Real-World Experience With Brolucizumab 6 mg for Diabetic Macular Edema.

Background This study aimed to assess functional and anatomical outcomes after one month of treatment with a single intravitreal injection (IVI) of brolucizumab in patients with diabetic macular edema (DME). Methodology A retrospective study was conducted on eyes with DME who received a single IVI of brolucizumab. The study was designed to assess visual function and optical coherence tomography (OCT) biomarkers at baseline and one month following a single brolucizumab IVI. A sub-analysis was conducted between the following two groups: group 1 - treatment with brolucizumab due to burden, needle phobia, or non-compliance (responders to standard anti-vascular endothelial growth factor (VEGF) or naïve); and group 2 - non-responsive to previous therapies (standard anti-VEGF ± corticosteroids). The main outcome measures included best-corrected visual acuity (BCVA; Early Treatment of Diabetic Retinopathy Study (ETDRS) letters), central foveal thickness, and OCT biomarkers such as the presence of subretinal fluid, the number of hyperreflective dots, the disorganization of retinal inner layers, the disruption of outer plexiform layer, external limiting membrane and ellipsoid zone, the presence of cysts in the nuclear layers (outer (ONL) and inner (INL)), and the number of cysts in ONL versus those in the INL. Safety outcomes were assessed. Results A total of 59 eyes from 42 patients were included, of which 47 eyes were in group 1 and 12 eyes were in group 2. At one month, patients had an improvement of two ETDRS letters on BCVA (p = 0.020), lower central foveal thickness (p < 0.001), fewer hyperreflective dots (p = 0.016), less outer plexiform layer disruption (p = 0.004), less inner and outer nuclear layer cysts (p < 0.001 and p = 0.001, respectively) and better relationship between ONL and INL cysts (p = 0.022). Results were significant in the subgroup of patients with previous responsive DME. No adverse events were reported. Conclusions This study demonstrates the effectiveness and safety after one injection of brolucizumab 6 mg in the management of DME, especially in previously responsive DME patients.

Retinal changes after fluocinolone acetonide implant (ILUVIEN®) for DME: SD-OCT imaging assessment using ESASO classification.

INTRODUCTION: A detailed understanding of the anatomical and structural changes occurring in the retina following intravitreal fluocinolone acetonide implantation may help improve the management and prognosis of persistent or recurrent diabetic macular edema (DME). METHODS: Overall, 45 eyes (from 35 patients) with refractory center-involved DME received an intravitreal fluocinolone acetonide implant. They were monitored at baseline and at 6, 12, 24, and 36 months for best-corrected visual acuity (BCVA), central foveal thickness (CFT), and the seven retinal parameters used in the classification of diabetic maculopathy recently developed at the European School for Advanced Studies in Ophthalmology (ESASO). RESULTS: Within 6 months of implantation, significant improvements were evident in BCVA, CFT, maculopathy stage, and the percentage of eyes with: intraretinal cysts; CFT > 30% above the upper normal value; and disrupted or absent ellipsoid zone (EZ) and/or external limiting membrane (ELM). Significant improvements were still maintained at 36 months post-implantation. At month 36, early treatment with the implant (i.e., after < 6 previous intravitreal injections for DME) trended toward being more effective than later treatment in improving BCVA, CFT, maculopathy stage, and the percentage of eyes with CFT > 30% above the upper normal value. However, statistical significance was not achieved. CONCLUSION: In persistent or recurrent DME, fluocinolone acetonide implantation can be effective in improving maculopathy stage and reducing the percentage of eyes with: intraretinal cysts; CFT > 30% above the upper normal value; and disrupted or absent EZ and/or ELM. It can also increase BCVA and reduce CFT.

Prácticas de enfermería en la reeducación profesional de los soldados en la Casa Pía de Lisboa durante la Primera Guerra Mundial / Práticas de Enfermagem na Reeducação Profissional de Soldados na Casa Pia de Lisboa durante a I Guerra Mundial / Nursing Practices in the Professional Re-education of Soldiers at Casa Pia of Lisboa during the First World War

