Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)-A systematic review and meta-analysis.

There is an established literature on the symptoms and complications of COVID-19 but the after-effects of COVID-19 are not well understood with few studies reporting persistent symptoms and quality of life. We aim to evaluate the pooled prevalence of poor quality of life in post-acute COVID-19 syndrome (PCS) and conducted meta-regression to evaluate the effects of persistent symptoms and intensive care unit (ICU) admission on the poor quality of life. We extracted data from observational studies describing persistent symptoms and quality of life in post-COVID-19 patients from March 10, 2020, to March 10, 2021, following PRISMA guidelines with a consensus of two independent reviewers. We calculated the pooled prevalence with 95% confidence interval (CI) and created forest plots using random-effects models. A total of 12 studies with 4828 PCS patients were included. We found that amongst PCS patients, the pooled prevalence of poor quality of life (EQ-VAS) was (59%; 95% CI: 42%-75%). Based on individual factors in the EQ-5D-5L questionnaire, the prevalence of mobility was (36, 10-67), personal care (8, 1-21), usual quality (28, 2-65), pain/discomfort (42, 28-55), and anxiety/depression (38, 19-58). The prevalence of persistent symptoms was fatigue (64, 54-73), dyspnea (39.5, 20-60), anosmia (20, 15-24), arthralgia (24.3, 14-36), headache (21, 3-47), sleep disturbances (47, 7-89), and mental health (14.5, 4-29). Meta-regression analysis showed the poor quality of life was significantly higher among post-COVID-19 patients with ICU admission (p = 0.004) and fatigue (p = 0.0015). Our study concludes that PCS is associated with poor quality of life, persistent symptoms including fatigue, dyspnea, anosmia, sleep disturbances, and worse mental health. This suggests that we need more research on PCS patients to understand the risk factors causing it and eventually leading to poor quality of life.

Sudden death in paediatrics as a traumatic experience for critical care nurses.

BACKGROUND: Research shows that nurses working in critical care units and in particular, paediatric units, are at risk of developing symptoms of secondary traumatic stress (STS). However, little attention has been given to this phenomenon when associated with situations of sudden death in paediatrics. AIM: This study aimed to examine the impact of sudden death in paediatrics on nurses working in paediatrics critical care units and to explore nurses' experiences of this event. METHODS: This study used a mixed-methods design. The Impact of Event Scale - Revised was used for investigating the presence of STS symptoms. In addition, an interview was conducted with six nurses. RESULTS: Fifty-seven percent of nurses responded to the surveys and six nurses were interviewed. The results showed that the sudden death of children and adolescents is an event that elicits symptoms of STS in nurses. The quantitative assessment, revealed that 19·4% presented total scores indicating high impact. The participants interviewed described experiences of subjective distress, such as intrusive thoughts, avoidance and hyperarousal. Other factors were also reported as influencing the experience of the sudden death of a child/adolescent, namely, the child's age, the cause of death and the family's reaction to the loss. According to the participants, the emotional impact was also determined by parenthood, previous training and professional experience. CONCLUSIONS: Sudden death in paediatric critical care units is one of the most difficult situations in nursing practice and elicits STS symptoms, which may severely impact the physical and psychological health of nurses and ultimately affect the quality of the provided care. RELEVANCE FOR CLINICAL PRACTICE: This study emphasizes the need for promoting better conditions for professional practice, namely, with regard to emotional support, as well as training programmes for skills development in the area of management of traumatic situations and of communication with clients.

Ultrasound-Derived Three-Dimensional Printing in Congenital Heart Disease.

Three-dimensional printing technology has significant clinical implications for the management of congenital heart disease. Computed tomography and magnetic resonance imaging have been established as imaging tools for the creation of physical three-dimensional models. The potential use of non-invasive bedside imaging techniques such as three-dimensional echocardiography to derive three-dimensional printed models can revolutionize the planning of interventions for complex congenital malformations. The feasibility of deriving three-dimensional printing from ultrasound provides an additional cost-effective and patient-centered option for interventional cardiologists and surgeons for the management and care of congenital heart disease patients.

Transition to fatherhood in the prenatal period: a qualitative study. / Transição para a paternidade no período pré-natal: um estudo qualitativo.

Becoming a father requires a process of personal development, inner reorientation, and adaptation to a new role. The literature on this process has been sparse, devaluing how challenging and problematic the transition to becoming a father can be. This qualitative, exploratory, descriptive, cross-sectional and retrospective study sought to understand the experiences of men in the transition to fatherhood during the prenatal period. It included a sample of 10 men experiencing, for the first time, a partner's pregnancy. The data collection technique used was semi-structured interviews. The content analysis technique with semantic categorization and an inductive approach was used to analyze the data. As a result, 3 topics emerged: "experiencing the transition," "development of the father identity" and "(de)constructing bridges for the transition". This study deepens the understanding of this developmental transition and challenges the restructuring of prenatal care towards the inclusion of the father figure.

