Bladder Perforation in the Elderly: Unraveling the Diagnostic Challenges With Magnetic Resonance Imaging.

Bladder perforation, a significant urological emergency, presents a diagnostic challenge due to its diverse etiologies and varying clinical manifestations. This paper discusses a rare case of bladder perforation in an 87-year-old woman with a history of hypertension and previous stomach and uterine cancer. The patient was admitted with a urinary tract infection and subsequently experienced mild abdominal discomfort and reduced urinary output, prompting further investigation. Imaging studies revealed bladder wall thickening and ureterohydronephrosis, raising suspicion of a bladder tumor. Intriguingly, a catheter-related bladder perforation was identified through MRI. This case emphasizes the importance of considering bladder perforation as a potential complication, especially in elderly patients with indwelling catheters. Clinicians must maintain a high index of suspicion and employ appropriate diagnostic modalities to ensure timely recognition and suitable management of this rare condition.

Impact of drinking water treatment processes on the residues of plant protection products for consumer and aquatic risk assessment: theoretical and experimental studies.

Pesticides residues can occur in ground and surface waters, and potentially react with chemicals used for water disinfection treatments, such as chlorine. This can lead to the formation of unknown reaction products, which can be more toxic and/or persistent than the active substances themselves, and therefore become a potential risk for human health and environment. Thus, in the framework of the EU Regulation 1107/2009, the identification of these by-products and their potential risk should be assessed. Within the European Food Risk Assessment (EU-FORA) Fellowship Programme, the fellow studied the behaviour of herbicides belonging to the families of imidazolinones and sulfonylureas in waters treated with chlorine disinfectants. Due to their physicochemical properties, these herbicides are susceptible of reaching natural waters. In fact, some of them have been detected in water monitoring programmes. During the experimental part of the present work programme, reactions between the active substances and the most used chlorine disinfecting reactants (hypochlorite and chloramines) were performed. Degradation kinetic parameters such as half-lives and degradation constants were calculated. Results showed that herbicide degradation was both pH and chlorine/chloramines concentration dependent. In order to identify the degradation by-products, high-resolution mass spectrometry experiments were performed, and a possible route of formation of these compounds was proposed. Finally, their risk assessment was carried out by using tox/ecotoxicological properties determined by QSAR methodology and FOCUS modelling for hazard and exposure assessment, respectively. These results will contribute to the definition of a risk assessment scheme for pesticides by-products potentially occurring in drinking water.

Cultura de segurança em unidade de terapia intensiva materna / Safety culture in a maternal intensive care unit / Cultura de seguridad en una unidad de cuidados intensivos maternos

Objetivo: identificar a cultura de segurança do paciente em uma unidade de terapia intensiva materna, na perspectiva da equipe de saúde. Método: estudo do tipo survey, aprovado pelo Comitê de Ética em Pesquisa, que utilizou o instrumento Hospital Survey on Patient Safety Culture para coleta de dados. Os dados foram analisados mediante estatística descritiva e as dimensões da cultura foram classificadas em forte, neutra e frágil. Resultados: identificou-se uma dimensão forte, quatro neutras e seis frágeis. A dimensão com maior percentual de respostas positivas foi "Trabalho em equipe dentro da unidade", já a com menor percentual foi "Frequência de notificações de eventos". Conclusão: a cultura de segurança do paciente na unidade de terapia intensiva materna foi considerada frágil, apontando para necessidade de prestação de cuidados com maior segurança as gestantes e puérperas que necessitam de cuidados intensivos.

Objective: to identify the patient safety culture in a maternal intensive care unit as seen by the healthcare team. Method: in this survey study approved by the research ethics committee, data were collected using the Hospital Survey on Patient Safety Culture and analyzed using descriptive statistics. The culture dimensions were classified as strong, neutral or weak. Results: one dimension was found to be strong, four neutral, and six weak. "Unit teamwork" returned the highest percentage of positive responses, while the lowest-scoring dimension was "Event notification frequency". Conclusion: the patient safety culture in the maternal intensive care unit was considered weak, pointing to the need to provide safer care to pregnant and postpartum women requiring intensive care.

Objetivo: identificar la cultura de seguridad del paciente en una unidad de cuidados intensivos maternos, desde la perspectiva del equipo sanitario. Método: estudio por encuesta de opinión (Survey), aprobado por el Comité de Ética de la Investigación, que utilizó el instrumento Hospital Survey on Patient Safety Culture para la recolección de datos. Los datos se analizaron por medio de una estadística descriptiva y las dimensiones de la cultura se clasificaron en fuerte, neutra y frágil. Resultados: se identificaron una dimensión fuerte, cuatro neutras y seis frágiles. La dimensión cuyo porcentaje de respuestas positivas fue más alto: "Trabajo en equipo dentro de la unidad"; mientras que la dimensión cuyo porcentaje fue más bajo fue: "Frecuencia de las notificaciones de eventos". Conclusión: la cultura de seguridad del paciente en la unidad de cuidados intensivos maternos se consideró frágil, lo que apunta hacia la necesidad de proporcionar una atención con mayor seguridad a las mujeres embarazadas y puérperas que requieren cuidados intensivos.

Cultura de segurança do paciente em serviços de alta complexidade no contexto da pandemia covid-19 / Safety culture in high complexity services in the context of the covid-19 pandemic / Cultura de la seguridad del paciente en los servicios de alta complejidad en el contexto de la pandemia de covid-19

RESUMO Objetivo: avaliar a cultura de segurança do paciente em unidades de alta complexidade de um hospital de ensino em tempos de pandemia. Método: delineamento transversal, realizado nas unidades de pronto atendimento e terapia intensiva em 2021. Utilizou-se o instrumento autoaplicável Hospital Survey on Patient Safety Culture com 103 profissionais da equipe multiprofissional. Foram realizadas análises descritivas e de consistência do instrumento. Resultados: apresentaram-se, como área forte para cultura de segurança do paciente, as dimensões de trabalho em equipe na unidade (79,5%) e expectativas e ações do supervisor/chefia para a promoção da segurança do paciente (73,6%), enquanto que nas áreas frágeis, destacaram-se as dimensões resposta não punitiva ao erro (37,9%) e transferências internas e passagem de plantão (31,8%). Observou-se predominância de subnotificações de eventos adversos (53,5%). Conclusão: setores críticos, mesmo durante a pandemia apresentaram áreas fortalecidas, embora o receio da punição e problemas quanto às transferências de informações tenham sido destacados pelos profissionais.