In the period of the First Republic in Portugal, during the First World War, professional re-education was implemented, based on the teaching experience of Casa Pia in Lisbon, and was particularly important in the recovery of mutilated and maimed soldiers. Objective: To interpret and analyse the nurses' practices in the professional re-education of Portuguese soldiers at the Santa Izabel Institute for the Re-education of War Mutilates at Casa Pia in Lisbon during the First World War. Methodology: Use of the historical method to synthesise the historical narrative. Results: Important references can be found in the Casa Pia of Lisbon Yearbooks to the functions carried out by the nurses, namely "the propaganda that the nurses made to the wounded about the advantages of re-education"; the "massotherapy treatment"; "the massage treatments" and also to the "extremely important role" of the ladies (nurses) in the "small infirmary" headed by Dr V. Pontes where there was a small "massotherapy" service, a "provisional prothesis" workshop and a laboratory for examining aptitudes. Conclusion: This confirms that the nurses played an important role in the "preparatory re-education" services at the Santa Izabel Institute for the Re-education of Mutilated People at Casa Pia in Lisbon, intervening in a distinctive and effective way, earning good recognition.(AU)

En el período de la Primera República en Portugal, durante la Primera Guerra Mundial, se implantó la reeducación profesional, basada en la experiencia pedagógica de la Casa Pia de Lisboa, y fue particularmente importante en la recuperación de soldados mutilados. Objetivo: Interpretar y analizar las prácticas de las enfermeras en la reeducación profesional de los soldados portugueses en el Instituto Santa Izabel de Reeducación de Mutilados de Guerra de la Casa Pia de Lisboa durante la Primera Guerra Mundial. Metodología: Utilización del método histórico para sintetizar el relato histórico. Resultados: Se encuentran importantes referencias en los Anuarios de la Casa Pia de Lisboa a las funciones desempeñadas por las enfermeras, a saber: "la propaganda que las enfermeras hacían a los heridos sobre las ventajas de la reeducación"; el "tratamiento de masoterapia"; "los tratamientos de masaje" y también al "importantísimo papel" de las señoras (enfermeras) en la "pequeña enfermería" dirigida por el Dr. V. Pontes, donde había un pequeño servicio de "masoterapia", un taller de "prótesis provisionales" y un laboratorio de examen de aptitudes. Conclusión: Esto confirma que las enfermeras desempeñaron un papel importante en los servicios de "reeducación preparatoria" del Instituto de Reeducación de Mutilados Santa Izabel, de la Casa Pia de Lisboa, interviniendo de forma diferenciada y eficaz, mereciendo un buen reconocimiento.(AU)

No período da Primeira República em Portugal, no decorrer da I Guerra Mundial, implementou-se, com base na experiência de ensino da Casa Pia de Lisboa, a reeducação profissional tendo sido particularmente importante na recuperação de mutilados e estropiados de guerra. Objetivo: Interpretar e analisar quais as práticas das enfermeiras na reeducação profissional de soldados portugueses no Instituto de Reeducação de Mutilados de Guerra de Santa Izabel na Casa Pia de Lisboa durante a I Guerra Mundial. Metodologia: Recurso ao método histórico para a síntese da narrativa histórica. Resultados: Encontram-se referências importantes nos Anuários da Casa Pia de Lisboa a funções exercidas pelas enfermeiras nomeadamente “a propaganda que as sr.as enfermeiras fizeram junto dos feridos sobre as vantagens da reeducação”; o “tratamento massoterápico”; “os tratamentos pela massagem” e ainda ao “papel importantíssimo” das senhoras (enfermeiras) na “pequena enfermaria” chefiada pelo Dr. V. Pontes onde havia um pequeno serviço de “massotherapia”, uma oficina de “prothese provisória” e um laboratório de exame de aptidões. Conclusão: Confirma-se que as enfermeiras desempenharam um papel importante nos serviços de “reeducação preparatória” no Instituto de Reeducação de Mutilados de Santa Izabel da Casa Pia de Lisboa, intervindo de forma diferenciadora e eficaz, obtendo um bom reconhecimento.(AU)

A formação em enfermagem de reabilitação em Portugal desde 2006 / Education/training in rehabilitation nursing in Portugal since 2006 / La formación en enfermería de rehabilitación en Portugal desde 2006

