saúde (BVS), EMBASE, PUBMED, CINAHL, PsycINFo, SCOPUS y Web of Science. No hubo restricción de año ni idioma de publicación. Resultados Se analizaron 85 artículos. Los estudios mostraron que, en general, toda la población adulta presentó cambios en los niveles de ansiedad durante la pandemia. Entre las intervenciones identificadas para el manejo de los síntomas de ansiedad, que pueden ser realizadas por enfermeros, se observó un singular énfasis en las diversas formas de intervenciones en línea, con frecuencia de 21,4 % en los estudios, seguida por actividades físicas, con frecuencia de 13,3 %. Conclusión Fue posible mapear las intervenciones que pueden reducir los síntomas de ansiedad de la población adulta, así como determinar las que pueden ser aplicadas por enfermeros, y así aumentar la visibilidad de esta categoría como protagonista del cuidado en los diferentes sectores de servicios de salud. Entre las intervenciones sintetizadas, se destaca la teleatención, la actividad física, los ejercicios cognitivos y las intervenciones no farmacológicas.

Abstract Objective To map the interventions that can be performed by nurses in the various health care services for the management of anxiety symptoms in adults during COVID-19. Methods The scoping review was conducted according to the JBI manual. The review question was: What is the knowledge available in the literature on interventions to manage anxiety symptoms that can be used by nurses in the various health care services, in the adult population, during COVID-19? The data sources searched were: Virtual Health Library (VHL), EMBASE, PubMed, CINAHL, PsycINFo, Scopus and Web of Science. There was no limitation of year or language of publication. Results Were analyzed 85 articles. Studies have shown that, in general, the entire adult population has experienced changes in anxiety levels during the pandemic. Among the identified interventions, which can be carried out by nurses to manage anxiety symptoms, there was singular emphasis on the various forms of online interventions, with a frequency of 21.4% in the studies, followed by physical activities, with a frequency of 13.3%. Conclusion It was possible to map interventions that can reduce anxiety symptoms in the adult population as well as delimit those that can be applied by nurses, increasing the visibility of this category as protagonist of care in the various sectors of health services. Among the synthesized interventions, teleassistance, physical activity, cognitive exercises and non-pharmacological interventions stood out.

KIdney aNd blooD prESsure ouTcomes in Childhood Cancer Survivors: Description of Clinical Research Protocol of the KINDEST-CCS Study.

Background: Approximately 30% of childhood cancer survivors (CCSs) will develop chronic kidney disease (CKD) or hypertension 15 to 20 years after treatment ends. The incidence of CKD and hypertension in the 5-year window after cancer therapy is unknown. Moreover, extent of monitoring of CCS with CKD and associated complications in current practice is underexplored. To inform the development of new and existing care guidelines for CCS, the epidemiology and monitoring of CKD and hypertension in the early period following cancer therapy warrants further investigation. Objective: To describe the design and methods of the KIdney aNd blooD prESsure ouTcomes in Childhood Cancer Survivors study, which aims to evaluate the burden of late kidney and blood pressure outcomes in the first ~10 years after cancer therapy, the extent of appropriate screening and complications monitoring for CKD and hypertension, and whether patient, disease/treatment, or system factors are associated with these outcomes. Design: Two distinct, but related studies; a prospective cohort study and a retrospective cohort study. Setting: Five Ontario pediatric oncology centers. Patients: The prospective study will involve 500 CCS at high risk for these late effects due to cancer therapy, and the retrospective study involves 5,000 CCS ≤ 18 years old treated for cancer between January 2008 and December 2020. Measurements: Chronic kidney disease is defined as Estimated glomerular filtration rate <90 mL/min/1.73 m2 or albumin-to-creatinine ratio ≥ 3mg/mmol. Hypertension is defined by 2017 American Academy of Pediatrics guidelines. Methods: Prospective study: we aim to investigate CKD and hypertension prevalence and the extent to which they persist at 3- and 5-year follow-up in CCS after cancer therapy. We will collect detailed biologic and clinical data, calculate CKD and hypertension prevalence, and progression at 3- and 5-years post-therapy. Retrospective study: we aim to investigate CKD and hypertension monitoring using administrative and health record data. We will also investigate the validity of CKD and hypertension administrative definitions in this population and the incidence of CKD and hypertension in the first ~10 years post-cancer therapy. We will investigate whether patient-, disease/treatment-, or system-specific factors modify these associations in both studies. Limitations: Results from the prospective study may not be generalizable to non-high-risk CCS. The retrospective study is susceptible to surveillance bias. Conclusions: Our team and knowledge translation plan is engaging patient partners, researchers, knowledge users, and policy group representatives. Our work will address international priorities to improve CCS health, provide the evidence of new disease burden and practice gaps to improve CCS guidelines, implement and test revised guidelines, plan trials to reduce CKD and hypertension, and improve long-term CCS health.