ABSTRACT Objective: to evaluate the patient safety culture in high complexity units of a teaching hospital in times of pandemic. Method: cross-sectional design, carried out in emergency and intensive care units in 2021. We used the self-administered instrument Hospital Survey on Patient Safety Culture with 103 professionals from the multi-professional team. Descriptive analyses and instrument consistency were performed. Results: the strongest areas for patient safety culture were the dimensions teamwork in the unit (79.5%) and expectations and actions of the supervisor/leadership to promote patient safety (73.6%). While the dimensions non-punitive response to error (37.9%) and internal transfers and shift change (31.8%) stood out in the weak areas. A predominance of adverse events underreporting was observed (53.5%). Conclusion: critical sectors, even during the pandemic, showed strengthened areas, although fear of punishment and problems regarding information transfers were highlighted by professionals.

RESUMEN Objetivo: evaluar la cultura de seguridad del paciente en unidades de alta complejidad de un hospital universitario en tiempos de pandemia. Método: delineación transversal, realizada en unidades de atención inmediata y terapia intensiva en 2021. Se utilizó el instrumento autoaplicado Encuesta hospitalaria sobre cultura de seguridad del paciente con 103 profesionales del equipo multiprofesional. Se realizó un análisis descriptivo y de consistencia de los instrumentos. Resultados: se presentaron como área fuerte para la cultura de seguridad del paciente las dimensiones del trabajo en equipo en la unidad (79,5%) y las expectativas y acciones del supervisor/chefia para la promoción de la seguridad del paciente (73,6%). Mientras que las dimensiones respuesta no punitiva al error (37,9%) y traslados internos y cambio de turno (31,8%) destacan como áreas débiles. Se observó un predominio de la subnotificación de eventos adversos (53,5%). Conclusión: los sectores críticos, incluso durante la pandemia, presentaron áreas reforzadas, aunque el miedo al castigo y los problemas de transferencia de información fueron destacados por los profesionales.

[Social distancing as protection factor against COVID-19 in a non-metropolitan area in the State of Rio Grande do Sul, BrazilLas medidas de distanciamiento social como factor de protección contra la COVID-19 en el interior de Rio Grande do Sul, Brasil]. / Medidas de distanciamento social como fator de proteção contra a COVID-19 no interior do Rio Grande do Sul, Brasil.

OBJECTIVE: To estimate the SARS-CoV-2 seroprevalence in a non-metropolitan area (Vale do Rio Pardo) in the state of Rio Grande do Sul, Brazil, and determine the association between seroprevalence and adherence to social distancing measures. METHOD: For the present population-based, cross-sectional study, data were collected in four stages from August to October 2020. SARS-CoV-2 seroprevalence was assessed using an IgG/IgM rapid test. Demographic, socioeconomic, clinical, and behavioral data were also collected, with administration of a three-question survey to determine adherence to social distancing measures with a focus on the level of social distancing practiced by participants, their routine activities, and circulation of people in the home. The association between sociodemographic data and social distancing was assessed using the chi-square test for linear trends in proportions, and the association between social distancing and seroprevalence was assessed using Poisson regression (95% confidence interval [95%CI]; P< 0.05). RESULTS: Of 4 252 tested and interviewed participants, 11.8% (95%CI: 10.8; 12.8) did not adhere to social distancing measures. The prevalence of a positive rapid test was 4.7% in participants who did not practice social distancing and 1.9% in participants who adhered to social distancing measures (P< 0.05). The variables male sex, age 20 to 59 years, having completed high school, monthly family income ranging from R$ 3 136.00 to R$ 6 270.00, and living in rural areas were associated with non-adherence to social distancing (P< 0.05). Adherence to all social distancing measures provided protection against SARS-CoV-2 infection (prevalence ratio: 0.37; 95%CI: 0.19; 0.73). CONCLUSIONS: The results indicate a reduction in seroprevalence with the adherence to social distancing measures.

OBJETIVO: Investigar la seroprevalencia del SARS-CoV-2 en la zona del Vale do Rio Pardo (Rio Grande do Sul, Brasil), y analizar la relación entre la seroprevalencia y el cumplimiento de las medidas de distanciamiento social por parte de la población. MÉTODO: Este estudio transversal basado en la población comprendió cuatro etapas de recopilación domiciliaria de datos entre agosto y octubre del 2020. La seroprevalencia se evaluó con la prueba rápida de anticuerpos IgM e IgG. Además, se recopilaron datos demográficos, socioeconómicos, clínicos y comportamentales por medio de un cuestionario de tres preguntas sobre el cumplimiento de las medidas de distanciamiento social, centrado en el grado de distanciamiento social que la persona entrevistada lograba tener, la rutina de las actividades de la persona entrevistada y la circulación de personas en el hogar. La relación entre los datos sociodemográficos y la práctica de distanciamiento social se evaluó con la prueba del ji cuadrado para determinar la tendencia lineal y la heterogeneidad de las proporciones, y la relación entre el distanciamiento social y la seroprevalencia se evaluó con el modelo de regresión de Poisson (intervalo de confianza de 95% [IC95%]; P< 0,05). RESULTADOS: De las 4 252 personas que se entrevistaron y a las que se les realizó la prueba, 11,8% (IC95%: 10,8; 12,8) no cumplían el distanciamiento social. La prevalencia de la realización de la prueba rápida con reactivo fue de 4,7% entre quienes no cumplían el distanciamiento social y de 1,9% entre quienes cumplían con esa medida (P< 0,05). Las variables relacionadas con el sexo masculino, el grupo etario de 20 a 59 años, la escolaridad de nivel medio, los ingresos familiares mensuales de R$ 3 136,00 a R$ 6 270,00 y la residencia en zonas urbanas guardaron relación con el incumplimiento del distanciamiento social (P< 0,05). El cumplimiento con todas las medidas de distanciamiento social fue un factor de protección contra la infección por SARS-CoV-2 (razón de prevalencia: 0,37; IC95%: 0,19; 0,73). CONCLUSIONES: Los resultados indican una reducción de la seroprevalencia a causa de las medidas de distanciamiento social.