Tornar-se pai exige um processo de desenvolvimento pessoal, reorientação interior e adaptação ao novo papel. A literatura sobre este processo tem sido parca, desvalorizando o quão desafiante e problemática pode ser a transição de se tornar pai. Este estudo, de caráter qualitativo, exploratório, descritivo, transversal e retrospetivo procurou compreender as vivências dos homens na transição para a paternidade durante o período pré-natal. Incluiu uma amostra de 10 homens a vivenciar, pela primeira vez, a gravidez da parceira. Recurso à entrevista semiestruturada como técnica de coleta de dados. Análise de dados com técnica de análise de conteúdo, com categorização semântica e abordagem indutiva. Como resultados, emergiram 3 temas: "experienciar da transição", "desenvolvimento da identidade como pai" e "(des)construção de pontes para a transição". Este estudo aprofunda a compreensão desta transição desenvolvimental e desafia a uma reestruturação dos cuidados pré-natais no sentido da inclusão da figura paterna.

Nursing intervention focusing on health promotion behaviors in adult cancer patients: a scoping review.

OBJECTIVE: This review aims to map and provide an overview of literature concerning nursing strategies and intervention programs that promote healthy behaviors in cancer patients. METHOD: A scoping review was conducted using the methodological framework developed by Joanna Briggs Institute and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. Twelve databases were searched (2012-2019). Retrieved data included descriptive analyses exploring studies' methodological characteristics and results. RESULTS: From 1589 studies, 12 were included. Most studies included patients on survivorship period (n=10) and selected intervention strategies focusing patient's knowledge and awareness (n=8). Educational sessions were supported by behavioral change reinforcements and motivational incentives. Only two of the considered studies analysed intervention cost effectiveness, but none disclosed intervention-related costs. CONCLUSION: Nursing interventions are effective in promoting health behaviors when include health education and encouragement towards change. Survivorship is the perfect time for health promotion. Nurses can be considered health promoters, by encouraging health education and enhance survivor's motivation.

Nursing strategies to support psychological adaptation in adult cancer patients: a scoping review.

OBJECTIVE: To map the scientific evidence published in the literature about nursing strategies and intervention programs directed at supporting psychological adaptation in adult cancer patients. METHOD: A scoping review based on Joanna Briggs Institute Reviewers' Manual 2015 Methodology for JBI Scoping Reviews was conducted. Twelve databases were searched between 1 January 2012 and 31 January 2019. RESULTS: From 2203 studies, 32 were included. Evidence was grouped in five subjects: procedures, outcome assessment measures, nursing feasibility, effectiveness and cost-effectiveness. The cognitive-behavioral therapy was most frequent intervention. These interventions were developed between 5 to 10 weeks, included 3 to 6 sessions and lasted up to 60 minutes. Despite a wide range of outcome measures employed, three main areas were identified, adjustment and coping; stress, anxiety and fear of recurrence; and quality of life. CONCLUSION: This review allowed to identify nursing strategies to support psychological adaptation in adult cancer patients, to assess vulnerabilities and difficulties related to nurse interventions and to recognize the need for further insights into the effectiveness and cost-effectiveness.

Post-Hemorrhagic Hydrocephalus and Outcomes Amongst Neonates With Intraventricular Hemorrhage: A Systematic Review and Pooled Analysis.

Introduction Intraventricular hemorrhage (IVH) is a common cause of morbidity and mortality in preterm neonates. IVH leads to complications such as posthemorrhagic hydrocephalus (PHH), which commonly occurs in neonates with a more severe degree of IVH. Hence, we aimed to evaluate the characteristics and outcomes of PHH in neonates with IVH. Methods We performed a systematic review of cases reported from January 1978 to December 2020 through the PubMed database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the keywords 'intraventricular hemorrhage,' 'cerebral intraventricular hemorrhage,' and 'newborn.' A total of 79 articles were considered for analysis, and data on neonatal and maternal characteristics and outcomes were collected. The analysis was performed by using the χ2 test, Wilcoxon rank-sum test, and multivariate logistic regression model. Results We analyzed a total of 101 IVH cases, 54.5% were male and 62.4% preterm. Thirteen point nine percent (13.9%) presented with grade I, 35.6% grade II, and grade III respectively, and 8% grade IV IVH. Among the 59 (58.4%) neonates with PHH, 33.6% had resolved PHH and 24.8% had unresolved. In adjusted regression analysis, we found that neonates with resolved PHH have lower odds of having neurodevelopmental delay (OR:0.15, 95%CI:0.03-0.74; p=0.02) and death (OR:0.9;95%CI:0.01-0.99; p=0.049) as compared to unresolved PHH. Conclusion Our study showed that neonates with resolved PHH have a statistically significant lower risk of neurodevelopmental delay (NDD) and mortality. Future studies should be planned to evaluate the role of treatment and its effect on outcomes in IVH neonates with PHH as a complication.

Early epidemiological indicators, outcomes, and interventions of COVID-19 pandemic: A systematic review.

