Protocol for the hyperinsulinemic euglycemic clamp to measure glucose kinetics in rats.

In rats, cannulation of the jugular vein and the carotid artery precedes the use of the hyperinsulinemic euglycemic clamp to determine insulin sensitivity in vivo. Here, we present a vascular surgery protocol to allow the infusion of substances via the vein and the collection of blood samples from the artery on the day of the hyperinsulinemic euglycemic clamp. We describe steps for preparing for and performing catheterization surgery. We then detail procedures for clamp preparation and its use. For complete details on the use and execution of this protocol, please refer to Pereira et al.1,2,3.

Exploring Seaweed and Glycine Betaine Biostimulants for Enhanced Phenolic Content, Antioxidant Properties, and Gene Expression of Vitis vinifera cv. "Touriga Franca" Berries.

Climate change will pose a challenge for the winemaking sector worldwide, bringing progressively drier and warmer conditions and increasing the frequency and intensity of weather extremes. The short-term adaptation strategy of applying biostimulants through foliar application serves as a crucial measure in mitigating the detrimental effects of environmental stresses on grapevine yield and berry quality. The aim of this study was to evaluate the effect of foliar application of a seaweed-based biostimulant (A. nodosum-ANE) and glycine betaine (GB) on berry quality, phenolic compounds, and antioxidant activity and to elucidate their action on the secondary metabolism. A trial was installed in a commercial vineyard (cv. "Touriga Franca") in the Cima Corgo (Upper Corgo) sub-region of the Douro Demarcated Region, Portugal. A total of four foliar sprayings were performed during the growing season: at flowering, pea size, bunch closer, and veraison. There was a positive effect of GB in the berry quality traits. Both ANE and GB increased the synthesis of anthocyanins and other phenolics in berries and influenced the expression of genes related to the synthesis and transport of anthocyanins (CHS, F3H, UFGT, and GST). So, they have the potential to act as elicitors of the secondary metabolism, leading to improved grape quality, and also to set the foundation for sustainable agricultural practices in the long run.

Future policy and research for advance care planning in dementia: consensus recommendations from an international Delphi panel of the European Association for Palliative Care.

Advance care planning (ACP) is increasingly recognised in the global agenda for dementia care. The European Association for Palliative Care (EAPC) Taskforce on ACP in Dementia aimed to provide recommendations for policy initiatives and future research. We conducted a four-round Delphi study with a 33-country panel of 107 experts between September, 2021, and June, 2022, that was approved by the EAPC Board. Consensus was achieved on 11 recommendations concerning the regulation of advance directives, equity of access, and dementia-inclusive approaches and conversations to express patients' values. Identified research gaps included the need for an evidence-based dementia-specific practice model that optimises engagement and communication with people with fluctuating and impaired capacity and their families to support decision making, while also empowering people to adjust their decisions if their goals or preferences change over time. Policy gaps included insufficient health services frameworks for dementia-inclusive practice. The results highlight the need for more evidence and policy development that support inclusive ACP practice models.

A bioethical perspective on the meanings behind a wish to hasten death: a meta-ethnographic review.

BACKGROUND: The expressions of a "wish to hasten death" or "wish to die" raise ethical concerns and challenges. These expressions are related to ethical principles intertwined within the field of medical ethics, particularly in end-of-life care. Although some reviews were conducted about this topic, none of them provides an in-depth analysis of the meanings behind the "wish to hasten death/die" based specifically on the ethical principles of autonomy, dignity, and vulnerability. The aim of this review is to understand if and how the meanings behind the "wish to hasten death/die" relate to and are interpreted in light of ethical principles in palliative care. METHODS: We conducted a meta-ethnographic review according to the PRISMA guidelines and aligned with Noblit and Hare's framework. Searches were performed in three databases, Web of Science, PubMed, CINAHL, with no time restrictions. Original qualitative studies exploring the meanings given by patients, family caregivers and healthcare professionals in any context of palliative and end-of-life care were included. A narrative synthesis was undertaken. PROSPERO registration CRD42023360330. RESULTS: Out of 893 retrieved articles, 26 were included in the analysis, accounting for the meanings of a total of 2,398 participants. Several factors and meanings associated with the "wish to hasten death" and/or "wish to die" were identified and are mainly of a psychosocial and spiritual nature. The ethical principles of autonomy and dignity were the ones mostly associated with the "wish to hasten death". Ethical principles were essentially inferred from the content of included articles, although not explicitly stated as bioethical principles. CONCLUSIONS: This meta-ethnographic review shows a reduced number of qualitative studies on the "wish to hasten death" and/or "wish to die" explicitly stating ethical principles. This suggests a lack of bioethical reflection and reasoning in the empirical end-of-life literature and a lack of embedded ethics in clinical practice. There is a need for healthcare professionals to address these topics compassionately and ethically, taking into account the unique perspectives of patients and family members. More qualitative studies on the meanings behind a wish to hasten death, their ethical contours, ethical reasoning, and implications for clinical practice are needed.

