Vaginal temperature modeling in Holstein cows and cluster analysis by the cophenetic correlation coefficient.

The objective was to establish a model for the prediction and characterization of vaginal temperature in Holstein cows, based on environmental predictors and thermal comfort indices, through cluster analysis, validation by the cophenetic correlation coefficient, and multiple regression analysis. The micrometeorological characterization of the site was carried out by recording the air temperature (Tair), the relative humidity (RH), the black globe temperature (BGT), the black globe temperature and humidity (BGHI), and dew point temperature (TDP). The recording of vaginal temperature (Tv) was performed in eight dairy cows using temperature sensors, equipped with data loggers, coupled with intravaginal devices. The data were analyzed using descriptive statistics and cluster analysis (CA) by using the hierarchical agglomerative method based on the value of the cophenetic correlation coefficient (CCC >0.70), in which representative physiological models were established, characterizing the Tv through multiple regression. In the afternoon the coefficient of variation (CV) was low for all variables, indicating homogeneity of the meteorological variables and efficiency of the ventilation system. The temperature and humidity index (THI) was mild only on the morning. There was a variation of 0.28 °C of Tv between shifts, sufficient to characterize the condition of comfort and stress of the animal, with values above 39 °C indicating animal stress. Tv showed strong correlation with BGT, Tair, TDP and RH, assuming that physiological variables, such as Tv, tend to have greater relationship with abiotic variables. Empirical models were established for estimating Tv based on the analyses performed in this study. Model 1 is recommended for TDP ranges of 14.00-21.00 °C and RH of 30-100%, while model 2 can be used for Tair situations up to 35 °C. The regression models for estimating Tv are promising for characterizing the thermal comfort of dairy cows housed in compost barn systems.

Fixed and on-demand regimens of acetaminophen in periodontal surgery: randomized clinical trial

Aim: to evaluate the clinical efficacy of an acetaminophen analgesic by comparing its prescription in fixed versus ondemand schedules after periodontal surgery. The hypothesis of the study was that the fixed regimen would be more effective than the on-demand regimen for postoperative analgesics following periodontal surgery. Methods: An open randomized clinical trial was conducted. The 68 patients who needed total flap surgery to restore supracrestal tissue attachment or surgical treatment of periodontitis were randomized". Visual Analogue Scale was used to assess pain. The fixed group (n = 34) received 500 mg of acetaminophen every 4 hours for 2 days. The on-demand group (n = 34) was instructed to use the acetaminophen "as needed," at intervals of no less than 4 hours between doses. Ibuprofen was the rescue medication for both groups. Pain scores and medication use were recorded 2, 6, 12, 24 and 48 hours after the surgical procedure. The study was registered at the Brazilian Registry of Clinical Trials under RBR-7wv259. Results: The two groups did not differ in relation to the frequency or the intensity of pain in a 48-hour period (n=20 in the fixed group, and n=22 in the on-demand group), or even in the intention-to-treat (n=34 in each group). Individuals who experienced moderate to severe pain used rescue medication more frequently in both groups. No adverse events were reported. Conclusion: Both regimens were effective in controlling postoperative pain after periodontal surgery

Frequency and characterization of potential drug interactions in dentistry-a cross-sectional study.

AIM: This study aimed to identify medications taken by patients before dental appointments and to simulate and characterize their interactions with medications often prescribed by dental surgeons. MATERIALS AND METHODS: A retrospective cross-sectional study evaluated 320 medical records, 118 from the Emergency Service (ES) archives, and 202 from elective appointments at the Dental Clinic (DC) of a university in southern Brazil. Drug interactions were identified and classified according to severity using the Medscape® application into four grades: (1) Minor, (2) Monitor closely, (3) Serious, or (4) Contraindicated. Descriptive and inferential statistical analyses were carried out (α = 5%). RESULTS: Preexisting systemic conditions were noted in 55.9% of the medical records from the ES and 64.35% from the DC. In the ES records, 47.45% contained information on continuous use medication for treatment of systemic conditions and 59.40% of DC records contained such information. A total of 359 potential interactions were found. Drug interactions with analgesics were most frequent, accounting for 50.41% of the sample. CONCLUSIONS: The most prevalent drug interaction severity was grade 2: monitor or use with caution. Many patients take medications to treat systemic conditions and seek dental care, generating a significant possible source of drug interactions. CLINICAL RELEVANCE: Prescribers must carefully analyze the patients' medical histories and obtain accurate data regarding their use of medications to be able to assess the risk-benefit relationships of possible combinations.