BACKGROUND: Coronavirus disease-2019 (COVID-19), a pandemic that brought the whole world to a standstill, has led to financial and health care burden. We aimed to evaluate epidemiological characteristics, needs of resources, outcomes, and global burden of the disease. METHODS: Systematic review was performed searching PubMed from December 1, 2019, to March 25, 2020, for full-text observational studies that described epidemiological characteristics, following MOOSE protocol. Global data were collected from the JHU-Corona Virus Resource Center, WHO-COVID-2019 situation reports, KFF.org, and Worldometers.info until March 31, 2020. The prevalence percentages were calculated. The global data were plotted in excel to calculate case fatality rate (CFR), predicted CFR, COVID-19 specific mortality rate, and doubling time for cases and deaths. CFR was predicted using Pearson correlation, regression models, and coefficient of determination. RESULTS: From 21 studies of 2747 patients, 8.4% of patients died, 20.4% recovered, 15.4% were admitted to ICU and 14.9% required ventilation. COVID-19 was more prevalent in patients with hypertension (19.3%), smoking (11.3%), diabetes mellitus (10%), and cardiovascular diseases (7.4%). Common complications were pneumonia (82%), cardiac complications (26.4%), acute respiratory distress syndrome (15.7%), secondary infection (11.2%), and septic shock (4.3%). Though CFR and COVID-19 specific death rates are dynamic, they were consistently high for Italy, Spain, and Iran. Polynomial growth models were best fit for all countries for predicting CFR. Though many interventions have been implemented, stern measures like nationwide lockdown and school closure occurred after very high infection rates (>10cases per 100 000population) prevailed. Given the trend of government measures and decline of new cases in China and South Korea, most countries will reach the peak between April 1-20, if interventions are followed. CONCLUSIONS: A collective approach undertaken by a responsible government, wise strategy implementation and a receptive population may help contain the spread of COVID-19 outbreak. Close monitoring of predictive models of such indicators in the highly affected countries would help to evaluate the potential fatality if the second wave of pandemic occurs. The future studies should be focused on identifying accurate indicators to mitigate the effect of underestimation or overestimation of COVID-19 burden.

Impact of Mesenteric Mass in Patients With Midgut Neuroendocrine Tumors.

OBJECTIVES: In this study, we used the institutional pathological and clinical databases from The Mount Sinai Hospital to investigate the impact of mesenteric mass on clinical and staging features in small intestinal neuroendocrine tumors. METHODS: Demographic, clinical, and staging data were collected. Tumor-node-metastasis stage was assigned according to the American Joint Committee on Cancer eighth edition staging manual. We used a χ-square test to evaluate the association between mesenteric mass and presenting symptoms, as well as the association between mesenteric mass and tumor characteristics, type of surgical resection, and use of somatostatin analogues. RESULTS: Presence of mesenteric mass was strongly associated with highly symptomatic clinical presentation (P < 0.0001). Patients with a mesenteric mass were more likely to have more advanced tumor status (T3 and T4; P = 0.005). The presence of a mesenteric mass was also more strongly associated with metastatic disease (P = 0.002). Patients with a mesenteric mass were more likely to undergo extensive surgical resection (P < 0.0001) and be treated with somatostatin analogues (P < 0.003). CONCLUSIONS: The data confirm our clinical observations that mesenteric involvement represents more extensive disease and is also associated with more aggressive treatment.

Intervenção educacional em enfermagem para promover a adaptação nos sobreviventes de câncer: protocolo para estudo-piloto / Educational nursing intervention to promote adaptation in cancer survivors: protocol for pilot study / Intervención educativa de enfermería para promover la adaptación en supervivientes de cáncer: protocolo de estudio piloto

RESUMO Objetivo: apresentar o protocolo de um estudo-piloto que visa avaliar a viabilidade e a aceitabilidade de uma intervenção educacional em enfermagem para promover a adaptação dos sobreviventes de câncer, focado no coping e na ansiedade. Método: este protocolo foi desenvolvido com base no Protocol Items: Recommendations for Interventional Trials 2013 (SPIRIT2013) Statement, na cidade do Porto - Portugal, em 2022. Resultados: foram definidos o desenho, a estrutura, o conteúdo, as estratégias e os instrumentos de avaliação da intervenção a serem implementados. Conclusão: este artigo fornece detalhadamente a estrutura e o conteúdo de uma intervenção educacional em enfermagem para promover a adaptação dos sobreviventes de câncer passível de integrar os procedimentos da fase de pilotagem. Pode, ainda, ser considerado um estímulo ao desenvolvimento de novas intervenções e programas de intervenções nesta fase da doença oncológica.

ABSTRACT Objective: to present the protocol of a pilot study that aims to evaluate the feasibility and acceptability of an educational nursing intervention to promote the adaptation of cancer survivors, focused on coping and anxiety. Method: this protocol was developed based on the Protocol Items: Recommendations for Interventional Trials 2013 (SPIRIT2013) Statement, in the city of Porto - Portugal, in 2022. Results: the design, structure, content, strategies, and evaluation instruments of the intervention to be implemented were defined. Conclusion: This article provides in detail the structure and content of an educational nursing intervention to promote the adaptation of cancer survivors that can be integrated into the piloting phase procedures. It can also be considered a stimulus for the development of new interventions and intervention programs in this phase of the cancer disease.

RESUMEN Objetivo: Presentar el protocolo de un estudio piloto destinado a evaluar la viabilidad y aceptabilidad de una intervención educativa de enfermería para promover la adaptación de los supervivientes de cáncer, centrándose en el afrontamiento y la ansiedad. Método: Este protocolo fue desarrollado con base en el Protocol Items: Recommendations for Interventional Trials 2013 (SPIRIT2013) Statement, en la ciudad de Porto - Portugal, en 2022. Resultados: Se definieron el diseño, la estructura, el contenido, las estrategias y las herramientas de evaluación de la intervención que se iba a llevar a cabo. Conclusión: Este artículo detalla la estructura y el contenido de una intervención educativa de enfermería para promover la adaptación de los supervivientes de cáncer que puede integrarse en los procedimientos de la fase de pilotaje. También puede considerarse un estímulo para el desarrollo de nuevas intervenciones y programas de intervención en esta fase de la enfermedad oncológica.