Foliar application of nettle and Japanese knotweed extracts on Vitis vinifera: impact on phenylpropanoid biosynthesis and antioxidant activity during veraison and harvest of cv. Touriga Franca.

BACKGROUND: Plant-based extracts have been recently used as sustainable tools to improve biotic and abiotic stress tolerance and increase grape (Vitis vinifera L.) quality. However, knowledge about the effect of these extracts on secondary metabolism compounds, that are fundamental for grape and wine quality, is still scarce. In this study, a trial was installed in an experimental vineyard with the variety Touriga Franca located at University of Trás-os-Montes e Alto Douro, Baixo Corgo sub-region of the Douro Demarcated Region, Portugal in two growing seasons: 2019 and 2020. The aim was to evaluate the effect of foliar application of nettle (Urtica spp.) extract (NE) and Japanese knotweed (Reynoutria japonica) extract (JKE) on grapevines leaves and berries bioactive compounds contents and antioxidant activity, at veraison and harvest. RESULTS: The application of NE increased the total carotenoids in leaves and the total phenolics content and the antioxidant activity (ferric reducing antioxidant power, FRAP) in berries while JKE increased flavonoids content in leaves and the antioxidant activity (2,2-diphenyl-1-picrylhydrazyl, DPPH) in berries. CONCLUSION: These extracts seem to have a stimulatory effect on grapevine, enhancing bioactive compounds contents and antioxidant capacity and, consequently, the physiological performance of the plant and the quality of the berries. © 2024 Society of Chemical Industry.

What are the triggers for palliative care referral in burn intensive care units? Results from a qualitative study based on healthcare professionals' views, clinical experiences and practices.

BACKGROUND: Burns are a global public health problem, accounting for around 300,000 deaths annually. Burns have significant consequences for patients, families, healthcare teams and systems. Evidence suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making processes and family care. Research is needed on how to optimise palliative care referrals. AIM: To identify triggers for palliative care referral in critically burned patients based on professionals' views, experiences and practices. DESIGN: Qualitative study using in-depth interviews. SETTING/PARTICIPANTS: All five Burn Intensive Care Units reference centres across Portugal were invited; three participated. Inclusion criteria: Professionals with experience/working in these settings. A total of 15 professionals (12 nurses and 3 physicians) participated. Reflexive thematic analysis was performed. RESULTS: Three main triggers for palliative care referral were identified: (i) Burn severity and extension, (ii) Co-morbidities and (iii) Multiorgan failure. Other triggers were also generated: (i) Rehabilitative palliative care related to patients' suffering and changes in body image, (ii) Family suffering and/or dysfunctional and complex family processes, (iii) Long stay in the burn intensive care unit and (iv) Uncontrolled pain. CONCLUSIONS: This study identifies triggers for palliative care in burn intensive care units based on professionals' views, clinical experiences and practices. The systematisation and use of triggers could help streamline referral pathways and strengthen the integration of palliative care in burn intensive care units. Research is needed on the use of these triggers in clinical practice to enhance decision-making processes, early and high-quality integrated palliative care and proportionate patient and family centred care.

A systematic practice review: Providing palliative care for people with Parkinson's disease and their caregivers.