Resumo Enquadramento: Desde o início do século que se verifica uma diminuição da natalidade e maior envelhecimento populacional, existindo mais pessoas com incapacidade e dependência, exigindo cuidados de enfermagem mais especializados. Objetivo: Descrever a evolução na formação da especialidade em enfermagem de reabilitação. Metodologia: Recolha documental no Diário da República, com análise e interpretação hermenêutica das fontes com referência à especialidade de enfermagem de reabilitação, publicadas desde 2006. Resultados: Foram aprovados vários planos de estudo de pós-licenciatura de especialização e mestrado em enfermagem de reabilitação. Progressivamente, houve inclusão de unidades curriculares como Epidemiologia Estatística e Demografia, Aspetos Psicossociais da Incapacidade, Políticas e Modelos de Cuidados de Saúde e Estágios de Cuidados de Enfermagem de Reabilitação à Pessoa com Problemas Oncológicos e em Fim de Vida. Conclusão: A formação em enfermagem de reabilitação desenvolveu-se com influência das alterações políticas e sociodemográficas. Com os avanços tecnológicos, científicos e a evolução dos sistemas de saúde, os cuidados de enfermagem de reabilitação têm evoluído na inovação e formação, com enquadramento legal e nas competências específicas.

Abstract Background: Since the beginning of the 21st century, fertility rates have decreased and life expectancy has increased, with more people with disabilities and dependent on others requiring more specialized nursing care. Objective: To describe the evolution of education/training in rehabilitation nursing. Methodology: Documental search conducted in the Portuguese official journal (Diário da República), with hermeneutic analysis and interpretation of the sources on the specialty of rehabilitation nursing since 2006. Results: Several curricula of postgraduate specialization and master's degrees in rehabilitation nursing have been approved since 2006. Several course units were gradually integrated into the curricula, such as Statistical Epidemiology and Demography, Psychosocial Aspects of Disability, Health Care Policies and Models, and Internships in Rehabilitation Nursing Care for People with Cancer and at the End of Life. Conclusion: Education/training in rehabilitation nursing evolved under the influence of political and socio-demographic changes. With the technological and scientific advances and the evolution of health systems, rehabilitation nursing care has evolved in terms of innovation and education/training within a legal framework and based on specific competencies.

Resumen Marco contextual: Desde principios de siglo se ha producido un descenso de la natalidad y un mayor envejecimiento de la población, con más personas con discapacidad y dependencia, que requieren más cuidados especializados de enfermería. Objetivo: Describir la evolución en la formación de la especialidad en enfermería de rehabilitación. Metodología: Recopilación documental en el Diario de la República, con análisis e interpretación hermenéutica de las fuentes con referencia a la especialidad de enfermería de rehabilitación, publicadas desde 2006. Resultados: Se aprobaron varios planes de estudio de posgrado de especialización y máster en enfermería de rehabilitación. Progresivamente, se incluyeron unidades curriculares, como Epidemiología Estadística y Demografía, Aspectos Psicosociales de la Discapacidad, Políticas y Modelos de Atención Sanitaria y Prácticas de Atención de Enfermería de Rehabilitación a la Persona con Problemas Oncológicos y al Final de la Vida. Conclusión: La formación en enfermería de rehabilitación ha evolucionado con la influencia de los cambios políticos y sociodemográficos. Con los avances tecnológicos y científicos, así como con la evolución de los sistemas sanitarios, los cuidados de enfermería de rehabilitación han evolucionado en innovación y formación, con marcos legales y competencias específicas.

Personalized checkpoint acupuncture can reduce postoperative pain after abdominal surgery-a STRICTA-conform pilot study.

BACKGROUND: Optimal pain management is one of the core elements of Enhanced Recovery After Surgery (ERAS®) protocols and remains a challenge. Acupuncture (AC) is an effective treatment for various pain conditions. Systematic and personalized allocation of acupoints may be decisive for efficacy. METHODS: Based on the predominant pressure sensitivity of six gastrointestinal (GI) checkpoints (G1-G6), we devised a method to detect personalized patterns of pain and a corresponding set of acupoints. We performed a single AC treatment with semi-permanent needles and assessed the visual analogue scale (VAS) score, pain threshold based on pressure algometry (PA), and temperature changes on abdominal skin areas before and 5 min after AC. RESULTS: Between April and June 2021, thirty-eight patients were prospectively included in this pilot study. The mean reduction in subjective pain sensation as assessed by VAS was 86%, paralleled by an augmentation of the pain threshold as measured by PA by 64%. A small but significant increase in the skin temperature was observed above the abdominal surface. These effects were independent of the type of surgery. CONCLUSION: Checkpoint acupuncture may be a complementary tool for postoperative pain management. Further investigations are needed to explore this analgesic effect.

Glass Fiber Reinforced Epoxy-Amine Thermosets and Solvate IL: Towards New Composite Polymer Electrolytes for Lithium Battery Applications.