Avaliação da viabilidade e aceitabilidade de uma intervenção educacional em enfermagem: protocolo de um estudo piloto / Evaluation of the feasibility and acceptability of an educational intervention in nursing: protocol of a pilot study

RESUMO: Objetivo: explanar o protocolo de um estudo piloto cujo finalidade é projetar a avaliação da viabilidade e aceitabilidade de uma intervenção educacional em enfermagem para promover os comportamentos de saúde nos sobreviventes de cancro. Método: o protocolo foi desenvolvido com base no Standard Protocol Items: Recommendations for Interventional Trials de 2013 - SPIRIT 2013 Statement, no Porto, Portugal em 2022. Resultados: o protocolo suportará a implementação do estudo piloto, de forma a avaliar a viabilidade e aceitabilidade dos procedimentos definidos para a intervenção, estimar o recrutamento e retenção dos participantes e definir o tamanho da amostra, de modo a que se possa considerar possíveis reformulações da intervenção educacional e se possa prosseguir para a fase de avaliação. Conclusão: este estudo definiu as bases estruturais e conteúdos para a realização de um estudo piloto e, posteriormente, poderá influenciar a decisão da concretização de um estudo randomizado controlado.

ABSTRACT Objective: to explain the protocol of a pilot study that aims to evaluate the feasibility and acceptability of a nursing educational intervention to promote health behaviors in cancer survivors. Method: the protocol was developed based on the Standard Protocol Items: Recommendations for Interventional Trials 2013 - SPIRIT 2013 Statement, in Porto, Portugal in 2022. Results: the protocol would support the implementation of the pilot study in order to assess the feasibility and acceptability of the procedures defined for the intervention, estimate the recruitment and retention of participants, and define the sample size so that possible reformulations of the educational intervention could be considered and proceed to the evaluation phase. Conclusion: this study has laid the structural foundations and content for conducting a pilot study and may later influence the decision to conduct a randomized controlled trial.

Validação de uma intervenção educacional para promover comportamentos de saúde nos sobreviventes de cancro: Técnica e-Delphi / Validation of an educational intervention to promote health behaviors in cancer survivors: e-Delphi technique / Validación de una intervención educativa para promover comportamientos saludables en los supervivientes de cáncer: técnica e-Delphi

Resumo Enquadramento: Embora as evidências internacionais demonstrem que a promoção da saúde melhora a qualidade de vida e otimiza vários comportamentos de saúde dos sobreviventes de cancro, os programas educacionais dirigidos aos sobreviventes de cancro em Portugal são escassos. Objetivos: Validar o conteúdo e a estrutura de uma intervenção educacional em enfermagem para promover os comportamentos de saúde nos sobreviventes de cancro. Metodologia: Conduziu-se um e-Delphi modificado, com três rondas de questionários online. Participaram 26 dos 30 enfermeiros peritos convidados. Resultados: Os peritos chegaram a consenso para inclusão de 25 itens relacionados com a estrutura e 110 relacionados com o conteúdo. Os peritos admitiram uma intervenção de quatro a oito sessões presenciais, com possível inclusão de um familiar ou em grupo, reforçaram a ideia de preparação inicial dos enfermeiros, pronunciaram-se sobre os critérios de inclusão dos participantes e cimentaram a utilização da linguagem classificada para suportar o conteúdo. Conclusão: O consenso obtido entre os peritos produz robustez e consistência à intervenção educacional em desenvolvimento e promoverá a saúde dos sobreviventes de cancro.

Abstract Background: Although international evidence demonstrates that health promotion improves the quality of life and optimizes several health behaviors of cancer survivors, educational programs for cancer survivors are scarce in Portugal. Objectives: To validate the content and structure of an educational nursing intervention to promote health behaviors in cancer survivors. Methodology: A modified e-Delphi study was conducted with three rounds of online questionnaires. Twenty-six of the 30 invited expert nurses participated in the study. Results: The experts reached a consensus to include 25 structure-related items and 110 content-related items. The experts considered that the intervention should include four to eight presential sessions, with the possible inclusion of a family member, or in a group, reinforced the idea of nurses' initial preparation, discussed participant inclusion criteria, and strengthened the use of standardized language to support the contents. Conclusion: The expert consensus adds robustness and consistency to this educational intervention and will promote the health of cancer survivors.

Resumen Marco contextual: Aunque las pruebas internacionales demuestren que la promoción de la salud mejora la calidad de vida y optimiza varios comportamientos de salud de los supervivientes de cáncer, los programas educativos dirigidos a los supervivientes de cáncer en Portugal son escasos. Objetivos: Validar el contenido y la estructura de una intervención educativa de enfermería para promover conductas de salud en los supervivientes de cáncer. Metodología: Se realizó un e-Delphi modificado, con tres rondas de cuestionarios en línea. Participaron 26 de los 30 enfermeros expertos invitados. Resultados: Los expertos llegaron a un consenso para incluir 25 elementos relacionados con la estructura y 110 con el contenido. Los expertos aceptaron una intervención de cuatro a ocho sesiones presenciales, con la posibilidad de incluir a un familiar o un grupo, reforzaron la idea de la preparación inicial de los enfermeros, opinaron sobre los criterios de inclusión de los participantes y cimentaron el uso de un lenguaje clasificado para apoyar el contenido. Conclusión: El consenso alcanzado entre los expertos proporciona solidez y coherencia a la intervención educativa que se está desarrollando y promoverá la salud de los supervivientes de cáncer.