Acute kidney injury in the pediatric intensive care unit: outpatient follow-up.

BACKGROUND: Few studies have characterized follow-up after pediatric acute kidney injury (AKI). Our aim was to describe outpatient AKI follow-up after pediatric intensive care unit (PICU) admission. METHODS: Two-center retrospective cohort study (0-18 years; PICU survivors (2003-2005); noncardiac surgery; and no baseline kidney disease). Provincial administrative databases were used to determine outcomes. EXPOSURE: AKI (KDIGO (Kidney Disease: Improving Global Outcomes) definitions). OUTCOMES: post-discharge nephrology, family physician, pediatrician, and non-nephrology specialist visits. Regression was used to evaluate factors associated with the presence of nephrology follow-up (Cox) and the number of nephrology and family physician or pediatrician visits (Poisson), among AKI survivors. RESULTS: Of n = 2041, 355 (17%) had any AKI; 64/355 (18%) had nephrology; 198 (56%) had family physician or pediatrician; and 338 (95%) had family physician, pediatrician, or non-nephrology specialist follow-up by 1 year post discharge. Only 44/142 (31%) stage 2-3 AKI patients had nephrology follow-up by 1 year. Inpatient nephrology consult (adjusted hazard ratio (aHR) 7.76 [95% confidence interval (CI) 4.89-12.30]), kidney admission diagnosis (aHR 4.26 [2.21-8.18]), and AKI non-recovery by discharge (aHR 2.65 [1.55-4.55]) were associated with 1-year nephrology follow-up among any AKI survivors. CONCLUSIONS: Nephrology follow-up after AKI was uncommon, but nearly all AKI survivors had follow-up with non-nephrologist physicians. This suggests that AKI follow-up knowledge translation strategies for non-nephrology providers should be a priority. IMPACT: Pediatric AKI survivors have high long-term rates of chronic kidney disease (CKD) and hypertension, justifying regular kidney health surveillance after AKI. However, there is limited pediatric data on follow-up after AKI, including the factors associated with nephrology referral and extent of non-nephrology follow-up. We found that only one-fifth of all AKI survivors and one-third of severe AKI (stage 2-3) survivors have nephrology follow-up within 1 year post discharge. However, 95% are seen by a family physician, pediatrician, or non-nephrology specialist within 1 year post discharge. This suggests that knowledge translation strategies for AKI follow-up should be targeted at non-nephrology healthcare providers.

Associations between Major Health Behaviors and Sleep Problems: Results from the 2015, 2016, 2017 Canadian Community Health Survey.