To effectively use (Li) lithium metal anodes, it is becoming increasingly necessary to create membranes with high lithium conductivity, electrochemical and thermal stabilities, as well as adequate mechanical properties. Composite gel polymer electrolytes (CGPE) have emerged as a promising strategy, offering improved ionic conductivity and structural performance compared to polymer electrolytes. In this study, a simple and scalable approach was developed to fabricate a crosslinked polyethylene oxide (PEO)-based membrane, comprising two different glass fiber reinforcements, in terms of morphology and thickness. The incorporation of a solvated ionic liquid into the developed membrane enhances the ionic conductivity and reduces flammability in the resulting CGPE. Galvanostatic cycling experiments demonstrate favorable performance of the composite membrane in symmetric Li cells. Furthermore, the CGPE demonstrated electrochemical stability, enabling the cell to cycle continuously for more than 700 h at a temperature of 40 °C without short circuits. When applied in a half-cell configuration with lithium iron phosphate (LFP) cathodes, the composite membrane enabled cycling at different current densities, achieving a discharge capacity of 144 mAh·g-1. Overall, the findings obtained in this work highlight the potential of crosslinked PEO-based composite membranes for high-performance Li metal anodes, with enhanced near room temperature conductivity, electrochemical stability, and cycling capability.

Reduction of Pain After Laparoscopic Bariatric Surgery by Personalized Checkpoint Acupuncture-Data of a STRICTA Conform Pilot Study.

BACKGROUND: It remains challenging in clinical practice to perform optimal pain management following bariatric surgeries. Acupuncture (AC) is an effective method of postoperative pain management, but its clinical efficacy depends on the rationale used to select AC points. METHODS: We developed a method to identify individual patterns of pain and a corresponding set of acupoints (corrAC) based on the relative pressure sensitivity of six abdominal visceral pressure points, i.e., the gastrointestinal (GI) checkpoints (G1-G6). Patients with moderate to severe pain were included and received a single AC treatment following surgery. The visual analog scale (VAS) score, pain threshold, and skin temperature were assessed before AC and at 5 min, 1 h, and 24 h following AC. AC was performed with 1-mm-deep permanent needles. RESULTS: From April 2021 to March 2022, 72 patients were included in the analysis. Fifty-nine patients received corrAC, whereas 13 received a noncorresponding AC (nonAC) as an internal control. Patients receiving corrAC showed a significant reduction (74%) in pain at 5 min after treatment (p < 0.0001) and a significant increase (37%) in the pain threshold (p < 0.0001). In this group, a significant increase in skin temperature above G1, G3, G4, and G5 was observed. Patients receiving nonAC showed neither significant pain reduction nor significant changes in pain threshold. The skin above G3 and G4 did not reveal temperature changes. CONCLUSION: Checkpoint AC may be an effective tool in postoperative pain therapy after bariatric surgery. Vegetative functional involvement might be associated with pain relief.

Macrogol: evaluación de la percepción de efectividad y calidad de vida en individuos con estreñimiento / Macrogol: evaluation of the perception of effectiveness and quality of life in individuals with constipation

Introducción: El estreñimiento tiene una prevalencia del 14-30% en España, su causa es multifactorial y afecta negativamente al bienestar y a la calidad de vida de las personas. Entre los tratamientos para el estreñimiento funcional se encuentran los laxantes osmóticos como Macrogol 4000. El grado de satisfacción con los laxantes es proporcional a la efectividad y mejora de la calidad de vida percibidas. Método: se realizó una encuesta en farmacias españolas a 100 consumidores que adquirían Macrogol 4000 como producto sanitario, con objeto de tratar los síntomas del estreñimiento. Se midieron los cambios en la calidad de vida y la percepción subjetiva de la efectividad a los 4, 8 y 14 días de tratamiento empleando la metodología CATI, basada en encuestas telefónicas. Resultados: Tras 14 días de consumo se observó una reducción significativa (p<0,05) del malestar físico y psicosocial. Las respuestas a los cuestionarios de percepción de efectividad mejoraron a partir del octavo día. Aumentó el acuerdo con las percepciones subjetivas de alivio del estreñimiento (81%-97%), de bienestar (90%-96%) y mejora de las sensaciones físicas (77%-97%). Al final del estudio, el 95% de los sujetos estaba satisfecho o muy satisfecho con el tratamiento elegido. Conclusiones: El uso del producto sanitario Macrogol 4000 durante 14 días mejora el malestar físico y psicosocial al mismo tiempo que se produce un incremento de la percepción de su efectividad en individuos con estreñimiento funcional. (AU)