Validação de uma intervenção educacional em enfermagem para promover a adaptação dos sobreviventes de cancro / Validation of an educational nursing intervention to promote the adaptation of cancer survivors / Validación de una intervención educativa de enfermería para promover la adaptación de los supervivientes de cáncer

Resumo Enquadramento: Os sobreviventes de cancro representam um grande desafio para os sistemas de saúde, pela escassez de planos assistenciais a estas pessoas. Objetivo: Validar a estrutura e o conteúdo de uma intervenção educacional em enfermagem (intervenção complexa) para promover a adaptação dos sobreviventes de cancro. Metodologia: Utilizou-se a técnica e-Delphi modificada, ao longo de três rondas, através de questionários online. Resultados: Um conjunto de 27 peritos validaram a inclusão de 33 itens relativos à estrutura e 177 itens relativos ao conteúdo. A intervenção educacional deve ser realizada ao longo de cinco a oito sessões, individualmente, com a possibilidade de integrar um familiar significativo, e de dinâmicas de grupo, integrando os quatro domínios propostos: Adaptação, Atitude/Coping, Emoção/Ansiedade e Recursos. Conclusão: O consenso alcançado é essencial para evidenciar o papel dos enfermeiros nesta fase da doença oncológica e para viabilizar a avaliação da eficácia da intervenção educacional em desenvolvimento.

Abstract Background: Cancer survivors represent a major challenge for health systems due to the lack of care plans for these patients. Objective: To validate the structure and content of an educational nursing intervention (complex intervention) to promote the adaptation of cancer survivors. Methodology: The modified e-Delphi technique consisted of three rounds of online questionnaires. Results: A group of 27 experts validated the inclusion of 33 items related to the structure and 177 items related to the content. The educational intervention should consist of five to eight individual (with the possibility of including a significant family member) and group sessions and focus on the four domains proposed: Adaptation, Attitude/Coping, Emotion/Anxiety, and Resources. Conclusion: The consensus reached is essential to highlight nurses' role in this stage of cancer and assess the effectiveness of this educational intervention.

Resumen Marco contextual: Los supervivientes de cáncer representan un gran reto para los sistemas sanitarios, debido a la escasez de planes de atención para estas personas. Objetivo: Validar la estructura y el contenido de una intervención educativa de enfermería (intervención compleja) para promover la adaptación de los supervivientes de cáncer. Metodología: Se utilizó la técnica e-Delphi modificada, a lo largo de tres rondas, mediante cuestionarios en línea. Resultados: Un conjunto de 27 expertos validó la inclusión de 33 ítems relacionados con la estructura y 177 ítems relacionados con el contenido. La intervención educativa debe realizarse a lo largo de cinco a ocho sesiones, de forma individual, con la posibilidad de incluir a un familiar significativo y en dinámicas de grupo, integrando los cuatro dominios propuestos: Adaptación, Actitud/Coping, Emoción/Ansiedad y Recursos. Conclusión: El consenso alcanzado es esencial para destacar el papel de los enfermeros en esta fase del cáncer y para permitir la evaluación de la eficacia de la intervención educativa que se está desarrollando.

Transição para a paternidade no período pré-natal: um estudo qualitativo / Transition to fatherhood in the prenatal period: a qualitative study

Resumo Tornar-se pai exige um processo de desenvolvimento pessoal, reorientação interior e adaptação ao novo papel. A literatura sobre este processo tem sido parca, desvalorizando o quão desafiante e problemática pode ser a transição de se tornar pai. Este estudo, de caráter qualitativo, exploratório, descritivo, transversal e retrospetivo procurou compreender as vivências dos homens na transição para a paternidade durante o período pré-natal. Incluiu uma amostra de 10 homens a vivenciar, pela primeira vez, a gravidez da parceira. Recurso à entrevista semiestruturada como técnica de coleta de dados. Análise de dados com técnica de análise de conteúdo, com categorização semântica e abordagem indutiva. Como resultados, emergiram 3 temas: "experienciar da transição", "desenvolvimento da identidade como pai" e "(des)construção de pontes para a transição". Este estudo aprofunda a compreensão desta transição desenvolvimental e desafia a uma reestruturação dos cuidados pré-natais no sentido da inclusão da figura paterna.

Abstract Becoming a father requires a process of personal development, inner reorientation, and adaptation to a new role. The literature on this process has been sparse, devaluing how challenging and problematic the transition to becoming a father can be. This qualitative, exploratory, descriptive, cross-sectional and retrospective study sought to understand the experiences of men in the transition to fatherhood during the prenatal period. It included a sample of 10 men experiencing, for the first time, a partner's pregnancy. The data collection technique used was semi-structured interviews. The content analysis technique with semantic categorization and an inductive approach was used to analyze the data. As a result, 3 topics emerged: "experiencing the transition," "development of the father identity" and "(de)constructing bridges for the transition". This study deepens the understanding of this developmental transition and challenges the restructuring of prenatal care towards the inclusion of the father figure.