Effect of listening to music on anxiety, pain, and cardiorespiratory parameters in cardiac surgery: study protocol for a randomized clinical trial.

BACKGROUND: Preoperative anxiety and postoperative pain are frequent in cardiac surgeries and constitute important stressors for patients, which can cause several complications. One strategy that aims to alleviate these phenomena is listening to music as a non-pharmacological intervention. The aim of this study is to evaluate the effect of listening to music on preoperative state-anxiety, postoperative pain, at rest and when instructed to cough, and cardiorespiratory parameters in patients undergoing cardiac surgery. METHODS: A randomized, parallel, simple masking clinical trial will be conducted with patients 18 years of age or older who have undergone elective cardiac surgery by sternotomy, who agree to participate in the research and sign a free and informed consent form. Study participants will be randomly divided, in a 1:1 ratio, to one of the two groups: experimental (subjected to listening to music for 20 min in the pre- and postoperative period) or control (standard care in the pre- and postoperative period), using a randomization scheme generated by the Randomization.com website. The sample size calculation was obtained after conducting a pilot study. DISCUSSION: The results of the study may contribute to the implementation of non-pharmacological interventions in health services, highlighting the protocols for listening to music, to minimize anxiety and pain in cardiac surgery. TRIAL REGISTRATION: ReBEC RBR-8mdyhd . Posted on December 10, 2019.

Isolation and Identification of Cytotoxic Compounds Present in Biomaterial Life®.

Direct pulp capping consists of a procedure in which a material is directly placed over the exposed pulp to maintain dental vitality. Although still widely used in clinical practice, previous in vitro studies found that the biomaterial Life® presented high cytotoxicity, leading to cell death. This study aimed to identify the Life® constituents responsible for its cytotoxic effects on odontoblast-like cells (MDPC-23). Aqueous medium conditioned with Life® was subjected to liquid-liquid extraction with ethyl acetate. After solvent removal, cells were treated with residues isolated from the organic and aqueous fractions. MTT and Trypan blue assays were carried out to evaluate the metabolic activity and cell death. The organic phase residue promoted a significant decrease in metabolic activity and increased cell death. On the contrary, no cytotoxic effects were observed with the mixture from the aqueous fraction. Spectroscopic and spectrometric methods allowed the identification of the toxic compounds. A mixture of the regioisomers ortho, para, and meta of N-ethyl-toluenesulfonamide was identified as the agent responsible for the toxicity of biomaterial Life® in MDPC-23 cells. These findings contribute to improving biomaterial research and development.

Parental burnout: a scoping review / Parental burnout: revisión del alcance / Burnout parental: revisão de escopo

ABSTRACT Objective: to map available evidence on parental burnout theme. Method: scoping review as according to the Joanna Briggs Institute. Search in January 2021, in six databases of publications in English, Portuguese or Spanish, without time limits. Data extracted and descriptively analyzed by three independent researchers. Results: 374 articles were identified and 20 were included in the final sample, all published in English, from 2017 onwards. Parental burnout is a complex, multifactorial problem, distinct from burnout cases, depressive symptoms and other mental health alterations. It affects 0.2 to 20% of parents, has validated and suitable instruments for measurement; if not treated, can have consequences on marital life, work relationships, child neglect and violence. Conclusions: this is a recent theme that needs to be explored, due to the possible impact on children's and families' health and on parents' work processes. Protocol registered in the Open Science Framework (https://osf.io/jd7vk).