Medidas de distanciamento social como fator de proteção contra a COVID-19 no interior do Rio Grande do Sul, Brasil

[RESUMO]. Objetivo. Investigar a soroprevalência de SARS-CoV-2 na região do Vale do Rio Pardo, Rio Grande do Sul, Brasil, e analisar a associação entre soroprevalência e adesão por parte da população às medidas de distanciamento social. Método. Este estudo transversal de base populacional compreendeu quatro etapas de coleta domiciliar de dados entre agosto e outubro de 2020. A soroprevalência foi avaliada utilizando teste rápido de anticorpos IgM e IgG. Foram coletados, ainda, dados demográficos, socioeconômicos, clínicos e comportamentais, com aplicação de um questionário de três perguntas sobre adesão a medidas de distanciamento social, com foco no nível de distanciamento social que o entrevistado conseguia praticar, rotina de atividades do entrevistado e circulação de pessoas na casa. A associação entre os dados sociodemográficos e a prática de distanciamento social foi avaliada pelo teste do qui-quadrado para tendência linear e heterogeneidade de proporções, e a associação entre o distanciamento social e a soroprevalência foi avaliada pela regressão de Poisson (intervalo de confiança de 95% [IC95%]; P < 0,05). Resultados. Dos 4 252 indivíduos testados e entrevistados, 11,8% (IC95%: 10,8; 12,8) não aderiram ao distanciamento social. A prevalência de teste rápido reagente foi de 4,7% entre aqueles que não realizaram distanciamento social e de 1,9% entre aqueles que realizaram distanciamento social (P < 0,05). As variáveis sexo masculino, faixa etária de 20 a 59 anos, ensino médio, renda familiar mensal de R$ 3 136,00 a R$ 6 270,00 e morar na zona urbana apresentaram associação com a não adesão ao distanciamento social (P < 0,05). A adesão a todas as medidas de distanciamento social foi fator de proteção contra a infecção de SARS-CoV-2 (razão de prevalência: 0,37; IC95%: 0,19; 0,73). Conclusões. Os resultados indicam uma redução da soroprevalência pelas medidas de distanciamento social.

[ABSTRACT]. Objective. To estimate the SARS-CoV-2 seroprevalence in a non-metropolitan area (Vale do Rio Pardo) in the state of Rio Grande do Sul, Brazil, and determine the association between seroprevalence and adherence to social distancing measures. Method. For the present population-based, cross-sectional study, data were collected in four stages from August to October 2020. SARS-CoV-2 seroprevalence was assessed using an IgG/IgM rapid test. Demographic, socioeconomic, clinical, and behavioral data were also collected, with administration of a three-question survey to determine adherence to social distancing measures with a focus on the level of social distancing practiced by participants, their routine activities, and circulation of people in the home. The association between sociodemographic data and social distancing was assessed using the chi-square test for linear trends in proportions, and the association between social distancing and seroprevalence was assessed using Poisson regression (95% confidence interval [95%CI]; P < 0.05). Results. Of 4 252 tested and interviewed participants, 11.8% (95%CI: 10.8; 12.8) did not adhere to social distancing measures. The prevalence of a positive rapid test was 4.7% in participants who did not practice social distancing and 1.9% in participants who adhered to social distancing measures (P < 0.05). The variables male sex, age 20 to 59 years, having completed high school, monthly family income ranging from R$ 3 136.00 to R$ 6 270.00, and living in rural areas were associated with non-adherence to social distancing (P < 0.05). Adherence to all social distancing measures provided protection against SARS-CoV-2 infection (prevalence ratio: 0.37; 95%CI: 0.19; 0.73). Conclusions. The results indicate a reduction in seroprevalence with the adherence to social distancing measures.

[RESUMEN]. Objetivo. Investigar la seroprevalencia del SARS-CoV-2 en la zona del Vale do Rio Pardo (Rio Grande do Sul, Brasil), y analizar la relación entre la seroprevalencia y el cumplimiento de las medidas de distanciamiento social por parte de la población. Método. Este estudio transversal basado en la población comprendió cuatro etapas de recopilación domiciliaria de datos entre agosto y octubre del 2020. La seroprevalencia se evaluó con la prueba rápida de anticuerpos IgM e IgG. Además, se recopilaron datos demográficos, socioeconómicos, clínicos y comportamentales por medio de un cuestionario de tres preguntas sobre el cumplimiento de las medidas de distanciamiento social, centrado en el grado de distanciamiento social que la persona entrevistada lograba tener, la rutina de las actividades de la persona entrevistada y la circulación de personas en el hogar. La relación entre los datos sociodemográficos y la práctica de distanciamiento social se evaluó con la prueba del ji cuadrado para determinar la tendencia lineal y la heterogeneidad de las proporciones, y la relación entre el distanciamiento social y la seroprevalencia se evaluó con el modelo de regresión de Poisson (intervalo de confianza de 95% [IC95%]; P < 0,05). Resultados. De las 4 252 personas que se entrevistaron y a las que se les realizó la prueba, 11,8% (IC95%: 10,8; 12,8) no cumplían el distanciamiento social. La prevalencia de la realización de la prueba rápida con reactivo fue de 4,7% entre quienes no cumplían el distanciamiento social y de 1,9% entre quienes cumplían con esa medida (P < 0,05). Las variables relacionadas con el sexo masculino, el grupo etario de 20 a 59 años, la escolaridad de nivel medio, los ingresos familiares mensuales de R$ 3 136,00 a R$ 6 270,00 y la residencia en zonas urbanas guardaron relación con el incumplimiento del distanciamiento social (P < 0,05). El cumplimiento con todas las medidas de distanciamiento social fue un factor de protección contra la infección por SARS-CoV-2 (razón de prevalencia: 0,37; IC95%: 0,19; 0,73). Conclusiones. Los resultados indican una reducción de la seroprevalencia a causa de las medidas de distanciamiento social.

