Realistic simulation in nursing education: Testing two scenario-based models.

AIM: To evaluate students' self-perceived pedagogical outcomes when using a digital scenario-based tool compared to traditional scenarios printed on paper. DESIGN: This study used a within-subjects experiment. METHOD: A digital platform for scenario development was developed, focusing on patients' regaining independence and returning home after an acute event. Students participated in two simulation activities, differing only in the type of scenario used and completed a questionnaire to evaluate their learning experience. RESULTS: Students considered that the new scenario template provided a clearer understanding of the situation under analysis, allowing them to recognize the focuses of attention to be prioritized when formulating the intervention plan. No Patient or Public Contribution: A digital platform for a standardized process of scenario writing to help realistic simulation in nursing education is a novelty in this study and will likely contribute to substantial learning gains.

A conceção de cuidados de enfermagem dirigida aos prestadores de cuidados espelhada na documentação / How documentation reflects nursing care design for caregivers / La concepción de los cuidados de enfermería dirigida a los prestadores de cuidados se refleja en la documentación

Resumo Enquadramento: A assunção do papel de cuidador exige a aquisição de conhecimentos e habilidades, garantindo a segurança dos cuidados à pessoa cuidada e assegurar o seu próprio autocuidado. O enfermeiro assume o papel de facilitador neste processo de transição, sendo os sistemas de informação em enfermagem uma ferramenta que garante a continuidade e qualidade dos cuidados. Objetivo: Compreender a conceção de cuidados de enfermagem relativa ao prestador de cuidados. Metodologia: Estudo descritivo exploratório com abordagem mista, através da análise da documentação do prestador de cuidados em 163 processos e aplicação de um questionário (N = 72). Resultados: Identificou-se subnotificação no prestador de cuidados. Estes eram predominantemente mulheres, com idade avançada e sobrecarga moderada. Expressaram dificuldades nas atividades instrumentais e necessidade de apoio de outro cuidador/redes formais. Conclusão: A identificação das necessidades e dificuldades do prestador de cuidados em confronto com a subnotificação observada reforça a necessidade de uma aproximação dos modelos em uso aos modelos expostos, traduzindo este processo numa melhoria dos padrões de qualidade em enfermagem dirigida aos prestadores de cuidados.

Abstract Background: Caregivers must acquire knowledge and develop skills that ensure the safety of the care delivered and guarantee their own self-care. Nurses take on the role of facilitators in this transition process, with nursing information systems being used as tools to safeguard the continuity and quality of care. Objective: To understand nursing care design for caregivers. Methodology: This is a mixed method study with a descriptive exploratory research design, analyzing 163 files of caregiver documentation and using a questionnaire (N = 72). Results: It was possible to identify the underreporting of caregivers. Caregivers were predominantly elderly women with moderate burden who reported difficulties in instrumental activities and needed support from an additional caregiver or a formal support network. Conclusion: Identifying the needs and difficulties of caregivers combined with the observed underreporting strengthens the need for bringing the models in use closer to the models presented, thus translating this process into an improvement of quality standards in nursing care for caregivers.

Resumen Marco contextual: La asunción del papel de cuidador requiere la adquisición de conocimientos y habilidades, lo que garantiza la seguridad de los cuidados a la persona cuidada y asegura su propio autocuidado. El enfermero asume el papel de facilitador en este proceso de transición, y los sistemas de información de enfermería son una herramienta que garantiza la continuidad y la calidad de los cuidados. Objetivo: Comprender la concepción de los cuidados de enfermería en relación con el cuidador. Metodología: Estudio descriptivo exploratorio con un enfoque mixto, para el cual se analizó la documentación del proveedor de cuidados en 163 procesos y se aplicó un cuestionario (N = 72). Resultados: Se identificó un subregistro en el cuidador. Eran predominantemente mujeres, con una edad avanzada y una sobrecarga moderada. Manifestaron dificultades en las actividades instrumentales y necesidad de apoyo de otro cuidador/redes formales. Conclusión: La identificación de las necesidades y dificultades del cuidador frente al subregistro observado refuerza la necesidad de una aproximación de los modelos en uso a los modelos expuestos, lo que traduce este proceso en una mejora de los estándares de calidad en enfermería dirigidos a los cuidadores.