Nursing strategies to support psychological adaptation in adult cancer patients: a scoping review / Estratégias de enfermagem para apoiar a adaptação psicológica em pacientes adultos com câncer: uma revisão de escopo / Estrategias de enfermería para apoyar la adaptación psicológica en pacientes adultos con cáncer: una revisión del alcance

ABSTRACT Objective: To map the scientific evidence published in the literature about nursing strategies and intervention programs directed at supporting psychological adaptation in adult cancer patients. Method: A scoping review based on Joanna Briggs Institute Reviewers' Manual 2015 Methodology for JBI Scoping Reviews was conducted. Twelve databases were searched between 1 January 2012 and 31 January 2019. Results: From 2203 studies, 32 were included. Evidence was grouped in five subjects: procedures, outcome assessment measures, nursing feasibility, effectiveness and cost-effectiveness. The cognitive-behavioral therapy was most frequent intervention. These interventions were developed between 5 to 10 weeks, included 3 to 6 sessions and lasted up to 60 minutes. Despite a wide range of outcome measures employed, three main areas were identified, adjustment and coping; stress, anxiety and fear of recurrence; and quality of life. Conclusion: This review allowed to identify nursing strategies to support psychological adaptation in adult cancer patients, to assess vulnerabilities and difficulties related to nurse interventions and to recognize the need for further insights into the effectiveness and cost-effectiveness.

RESUMO Objetivo: Mapear as evidências científicas publicadas na literatura sobre estratégias e programas de intervenção de enfermagem voltados para o apoio à adaptação psicológica em pacientes adultos com câncer. Método: Foi realizada uma revisão de escopo com base na Metodologia do Manual dos Revisores 2015 do Joanna Briggs Institute para revisões de escopo JBI. Doze bancos de dados foram pesquisados entre 1º de janeiro de 2012 e 31 de janeiro de 2019. Resultados: De 2.203 estudos, 32 foram incluídos. As evidências foram agrupadas em cinco temas: procedimentos, medidas de avaliação de resultados, viabilidade de enfermagem, eficácia e custo-efetividade. A terapia cognitivo-comportamental foi a intervenção mais frequente. Essas intervenções foram desenvolvidas entre 5 a 10 semanas, incluíram 3 a 6 sessões e duraram até 60 minutos. Apesar de uma ampla gama de medidas de resultados empregadas, três áreas principais foram identificadas: ajuste e enfrentamento; estresse, ansiedade e medo de recorrência; e qualidade de vida. Conclusão: Esta revisão permitiu identificar estratégias de enfermagem para apoiar a adaptação psicológica em pacientes adultos com câncer, avaliar vulnerabilidades e dificuldades relacionadas às intervenções de enfermagem e reconhecer a necessidade de maiores esclarecimentos sobre a eficácia e custo-efetividade.

RESUMEN Objetivo: Mapear la evidencia científica publicada en la literatura sobre estrategias y programas de intervención de enfermería dirigidos a apoyar la adaptación psicológica en pacientes adultos con cáncer. Método: Se realizó una revisión de alcance basada en la metodologia 2015 del Manual de revisores del Joanna Briggs Institute para revisiones de alcance del JBI. Se realizaron búsquedas en doce bases de datos entre el 1 de enero de 2012 y el 31 de enero de 2019. Resultados: De 2203 estudios, se incluyeron 32. La evidencia se agrupó en cinco temas: procedimientos, medidas de evaluación de resultados, viabilidad de enfermería, efectividad y costo-efectividad. La terapia cognitivo-conductual fue la intervención más frecuente. Estas intervenciones se desarrollaron entre 5 y 10 semanas, incluyeron de 3 a 6 sesiones y duraron hasta 60 minutos. A pesar de una amplia gama de medidas de resultado empleadas, se identificaron tres áreas principales, ajuste y afrontamiento; estrés, ansiedad y miedo a la recurrencia; y calidad de vida. Conclusión: Esta revisión permitió identificar estrategias de enfermería para apoyar la adaptación psicológica en pacientes adultos con cáncer, evaluar vulnerabilidades y dificultades relacionadas con las intervenciones de enfermería y reconocer la necesidad de mayores conocimientos sobre la efectividad y la rentabilidad.

Nursing intervention focusing on health promotion behaviors in adult cancer patients: a scoping review / Intervención de enfermería centrada en los comportamientos de promoción de la salud en pacientes adultos con cáncer: una revisión del alcance

ABSTRACT Objective: This review aims to map and provide an overview of literature concerning nursing strategies and intervention programs that promote healthy behaviors in cancer patients. Method: A scoping review was conducted using the methodological framework developed by Joanna Briggs Institute and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. Twelve databases were searched (2012-2019). Retrieved data included descriptive analyses exploring studies' methodological characteristics and results. Results: From 1589 studies, 12 were included. Most studies included patients on survivorship period (n=10) and selected intervention strategies focusing patient's knowledge and awareness (n=8). Educational sessions were supported by behavioral change reinforcements and motivational incentives. Only two of the considered studies analysed intervention cost effectiveness, but none disclosed intervention-related costs. Conclusion: Nursing interventions are effective in promoting health behaviors when include health education and encouragement towards change. Survivorship is the perfect time for health promotion. Nurses can be considered health promoters, by encouraging health education and enhance survivor's motivation.