RESUMEN Objetivo: mapear la evidencia disponible sobre el tema del agotamiento de los padres. Método: revisión del alcance, según el Instituto Joanna Briggs. Búsqueda en enero de 2021, en seis bases de datos de publicaciones en inglés, portugués o español, sin límite de tiempo. Datos extraídos y analizados descriptivamente por tres investigadores independientes. Resultados: se capturaron 374 artículos y se incluyeron 20 en la muestra final, todos publicados en inglés, a partir de 2017. El burnout parental es un problema complejo y multifactorial, distinto de los casos de burnout, síntomas depresivos y otras alteraciones de la salud mental. Afecta entre el 0,2 y el 20% de los padres, cuenta con instrumentos de medición validados y adecuados y, si no se trata, puede tener consecuencias en la vida conyugal, las relaciones laborales, el abandono y la violencia contra el niño. Conclusiones: este es un tema reciente que necesita ser explorado, por el posible impacto en la salud de los niños y las familias y en los procesos laborales de los padres. Protocolo registrado en el Open Science Framework (https://osf.io/jd7vk).

RESUMO Objetivo: mapear evidências disponíveis sobre a temática burnout parental Método: revisão de escopo, conforme o Joanna Briggs Institute. Busca em janeiro de 2021, em seis bases de dados de publicações em inglês, português ou espanhol, sem delimitação de tempo. Dados extraídos e analisados descritivamente por três pesquisadores independentes. Resultados: capturados 374 artigos e incluídos 20 na amostra final, todos publicados em inglês, a partir de 2017. Burnout parental consiste em problema complexo, multifatorial, distinto dos casos de burnout, sintomas depressivos e outras alterações de saúde mental. Acomete 0,2 a 20% dos pais, possui instrumentos validados e adequados para mensuração e, se não tratado, pode acarretar consequências na vida conjugal, relações de trabalho, negligência e violência contra a criança. Conclusões: trata-se de temática recente que necessita ser explorada, pelo possível impacto na saúde de crianças e famílias e nos processos de trabalho dos pais. Protocolo registrado no Open Science Framework (https://osf.io/jd7vk).

Prevention of medical adhesive-related skin injury during patient care: A scoping review.

Background: : Medical adhesive-related skin injury can occur during health care. Professionals must adopt preventive measures to maintain the integrity of the skin and patient comfort and safety. Objective: : To map the existing scientific evidence on preventing medical adhesive-related skin injury in adults. Design: : Scoping Review. Methods: : Searches were conducted in PubMed/Medline, Cochrane Library, Embase®, Latin American and Caribbean Literature in Health Sciences, Cumulative Index for Nursing and Allied Health Literature, and Google Scholar, without period delimitation. Duplicate studies and those that didn´t answer the research question were excluded. Results: : Of the 209 studies identified in the search process, 30 made up the final sample. The prevention of injury by adhesives mainly involves identifying risk factors, proper adhesive selection, and correct application and removal. Health education and medical records about injuries related to medical adhesives are essential. Conclusions: : The prevention of medical adhesive-related skin injury should be done by adopting multifactorial measures, which range from identifying risk factors and correct handling of adhesives to the process of educating professionals, patients and communities about these injuries. Registration: : The research was registered on the Open Science Framework DOI 10.17605/OSF.IO/NSWP8.

Parental burnout: a scoping review.

OBJECTIVE: to map available evidence on parental burnout theme. METHOD: scoping review as according to the Joanna Briggs Institute. Search in January 2021, in six databases of publications in English, Portuguese or Spanish, without time limits. Data extracted and descriptively analyzed by three independent researchers. RESULTS: 374 articles were identified and 20 were included in the final sample, all published in English, from 2017 onwards. Parental burnout is a complex, multifactorial problem, distinct from burnout cases, depressive symptoms and other mental health alterations. It affects 0.2 to 20% of parents, has validated and suitable instruments for measurement; if not treated, can have consequences on marital life, work relationships, child neglect and violence. CONCLUSIONS: this is a recent theme that needs to be explored, due to the possible impact on children's and families' health and on parents' work processes. Protocol registered in the Open Science Framework (https://osf.io/jd7vk).