A co-construção de um modelo de acompanhamento aos familiares cuidadores / Co-construction of a caregiver-monitoring model / La coconstrucción de un modelo de apoyo a los familiares cuidadores

Resumo Enquadramento: A abordagem aos cuidadores informais coloca novos desafios à enfermagem, que deve sustentar a conceção de cuidados na melhor evidência científica. A documentação dos sistemas de informação deve gerar indicadores que espelhem o papel dos enfermeiros como facilitadores de uma transição saudável. Objetivo: Redefinir a conceção de cuidados ao familiar cuidador a partir da análise dos registos que espelha a atividade dos enfermeiros com os cuidadores. Metodologia: Estudo com abordagem qualitativa assente na pesquisa ação participativa em saúde, desenvolvido com uma amostra de 16 enfermeiros em atividade de cuidados de saúde primários. Recorreu-se às notas de campo e considerou-se os pressupostos defendidos por Bardin para a análise de conteúdo. Resultados: Emergiram três categorias, organização do trabalho dos enfermeiros, limitações à documentação em enfermagem e uniformização dos registos. Em conjunto com os participantes desenvolveu-se um modelo de acompanhamento aos familiares cuidadores. Conclusão: Os pressupostos da pesquisa-ação participativa em saúde facilitaram a redefinição do modelo assistencial conducente a melhoria na qualidade de cuidados e documentação nos sistemas de informação em enfermagem.

Abstract Background: The approach to informal caregivers poses new challenges to nursing, supporting the conception of care based on the best available scientific evidence. Care documentation in information systems should create indicators that reflect the nurses' role as facilitators of a healthy transition. Objective: To redefine the conception of care to the family caregiver though the analysis of records that mirrors the nurses' activity with caregivers. Methodology: Qualitative study based on the assumptions of participatory action research in health with 16 nurses from primary health care units. Field notes were taken and Bardin's content analysis method was used. Results: Three categories emerged: work organization, limitations to nursing documentation, and standardization of records. A family caregiver support model was developed in collaboration with the participants. Conclusion: The assumptions of participatory action research in health facilitated the redefinition of the care model to improve the quality of care and documentation process in nursing information systems.

Resumen Marco contextual: El enfoque hacia los cuidadores informales plantea nuevos retos a la enfermería, que debe apoyar el diseño de cuidados basados en la mejor evidencia científica. La documentación de los sistemas de información debe generar indicadores que reflejen el papel de los enfermeros como facilitadoras de una transición saludable. Objetivo: Redefinir el concepto de cuidados al familiar cuidador a partir del análisis de los registros que reflejan la actividad de los enfermeros con los cuidadores. Metodología: Estudio con enfoque cualitativo basado en la investigación-acción participativa en salud, desarrollado con una muestra de 16 enfermeros que trabajan en atención primaria. Se utilizaron notas de campo y se tuvieron en cuenta los supuestos defendidos por Bardin para el análisis de contenido. Resultados: Surgieron tres categorías, organización del trabajo de los enfermeros, limitaciones a la documentación en enfermería y normalización de los registros. En conjunto con los participantes, se elaboró un modelo de apoyo a los familiares cuidadores. Conclusión: Las premisas de la investigación-acción participativa en salud facilitaron la redefinición del modelo de atención que condujo a la mejora de la calidad de los cuidados y la documentación en los sistemas de información de enfermería.

Intervenções eficazes na prevenção ou redução da sobrecarga do familiar cuidador: revisão sistemática da literatura / Effective interventions for the prevention and reduction of the family caregiver burden: a systematic literature review

The family caregiver role is highly demanding and very likely to trigger burden. A systematic literature review was conducted in order to identify effective interventions for the prevention/reduction of the family caregiver burden. A search was conducted in SCOPUS, Web of Science and EBSCO databases from 2006 to 2016. Ten studies were selected involving different interventions (educational, psychoeducational, psycho-social and psycho-socio-educational). Despite the positive results of the different types of approach, the educational and multicomponent programmes revealed the most favorable outcomes. Considering the methodological heterogeneity observed, multicenter, longitudinal, prospective, controlled and mixed methodology studies should be carried out, leading to high-quality evidence-based results

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El cuidado de familiares adultos. Cómo afecta a la salud y al bienestar del cuidador familiar? / Caring for adult relatives: what impact on health and well-being of the family caregiver