BACKGROUND: People with Parkinson's disease has significant and increasing physical, psychosocial and spiritual needs, as well as problems with coordination and continuity of care. Despite the benefits that palliative care could offer, there is no consensus on how it should be delivered. AIM: The aim of this study is to provide a pragmatic overview of the evidence to make clinical recommendations to improve palliative care for people with Parkinson's disease and their caregivers. DESIGN: A systematic review method was adopted to determine the strength of evidence, supported by feedback from an expert panel, to generate the 'do', 'do not do' and 'do not know' recommendations for palliative care. DATA SOURCES: Searches were conducted via OVID to access CINAHL, MEDLINE, EMBASE and the Cochrane Library from 01/01/2006 to 31/05/2021. An additional search was conducted in December 2022. The search was limited to articles that included empirical studies of approaches to enabling palliative care. RESULTS: A total of 62 studies met inclusion criteria. There is evidence that education about palliative care and movement disorders is essential. palliative care should be multi-disciplinary, individualised and coordinated. Proactive involvement and support of caregivers throughout the illness is recommended. Limited data provide referral indicators for palliative care integration. Discussions about advance care planning should be held early. CONCLUSIONS: Consideration of palliative care integration based on symptom burden and personal preferences, coordination and continuity of care are needed to maintain the quality of life of people with Parkinson's disease and their caregivers.

Incidence of postoperative residual neuromuscular blockade - A multicenter, observational study in Portugal (INSPIRE 2).

Background: Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal. Methods: Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of patients arriving at postanesthesia care unit (PACU) with a TOF ratio <0.9. Results: A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine. Twenty patients displayed a TOF ratio <0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%-7.8%). Only two patients displayed a TOF ratio <0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex (P = .114). In patients with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%-8%), which varied significantly according to the type of monitoring (P = .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate). Conclusions: The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event.

Molecular Recognition of GalNAc in Mucin-Type O-Glycosylation.

Acetylgalactosamine (GalNAc)-type O-glycosylation is an essential posttranslational modification (PTM) that plays fundamental roles in biology. Malfunction of this PTM is exemplified by the presence of truncated O-glycans in cancer. For instance, the glycoprotein MUC1 is overexpressed in many tumor tissues and tends to carry simple oligosaccharides that allow for the presentation of different tumor-associated antigens, such as the Tn or sTn antigens (GalNAc-α-1-O-Thr/Ser and Neu5Acα2-6GalNAcα1-O-Ser/Thr, respectively). In other cases, such as tumoral calcinosis associated with O-glycosylation of the fibroblast growth factor 23, O-glycans are absent or less abundant. Significant progress has been made in determining the three-dimensional structures of biomolecules that recognize GalNAc, such as antibodies, lectins, mucinases, GalNAc-transferases, and other glycosyltransferases. Analysis of the complexes between these entities and GalNAc-containing glycopeptides, in most cases derived from crystallographic or NMR analysis, provides an understanding of the key structural elements that control molecular recognition of these glycopeptides. Here, we describe and compare the binding sites of these proteins in detail, focusing on how the GalNAc moieties interact selectively with them. We also summarize the differences and similarities in GalNAc recognition. In general, the recognition of GalNAc-containing glycopeptides is determined by hydrogen bonds between hydroxyl groups and the N-acetyl group of GalNAc with proteins, as well as CH-π contacts in which the hydrophobic α-face of the sugar and the methyl group of NHAc can be involved. The latter interaction usually provides the basis for selectivity. It is worth noting that binding of these glycopeptides depends primarily on recognition of the sugar moiety, with some exceptions such as a few anti-MUC1 antibodies that primarily recognize the peptide backbone and use the sugar to facilitate shape complementarity or to establish a limited number of interactions with the protein. Focusing specifically on the GalNAc moiety, we can observe that there is some degeneracy of interactions within the same protein families, likely due to substrate flexibility. However, when all studied proteins are considered together, despite the commonalities within each protein family, no pattern can be discerned between the different families, apart from the presence of common residues such as Tyr, His, or Asp, which are responsible for hydrogen bonds. The lack of a pattern can be anticipated, given the diverse functions of mucinases, glycosyltransferases, antibodies, and lectins. Finally, it is important to point out that the conformational differences observed in solution in glycopeptides bearing GalNAc-α-1-O-Ser or GalNAc-α-1-O-Thr also can be found in the bound state. This unique characteristic is exploited, for instance, by the enzyme C1GalT1 to broadly glycosylate both acceptor substrates. The findings summarized in this review may contribute to the rational structure-guided development of therapeutic vaccines, novel diagnostic tools for early cancer detection, and new cancer treatments for cancer with tailored anti-Tn or anti-STn antibodies or new drugs to inhibit GalNAc-T isoenzymes.