Associations between surgical wound infectious and clinical profile in patients undergoing cardiac surgery.

BACKGROUND: Infections are surgical severe adverse events that pose risks to patient safety in health services, in addition to increasing costs and morbidity and mortality. AIM: This study aims to describe the infectious profile of patients undergoing cardiac surgery and associate comorbidities and lifestyle habits with surgical wound infection. DESIGN: Observational and retrospective study. METHODS: The study included 453 patients undergoing cardiac surgery in a public teaching hospital from January 2014 to January 2019. Data were collected from the clinical records through an instrument composed of variables clinical characteristics, comorbidities, life habits, infection rates, infectious agents, clinical management and surgical wound features. Simple frequency, measures of central tendency and variability, Chi-Square test and logistic regression were used for data analysis. RESULTS: There was a predominance of hypertensive patients (367; 81%), smokers (107; 23.6%), alcoholics (76; 16.8%). Surgical wound infection affected 86 (19%) patients. Besides, most patients were under antibiotic therapy (310; 68.4%). Klebsiella pneumoniae; Staphylococcus epidermides and Staphylococcus aureus were the most frequent pathogens. Diabetes Mellitus, nephropathy and age were statistically significant (P<0.05) for higher risk of surgical wound infection. CONCLUSION: Chronic diseases and lifestyle habits were related to postoperative infection. More research is needed, focusing on risk factors for the development of surgical wound infection.

Cultural adaptation and validation of an instrument about nursing critical thinking skills.

OBJECTIVES: to validate the Nursing Critical Thinking in Clinical Practice Questionnaire regarding cultural aspects and metric properties. METHODS: a methodological research carried out through cross-cultural adaptation, face and content validity, dimensional construct and known groups validity, test-retest reliability and internal consistency. 511 nurses from four hospitals participated in the study, of which 54 participated in retest. RESULTS: the instrument validation for Brazilian Portuguese maintained equivalences, according to the original version. The dimensional validity demonstrated adjustment to the tetrafactorial structure of the original version (GFI=0.69). There were statistically significant differences in critical thinking skills between nurses with graduate degrees and who undertook training, reading articles, developing research and working in an institution with a longer time implementation of the Nursing Process. The instrument showed temporal stability (ICC 073-0.84; p<0.001) and adequate internal consistency (α=0.97). CONCLUSIONS: the instrument proved to be valid and reliable for the studied population.

Effectiveness of the serious game for learning in nursing: systematic review.

OBJECTIVE: To identify the effectiveness of the serious game in improving learning outcomes compared to the different teaching strategies used in the education of nursing students. METHOD: Systematic review, conducted from July 2019 to May 2020, at PubMed®, Scopus, CINAHL, Web of Science and LILACS. Studies of experimental and quasi-experimental design were included, with no delimitation of time frame, aimed at nursing students, who approached the use of the serious game as the main teaching strategy compared with other pedagogical methods. RESULTS: Six articles were included, which compared the serious game with traditional and active teaching and learning strategies (expository class, text reading and simulation). The studies were considered of moderate quality, with an average score of 12.83. Nursing students submitted to the serious game showed better learning results. CONCLUSION: The serious game proved to be more effective for learning in nursing when compared to other teaching strategies.

Barriers to research utilization influencing patient safety climate: A cross-sectional study.