Necessidades da família do paciente crítico em terminalidade de vida: revisão integrativa / Critical patient's family needs in terminality of life: integrative review

Objetivo: identificar na literatura científica as principais necessidades da família do paciente crítico terminal. Método:revisão integrativa realizada de acordo com as seis etapas propostas. As buscas foram realizadas nas bases de dados SciELO, LILACS e PubMed, sendo incluídos artigos publicados entre 2010 e março de 2021. Resultados:do total da amostra analisada (n=6), destacaram-se os ensaios clínicos (50%) e pesquisas qualitativas (33%). Foram evidenciadas diferentes necessidades dos familiares de pacientes críticos na terminalidade, com destaque para as necessidades de comunicação e as necessidades emocionais, espirituais, psicológicas e sociais. Considerações finais:a literatura científica aponta que a família do paciente em terminalidade de vida no âmbito da terapia intensiva apresenta uma diversidade de necessidades, e que o investimento na melhor comunicação com a equipe clínica durante o período de hospitalização na Unidade de Terapia Intensiva é uma premência. Percebe-se a importância da integração da equipe de saúde no contexto de terminalidade para auxiliar a família nesse momento delicado, corroborando para uma resposta adequada de um plano terapêutico. O trabalho interdisciplinar é uma alternativa, visto que as necessidades são de ordens diversas e não se limitam à alta densidade tecnológica comum a terapia intensiva.

Objective: to identify in the scientific literature the main needs of the terminally critical patient's family. Method:integrative review carried out according to the six proposed steps. Searches were performed in the SciELO, LILACS and PubMed databases, including articles published between 2010 and March 2021. Results:from the total sample analyzed (n=6), clinical trials (50%) and research stood out qualitative (33%). Different needs of families of critically ill patients in terminality were highlighted, with emphasis on communication needs and emotional, spiritual, psychological and social needs. Final considerations:the scientific literature indicates that the family of the terminally ill patient in the intensive care setting has a variety of needs, and that investing in better communication with the clinical team during the period of hospitalization in the Intensive Care Unit is a urgency. The importance of integrating the health team in the context of terminality to help the family in this delicate moment is perceived, supporting an adequate response to a therapeutic plan. Interdisciplinary work is an alternative, as the needs are of different orders and are not limited to the high technological density common to intensive care.

Cultura de segurança do paciente: perspectiva de trabalhadores da saúde e apoio / Cultura de seguridad del paciente: perspectiva de trabajadores de la salud y de apoyo / Patient safety culture: perspective of health and support workers

Resumo Objetivo Analisar a cultura de segurança do paciente na perspectiva dos trabalhadores que atuam direta ou indiretamente no cuidado ao paciente hospitalizado. Métodos Estudo transversal, com 2.634 trabalhadores do serviço hospitalar de sete instituições do Rio Grande do Sul, Brasil. Utilizou-se a versão brasileira do Safety Attitudes Questionnaire. Realizaram-se análises descritiva e inferencial, considerando cultura positiva escore ≥ 75 pontos. Resultados Evidenciou-se avaliação positiva da cultura de segurança nos domínios Clima de trabalho em equipe (mediana 75) e Satisfação no Trabalho (mediana 90). Os fisioterapeutas, dentistas e trabalhadores da manutenção avaliaram de forma positiva a cultura de segurança (p<0,05). Psicólogos, profissionais da nutrição/dietética e vigilantes/porteiros tiveram maiores percentuais para cultura negativa (p<0,05). Conclusão A cultura de segurança obteve escores predominantemente negativos, mais expressivos no domínio percepção da gerência do hospital. Quando comparadas as categorias da saúde e apoio, identificou-se pouca variabilidade nos escores dos domínios do instrumento. No entanto, os profissionais do apoio tenderam a pontuações mais baixas. Avaliar as dimensões da cultura de segurança fornece um diagnóstico situacional da organização ou unidade de trabalho e pode subsidiar estratégias gerenciais com vistas ao aprimoramento da qualidade da assistência prestada ao paciente.

Resumen Objetivo Analizar la cultura de seguridad del paciente desde la perspectiva de los trabajadores que actúan directa o indirectamente en el cuidado al paciente hospitalizado. Métodos Estudio transversal con 2.634 trabajadores del servicio hospitalario de siete instituciones del estado de Rio Grande do Sul, Brasil. Se utilizó la versión brasileña del Safety Attitudes Questionnaire. Se realizó un análisis descriptivo e inferencial y se consideró como cultura positiva la puntuación ≥ 75. Resultados Se observó una evaluación positiva de la cultura de seguridad en los dominios Clima de trabajo en equipo (mediana 75) y Satisfacción en el trabajo (mediana 90). Los fisioterapeutas, dentistas y trabajadores de mantenimiento evaluaron de forma positiva la cultura de seguridad (p<0,05). Los psicólogos, profesionales de nutrición/dietética y vigilantes/porteros tuvieron porcentajes mayores de cultura negativa (p<0,05). Conclusión La cultura de seguridad obtuvo puntuaciones predominantemente negativas, más significativas en el dominio Percepción de la gerencia del hospital. Al comparar las categorías de salud y de apoyo, se identificó poca variabilidad en las puntuaciones de los dominios del instrumento. Sin embargo, los profesionales de apoyo tuvieron una tendencia de puntajes más bajos. Evaluar las dimensiones de seguridad ofrece un diagnóstico situacional de la organización o unidad de trabajo y puede respaldar estrategias gerenciales con el fin de mejorar la calidad de la atención prestada al paciente.

Abstract Objective To analyze the culture of patient safety from the perspective of workers working directly or indirectly in the care of hospitalized patients. Methods Cross-sectional study of 2,634 hospital service workers from seven institutions in Rio Grande do Sul, Brazil. The Brazilian version of the Safety Attitudes Questionnaire was used. Descriptive and inferential analyzes were performed, considering scores ≥ 75 points as positive culture. Results A positive evaluation of the safety culture was evidenced in the Teamwork climate (median 75) and Job Satisfaction (median 90) domains. Physiotherapists, dentists and maintenance workers evaluated the safety culture positively (p<0.05). Psychologists, nutrition/dietetics professionals and security guards/doormen achieved higher percentages for negative culture (p<0.05). Conclusion The safety culture obtained predominantly negative scores, more expressive in the Perception of hospital management domain. When comparing the health and support categories, little variability was identified in scores of the instrument domains, although support professionals tended to score lower. Assessing the dimensions of the safety culture provides a situational diagnosis of the organization or work unit and can support management strategies aimed at improving the quality of patient care.