BACKGROUND AND OBJECTIVES: Key health behaviors including cigarette smoking, alcohol consumption, fruit and vegetable (FV) consumption, and physical activity have been associated with sleep-related problems. This cross-sectional study describes sleep quality and duration by gender in a large adult population and examines whether health behavioral factors are associated with short/long sleep duration and sleep problems (difficulty initiating/maintaining sleep [DIMS], daytime sleepiness, and finding sleep refreshing). METHODS: Using Canadian Community Health Survey data from cycles 2015, 2016, and 2017, binary and multinomial logistic regression models were computed. RESULTS: Of the 44,911 respondents included, only half of respondents met the recommended sleep duration. Fifty-five percent of females and forty-one percent of males reported DIMS. Binge drinking was associated with increased DIMS, with the strongest relationship being among females reporting weekly binge drinking (odds ratio (OR) 2.03 [1.59,2.60]). Binge drinking was also associated with decreased odds of finding sleep refreshing among females only (OR 0.73 [0.56,0.96] in weekly binge drinkers). Compared to respondents who had never smoked, daily smokers had higher odds of short sleep (OR 1.50 [1.30,1.74] and OR 1.39 [1.21,1.60]; females and males, respectively). Similarly, former smokers had higher odds of DIMS (OR 1.18 [1.06,1.31]) and not finding sleep refreshing (OR 0.85 [0.77,0.95]), among females; similar OR among males. Increased FV consumption was associated with increased odds of finding sleep refreshing (OR 1.05 [1.03,1.07] and OR 1.06 [1.04,1.08] in females and males, respectively). CONCLUSION: There is a high prevalence of sleep problems among Canadians. Potential gender differences in the relationships between health behaviors and sleep problems warrant further research.

Association of pediatric cardiac surgery-associated acute kidney injury with post-discharge healthcare utilization, mortality and kidney outcomes.

BACKGROUND: Acute kidney Injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with hospital morbidity. Post-discharge CS AKI outcomes are less clear. We evaluated associations between AKI and post-discharge (a) healthcare utilization, (b) chronic kidney disease (CKD) or hypertension and (c) mortality. METHODS: This is a retrospective two-centre cohort study of children surviving to hospital discharge after CS. Primary exposures were post-operative ≥Stage 1 AKI and ≥Stage 2 AKI defined by Kidney Disease Impoving Global Outcomes. Association of AKI with time to outcomes was determined using multivariable Cox-Proportional Hazards analysis. RESULTS: Of 350 participants included (age 3.1 (4.5) years), 180 [51.4%] developed AKI and 60 [17.1%] developed ≥Stage 2 AKI. Twenty-eight (9%) participants developed CKD or hypertension (composite outcome), and 17 (5%) died within 5 years of discharge. Post-operative ≥Stage 1 and ≥Stage 2 AKI were not associated with post-discharge hospitalizations, emergency room (ER) visits, physician visits or CKD or hypertension in adjusted analyses. A trend was observed between ≥Stage 2 AKI and mortality but was not statistically significant. In unadjusted stratified analyses, AKI was associated with post-discharge hospitalizations in children with RACHS-1 score ≥3, complex chronic disease classification and children living in urban areas. CONCLUSIONS: Post-CS AKI is not associated with post-discharge healthcare utilization, death and CKD or hypertension, though it may be associated with healthcare utilization in more complex paediatric CS children. Studies should aim to better understand post-CS healthcare utilization patterns and non-AKI risk factors for CKD, hypertension and mortality, to reduce adverse long-term outcomes after CS.

The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery.

Background: Acute kidney injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with increased hospital mortality and length of stay. The association of AKI with postdischarge outcomes is unclear. We evaluated the association of AKI with all-cause readmissions and death within 30 days and 1 year of CS discharge. Methods: This was a prospective, 3-center cohort study of children after CS with cardiopulmonary bypass. The primary exposures were postoperative ≥stage 1 AKI and ≥stage 2 AKI defined by Kidney Disease: Improving Global Outcomes AKI definition. Two separate outcomes were hospital readmission and death within 30 days and 1 year of discharge. Association of AKI with time to outcomes was determined using multivariable Cox-proportional hazards analysis. Age, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery risk adjustment tool score ≥3, cardiopulmonary bypass >120 minutes, and cyanotic heart disease were evaluated as effect modifiers. Results: Of 402 participants included (median age 1.8 years [interquartile range 0.4, 5.2]), 32 (8.0%) and 109 (27.1%) were readmitted; 7 (1.7%) and 9 (2.2%) died within 30 days and 1 year of CS, respectively. AKI was not associated with readmission at 30 days or 1 year postdischarge. ≥Stage 2 AKI (adjusted hazard ratio, 11.68 [1.88, 72.61]) was associated with mortality 30 days post-CS. Conclusions: Postoperative AKI was not associated with readmission at 30 days and 1-year postdischarge. However, more severe AKI (≥stage 2) appears to be associated with increased morality risk at 30 days post-CS.