Introducción. El cuidado de un miembro de la familia con dependencia para los cuidados personales es un proceso complejo que afecta a la salud y al bien-estar del cuidador familiar. Objetivos. El objetivo de este estudio es identificar este impacto. Método. Se llevó a cabo una revisión integradora, respaldada por el Repositório Científico de Acesso Aberto de Portugal entre los años 2000 y 2012, en la que se tuvieron en cuenta todos los documentos completos accesibles. Se utilizó el método PI(CO)D. Para el análisis de los datos se solicitó la intervención de dos revisores independientes. Se utilizaron los indicadores del Joanna Briggs Institute para analizar la calidad metodológica de los estudios. Resultados. Se seleccionaron doce estudios principales. La mayoría de ellos se basaban en investigación observacional de tipo transversal/descriptivo, lo cual permite dibujar el perfil de los cuida-dores familiares e identificar sus necesidades y los factores relacionados con la carga. Los resultados muestran una mayor carga/estrés en los cuidadores familiares de personas con demencia y con un nivel elevado de dependencia. La mayor carga está relacionada con una mala percepción del estado de salud, de la satisfacción y de la calidad de vida del cuidador familiar. Los niveles de carga asociada, depresión emocional y estrés son más elevados en las mujeres que en los hombres. conclusiones. La naturaleza de los estudios utilizados permite identificar el impacto que supone el cuidado de un familiar con dependencia para los cui-dadores familiares. No obstante, es imposible analizar los resultados de mane-ra dinámica a lo largo de un periodo de tiempo. Es importante centrarse en la investigación basándose en los mejores datos clínicos disponibles para poten-ciar la toma de decisiones en la práctica clínica

IntroductIon. Caring for a family member dependent in self-care is a complex process with impact on health and well-being of the family caregiver. ObjectIve. This study aimed to identify this impact. Method. An integrative review was con-ducted supported on the Repositório Científico de Acesso Aberto de Portugal [Open Access Scientific Repository of Portugal], within the time period from 2000 to 2012 and considering all full text accessible documents. The PI(CO)D method was used. Two independent reviewers were invited to analyse data. The grids suggested by the Joanna Briggs Institute were used to analyse the methodological quality of the studies. Results. Twelve primary studies were selected. The majority of the studies were based on observational research of transversal/descriptive nature, enabling to trace the family caregivers' profile, to identify their needs and factors associated to bur-den. The results show increased burden/stress in family caregivers of persons with dementia and high dependency levels. Increased burden is associated with poor perception of the health status, satisfaction and quality of life of the family caregiver. Women show higher levels of associated burden, emotional depression and stress than men. Conclusions. The nature of the identified studies enables to identify the impact that caring for a dependent relative has on family caregivers. Notwithstanding, it is not possible to analyse the findings in a dynamic way throughout a period of time. It is important to focus on research based on the best clinical evidence available to enhance decision making in clinical practice

Feelings for the acceptance of the family caregivers' role

Introduction: Despite the progressive reduction of the members in family aggre-gations, families continue being the main support source to homebound people, whether in their direct caregiving, or in the psychological support and social con-tacts. Thus, it is questioned: What feelings lead to the acceptance of the family caregivers' role?. Purpose: To identify the feelings evolved from the acceptance of the caregiver's role. Research Methods: Descriptive, exploratory qualitative research carried out with fa-mily caregivers of dependent elderly. Data collection was developed by means of questionnaire application and logbooks. The guiding question was "Why do you have to care?" After the results, it was held the content analysis. Results and discussion: Two hundred and twenty-six (226) answers were analyzed. The following categories were elaborated: feeling of recognition, feeling of responsibility, feeling of affection, feeling of obligation, feeling of interest, feeling of avai-lability, feeling of acceptance from the social context. Conclusion: Apprehending the feelings involved in the acceptance of the family caregiver's role enables health professionals to elaborate actions and strategies to strengthen such acting

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[Development of the short version of the informal caregiver burden assessment questionnaire]. / Desenvolvimento de uma versão reduzida do Questionário De Avaliação Da Sobrecarga do Cuidador Informal.

OBJETIVE: to create a reduced version of the QASCI, which is structurally equivalent to the long one and meets the criteria of reliability and validity. METHOD: Through secondary data from previous studies, the participants were divided into two samples, one for the development of reduced version and the second for study of the factorial validity. Participants responded to QASCI, the SF 36, the ADHS and demographic questions. RESULTS: A reduced version of 14 items showed adequate psychometric properties of validity and internal consistency, adapted to a heptadimensional structure that assesses positive and negative aspects of care. CONCLUSION: Confirmatory factor analysis revealed a good fit with the advocated theoretical model.