Máscara de mergulho adaptada para ventilação não-invasiva e posição prona em paciente com COVID-19 grave: relato de caso / Diving mask adapted for non-invasive ventilation and prone position in a patient with severe covid-19: case report / Máscara de buceo adaptada para ventilación no invasiva y posición de prono en un paciente con covid-19 grave: reporte de caso

Justificativa e objetivos: Na busca de estratégias para o tratamento da insuficiência respiratória aguda causada pela COVID-19, surge a ventilação não invasiva (VNI) e o uso da posição prona em respiração espontânea. Objetiva-se apresentar o caso de uma paciente com COVID-19 grave admitida em unidade de terapia intensiva (UTI) e submetida à máscara de mergulho adaptada, que se configura em uma interface inovadora para VNI, bem como a posição prona. Métodos: Relato de caso de paciente hospitalizado diagnosticado com COVID-19 submetido à VNI precoce por meio da máscara de mergulho adaptada e uso da posição prona em respiração espontânea por 8 horas noturnas e 6 horas diurnas. Resultados: Paciente do sexo feminino, 56 anos, hipertensão arterial sistêmica e obesidade, apresentando tosse seca, odinofagia, fadiga e dispneia intensa na admissão. A tomografia de tórax demonstrou opacidades em vidro fosco bilaterais. A VNI foi instituída 1-2,75 vezes/dia, por 40-60 minutos, com pressão positiva ao final da expiração de 8 (7,25-8,00) cmH2O e pressão de suporte de 5,5 (4,00-6,00) cmH2O. Fuga aérea de 6 a 30%, com boa tolerância. A posição prona em respiração espontânea resultou em aumento da saturação periférica de oxigênio e redução do desconforto respiratório 30 minutos após. Conclusão: A associação do uso da VNI com máscara de mergulho adaptada e posição prona em respiração espontânea demonstrou ser eficaz em evitar a intubação orotraqueal de paciente com COVID-19 grave, ressaltando a importância da intervenção proposta.(AU)

Justification and objectives: In the search of strategies to treat acute respiratory failure caused by COVID-19, non-invasive ventilation (NIV) and the use of prone position in spontaneous breathing appear. The objective is to present the case of a patient with severe COVID-19 admitted to an intensive care unit (ICU) who used an adapted diving mask, which is configured as an innovative interface for NIV, and the prone position. Methods: Case report of a hospitalized patient diagnosed with COVID-19 who underwent early NIV by means of an adapted diving mask and the prone position during spontaneous breathing for 8 hours at night and 6 hours in the day. Results: Female patient, 56 years old, systemic arterial hypertension and obesity, with dry cough, odynophagia, fatigue and severe dyspnea on admission. Chest tomography with bilateral ground-glass opacities. Non-invasive ventilation was instituted 1-2.75 times/day, for 40-60 minutes, with positive pressure at the end of expiration of 8 (7.25-8.00) cmH2O and support pressure of 5.5 (4.00 -6.00) cmH2O. Air leaks of 6 to 30%, with good tolerance. The prone position during spontaneous breathing resulted in increased peripheral oxygen saturation and reduced respiratory discomfort 30 minutes later. Conclusion: The association of the use of NIV with an adapted diving mask and prone position during spontaneous breathing proved to be effective in preventing the orotracheal intubation of a patient with severe COVID-19, emphasizing the importance of the proposed intervention.(AU)

Justificación y objetivos: En la búsqueda de estrategias para el tratamiento de la insuficiencia respiratoria aguda causada por COVID-19, aparecen la ventilación no invasiva (VNI) y el uso de la posición de prono con la respiración espontánea. El objetivo es presentar el caso de un paciente con COVID-19 grave ingresado en una unidad de cuidados intensivos (UCI) que utilizó una máscara de buceo adaptada, que se configura como una interfaz innovadora para VNI, así como la posición de prono. Métodos: Reporte de caso de una paciente hospitalizada con diagnóstico de COVID-19 que fue sometida a VNI precoz mediante máscara de buceo adaptada y la posición de prono con respiración espontánea durante 8 horas en la noche y 6 horas en el día. Resultados: Paciente de sexo femenino, 56 años, hipertensión arterial sistémica y obesidad, con tos seca, odinofagia, fatiga y disnea severa al ingreso. Tomografía de tórax con opacidades bilaterales en vidrio esmerilado. La VNI se instituyó de 1 a 2,75 veces/día, durante 40-60 minutos, con presión positiva al final de la espiración de 8 (7,25-8,00) cmH2O y presión de soporte de 5,5 (4, 00 -6,00) cmH2O. Fugas de aire del 6 al 30%, con buena tolerancia. La posición de prono con respiración espontánea resultó en un aumento de la saturación de oxígeno periférico y una reducción de las molestias respiratorias 30 minutos después. Conclusión: La asociación del uso de VNI con máscara de buceo adaptada y la posición de prono con respiración espontánea demostró ser efectiva para prevenir la intubación orotraqueal de una paciente con COVID-19 severo, enfatizando la importancia de la intervención propuesta.(AU)

Nursing diagnoses in the hemodynamics sector: an adaptive perspective.

OBJECTIVE: To identify nursing diagnoses of NANDA-I Taxonomy II in patients treated in the Hemodynamics Sector. METHOD: A descriptive, cross-sectional study with a quantitative approach conducted in a teaching hospital in the interior of Rio Grande do Sul. Data were collected through a sociodemographic characterization instrument and information regarding the problems of physical-physiological adaptation. RESULTS: 100 patients participated in the study. Defining characteristics, risk factors and related factors were identified through adaptation problems. In all, 28 nursing diagnoses were identified, and 13 were considered for the discussion which presented frequency above 50% and represented the main adaptive problems. Protection, neurological and activity and rest components were the most frequent. CONCLUSION: The recognition of nursing diagnoses facilitates a connection between the main problems of adaptation and nursing interventions.

Effect of characteristics of pharmacotherapy on non-adherence in chronic cardiovascular disease: A systematic review and meta-analysis of observational studies.