AIMS: This study aimed to investigate the influence of barriers to the use of research results in the practice of nurses on patient safety perception. BACKGROUND: The use of research results in clinical practice promotes safe care, increases quality and reduces the possibility of adverse events. DESIGN: This is a cross-sectional study. METHODS: The sample consisted of 207 nurses from three public university hospitals in the state of Minas Gerais, Brazil from March 2017 to November 2018. They answered a questionnaire with professional characteristics, The Barriers Scale and Safety Attitudes Questionnaire. Descriptive analysis, Student's t test, Pearson correlation and multiple linear regression were used for data analysis. RESULTS: The findings showed most nurses had unfavourable competencies for implementing research results in practice. As barrier scores for the use of research results in practice increase, safety climate scores decrease. Taking a training course on the use of research results in clinical practice and organization characteristics, limitations of the setting were statistically significant, constituting factors that influence the perception of the safety climate. CONCLUSION: Investments in education are needed for health professionals to be aware of evidence-based practice and how to use evidence to impact decision-making outcomes, strengthening safety outcomes in health services.

Incidence and risk factors for oral mucositis in pediatric patients receiving chemotherapy.

PURPOSE: To investigate the incidence and risk factors for oral mucositis (OM) in patients with childhood cancer undergoing chemotherapy. METHODS: Eight hundred and twenty-nine cycles of chemotherapy were evaluated in 112 patients with childhood cancer undergoing chemotherapy. Chemotherapy protocol, hematological, hepatic, and renal function parameters were collected and compared to presence and severity of OM, as graded by the World Health Organization (WHO) scale. Patients received counseling on oral hygiene and those who presented with OM (grade ≥1) received photobiomodulation therapy (PBMT). RESULTS: Age ranged from 0 to 17 years (mean/SD, 8.58 ± 5.05) and fifty-one patients (45.54%) were females. The most common baseline diseases were leukemia (51%) followed by sarcomas (23%) and lymphomas (18%). Eight hundred and twenty-nine cycles of chemotherapy were evaluated, and OM was diagnosed in 527 cycles (63.57%). Higher incidence and severity of OM was observed in protocols using high-dose methotrexate (MTX-HD), MTX-HD cyclophosphamide/doxorubicin combination, and MTX-HD combined with cyclophosphamide (p <0.001). Patients with severe OM had lower levels of leukocytes (p = 0.003), hemoglobin (p = 0.005), platelets (p = 0.034), and higher levels of total bilirubin (p = 0.027), alanine aminotransferase (ALT) (p = 0.001), and creatinine (p = 0.007). CONCLUSION: The study contributes to the elucidation of the risk factors for OM in pediatric cancer patients. Chemotherapy protocols using MTX-HD, MTX-HD associated with doxorubicin and cyclophosphamide, and MTX-HD and cyclophosphamide a have higher incidence of severe grades of OM. Other toxicities such as hematological, hepatic, and renal also developed in patients with OM.

Medications Used for Prevention and Treatment of Postoperative Endodontic Pain: A Systematic Review.

OBJECTIVE: Prevention and management of postoperative endodontic pain is a common challenge for the endodontists. This systematic review was conducted to evaluate the efficacy and safety of medicament therapeutic protocols in the prevention and management of endodontic pain. METHODS: A literature search was undertaken in MEDLINE, Cochrane Library, LILACs, and SciELO, for articles published until December 2017, without year restriction and written only in English. An additional search was performed in the references of the retrieved studies. Study eligibility criteria, participants, and interventions: The inclusion criteria were randomised clinical trials that evaluated the use of medications to prevent or control moderate to severe pain in adult patients, using a visual analog scale as a tool for pain measurement. The primary outcome evaluated was the reduction of pain scores. The second outcome evaluated was the need for additional analgesia and the occurrence of adverse events. STUDY APPRAISAL AND SYNTHESIS METHODS: The quality assessment of the included studies was performed following the Jadad scale to measure the likelihood of bias in pain research reports. RESULTS: After removing duplicates and excluding the studies that did not meet the selection criteria, ten studies were included tin the systematic review. Among these studies, five studies administered the medications before the endodontic procedures and five studies after. These studies evaluated non-opioid analgesics (acetaminophen), opioid analgesics (tramadol and codeine), nonsteroidal anti-inflammatories (ibuprofen, flurbiprofen, ketorolac tromethamine, etodolac, tenoxicam, and naproxen), steroidal anti-inflammatory (prednisolone) or the association of medications to prevent or control postoperative pain. It was possible to establish a significant relationship between the use of additional analgesics and periapical diagnosis. Adverse events were not observed when the administration occurred before the endodontic procedure. When it was administered after the procedure, adverse reactions were reported in 2 of 3 trials included in the analysis. LIMITATIONS: A restricted number of randomised clinical trials were found, and the difference in the methodology of the studies did not meet the definition of a systemic treatment protocol for prevention or control of postoperative pain. CONCLUSION: Nonsteroidal anti-inflammatory drugs are the most common medicament to prevent and control postoperative pain, with ibuprofen being the most investigated. There is a significant association between the use of additional analgesics and periapical diagnoses.