Oficina de formação bioética para a Estratégia Saúde da Família: perspectivas e olhares dos diferentes atores acerca dos cenários, montagem e espetáculo / Bioethics Training Workshop for Family Health Strategy: perspectives of the different players about scenarios, setup and show / Taller de formación en bioética para la estrategia salud de la familia: perspectivas y miradas de los diferentes actores sobre los escenarios, montaje y espectáculo

A formação dos profissionais de saúde segue em discussão há tempos ­ no Brasil e no mundo ­, assim como as mudanças dos paradigmas sanitários e dos modelos de cuidado em saúde. Com a criação do Sistema Único de Saúde e a implantação da Estratégia de Saúde da Família (ESF) como reorganizadores da atenção em saúde, brotam, neste cenário, questões e problemas bioéticos não vividos anteriormente no âmbito da prática de saúde hospitalar. Este artigo apresenta os resultados da realização de uma oficina de formação em bioética com a participação de 130 pessoas (128 profissionais da ESF no município de Viçosa, Minas Gerais, e dois convidados), promovida pela integração da universidade com o serviço de saúde local. Os referenciais utilizados incluíram o pluralismo metodológico, o trabalho em pequenos grupos, a aprendizagem significativa e o uso da arte para a construção das competências em bioética. Os resultados verificados foram otimistas quanto à efetividade da ação, tanto na ótica dos profissionais da ESF quanto dos participantes (facilitadores e docentes envolvidos), promovendo-se uma construção coletiva de saberes para a práxis.

The training of health professionals has been a point of discussion for a long time in Brazil and around the world, as well as changes in health paradigms and health care models. With the merger of the National Health System and the implementation of the Family Health Strategy (FHS) as organizer of health care, issues and problems emerged, which were not previously thought about in the context of health and hospital practice, mainly reflections on ethical and bioethical aspects. This paper presents the results of conducting a training workshop on bioethics with the participation of 130 people (128 FHS professionals in Viçosa, Minas Gerais and two guests), sponsored by the university's integration with the local health service, based on the use of methodological pluralism, small group work, learning and meaningful use of art for the construction of expertise in bioethics. Actual outcomes were optimistic about the effectiveness of the action, from the viewpoint of both the FHS professionals and participants (facilitators and professors involved), promoting a collective construction of knowledge for practice.

La formación de los profesionales de la salud es objeto de debate desde hace mucho tiempo - en Brasil y en el mundo -, así como los cambios de paradigmas y modelos de salud para el cuidado de la salud. Con la creación del Sistema Único de Salud (SUS) y de la aplicación de la Estrategia Salud de la Familia (ESF) como de reorganizadores cuidado de la salud, surgen, en este escenario, los problemas y las cuestiones de bioética que no se vivieron dentro de la práctica de la salud del hospital. Este artículo presenta los resultados de la realización de una capacitación sobre la bioética con la participación de 130 personas (128 profesionales de la ESF en Viçosa, Minas Gerais y dos invitados), promovido por la integración de la universidad con el servicio de salud local. Los puntos de referencia utilizados incluyen el pluralismo metodológico, el trabajo en pequeños grupos, el aprendizaje significativo y el uso del arte para la construcción de capacidades en bioética. Los resultados observados se mostraron optimistas acerca de la efectividad de la acción, tanto desde el punto de vista de los profesionales de la ESF, y los participantes (facilitadores y profesores involucrados), la promoción de una construcción colectiva de conocimiento a la práctica.