Introduction: Constipation has a prevalence of 14-30% in Spain, its cause is multifactorial and negatively affects people’s well-being and quality of life. Treatments for functional constipation include osmotic laxatives such as Macrogol 4000. The degree of satisfaction with laxatives is proportional to the perceived effectiveness and improvement in quality of life. Method: a survey was conducted in Spanish pharmacies among 100 consumers who purchased Macrogol 4000 as a medical device, in order to treat the symptoms of constipation. Changes in quality of life and subjective perception of effectiveness were measured after 4, 8 and 14 days of treatment using CATI methodology, based on telephone surveys.Results: After 14 days of consumption, a significant reduction (p<0.05) in physical and psychosocial discomfort was observed. Responses on the effectiveness perception questionnaires improved after day 8. The number of responses expressing agreement with subjective perceptions of relief from constipation (81%-97%), of well-being (90%-96%) and of improved physical sensations (77%-97%) increased. At the end of the study, 95% of participants were satisfied or very satisfied with the chosen treatment. Conclusions: The use of Macrogol 4000 for 14 days improves physical and psychosocial discomfort at the same time as there is an increase in the perception of its effectiveness in individuals with functional constipation. (AU)

Los costes indirectos de la cefalea tensional. Una revisión sistemática de la literatura / The indirect costs of tension type headache. A systematic literature review

Objetivo: El objetivo de este trabajo fue revisar sistemáticamente la literatura publicada con relación a los costes indirectos estimados asociados al TTH.DiseñoEsta revisión sistemática siguió la declaración de elementos de informes preferidos para revisiones sistemáticas y metaanálisis (PRISMA).Fuentes de datosLa revisión se realizó en dos bases de datos principales, PubMed y EconLit, y fue completada con la búsqueda de literatura gris.Selección de estudiosEl criterio básico para la inclusión de estudios fue que presentaran al menos una medida de costes indirectos específicos del TTH.Extracción de datosSe seleccionaron finalmente 12 estudios para la extracción de la información. De todos los artículos seleccionados se sintetizaron las características del diseño del estudio, los tipos de coste incluidos, así como el instrumento de medida, y los resultados principales.ResultadosLa búsqueda arrojó en total 568 estudios. Se encontró heterogeneidad en los diseños y muestras/poblaciones de los estudios incluidos. Sólo dos estudios estimaron costes directos e indirectos para el TTH. Entre los resultados más destacables, encontramos un impacto moderado estimado de la discapacidad por TTH (entre 0,037 y 0,15 por persona, 0,06-0,09% para la población). Las pérdidas de productividad y eficiencia se observaron y fueron muy heterogéneas. La disposición a pagar por un tratamiento efectivo oscilaría entre $1,32 y $9,20 mensuales. La calidad de vida es baja, entre 28,2 y 28,4 puntos sobre 100, y la calidad de vida relacionada con la salud, parece mejorar significativamente con un tratamiento.ConclusionesA pesar de la elevada heterogeneidad de los resultados, podemos concluir que la cefalea tensional se caracteriza por un impacto moderado en la discapacidad, en la productividad y eficiencia en el trabajo o la escuela, y en la calidad de vida de quien la sufre.

Objective: The objective of this work was to systematically review the published literature in relation to the estimated indirect costs associated with TTH.DesignThis systematic review followed the Preferred Reporting Items Statement for Systematic Reviews and Meta-analyzes (PRISMA).Data sourcesThe review was performed in two main databases, PubMed and EconLit, and was completed with the gray literature search.Study selectionThe basic criterion for the inclusion of studies was that they present at least one measure of indirect costs specific to TTH.Data extraction12 studies were finally selected for information extraction. Of all the selected articles, the characteristics of the study design, the types of costs included, as well as the measurement instrument, and the main results were synthesized.ResultsThe search yielded a total of 568 studies. Heterogeneity was found in the designs and samples/populations of the included studies. Only two studies estimated direct and indirect costs for TTH. Among the most notable results, we find an estimated moderate impact of disability due to TTH (between 0.037 and 0.15 per person, 0.06–0.09% for the population). Productivity and efficiency losses were observed and were very heterogeneous. The willingness to pay for effective treatment would range from $1.32 to $9.20 per month. Quality of life is low, between 28.2 and 28.4 points out of 100, and health-related quality of life seems to improve significantly with treatment.ConclusionsDespite the high heterogeneity of the results, we can conclude that tension headache is characterized by a moderate impact on disability, on productivity and efficiency at work or school, and on the quality of life of those who suffer it.