Oral mucositis in childhood cancer patients receiving high-dose methotrexate: Prevalence, relationship with other toxicities and methotrexate elimination.

BACKGROUND: Oral mucositis (OM) is one of the main adverse effects of the chemotherapeutic agent methotrexate (MTX). AIM: To evaluate the relationship of OM with MTX metabolism time and other toxicities in childhood, cancer patients receiving high-dose of methotrexate (HD-MTX). DESIGN: Seventy-seven childhood patients receiving HD-MTX for treatment of leukaemia, osteosarcoma or lymphoma were evaluated. MTX serum level, hepatic and renal function parameters, and presence and intensity of OM were analysed. RESULTS: The patients were submitted to 255 cycles of chemotherapy. OM was diagnosed in 191 (74.9%) cycles. Of these, 119 (46.6%) presented ulcerative lesions. Lymphoma was associated with severe OM (P = .01). OM was associated with higher serum levels of aspartate aminotransferase (P = .006), alanine aminotransferase (P = .04) and creatinine (P = .008). Increase of one unit of total bilirubin and indirect bilirubin associated, respectively, with 11% and 39% higher prevalence of OM. For each increase of one unit of creatinine serum level, it was observed a 37% higher prevalence of OM in patients with lymphoma. No association was found between delayed excretion of MTX and OM development. CONCLUSIONS: OM is a prevalent complication of childhood cancer patients receiving HD-MTX. Renal and hepatic toxicity could be considered risk factors for OM, especially in patients with lymphoma.

Lesão por pressão decorrente do posicionamento cirúrgico e fatores associados / Úlcera por presión resultante de posicionamiento quirúrgico y factores asociados / Pressure injury related to surgical positioning and associated factors

Resumo Objetivo: Analisar a ocorrência de lesão por pressão decorrente do posicionamento cirúrgico e os fatores associados. Método: Estudo observacional, longitudinal, realizado com 239 pacientes submetidos à cirurgia eletiva. Para coleta de dados, utilizou-se instrumento de caracterização sociodemográfica e clínica e Escala de Avaliação de Risco para o Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico. Para a análise dos dados empregou-se estatística descritiva e regressão logística binominal múltipla e o nível de significância considerado foi α = 0,05. Resultados: A maioria dos pacientes era do sexo masculino, branco e adultos. A ocorrência de lesão por pressão decorrente do posicionamento cirúrgico foi de 37,7%, sendo que 81 (90,0%) pacientes apresentaram lesão por pressão estágio 1 e os locais mais frequentes de ocorrência deste tipo de lesão foram a região sacral (19; 13,9%) e calcâneos direito (16; 11,7%) e esquerdo (13; 9,5%). A idade (adulto) e o risco maior conforme escore da Escala de Avaliação de Risco para o Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico foram preditores para a ocorrência de lesão por pressão. Conclusão: A elevada ocorrência e os fatores associados (idade e risco maior na escala aplicada) para lesão por pressão decorrente do posicionamento cirúrgico foram resultados evidenciados que podem auxiliar na compreensão da problemática no cenário nacional, e para a implementação de intervenções com o propósito de reduzir o risco do paciente de ser acometido por este tipo de lesão no perioperatório.