Development of the short version of the informal caregiver burden assessment questionnaire / Desarrollo De Una Versión Reducida Del Cuestionario De Evaluación De La Sobrecarga Del Cuidador Informal / Desenvolvimento de uma versão reduzida do Questionário de Avaliação da Sobrecarga do Cuidador Informal

OBJETIVE to create a reduced version of the QASCI, which is structurally equivalent to the long one and meets the criteria of reliability and validity. METHOD Through secondary data from previous studies, the participants were divided into two samples, one for the development of reduced version and the second for study of the factorial validity. Participants responded to QASCI, the SF 36, the ADHS and demographic questions. RESULTS A reduced version of 14 items showed adequate psychometric properties of validity and internal consistency, adapted to a heptadimensional structure that assesses positive and negative aspects of care. CONCLUSION Confirmatory factor analysis revealed a good fit with the advocated theoretical model. .

OBJETIVO Crear una versión reducida del Cuestionario de Evaluación de la Sobrecarga del Cuidador Informal (CESCI) que sea estructuralmente equivalente y que reúna criterios de fidelidad y validez. MÉTODO Mediante datos secundarios a estudios anteriores se constituyeron dos muestras, la primera para el desarrollo de la versión reducida y la segunda para estudiar la validez factorial. Los participantes respondieron al CESCI, el SF 36, la HAD y a preguntas sociodemográficas. RESULTADOS La versión reducida de 14 ítems demostró adecuadas propiedades psicométricas de validez y consistencia interna adaptadas a una estructura heptadimensional que evalúa los aspectos negativos y positivos del cuidar. CONCLUSIÓN El análisis factorial confirmatorio reveló un buen ajuste al modelo teórico preconizado. .

OBJETIVO Criar uma versão reduzida do Questionário de Avaliação da Sobrecarga do Cuidador Informal (QASCI), que seja estruturalmente equivalente e que reúna critérios de fidelidade e validade. MÉTODO Através de dados secundários a estudos anteriores constituíram-se duas amostras, uma para o desenvolvimento da versão reduzida e a segunda para estudar a validade fatorial. Os participantes responderam ao QASCI, ao SF 36, à EADH e a perguntas sociodemográficas. RESULTADOS A versão reduzida de 14 itens mostrou adequadas propriedades psicométricas de validade e consistência interna adaptada a uma estrutura heptadimensional que avalia aspetos negativos e positivos do cuidar. CONCLUSÃO A análise fatorial confirmatória revelou um bom ajustamento ao modelo teórico preconizado. .

BTNL2 gene polymorphism associations with susceptibility and phenotype expression in sarcoidosis.

A functional polymorphism within butyrophilin-like 2 (BTNL2) gene has been described as a potential risk factor for sarcoidosis. The association between chronicity and the rs2076530 SNP A allele has also been reported. This study evaluates the BTNL2 rs2076530 G/A allele associations with sarcoidosis susceptibility and disease evolution in a Portuguese cohort of patients. A case-control study of 151 patients and 150 controls was performed. Allele frequencies were compared with Chi-square test in a univariate analysis and with logistic regression in a multivariate analysis. BTNL2 rs206530 A allele frequencies were significantly higher in sarcoidosis with no linkage disequilibrium with HLA-DRB1 alleles, except in the subgroup of patients with Löfgren syndrome where the determinant allele was HLA-DRB1*03. The A allele was also increased in those with isolated thoracic disease, with no differences regarding radiological stages or disease evolution. HLA-DRB1*03, besides the association with Löfgren syndrome was significantly related with disease resolution. Our data confirms the association of BTNL2 rs2076530 A allele with sarcoidosis susceptibility in a Portuguese population. We found independent genetic risk factors in clinically distinct disease phenotypes: BTNL2 rs2076530 A allele in patients without Löfgren syndrome or with isolated thoracic disease, and HLA-DRB1*03 in Löfgren syndrome or disease resolution.

HLA class-I diversity in Cameroon: evidence for a north-south structure of genetic variation and relationships with African populations.

HLA class I diversity (loci A, B and C) was analysed in four populations, two from North Cameroon (Podokwo and Uldeme) and two from South Cameroon (Ewondo and Bamileke). Northern and southern Cameroon populations show a substantial genetic diversity in terms of haplotype sharing and genetic distances, even despite the low percentage of variance due to differences among populations evidenced by analysis of molecular variance. The signals of differentiation among populations are consistent with their linguistic affiliation, and support previous evidence, based on autosomal microsatellites and protein loci, which has shown that the complex pattern of genetic variation of Cameroon can in part be described by contrasting the northern and southern part of the country. Looking at our results in the more general framework of HLA diversity in sub-Saharan Africa, it turns out that the Podokwo and Uldeme show some genetic links to populations of the southern western branch of the Sahel corridor, while their high frequency of A*02 and C*04 alleles is congruent with previously hypothesised introgression of non-sub-Saharan alleles. On the other hand, signals of shared ancestry between the Bamileke and Ewondo and the Bantu speakers from central and southern Africa were detected.