Designing Versatile Polymers for Lithium-Ion Battery Applications: A Review.

Solid-state electrolytes are a promising family of materials for the next generation of high-energy rechargeable lithium batteries. Polymer electrolytes (PEs) have been widely investigated due to their main advantages, which include easy processability, high safety, good mechanical flexibility, and low weight. This review presents recent scientific advances in the design of versatile polymer-based electrolytes and composite electrolytes, underlining the current limitations and remaining challenges while highlighting their technical accomplishments. The recent advances in PEs as a promising application in structural batteries are also emphasized.

[The indirect costs of tension type headache. A systematic literature review]. / Los costes indirectos de la cefalea tensional. Una revisión sistemática de la literatura.

OBJECTIVE: The objective of this work was to systematically review the published literature in relation to the estimated indirect costs associated with TTH. DESIGN: This systematic review followed the Preferred Reporting Items Statement for Systematic Reviews and Meta-analyzes (PRISMA). DATA SOURCES: The review was performed in two main databases, PubMed and EconLit, and was completed with the gray literature search. STUDY SELECTION: The basic criterion for the inclusion of studies was that they present at least one measure of indirect costs specific to TTH. DATA EXTRACTION: 12 studies were finally selected for information extraction. Of all the selected articles, the characteristics of the study design, the types of costs included, as well as the measurement instrument, and the main results were synthesized. RESULTS: The search yielded a total of 568 studies. Heterogeneity was found in the designs and samples/populations of the included studies. Only two studies estimated direct and indirect costs for TTH. Among the most notable results, we find an estimated moderate impact of disability due to TTH (between 0.037 and 0.15 per person, 0.06-0.09% for the population). Productivity and efficiency losses were observed and were very heterogeneous. The willingness to pay for effective treatment would range from $1.32 to $9.20 per month. Quality of life is low, between 28.2 and 28.4 points out of 100, and health-related quality of life seems to improve significantly with treatment. CONCLUSIONS: Despite the high heterogeneity of the results, we can conclude that tension headache is characterized by a moderate impact on disability, on productivity and efficiency at work or school, and on the quality of life of those who suffer it.

Desenvolvimento de competências de comunicação clínica dos estudantes de enfermagem em portugal / Development of clinical communication skills of nursing students in Portugal

Enquadramento: É fundamental a importância de um enfermeiro comunicar com efetividade, seja para os clientes que cuidam, para as instituições com que colaboram ou para a classe que representam. O curso de licenciatura em enfermagem (CLE) em Portugal enfrenta desafios externos e internos que podem comprometer o processo de desenvolvimento de competências de comunicação clínica (CCC), fundamentais para a construção da identidade individual e profissional. Na ausência de evidência sobre este processo, desenvolve-se este estudo. Objetivo: Conhecer o processo utilizado nas escolas superiores de enfermagem portuguesas no desenvolvimento de CCC nos estudantes de licenciatura em enfermagem. Pretende-se identificar obstáculos pedagógicos, conteúdos lecionados e as metodologias de ensino e avaliação destas competências. Metodologia: A Maio de 2019 contactam-se via email todas as instituições de ensino superior em Portugal que lecionam o CLE, remetendo um questionário estruturado e previamente testado com peritos na área das CCC. A recolha de dados foi articulada com os docentes que lecionam a temática das CCC e com os alunos do CLE. O estudo é exploratório e descritivo, do tipo quantitativo. Através do SPSS v.25.0 analisaram-se medidas de estatística descritiva e inferencial. Resultados: Todas as 40 escolas de enfermagem (públicas e privadas) de Portugal foram contactadas, tendo obtido feedback de 31. Os resultados demonstram que (1) é dada elevada importância ao desenvolvimento de CCC pelos inquiridos, (2) existem barreiras identificadas no desenvolvimento destas competências, (3) o processo de desenvolvimento de CCC é muito heterogéneo entre instituições de ensino. Conclusões: O processo de desenvolvimento de CCC é dotado de grande variabilidade entre instituições de ensino, seja quanto ao momento em que são lecionadas, conteúdos ministrados (quantidade, qualidade e diversidade), mas também metodologias pedagógicas e de avaliação adotadas. Apesar de mais estudos serem necessários, os dados obtidos deste estudo reforçam a necessidade de melhoria do currículo de CCC, de forma helicoidal, ao longo do CLE em Portugal.