What do we know about experiencing end-of-life in burn intensive care units? A scoping review.

OBJECTIVES: The aim of this article is to review and synthesize the evidence on end-of-life in burn intensive care units. METHODS: Systematic scoping review: Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in 3 databases, with no time restriction and up to September 2021. RESULTS: A total of 16,287 documents were identified; 18 were selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes, and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients' comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care, and palliative care. SIGNIFICANCE OF RESULTS: End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.

Antipsychotics impair regulation of glucose metabolism by central glucose.

Hypothalamic detection of elevated circulating glucose triggers suppression of endogenous glucose production (EGP) to maintain glucose homeostasis. Antipsychotics alleviate symptoms associated with schizophrenia but also increase the risk for impaired glucose metabolism. In the current study, we examined whether two acutely administered antipsychotics from different drug classes, haloperidol (first generation antipsychotic) and olanzapine (second generation antipsychotic), affect the ability of intracerebroventricular (ICV) glucose infusion approximating postprandial levels to suppress EGP. The experimental protocol consisted of a pancreatic euglycemic clamp, followed by kinomic and RNA-seq analyses of hypothalamic samples to determine changes in serine/threonine kinase activity and gene expression, respectively. Both antipsychotics inhibited ICV glucose-mediated increases in glucose infusion rate during the clamp, a measure of whole-body glucose metabolism. Similarly, olanzapine and haloperidol blocked central glucose-induced suppression of EGP. ICV glucose stimulated the vascular endothelial growth factor (VEGF) pathway, phosphatidylinositol 3-kinase (PI3K) pathway, and kinases capable of activating KATP channels in the hypothalamus. These effects were inhibited by both antipsychotics. In conclusion, olanzapine and haloperidol impair central glucose sensing. Although results of hypothalamic analyses in our study do not prove causality, they are novel and provide the basis for a multitude of future studies.

Protagonismo da enfermagem na vacinação contra a covid-19 versus irregularidades contestáveis: estudo descritivo-exploratório / The leading role of nursing in the vaccination against covid-19 versus questionable irregularities: a descriptive-exploratory study / Protagonismo de la enfermería en la vacunación contra el covid-19 versus irregularidades cuestionables: estudio descriptivo exploratorio

OBJETIVO: Analisar notícias que tratem de irregularidades envolvendo profissionais de enfermagem durante o processo de vacinação contra a Covid-19 e discutir condutas técnicas, éticas e legais aplicadas ou sugeridas pelos Conselhos Federal e Regionais de Enfermagem. MÉTODO: Pesquisa documental, qualitativa, descritiva-exploratória, cujas fontes foram notícias veiculadas pelos Conselhos de Enfermagem. Os dados foram processados pelo software IRAMUTEQ®, por meio da classificação hierárquica descendente que permitiu a análise lexical dos dados. RESULTADOS: 19 notícias constituíram o corpus textual, sendo identificados 117 Segmentos de Textos, dos quais 95 foram aproveitados (81,20%) e originaram dois blocos temáticos. O primeiro trata sobre o momento da vacinação e o segundo sobre os dilemas éticos deste processo. CONCLUSÃO: Evidencia-se um protagonismo da equipe de enfermagem na imunização. Surgiram a desconfiança e o patrulhamento, em função de notícias sobre atos antiéticos. Verifica-se a necessidade de proteção da imagem dos profissionais e assegurar práticas seguras à população.

OBJECTIVE: To analyze news items that deal with irregularities involving Nursing professionals during the vaccination process against COVID-19 and to discuss technical, ethical and legal courses of action applied or suggested by the Federal and Regional Nursing Councils. METHOD: A documentary, qualitative and descriptive-exploratory research study, whose sources were news items published by the Nursing Councils. The data were processed in the IRAMUTEQ® software through descending hierar-chical classification, which allowed performing the lexical data analysis. RESULTS: A total of 19 news items constituted the textual corpus, with identification of 117 Text Segments, of which 95 were used (81.20%) and created two thematic blocks. The first deals with the vaccination moment and the second is on the ethical dilemmas of this process. CONCLUSION: The leading role of the Nursing team in immunization is evidenced. Mistrust and patrolling emerged, due to news items about unethical actions. There is a need to protect the professionals' image and ensure safe practices for the population