INTRODUCTION: Cardiovascular medications are effective in prevention of cardiovascular diseases (CVD); however, medication non-adherence contributes to morbidity and mortality. OBJECTIVE: This systematic review and meta-analysis aims to summarise the evidence regarding the relationship between characteristics of drug therapy (pharmacotherapy) and medication non-adherence in the CVD population. METHODS: Systematic searches in PubMed, LILACS, Academic Search and CINAHL databases for observational studies that enrolled adults with CVD were performed, from January 1960 to December 2015. The meta-analysis tested the association between characteristics of pharmacotherapy and self-reported medication non-adherence outcome, using a random effects model. To investigate heterogeneity, we performed subgroup analysis and sensitivity analysis. RESULTS: Twenty-four cross-sectional studies and 7 cohort studies were included in this review. Based on 31 studies including 27 441 participants, we performed meta-analyses for all the characteristics of drug therapy that at least 2 studies evaluated, with a total of fourteen meta-analyses. The pooled results showed that studies which evaluate whether participants have insurance or another program that assists with medication costs, but not full coverage (OR = 0.63; 95% CI: 0.53-0.74; P < .001; I2  = 0%, P = .938), and a dosing frequency of twice or more daily (OR = 1.38; 95% CI: 1.13-1.69; P < .001) were associated with non-adherence. CONCLUSIONS AND RELEVANCE: The results of this review suggest that access to insurance or another program that assists with medication costs was a protection factor for non-adherence. On the other hand, a high frequency of dosing was a risk factor for non-adherence. Therefore, these characteristics of pharmacotherapy must be considered to improve medication adherence among CVD patients.

Chemical metabolome assay by high-resolution Orbitrap mass spectrometry and assessment of associated antitumoral activity of Actinocephalus divaricatus.

RATIONALE: Actinocephalus divaricatus (Eriocaulaceae) is an important source of income for rural communities as it is sold as an ornamental plant. To date, no investigation has been conducted concerning the chemical composition and biological studies of the aerial parts of A. divaricatus. METHODS: The methanolic extract of the aerial parts of this species was chemically characterized. We applied an analytical dereplication approach based on Liquid Chromatography coupled to High-Resolution Orbitrap Mass Spectrometry in order to develop, identify and define rapidly the metabolite fingerprint of the aerial parts of A. divaricatus. Biological in vitro antitumor tests were undertaken using breast and lung cell lines of mice and humans. RESULTS: High-Resolution Mass Spectrometry (HRMS) allowed the fast determination of 30 compounds, which comprised three different classes of compounds: naphthopyranones, flavonoids and saponins. Chromatographic fractionation of the crude methanolic extract validated these results, since it led to the isolation of compounds belonging to the aforementioned classes of compounds, including new acyl glycosylated flavonoids (6-hydroxy-7-methoxyquercetin-3-O-(2"-O-acetyl)-ß-D-glucopyranoside and 6-hydroxy-7-methoxyquercetin-3-O-(6"-O-acetyl)-ß-D-glucopyranoside), which were fully characterized by Nuclear Magnetic Resonance and Mass Spectrometry experiments, and a known triterpenic saponin (3-O-ß-D-glucuronopyranosyl-30-norolean-12,20(29)-dien-28-O-ß-D-glucopyranosyl ester). Biological assays indicated that the methanolic extract of the capitula exhibited the best in vitro cytotoxicity against MCF7 cells (human breast cancer). CONCLUSIONS: The HRMS technique enabled us to identify several classes of compounds. In addition, saponins were identified for the first time in plants belonging to the Eriocaulaceae family. Thus, the essential contribution of this work lies in the new elements it brings to the taxonomic discussion which the Actinocephalus genus as a distinct genus of the Paepalanthus. The results obtained show that the methanolic extract of the capitula could be a promising source of bioactive fractions and/or compounds that may contribute towards breast cancer treatment.

Phenolics from Castanea sativa leaves and their effects on UVB-induced damage.

The phytochemical investigation of the methanol extract of the leaves of Castanea sativa Mill., source of the Italian PGI (Protected Geographical Indication) product 'Marrone di Roccadaspide' (Campania region) afforded as main compounds crenatin (1), chestanin (2), gallic acid (3), cretanin (4), 5-O-p-coumaroylquinic acid (5), p-methylgallic acid (6) and quercetin-3-O-glucoside (7). To quantify the isolated compounds a LC-ESI(QqQ)MS method working with a very sensitive and selective mass tandem experiment called Multiple Reaction Monitoring (MRM) has been developed. Moreover the antioxidant capacity by TEAC assay and the ability of compounds 1-7 to protect HaCaT human keratinocytes from UVB-induced damage has been investigated.

Nursing diagnoses in the hemodynamics sector: an adaptive perspective / Diagnósticos de enfermería en el sector de hemodinámica: una perspectiva adaptativa / Diagnósticos de enfermagem no setor de hemodinâmica: uma perspectiva adaptativa

ABSTRACT Objective: To identify nursing diagnoses of NANDA-I Taxonomy II in patients treated in the Hemodynamics Sector. Method: A descriptive, cross-sectional study with a quantitative approach conducted in a teaching hospital in the interior of Rio Grande do Sul. Data were collected through a sociodemographic characterization instrument and information regarding the problems of physical-physiological adaptation. Results: 100 patients participated in the study. Defining characteristics, risk factors and related factors were identified through adaptation problems. In all, 28 nursing diagnoses were identified, and 13 were considered for the discussion which presented frequency above 50% and represented the main adaptive problems. Protection, neurological and activity and rest components were the most frequent. Conclusion: The recognition of nursing diagnoses facilitates a connection between the main problems of adaptation and nursing interventions.

RESUMEN Objetivo: Identificar los diagnósticos de enfermería de la Taxonomía II de NANDA-I en pacientes atendidos en el Sector de Hemodinámica. Método: Estudio descriptivo, transversal, con abordaje cuantitativo, llevado a cabo en un Hospital de Enseñanza del interior de Río Grande do Sul. Los datos fueron recogidos por intermedio de un instrumento de caracterización sociodemográfica e informaciones referentes a los problemas de adaptación del modo físico fisiológico. Resultados: Participaron en el estudio 100 pacientes. Fueron identificadas las características definidoras, los factores de riesgo y los factores relacionados mediante los problemas de adaptación. En total, se identificaron 28 diagnósticos de enfermería, y para la discusión fueron considerados 13, los que presentaron frecuencia superior al 50% y representaron los principales problemas adaptativos. Los componentes protección, neurológico y actividad y reposo fueron los más frecuentes. Conclusión: El reconocimiento de los diagnósticos de enfermería facilita la conexión entre los principales problemas de adaptación y las intervenciones enfermeras.