Valsalva Retinopathy after a Vomiting Episode.

This case presents a minimal invasive alternative for the treatment of subhyaloid hemorrhages. Young, female, 32 years old, with no regular medication and with no personal or ophthalmological history, reports a sudden and profound decrease in visual acuity after an episode of vomiting, with 2 days of evolution. After funduscopic observation and complementary diagnostic tests, subhyaloid hemorrhage was detected and laser hyaloidotomy was performed, with restoration of visual acuity after 1 week. Nd:YAG laser treatment made it possible to quickly restore the visual acuity of the patient after following diagnostic procedures, avoiding other types of treatments, such as pars plana vitrectomy. This case reports a Valsalva retinopathy with clinical presentation in the form of subhyaloid hemorrhage after an episode of self-limited vomiting, effectively treated with Nd: YAG laser.

A formação em enfermagem de reabilitação em Portugal entre 1963 e 2005 / Education/training in rehabilitation nursing in Portugal between 1963 and 2005 / La formación en enfermería de rehabilitación en Portugal entre 1963 y 2005

Resumo Enquadramento: A formação de especialistas em enfermagem de reabilitação sofreu sucessivas transformações, sob influência de diferentes contextos. Objetivos: Descrever a evolução da formação de enfermeiros de reabilitação em Portugal, tendo em conta as alterações no conteúdo dos planos de estudo. Metodologia: Recolha documental no Diário da República, com análise e interpretação hermenêutica das fontes com referência à especialidade de enfermagem de reabilitação, publicadas entre 1963 e 2005. Resultados: Em 1963 o Ministério do Ultramar refere a necessidade de incluir enfermeiras especialistas de reabilitação. A especialidade sofre alterações no conteúdo programático, consolidando-se no ensino superior português em 2002. Conclusão: Os planos de estudo desenvolvem-se com o contributo da crescente complexidade dos serviços de saúde, bem como da visão que a sociedade tinha da profissão. A necessidade de promover a readaptação de pessoas portadoras de deficiência também moldou o ensino ao longo dos anos.

Abstract Background: The education/training of specialists in Rehabilitation Nursing has undergone successive transformations under the influence of different contexts. Objectives: To describe the evolution of the education/training of rehabilitation nurses in Portugal, considering changes in the content of study plans. Methodology: Documentary collection in the Portuguese Official Journal (Diário da República), with hermeneutic analysis and interpretation of the sources with reference to the specialty of rehabilitation nursing, published between 1963 and 2005. Results: In 1963, the Ministry of Overseas referred to the need of including rehabilitation nurses. The study plan contents of the specialty changed until they consolidated in the Portuguese higher education in 2002. Conclusion: Study plans are greatly influenced by the growing complexity of health services and how the society views the profession. The need to promote the readaptation of people with disabilities has also shaped education/training over the years.

Resumen Marco contextual: La formación de especialistas en enfermería de rehabilitación ha experimentado sucesivas transformaciones, influidas por diferentes contextos. Objetivos: Describir la evolución de la formación de los enfermeros de rehabilitación en Portugal, teniendo en cuenta los cambios en el contenido de los planes de estudio. Metodología: Recopilación documental en el Diario de la República, con análisis e interpretación hermenéutica de las fuentes con referencia a la especialidad de enfermería de rehabilitación, publicadas entre 1963 y 2005. Resultados: En 1963 el Ministerio de Ultramar mencionó la necesidad de incluir a enfermeros especializados en rehabilitación. La especialidad experimenta cambios en el contenido programático y se consolida en la enseñanza superior portuguesa en 2002. Conclusión: Los planes de estudio se elaboran con la contribución de la creciente complejidad de los servicios de salud, así como de la visión que la sociedad tenía sobre la profesión. La necesidad de promover la rehabilitación de las personas con discapacidades también ha conformado la educación a lo largo de los años.

Epiretinal membrane vitrectomy: outcomes with or without cataract surgery and a novel prognostic factor for cystoid macular edema.