RESUMO Objetivo: Esta revisão tem como objetivo mapear e fornecer um panorama da literatura sobre estratégias e programas de intervenção de enfermagem que promovem comportamentos saudáveis ​​em pacientes com câncer. Método: Uma revisão de escopo foi conduzida usando a estrutura metodológica desenvolvida pelo Instituto Joanna Briggs e PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) extensão para revisões de escopo. Doze bancos de dados foram pesquisados ​​(2012-2019). Os dados recuperados incluíram análises descritivas explorando as características metodológicas e os resultados dos estudos. Resultados: De 1589 estudos, 12 foram incluídos. A maioria dos estudos incluiu pacientes em período de sobrevivência (n = 10) e estratégias de intervenção selecionadas com foco no conhecimento e consciência do paciente (n = 8). As sessões educacionais foram apoiadas por reforços de mudança comportamental e incentivos motivacionais. Apenas dois dos estudos considerados analisaram a efetividade do custo da intervenção, mas nenhum revelou custos relacionados à intervenção. Conclusão: As intervenções de Enfermagem são eficazes na promoção de comportamentos de saúde quando incluem a educação em saúde e o incentivo à mudança. A sobrevivência é o momento perfeito para a promoção da saúde. Os enfermeiros podem ser considerados promotores da saúde, por estimularem a educação para a saúde e aumentar a motivação dos sobreviventes.

RESUMEN Objetivo: Esta revisión tiene como objetivo mapear y proporcionar una visión general de la literatura sobre estrategias y programas de intervención de enfermería que promueven conductas saludables en pacientes con cáncer. Método: Se realizó una revisión del alcance utilizando el marco metodológico desarrollado por el Instituto Joanna Briggs y PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) extensión para revisiones de alcance. Se realizaron búsquedas en doce bases de datos (2012-2019). Los datos recuperados incluyeron análisis descriptivos que exploran las características metodológicas y los resultados de los estudios. Resultados: De 1589 estudios, se incluyeron 12. La mayoría de los estudios incluyeron pacientes en el período de supervivencia (n = 10) y estrategias de intervención seleccionadas que se centraron en el conocimiento y la conciencia del paciente (n = 8). Las sesiones educativas fueron apoyadas por refuerzos de cambio de comportamiento e incentivos motivacionales. Solo dos de los estudios considerados analizaron la rentabilidad de la intervención, pero ninguno reveló costos relacionados con la intervención. Conclusión: Las intervenciones de enfermería son efectivas para promover comportamientos de salud cuando incluyen educación para la salud y fomentan el cambio. La supervivencia es el momento perfecto para la promoción de la salud. Los enfermeros pueden considerarse promotores de la salud, ya que fomentan la educación sanitaria y aumentan la motivación de los supervivientes.

Intervenção educacional de enfermagem dirigida à promoção dos comportamentos de saúde nos sobreviventes de cancro / Educational nursing intervention to promote health behaviors in cancer survivors / Intervención educativa de enfermería dirigida a promover comportamientos saludables en supervivientes de cáncer

Resumo Enquadramento: O cancro reclama uma abordagem profissional concertada que se estenda para além do diagnóstico e do tratamento. Os comportamentos de promoção de saúde após a doença são um desafio para os enfermeiros e altamente relevantes para os sobreviventes. Objetivos: Explorar os aspetos centrais a integrar numa intervenção educacional de enfermagem para promover os comportamentos de saúde nos sobreviventes de cancro. Metodologia: Realizou-se um estudo exploratório, qualitativo, com um grupo de 9 peritos. Utilizou-se o grupo focal como estratégia de colheita de dados. Resultados: Os resultados propõem a construção de uma intervenção através da negociação e contratualização, que contemple várias áreas, que promova o envolvimento em comportamentos saudáveis e que sensibilize sobre os comportamentos de risco. Sugere-se um início precoce, preferencialmente no hospital. Conclusão: A intervenção de enfermagem deve recair num processo de tomada de decisão partilhada, considerar as preferências dos sobreviventes, a motivação e o membro familiar como catalisadores da mudança, possibilitar a expressão privada de emoções e, sobretudo, antecipar as necessidades dos sobreviventes.

Abstract Background: Cancer calls for a joint professional approach that goes beyond diagnosis and treatment. Health-promoting behaviors after cancer are a challenge for nurses and highly relevant for cancer survivors. Objective: To explore the key aspects to be integrated into an educational nursing intervention to promote health behaviors in cancer survivors. Methodology: A qualitative exploratory study was conducted with nine experts, using the focus group as the data collection method. Results: The results suggest the development of an intervention based on negotiation and the use of contracts, covering several areas, encouraging the adoption of healthy behaviors, and raising awareness about risky behaviors. An early application is recommended, preferably at the hospital. Conclusion: The nursing intervention should be based on a shared decision-making process, take into account the survivor's preferences and motivation and family members as catalysts for change, foster private emotional expression, and, above all, anticipate the survivor's needs.

Resumen Marco contextual: El cáncer requiere un enfoque profesional concertado que vaya más allá del diagnóstico y el tratamiento. Los comportamientos de promoción de la salud después de la enfermedad son un desafío para los enfermeros y muy relevantes para los supervivientes. Objetivos: Explorar los aspectos centrales que se deben integrar en una intervención educativa de enfermería para promover comportamientos saludables en los supervivientes de cáncer. Metodología: Se realizó un estudio exploratorio y cualitativo con un grupo de 9 expertos. Se utilizó el grupo focal como estrategia de recogida de datos. Resultados: Los resultados proponen la construcción de una intervención a través de la negociación y la contractualización, que abarque varios ámbitos, promueva la participación en comportamientos saludables y sensibilice sobre los comportamientos de riesgo. Se sugiere comenzar temprano, preferiblemente en el hospital. Conclusión: La intervención de enfermería debe centrarse en un proceso de toma de decisiones compartido, considerar las preferencias de los supervivientes, la motivación y al miembro de la familia como catalizadores del cambio, permitir la expresión privada de las emociones y, sobre todo, anticiparse a las necesidades de los supervivientes.