Role of human leukocyte antigen, killer-cell immunoglobulin-like receptors, and cytokine gene polymorphisms in leptospirosis.

Leptospirosis is an emerging zoonotic disease caused by pathogenic species of the genus Leptospira. It has a broad range of clinical presentations in humans. Although progress has been made in the characterization of the host immune system factors that may affect disease progression and outcome, to date few reports have addressed the role of genetic polymorphisms in the susceptibility to leptospirosis. In this work a group of patients with a history of leptospiral infection and a control group were compared for polymorphisms in the human leukocyte antigen (HLA), in killer-cell immunoglobulin-like receptors (KIR), and in cytokine genes. Alleles in the HLA-A and -B loci were associated with susceptibility, as were the class I haplotype A*01-B*08-Cw*07 and the 8.1 ancestral haplotype (A*01-B*08-Cw*07-DRB1*03-DQB1*02). Single nucleotide polymorphisms in the interleukin (IL)-4 and IL-4Ralpha genes also had significantly higher frequencies in the patient group. No association was reported between KIR gene profile and leptospirosis. This work highlights the importance of using genetic polymorphisms to better understand the mechanisms involved in the immune response to leptospirosis.

Ectopic calcification among families in the Azores: clinical and radiologic manifestations in families with diffuse idiopathic skeletal hyperostosis and chondrocalcinosis.

OBJECTIVE: Twelve families that were multiply affected with diffuse idiopathic skeletal hyperostosis (DISH) and/or chondrocalcinosis, were identified on the island of Terceira, The Azores, potentially supporting the hypothesis that the 2 disorders share common etiopathogenic factors. The present study was undertaken to investigate this hypothesis. METHODS: One hundred three individuals from 12 unrelated families were assessed. Probands were identified from patients attending the Rheumatic Diseases Clinic, Hospital de Santo Espírito, in The Azores. Family members were assessed by rheumatologists and radiologists. Radiographs of all family members were obtained, including radiographs of the dorsolumbar spine, pelvis, knees, elbows, and wrists, and all cases were screened for known features of chondrocalcinosis. RESULTS: Ectopic calcifications were identified in 70 patients. The most frequent symptoms or findings were as follows: axial pain, elbow, knee and metacarpophalangeal (MCP) joint pain, swelling, and/or deformity, and radiographic enthesopathic changes. Elbow and MCP joint periarticular calcifications were observed in 35 and 5 patients, respectively, and chondrocalcinosis was identified in 12 patients. Fifteen patients had sacroiliac disease (ankylosis or sclerosis) on computed tomography scans. Fifty-two patients could be classified as having definite (17%), probable (26%), or possible (31%) DISH. Concomitant DISH and chondrocalcinosis was diagnosed in 12 patients. Pyrophosphate crystals were identified from knee effusions in 13 patients. The pattern of disease transmission was compatible with an autosomal-dominant monogenic disease. The mean age at which symptoms developed was 38 years. CONCLUSION: These families may represent a familial type of pyrophosphate arthropathy with a phenotype that includes peripheral and axial enthesopathic calcifications. The concurrence of DISH and chondrocalcinosis suggests a shared pathogenic mechanism in the 2 conditions.

Linkage disequilibrium between S65C HFE mutation and HLA A29-B44 haplotype in Terceira Island, Azores.

Our objective was to investigate the frequency of HFE gene mutations and to study linkage disequilibrium (LD) between HLA-Class I alleles and these mutations in the population of Terceira Island, Azores, Portugal. A total of 218 unrelated individuals were investigated. Three HFE mutations--C282Y, H63D, and S65C--were identified by restriction endonuclease digestion of polymerase chain reaction (PCR)-amplified genomic DNA. HLA-Class I alleles were typed by PCR-single-strand polymorphism. Gene frequencies and LD were estimated using Arlequin V 1.1. Six genotypes were found in the population: WT/WT (58.3%), H63D/WT (31.2%), H63D/H63D (2.3%), H63D/C282Y (0.9%), S65C/WT (4.1%), and C282Y/WT (3.2%). No cases of C282Y or S65C homozygosity were identified. HLA haplotype A3-B7 was in LD with C282Y; HLA alleles A29, B44, and HLA haplotype A29-B44 were in LD with S65C mutation. HFE gene frequencies in this population are similar to those in other European populations; HFE S65C mutation was found in LD with the alleles A29, B44, and with A29-B44 HLA haplotype.