RESUMO Objetivo: Identificar os diagnósticos de enfermagem da Taxonomia II da NANDA-I em pacientes atendidos no Setor de Hemodinâmica. Método: Estudo descritivo, transversal, com abordagem quantitativa, realizado em um Hospital de Ensino do interior do Rio Grande do Sul. Os dados foram coletados por intermédio de um instrumento de caracterização sociodemográfica e informações referentes aos problemas de adaptação do modo físico-fisiológico. Resultados: Participaram do estudo 100 pacientes. Foram identificados as características definidoras, os fatores de risco e os fatores relacionados por meio dos problemas de adaptação. No total, identificaram-se 28 diagnósticos de enfermagem, e para a discussão foram considerados 13, os quais apresentaram frequência acima de 50% e representaram os principais problemas adaptativos. Os componentes proteção, neurológico e atividade e repouso foram os mais frequentes. Conclusão: O reconhecimento dos diagnósticos de enfermagem facilita a ligação entre os principais problemas de adaptação e as intervenções de enfermagem.

LC-MS profiling highlights hazelnut (Nocciola di Giffoni PGI) shells as a byproduct rich in antioxidant phenolics.

The Italian "Nocciola di Giffoni", also known as "Tonda di Giffoni", a labelled Protected Geographical Indication (PGI) product, represents an important economic resource for the Italian market. The methanol (MeOH) extract of "Tonda di Giffoni" shells has been investigated for the phenolic content, assayed by the Folin-Ciocalteu method, and for the antioxidant activity by the 1,1-diphenyl-2-picrylhydrazyl (DPPH) and Trolox Equivalent Antioxidant Capacity (TEAC) assays. In order to achieve deeper insight into the chemical composition of the shells of hazelnut "Nocciola di Giffoni" and to highlight the occurrence of biologically active compounds, a phytochemical investigation was carried out. An initial Liquid Chromatography - Mass Spectrometry (LC-MS) profile of the methanol (MeOH) extract of the shells of C. avellana, cultivar "Tonda di Giffoni" led to the identification of sixteen compounds, of which the structures were elucidated by Nuclear Magnetic Resonance (NMR) spectroscopy. These were identified as a new diarylheptanoid, giffonin V (13), along with fifteen known phenolic compounds belonging to diarylheptanoid, neolignan, phenilpropanoid and flavonoid classes. In order to perform the quantitative determination of the main compounds of MeOH extract of C. avellana L. shells, an analytical method based on liquid chromatography coupled to mass spectrometry (LC-MS) with electrospray ionization source (ESI) and triple quadrupole mass analyzer (QqQ), using multiple reaction monitoring (MRM) scan mode, was developed and validated. The quantitative results highlight that main compounds occurred in the extract in concentration ranging from 6.4 to 83.3 (mg/100g). The antioxidant activity of all the isolated compounds evaluated by TEAC assay showed as the flavonoid derivatives exhibited a higher free-radical-scavenging activity. Moreover, the cytotoxicity of each compound was tested against the cancer cell lines A549 and Hela and against the human skin fibroblasts HaCat. None of tested compounds, in a range of concentrations between 12.5 and 100µM, cause a significant reduction of the cell number.

Risk assessment and incidence of falls in adult hospitalized patients.

OBJECTIVES: assess the risk of falls in adult hospitalized patients and verify the incidence of the event in this environment. METHOD: cohort study, with approval by the Research Ethics Committee, which monitored 831 patients hospitalized at a university hospital. The Morse Fall Scale (MFS) was used to assess the risk and patients with high risk (≥45 points) were considered exposed to falls. RESULTS: the mean MFS score was 39.4 (±19.4) points. Between the first and the final assessment, the score increased by 4.6%. The first assessment score presented a strong and positive correlation with the final assessment score (r=0.810; p=0.000). CONCLUSION: the higher the risk score for falls when the patient is admitted, the higher the score at the end of the hospitalization period and vice-versa. The incidence rate corresponded to 1.68% with a higher percentage of patients classified at high risk of falls.

Isolation of antioxidant phenolics from Schinopsis brasiliensis based on a preliminary LC-MS profiling.

The phenolic content of the ethanol extract of the stem bark of the Brazilian plant Schinopsis brasiliensis Engl. (Anacardiaceae) has been evaluated together with the antioxidant activity. The good antioxidant activity exhibited in the Trolox Equivalent Antioxidant Capacity (TEAC) assay (TEAC value = 3.04 mg/mL) encouraged us to investigate its constituents. An analytical approach based on LC-ESIMSn was applied to rapidly obtain a metabolite profile of the ethanol extract of the stem bark of S. brasiliensis. Sixteen phenolic compounds, among which five galloyl derivatives, never reported before, have been isolated and their structures have been unambiguously elucidated by extensive spectroscopic methods, including 1D (1H, 13C, TOCSY) and 2D (DQF-COSY, HMBC, and HSQC) NMR experiments. Moreover, the antioxidant activity of all the isolated compounds was evaluated, along with the cytotoxicity against the cancer cell lines A549 (human alveolar basal carcinoma) and Hela (human epitheloid cervix carcinoma). The previously undescribed compounds exhibited a high free-radical-scavenging activity, in the range of 1.10-1.86 mM. None of the tested compounds, in a range of concentrations between 12.5 and 100 µM, caused a significant reduction of the cell number.

Research survey on iridoid and phenylethanoid glycosides among seven populations of Euphrasia rostkoviana Hayne from the Alps.

The traditional use of extracts of Euphrasia rostkoviana to relieve ocular inflammation or infections is well documented and supported by clinical studies. Various classes of chemical compounds such as iridoids, phenylethanoids, flavonoids and hydroxycinnamic acids have been reported. The present work aims to assess the chemical diversity among seven populations of Euphrasia rostkoviana found in northern Italy. A meticulous separation of components led to the isolation and structural characterization of two previously unrecorded phenylethanoids methoxycrassifolioside and deoxycrassifolioside and one previously undescribed terpene glucoside (1E,6E)-8-hydroxy-3,7-dimethyl-octa-1,6-dienyl 1-O-ß-D-glucopyranoside. We have also identified known phenylethanoids and iridoids that are reported in this genus for the first time. Finally, a targeted quantitative analysis for the standardization of herbal preparations revealed that iridoids occur in all populations whereas the presence and the levels of rutin and phenylethanoids are highly variable.