PURPOSE: To assess the outcomes of vitrectomy with or without cataract surgery for the treatment of idiopathic ERM in phakic eyes and evaluate predictors of functional and anatomical outcomes. METHODS: Retrospective cohort of consecutive phakic ERM eyes distributed in three groups: a) combined (phacovitrectomy) group, b) PPV-only group, and c) consecutive group (PPV followed by cataract surgery). Main outcomes were final visual acuity (VA) and cystoid macular edema (CME) occurrence. Potential predictors of VA or CME included clinical variables and SD-OCT parameters. RESULTS: A total of 108 eyes were included in this study. There were no differences in the final VA between consecutive and combined groups (0.22 vs 0.10 logMAR, p = 0.851). Twelve eyes from the combined group (23%) and one eye from the PPV-only group presented CME (p = 0.001). There were no differences between postoperative CME occurrence in combined versus consecutive group (12 vs 7, p = 0.38). The presence of cotton-ball sign predicted the development of CME [OR 2.86 (95%CI 1.01-8.18), p = 0.049] while separated ERM-ILM complex was found to be protective [OR 0.25 (95%CI 0.08-0.77), p = 0.015]. CONCLUSIONS: Functional and anatomical results of PPV with ERM and ILM peeling combined with cataract surgery was equivalent to the consecutive procedure, with both strategies being effective. Separated ERM-ILM complex has prognostic value in these patients, as its presence at baseline was found to be protective for postoperative CME.

Dealing with rhegmatogenous retinal detachment in patients under 40 years old: a tertiary center results.

PURPOSE: The risk of rhegmatogenous retinal detachment (RRD) increases with age, but some studies report a secondary peak in younger patients. Since visual recovery in RRD depends on surgical treatment and, considering the personal, social and economic burden of low vision in the working-age population, our purpose was to analyze the features and outcomes of RRD in young patients. METHODS: Clinical data of patients under 40 years old submitted to surgery for first time RRD, consecutively selected between 2016 and 2019, was analyzed. Patients with less than 3 months follow-up were excluded. RESULTS: Eighty-nine eyes from 89 patients were included. Mean age was 31.2 ± 7.8 years (minimum 10 years) and 56% were female gender. Most patients (63%) had high myopia. Pars plana vitrectomy (79%) alone, combined with scleral buckling (1%) or scleral buckling alone (20%) was performed. Primary anatomical success was 72%, and final anatomical success was 91%. Final visual acuity of 20/40 or better was achieved in 29% of cases, but 28% remained under 20/400. The presence of myopia (p = 0.022), localized RRD (p = 0.007) and attached macula at presentation (p < 0.001) was associated with a better final visual acuity. CONCLUSION: Management of RRD in young patients must be thorough. In younger patients, anatomical outcomes may be worse than in older patients. Myopia may be recognized as a major risk factor for RRD in this age group, but also as a protective factor for retinal function after surgery.

Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience.

PURPOSE: To evaluate the ellipsoid zone (EZ) structural recovery, hole closure rate, and visual acuity improvement after inverted internal limiting membrane (ILM) flap technique. METHODS: Retrospective cohort of eyes affected by idiopathic macular holes (MH) that underwent pars plana vitrectomy combined with inverted ILM flap technique in a tertiary center, over an 8-year period (2011-2019). The main outcomes were the postoperative qualitative analysis of EZ structure on spectral-domain optical coherence tomography, hole closure rate, and best-corrected visual acuity (BCVA) improvement of ≥ 0.3 units in the logarithm of minimal angle of resolution (logMAR) scale. RESULTS: Our study included 76 eyes of 72 patients; 65% were female, with a mean age of 70 ± 8 years-old. Median (range) follow-up was 21 (3-92) months. Hole closure rate was 92%. Structural defects in EZ were observed in 66% of closed holes (EZ atrophy in 33%, EZ disruption in 22%, and EZ thinning in 11%). The mean final BCVA was 0.5 ± 0.4 logMAR (Snellen 20/63), but visual acuity improvement occurred in 80% of the eyes. Final BCVA was significantly worse in eyes with EZ atrophy compared with eyes with EZ disruption (0.75 vs. 0.36 logMAR, p = 0.004) and EZ thinning (0.75 vs. 0.32 logMAR, p = 0.015). In multivariate regression, minimum linear diameter (OR 1.01; IC 95% 1.01-1.02) independently predicted a final BCVA (logMAR) < 0.3 units. CONCLUSION: Inverted ILM flap technique provided a hole closure rate above 90%, similar to previous studies. Although the modest value of the final BCVA, a significant visual acuity improvement occurred in most eyes. Structural defects of EZ were found in more than half of closed MHs after surgery. Evidence of postoperative retinal atrophy was associated with a worse visual outcome.