Resumen Objetivo: Analizar la incidencia de úlcera por presión resultante del posicionamiento quirúrgico y los factores asociados. Métodos: Estudio observacional, longitudinal, realizado con 239 pacientes sometidos a cirugía electiva. Para la recolección de datos, se utilizó un instrumento de caracterización sociodemográfica y clínica y la Escala de Evaluación de Riesgo para la Aparición de Úlceras Resultantes del Posicionamiento Quirúrgico. Para el análisis de datos se usó estadística descriptiva y regresión logística binominal múltiple y el nivel de significación considerado fue α = 0,05. Resultados: La mayoría de los pacientes era de sexo masculino, blanco y adulto. La incidencia de úlcera por presión resultante del posicionamiento quirúrgico fue del 37,7 %, en el que 81 (90,0 %) pacientes presentaron úlcera por presión de estado 1 y los lugares más frecuentes de incidencia de este tipo de lesión fueron la región sacra (19; 13,9 %) y calcáneo derecho (16; 11,7 %) e izquierdo (13; 9,5 %). La edad (adulto) y el riesgo mayor, según la puntuación de la Escala de Evaluación de Riesgo para la Aparición de Úlceras Resultantes del Posicionamiento Quirúrgico, fueron predictores de los casos de úlcera por presión. Conclusión: La elevada incidencia y los factores asociados (edad y riesgo mayor en la escala aplicada) de úlceras por presión resultantes del posicionamiento quirúrgico fueron resultados evidenciados que pueden ayudar a comprender la problemática en el escenario nacional y a implementar intervenciones con el objetivo de reducir el riesgo de que el paciente presente este tipo de úlcera en el perioperatorio.

Abstract Objective: To analyze the occurrence of pressure injury resulting from surgical positioning and the associated factors. Method: An observational and longitudinal study, involving 239 patients undergoing elective surgery. Data collection was performed using an instrument for sociodemographic and clinical characteristics, and a risk assessment scale for the development of injuries due to surgical positioning. Descriptive statistics and multiple binominal logistic regression were used for data analysis, and the level of significance considered was α = 0.05. Results: Most of the patients were adult male Caucasians. The occurrence of pressure injury resulting from surgical positioning was 37.7%, and 81 (90.0%) patients developed stage 1 pressure injury, and the most frequent sites were sacral (19; 13.9%), and right (16; 11.7%) and left (13; 9.5%) calcaneus regions. Age (adult) and those identified at higher risk according to the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (ELPO) were predictors for occurrence of pressure injury. Conclusion: The high incidence and associated factors (age and higher risk on the administered scale) for pressure injuries resulting from surgical positioning provide results to help understand the problem within the national scenario, and to implement interventions to reduce the patient's risk of being affected by this type of injury in the perioperative period.

Cultural adaptation and validation of an instrument about nursing critical thinking skills / Adaptación cultural y validación de un instrumento sobre habilidades de pensamiento crítico en enfermería / Adaptação cultural e validação de instrumento sobre habilidades de pensamento crítico em enfermagem

ABSTRACT Objectives: to validate the Nursing Critical Thinking in Clinical Practice Questionnaire regarding cultural aspects and metric properties. Methods: a methodological research carried out through cross-cultural adaptation, face and content validity, dimensional construct and known groups validity, test-retest reliability and internal consistency. 511 nurses from four hospitals participated in the study, of which 54 participated in retest. Results: the instrument validation for Brazilian Portuguese maintained equivalences, according to the original version. The dimensional validity demonstrated adjustment to the tetrafactorial structure of the original version (GFI=0.69). There were statistically significant differences in critical thinking skills between nurses with graduate degrees and who undertook training, reading articles, developing research and working in an institution with a longer time implementation of the Nursing Process. The instrument showed temporal stability (ICC 073-0.84; p<0.001) and adequate internal consistency (α=0.97). Conclusions: the instrument proved to be valid and reliable for the studied population.