Elementos-chave de uma intervenção educacional em enfermagem promotora da adaptação dos sobreviventes de cancro / Key elements of an educational intervention in nursing for the promotion of cancer survivor adaptation / Elementos clave de una intervención educativa en enfermería que promueva la adaptación de los supervivientes de cáncer

Resumo Enquadramento: Em todo o mundo assiste-se a um menor investimento na fase de sobrevivência ao cancro e em Portugal desconhece-se a existência de qualquer programa de intervenção centrada na adaptação dos sobreviventes de cancro. Objetivo: Explorar os elementos-chave a considerar no desenvolvimento de uma intervenção educacional em enfermagem promotora da adaptação dos sobreviventes de cancro. Metodologia: Estudo exploratório qualitativo com recurso a técnica do grupo focal com 9 peritos para a colheita dos dados. Resultados: O conhecimento sobre a doença, a autogestão dos sintomas, o autocontrolo das emoções, o conhecimento sobre estratégias de coping e o envolvimento dos familiares devem integrar o conteúdo da intervenção a desenvolver. Estratégias do tipo educacional devem ser articuladas com estratégias motivacionais e relacionais. É fulcral que os sobreviventes estejam implicados no processo de aprendizagem. O plano de cuidados deve ser individualizado e contemplar um contrato de saúde. Conclusão: Este estudo permitiu identificar um conjunto mínimo de características que deve integrar uma intervenção educacional em enfermagem.

Abstract Background: There is less investment in the cancer survival phase worldwide, and in Portugal, there is no known intervention program focused on cancer survivor adaptation. Objective: To explore the key elements in the development of an educational intervention in nursing that promotes cancer survivor adaptation. Methodology: Qualitative exploratory study using a focus group with 9 experts for data collection. Results: Knowledge about the disease, self-management of symptoms, self-control of emotions, knowledge about coping strategies, and involvement of family members should integrate the content of the intervention to be developed. Educational strategies should be articulated with motivational and relational strategies. Cancer survivors must be involved in the learning process. The care plan must be individualized and include a health contract. Conclusion: This study allowed identifying a minimum set of characteristics that should integrate an educational intervention in nursing.

Resumen Marco contextual: En todo el mundo se invierte menos en la fase de supervivencia del cáncer y en Portugal se desconoce la existencia de un programa de intervención centrada en la adaptación de los supervivientes de cáncer. Objetivo: Explorar los elementos clave que se deben considerar en el desarrollo de una intervención educativa en enfermería que promueva la adaptación de los supervivientes de cáncer. Metodología: Estudio exploratorio cualitativo, para el cual se utilizó la técnica del grupo focal con 9 expertos para recoger los datos. Resultados: El conocimiento de la enfermedad, el autocontrol de los síntomas, el autocontrol de las emociones, el conocimiento de las estrategias de afrontamiento y la participación de los miembros de la familia deben integrar el contenido de la intervención que se desarrolle. Las estrategias educativas deben articularse con las estrategias motivacionales y relacionales. Es fundamental que los supervivientes se impliquen en el proceso de aprendizaje. El plan de atención debe ser individualizado e incluir un contrato de salud. Conclusión: En este estudio se identificó un conjunto mínimo de características que debe incluir una intervención educativa en enfermería.

Postpartum pulmonary embolism in a patient with Fontan circulation.

Pregnancy is typically not recommended in patients with Fontan circulation. Although patients are well aware of the risks for the mother and fetus, an increasing number opt to become pregnant. The higher rate of survival into adulthood post-Fontan procedure is a likely factor as a result of improved management of single ventricle anatomy. Postpartum thromboembolism is a known complication, but its prevalence and management are not clearly defined. We present a case of massive pulmonary embolism two weeks postpartum in a patient with double inlet left ventricle palliated with lateral tunnel Fontan.

Perceção dos pais sobre o futuro da criança com cancro / Perception of parents about the future of the child with cancer

Cancer in the child affects the whole family, which experiences the uncertainty of the prognosis, projecting itself into an unpredictable future. Parents come to live with the disease, the treatments and their effects, in a sinuous path lined by the uncertainty of the next day. The aim was to identify parents' perceptions regarding the future of children / adolescents with cancer undergoing chemotherapy. A qualitative, exploratory, descriptive and transversal study was developed. Eleven parents of children with cancer who underwent chemotherapy after their homecare were enrolled. Data were collected by semi-structured interview and analyzed according to Bardin. From the content analysis emerged the domain "Future Uncertain", which integrates the category "Syndrome of Damocles" and the subcategories "Fear" and "Unpredictability of the Future". Fear is a negative emotion experienced by parents of children with cancer, from the time of diagnosis and throughout the course of the disease. The unpredictability of the future is a constant in the life of parents, generating a continuous concern, so they resort to the strategy of thinking and living only in the present. However, uncertainty can catalyze psychological growth, leading them to value small moments, and to incorporate uncertainty as an integral part of life. Nurses must carry out interventions aimed at better management of uncertainty, as they help in the process of adaptation and management of stress. These interventions should lead to a "new normality" in family life, in which confrontation with adversity leads to a whole new meaning of existence

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