OBJETIVO: Analizar noticias que aborden irregularidades que involucran a profesionales de enfermería durante el proceso de vacunación contra el Covid-19 y discutir conductas técnicas, éticas y legales aplicadas o sugeridas por el Consejo Federal y los Consejos Regionales de Enfermería. MÉTODO: Investigación documental, cualitativa, descriptiva, exploratoria, cuyas fuentes fueron noticias publicadas por los Consejos de Enfermería. Los datos fueron procesados por el software IRAMUTEQ®, mediante la clasificación jerárquica descendente que permitió el análisis léxico de los datos. RESULTADOS: El corpus textual estuvo compuesto por 19 noticias, se identificaron 117 Segmentos de Texto, de los cuales se utilizaron 95 (81,20%) y originaron dos bloques temáticos. El primero se refiere al momento de la vacunación y el segundo a los dilemas éticos de este proceso. CONCLUSIÓN: El equipo de enfermería tiene un papel protagónico en la inmunización. Surgió la desconfianza y el control, debido a noticias sobre actos poco éticos. Es necesario proteger la imagen de los profesionales y garantizar prácticas seguras para la población.

Avaliação do conhecimento dos profissionais de Enfermagem na prevenção da lesão por pressão na terapia intensiva / Evaluación del conocimiento de los profesionales de Enfermería en la prevención de lesiones por presión en cuidados intensivos / Evaluation of the knowledge of nursing professionals in the prevention of pressure ulcer in intensive care

RESUMO Objetivo analisar o conhecimento dos profissionais de Enfermagem sobre a avaliação, prevenção e classificação das lesões por pressão na terapia intensiva antes e após a realização de um treinamento. Método trata-se de um estudo comparativo, tipo antes e depois, transversal, com delineamento prospectivo, que utilizou o instrumento Teste de Conhecimento sobre Lesão por Pressão de Caliri-Pieper (TCLP CALIRI-PIEPER) aplicado antes e após a realização de um treinamento com 55 e 50 profissionais da Enfermagem, respectivamente. A média de acerto aceitável foi de acima de 90%. Resultados do total de 41 itens do instrumento, 14 (34%) não obtiveram pontuação média acima de 90% de acerto, sendo os técnicos de Enfermagem inseridos neste contingente. Evidenciou-se que o efeito do treinamento na amostra total obteve, em média, um acréscimo de 3,5 pontos no nível de conhecimento. A diferença média entre a pontuação obtida no pré e pós-teste foi estatisticamente significativa (p<0,001). Conclusões e implicações para a prática os participantes avaliados demonstraram níveis de conhecimento eficaz e baixa divergência entre as categorias, evidenciando que os profissionais estão capacitados e preparados, possuindo domínio nos fatores relacionados à avaliação, prevenção e classificação das lesões por pressão na terapia intensiva após a realização de um treinamento.

RESUMEN Objetivo analizar los conocimientos de los profesionales de Enfermería sobre la evaluación, prevención y clasificación de las lesiones por presión en cuidados intensivos antes y después de la realización de una formación. Método se trata de un estudio comparativo, antes y después, transversal con un diseño prospectivo que utilizó el instrumento Caliri-Pieper Pressure Injury Knowledge Test (CALIRI-PIEPER TCLP) aplicado antes y después del entrenamiento con 55 y 50 profesionales de Enfermería, respectivamente. La media aceptable de derecho a golpe fue superior al 90%. Resultados del total de 41 ítems del instrumento, 14 (34%) no obtuvieron un puntaje promedio superior al 90% de acierto, con los técnicos de Enfermería incluidos en este contingente. Se evidenció que el efecto formación en la muestra total obtuvo, en promedio, un incremento de 3,5 puntos en el nivel de conocimientos. La diferencia promedio entre las puntuaciones previas y posteriores a la prueba fue estadísticamente significativa (p <0,001). Conclusiones e implicaciones para la práctica los participantes evaluados demostraron niveles de conocimiento efectivo y baja divergencia entre las categorías, evidenciando que los profesionales están capacitados y preparados, teniendo dominio de los factores relacionados con la evaluación, prevención y clasificación de lesiones por presión en cuidados intensivos después del entrenamiento.