Risk assessment and incidence of falls in adult hospitalized patients / Evaluación del riesgo e incidencia de caídas en pacientes adultos hospitalizados / Avaliação do risco e incidência de quedas em pacientes adultos hospitalizados

Abstract Objectives: assess the risk of falls in adult hospitalized patients and verify the incidence of the event in this environment. Method: cohort study, with approval by the Research Ethics Committee, which monitored 831 patients hospitalized at a university hospital. The Morse Fall Scale (MFS) was used to assess the risk and patients with high risk (≥45 points) were considered exposed to falls. Results: the mean MFS score was 39.4 (±19.4) points. Between the first and the final assessment, the score increased by 4.6%. The first assessment score presented a strong and positive correlation with the final assessment score (r=0.810; p=0.000). Conclusion: the higher the risk score for falls when the patient is admitted, the higher the score at the end of the hospitalization period and vice-versa. The incidence rate corresponded to 1.68% with a higher percentage of patients classified at high risk of falls.

Resumen Objetivos: evaluar el riesgo para caídas de pacientes hospitalizados y verificar la incidencia del evento en ese ambiente. Método: estudio de cohorte, aprobado por Comité de Ética en Investigación, que siguió 831 pacientes internados en un hospital universitario. Se utilizó la Morse Fall Scale (MFS) para evaluar el riesgo y se consideró como expuesto a las caídas el paciente con riesgo elevado (≥45 puntos). Resultados: la puntuación media de la MFS fue de 39,4 (±19,4) puntos. Entre la primera y la última evaluación, la puntuación aumentó en 4,6%. La puntuación de la primera evaluación mostró correlación positiva fuerte con la de la última evaluación (r=0,810; p=0,000). Conclusión: cuanto mayor la puntuación de riesgo para caídas en el momento de la admisión del paciente, mayor al final del período de internación y vice-versa. La tasa de incidencia fue 1,68% con mayor porcentaje de pacientes clasificados con riesgo elevado para caídas.

Resumo Objetivos: avaliar o risco para quedas de pacientes adultos hospitalizados e verificar a incidência do evento nesse ambiente. Método: estudo de coorte, aprovado por Comitê de Ética em Pesquisa, que acompanhou 831 pacientes internados em um hospital universitário. Utilizou-se a Morse Fall Scale (MFS) para avaliar o risco e considerou-se exposto às quedas o paciente com risco elevado (≥45 pontos). Resultados: a média da pontuação da MFS foi de 39,4 (±19,4) pontos. Entre a primeira e a última avaliação, existiu um aumento de 4,6% na pontuação. O escore da primeira avaliação apresentou uma correlação positiva forte com o da última avaliação (r=0,810; p=0,000). Conclusão: quanto maior a pontuação de risco para quedas na admissão do paciente, maior ao final do período de internação e vice-versa. A taxa de incidência foi de 1,68% com maior percentual de pacientes classificados com risco elevado para quedas.

Cultura de segurança do paciente no cenário hospitalar: revisão integrativa / Culture of patient safety in the hospital setting: an integrative review / Cultura de la seguridad del paciente en el medio hospitalario: una revisión integradora

Objetivo: identificar produções relativas à segurança do paciente e cultura organizacional, que utilizaram como instrumento de coleta de dados o Safety Attitudes Questionnaire. Método: uma revisão integrativa, nas bases de dados LILACS, MEDLINE/PubMed, SCOPUS e Web of Science, com os descritores patient safety, organizational culture, climate, attitude of health personnel e a palavra-chave safety attitudes questionnaire, com artigos publicados online, na íntegra, até o ano 2013. Resultados: obtiveram-se 16 publicações para análise e discussão, apresentadas em duas categorias. Os estudos utilizaram como sujeitos profissionais da saúde. A inserção dos demais profissionais não foi suficientemente contemplada, porém representam um papel relevante na criação de ambientes de trabalho seguros. Verificou-se associação da cultura organizacional com o clima de segurança dos profissionais nas instituições. Conclusão: acredita-se que este estudo trará contribuições à equipe de saúde, em especial à enfermagem, no que tange a implementação de ações de melhoria nas instituições de saúde.(AU)

Objective: to identify productions related to patient safety and organizational culture, which used as data collection instrument the Safety Attitudes Questionnaire. Method: an integrative review, in the databases LILACS, MEDLINE/PubMed, Scopus and Web of Science, with patient safety descriptors, organizational culture, climate, attitude of health personnel and the keyword safety attitudes questionnaire, with articles published online, in full, by the year 2013. Results: we obtained 16 publications for analysis and discussion, presented in two categories. The studies used as subjects health professionals. The inclusion of other professionals was not sufficiently covered, but represents an important role in creating safe work environments. An association of organizational culture with safety environment for the professionals was verified. Conclusion: it is believed that this study will bring contributions to the health team, especially to nursing, regarding the implementation of improvement actions in health institutions.(AU)

Objetivo: identificar las producciones relacionadas con la seguridad del paciente y la cultura de la organización, que utiliza como un instrumento de recolección de datos del Cuestionario de Actitudes de Seguridad. Método: una revisión integradora, en las bases de datos LILACS, MEDLINE/PubMed, Scopus y Web of Science, con los descriptores de seguridad de los pacientes, la cultura organizacional, el clima, la actitud del personal de salud y el cuestionario de actitudes de palabras clave de seguridad, con artículos publicados en línea, en su totalidad, para el año 2013. Resultados: se obtuvieron 16 publicaciones para el análisis y la discusión, presentadas en dos categorías. Siendo utilizados como sujetos del estudio los profesionales de la salud. La inclusión de otros profesionales no estaba suficientemente cubierta, sino que representan un papel importante en la creación de ambientes de trabajo seguros. Una asociación de cultura de la organización con el entorno de la seguridad al profesional en las instituciones fue observada. Conclusión: se cree que este estudio aportará contribuciones al equipo de salud, sobre todo a la enfermería, en cuanto a la implementación de acciones de mejora en las instituciones de salud.(AU)