RESUMEN Objetivos: realizar la validación del Nursing Critical Thinking in Clinical Practice Questionnaire sobre aspectos culturales y propiedades métricas. Métodos: investigación metodológica realizada a través de adaptación transcultural, validez de rostro y contenido, validez de constructo dimensional y grupos conocidos, confiabilidad test-retest y consistencia interna. En el estudio participaron 511 enfermeras de cuatro hospitales, de las cuales 54 participaron en la nueva prueba. Resultados: la validación del instrumento para portugués brasileño mantuvo las equivalencias, según la versión original. La validez dimensional demostró ajuste a la estructura tetrafactorial de la versión original (GFI=0,69). Hubo diferencias estadísticamente significativas en las habilidades de pensamiento crítico entre enfermeros con posgrados, que completaron su formación, leyendo artículos, desarrollando investigaciones y trabajando en una institución con un tiempo de implementación más largo del Proceso de Enfermería. El instrumento mostró estabilidad temporal (ICC=073-0,84; p<0,001) y adecuada consistencia interna (α=0,97). Conclusiones: el instrumento resultó válido y confiable para la población estudiada.

RESUMO Objetivos: realizar a validação do instrumento Nursing Critical Thinking in Clinical Practice Questionnaire quanto a aspectos culturais e propriedades métricas. Métodos: pesquisa metodológica, realizada por meio de adaptação transcultural, validade de face e conteúdo, validade de construto dimensional e de grupos conhecidos, confiabilidade teste-reteste e consistência interna. Participaram do estudo 511 enfermeiros de quatro hospitais, dos quais 54 participaram do reteste. Resultados: a validação do instrumento para o português brasileiro manteve as equivalências, conforme versão original. A validade dimensional demonstrou ajuste à estrutura tetrafatorial da versão original (GFI=0,69). Observaram-se diferenças estatisticamente significativas de habilidades do pensamento crítico entre enfermeiros com pós-graduação e que realizaram capacitações, com leitura de artigos, desenvolvimento de pesquisas e atuação em instituição com maior tempo de implantação do Processo de Enfermagem. Instrumento apresentou estabilidade temporal (CCI=073-0,84; p<0,001) e adequada consistência interna (α=0,97). Conclusões: instrumento se mostrou válido e confiável para população estudada.

Correction: Analgesic use among the Brazilian population: Results from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM).

[This corrects the article DOI: 10.1371/journal.pone.0214329.].

Self-reported confidence and anxiety over endodontic procedures in undergraduate students-Quantitative and qualitative study.

PURPOSE: The current literature shows a growing interest to assess the feelings and perceptions of students associated with the performance of elective endodontic procedures. This study aimed to evaluate the students' anxiety and self-perceptions related to performing such treatments. METHODS: Forty-five students participated in the research (G1 = 22 beginners students; G2 = 23 senior students). Demographic data, STAI-State and Numerical Rating Scale (NRS) for pre-operative anxiety were completed before the appointment with patient. The STAI-Trait; NRS for post-operative anxiety; previous experiences in endodontics; and level of confidence in each stage of endodontic treatments were collected after appointment. Focal groups for qualitative data collection were performed on separate occasion. RESULTS: Both groups showed higher scores in STAI-State than for STAI-Trait scale. G1 showed higher levels of anxiety in the pre-operative, compared with post-operative moment in the NRS scale. G2 reported feeling more confidence to insert intracanal medication and to restore teeth between appointments than G1. In both focus groups, participants reported insecurity in performing endodontic procedures due to difficulty in visualisation and to anatomic complexities. G1 reported that all the confidence they had was based in pre-clinical experience, and G2 mentioned concern about the end of graduation. CONCLUSION: The participants' anxiety diminishes as they gain more experience in performing endodontic procedures. However, as they approach the end of the course anxiety levels increase. Greater availability of elective courses in endodontics could be a valuable alternative to provide students with more exposure to and experience with these procedures.