ABSTRACT Objective to analyze the knowledge of Nursing professionals on the assessment, prevention and classification of pressure ulcers in intensive care before and after a training course. Method this is a comparative, before-and-after, cross-sectional, prospective study that used the Caliri-Pieper Pressure Ulcer Knowledge Test (CALIRI-PIEPER PUKT) applied before and after training with 55 and 50 nursing professionals, respectively. The acceptable mean score was above 90%. Results of the total of 41 items of the instrument, 14 (34%) did not obtain an average score above 90% of correct answers, and the nursing technicians were included in this contingent. It was evident that the effect of the training on the total sample obtained, on average, a 3.5 point increase in the level of knowledge. The mean difference between the scores obtained in the pre- and post-test was statistically significant (p<0.001). Conclusions and implications for the practice the participants evaluated demonstrated effective levels of knowledge and low divergence between the categories, showing that the professionals are trained and prepared, having domain in the factors related to the evaluation, prevention and classification of pressure ulcers in intensive care after training.

Nicotinamide Mononucleotide Prevents Free Fatty Acid-Induced Reduction in Glucose Tolerance by Decreasing Insulin Clearance.

The NAD-dependent deacetylase SIRT1 improves ß cell function. Accordingly, nicotinamide mononucleotide (NMN), the product of the rate-limiting step in NAD synthesis, prevents ß cell dysfunction and glucose intolerance in mice fed a high-fat diet. The current study was performed to assess the effects of NMN on ß cell dysfunction and glucose intolerance that are caused specifically by increased circulating free fatty acids (FFAs). NMN was intravenously infused, with or without oleate, in C57BL/6J mice over a 48-h-period to elevate intracellular NAD levels and consequently increase SIRT1 activity. Administration of NMN in the context of elevated plasma FFA levels considerably improved glucose tolerance. This was due not only to partial protection from FFA-induced ß cell dysfunction but also, unexpectedly, to a significant decrease in insulin clearance. However, in conditions of normal FFA levels, NMN impaired glucose tolerance due to decreased ß cell function. The presence of this dual action of NMN suggests caution in its proposed therapeutic use in humans.

Uso do cateter vesical de demora em uma unidade de terapia intensiva: estudo transversal / Use of indwelling bladder catheters in an intensive care unit: cross-sectional study / El uso del catéter vesical de larga duración en una unidad de cuidados intensivos: estudio transversal

Objetivo: analisar o uso de cateter vesical de demora em unidade de terapia intensiva. Método: estudo observacional, transversal, descritivo, documental, realizado em uma unidade de terapia intensiva no Rio de Janeiro, entre maio e agosto de 2020. Amostra por conveniência, composta por 190 prontuários de pacientes com esse dispositivo. Utilizou-se questionário relacionado à caracterização dos pacientes, critérios de inserção; boas práticas; complicações não infecciosas. Os dados foram analisados pela estatística descritiva, apresentados em frequência absoluta e relativa. Para eventos não infecciosos, foi realizado o Teste Exato de Fischer, com auxílio do programa Statistical Package for Social Sciences. Resultados: a inserção de cateter vesical de demora se deu majoritariamente no sexo feminino (123-64,7%), pacientes com média de 62,9 anos e diagnóstico de COVID 19 (97 - 51,1%). Em 134 (70,5%) dos casos, os critérios foram atendidos. Conclusão: reforça-se a importância do cumprimento de protocolos e boas práticas no uso do cateter vesical de demora.

Objective: to analyze the use of indwelling bladder catheters in an intensive care unit. Method: this descriptive, cross-sectional, documentary study was conducted in an intensive care unit in Rio de Janeiro, between May and August 2020 with a convenience sample, comprising 190 medical records of patients with such devices. A questionnaire was used to characterize the patients, insertion criteria, best practices and non-infectious complications. The data were analyzed by descriptive statistics, presented in absolute and relative frequencies. For non-infectious events, Fischer's Exact Test was performed using the Statistical Package for Social Sciences. Results: indwelling bladder catheters were inserted mostly in females (123; 64.7%), patients with mean age 62.9 years, and diagnosis of COVID 19 (97; 51.1%). In 134 (70.5%) of cases, the criteria were met. Conclusion: the findings underline the importance of compliance with protocols and good practices when using indwelling bladder catheters.

Objetivo: analizar el uso del catéter vesical de larga duración en una unidad de cuidados intensivos. Método: estudio observacional, transversal, descriptivo, documental, realizado en una unidad de cuidados intensivos en Río de Janeiro, entre mayo y agosto de 2020. Muestra de conveniencia, compuesta por 190 historias clínicas de pacientes con este dispositivo. Se utilizó un cuestionario relacionado con la caracterización de los pacientes, criterios de inserción; buenas prácticas; complicaciones no infecciosas. Los datos fueron analizados por estadística descriptiva, presentados en frecuencia absoluta y relativa. Para los eventos no infecciosos, se realizó la Prueba Exacta de Fischer, con la ayuda del programa Statistical Package for Social Sciences. Resultados: la inserción de catéter vesical de larga duración se produjo principalmente en mujeres (123- 64,7%), pacientes con media de edad de 62,9 años y diagnóstico de COVID 19 (97 - 51,1%). En 134 (70,5%) de los casos, se cumplieron los criterios. Conclusión: Se refuerza la importancia del cumplimiento de protocolos y buenas prácticas en el uso del catéter vesical de larga duración.

Deletion of pancreas-specific miR-216a reduces beta-cell mass and inhibits pancreatic cancer progression in mice.

miRNAs have crucial functions in many biological processes and are candidate biomarkers of disease. Here, we show that miR-216a is a conserved, pancreas-specific miRNA with important roles in pancreatic islet and acinar cells. Deletion of miR-216a in mice leads to a reduction in islet size, ß-cell mass, and insulin levels. Single-cell RNA sequencing reveals a subpopulation of ß-cells with upregulated acinar cell markers under a high-fat diet. miR-216a is induced by TGF-ß signaling, and inhibition of miR-216a increases apoptosis and decreases cell proliferation in pancreatic cells. Deletion of miR-216a in the pancreatic cancer-prone mouse line KrasG12D;Ptf1aCreER reduces the propensity of pancreatic cancer precursor lesions. Notably, circulating miR-216a levels are elevated in both mice and humans with pancreatic cancer. Collectively, our study gives insights into how ß-cell mass and acinar cell growth are modulated by a pancreas-specific miRNA and also suggests miR-216a as a potential biomarker for diagnosis of pancreatic diseases.

Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports.

BACKGROUND: Nurses are the largest regulated group of healthcare professionals involved in palliative care. In 2004, a taskforce of the European Association for Palliative Care (EAPC) launched the 'Guide for development of palliative nurse education in Europe' (hereinafter, the EAPC 2004 Guide). No systematic evaluation of its impact in the development of palliative care education was undertaken. AIMS: To describe current undergraduate and postgraduate nursing education across Europe; to identify the roles that nurses with different palliative care educational levels have in palliative care; and to assess the uptake of the EAPC 2004 Guide in the development of palliative care nursing in Europe. DESIGN: Descriptive research involving an online survey among nursing experts, and the consultation of national representatives. SETTING/PARTICIPANTS: A total of 135 nurses (52% response rate) from 25 countries completed the online survey; representatives from 16 countries were consulted. RESULTS: In 14 (56%) countries, palliative care was not identified as a mandatory subject within undergraduate nursing education. The EAPC 2004 Guide is widely known and was/is being used in many countries to promote palliative care nursing education. Large variations were found across and within country responses. CONCLUSIONS: Palliative care nursing education varies largely in Europe. The wide awareness and use of the EAPC 2004 Guide show how policy measures can influence the development of palliative care education. Recommendations are built and focus on both fostering the use of this guide and implementing policy measures to ensure that palliative care nursing is recognised and certified as a specialty in all European countries.