Implementação da tele-consulta de enfermagem em sinistrados com ferida traumática: estudo comparativo - Relatório Crítico - Desenvolvimento de Competências Especializadas em Enfermagem na Área da Pessoa em Situação Crítica / Implementation of tele-consultation of nursing in casualties with traumatic wound: comparative study - Critical Report - Development of Specialised Competences in Nursing in the Area of People in Critical Condition

O presente relatório constitui o produto final do percurso realizado durante o Curso de Mestrado em Enfermagem Médico-Cirúrgica ­ área de especialização em Enfermagem à Pessoa em Situação Critica, da Escola Superior de Saúde de Leiria do Instituto Politécnico de Leiria. Estruturalmente, encontra-se dividido em duas partes distintas. Na parte I é feita uma descrição, análise e reflexão crítica acerca do desenvolvimento de competências especializadas com base nas experiências e atividades desenvolvidas nos últimos dois anos, essencialmente, em ambiente de ensino clínico. Complementam-se também com as dificuldades sentidas e constrangimentos encontrados durante a prestação dos cuidados de enfermagem especializados. Ao longo deste período, focam-se a atualização constante dos conhecimentos e a pesquisa contínua da evidência científica mais recente para alicerçar o estudante no processo de tomada de decisão. A mobilização dos componentes teóricos para a prática clínica marca a qualidade dos cuidados prestados pelo enfermeiro especialista, visando a excelência no cuidar e a prática baseada na evidência. A parte II apresenta um estudo comparativo, com análise quantitativa, baseado num projeto de melhoria contínua implementado numa unidade de um grupo de saúde privado português. A existência de uma teleconsulta após a alta do utente tem-se evidenciado benéfica em diversos aspetos como a satisfação do utente em relação aos cuidados, a sua adesão ao tratamento, promoção do autocuidado com consequente redução do número dos episódios hospitalares e custos associados. Desta forma, o estudo pretendia responder à questão: "A Teleconsulta de Enfermagem poderá melhorar a satisfação e a diminuição do consumo de cuidados de saúde dos utentes com ferida traumática, submetidos a tratamento cirúrgico?". Foram estudados dois grupos independentes: o grupo experimental que foi submetido a teleconsulta de follow-up após a alta do serviço e o grupo de controlo que recebeu os cuidados convencionais. Atestaram-se as hipóteses formuladas e concluiu-se que existiram diferenças estatisticamente significativas na satisfação dos cuidados de enfermagem oferecidos entre o grupo experimental e o grupo de controlo assim como no consumo de cuidados de saúde entre os dois grupos. O grupo experimental apresentou valores de satisfação final mais elevados que o grupo de controlo e um número de atendimentos presenciais menor que o grupo de controlo desde o dia do acidente até ao dia de remoção do material de sutura.

This report is the final product of the course completed during the Master's Degree in Medical-Surgical Nursing - specialisation area in Critical Care Nursing, Escola Superior de Saúde de Leiria of the Polytechnic Institute of Leiria. Structurally, it is divided into two distinct parts. Part I describes, analyses and critically reflects on the development of specialised skills based on the experiences and activities developed over the past two years, mainly in clinical teaching environments. They are also complemented with the difficulties experienced and constraints encountered during the provision of specialised nursing care. Throughout this period, the focus is on the constant updating of knowledge and the continuous search for the most recent scientific evidence to support the student in the decision-making process. The mobilisation of theoretical components into clinical practice marks the quality of care provided by specialist nurses, aiming at excellence in care and evidence-based practice. Part II presents a comparative study, with quantitative analysis, based on a continuous improvement project implemented in a unit of a Portuguese private healthcare group. The existence of a teleconsultation after patient discharge has proven beneficial in several aspects such as patient satisfaction regarding care, adherence to treatment, promotion of self-care with a consequent reduction in the number of hospital episodes and associated costs. Thus, the study aimed to answer the following question: "Can Nursing Teleconsultation improve the satisfaction and decrease the consumption of health care in users with traumatic wounds undergoing surgical treatment? Two independent groups were studied: the experimental group which underwent follow-up teleconsultation after discharge from the service and the control group which received conventional care. The hypotheses formulated were confirmed and it was concluded that there were statistically significant differences in the satisfaction with nursing care provided between the experimental group and the control group, as well as in healthcare consumption between both groups. The experimental group showed higher values of final satisfaction than the control group and a lower number of face-to-face visits than the control group from the day of the accident to the day the suture material was removed.

How promising are HIV-1-based virus-like particles for medical applications.

New approaches aimed at identifying patient-specific drug targets and addressing unmet clinical needs in the framework of precision medicine are a strong motivation for researchers worldwide. As scientists learn more about proteins that drive known diseases, they are better able to design promising therapeutic approaches to target those proteins. The field of nanotechnology has been extensively explored in the past years, and nanoparticles (NPs) have emerged as promising systems for target-specific delivery of drugs. Virus-like particles (VLPs) arise as auspicious NPs due to their intrinsic properties. The lack of viral genetic material and the inability to replicate, together with tropism conservation and antigenicity characteristic of the native virus prompted extensive interest in their use as vaccines or as delivery systems for therapeutic and/or imaging agents. Owing to its simplicity and non-complex structure, one of the viruses currently under study for the construction of VLPs is the human immunodeficiency virus type 1 (HIV-1). Typically, HIV-1-based VLPs are used for antibody discovery, vaccines, diagnostic reagent development and protein-based assays. This review will be centered on the use of HIV-1-based VLPs and their potential biomedical applications.

[The importance of intensive lipid-lowering therapy after acute coronary syndrome: changing the paradigm to improve the achievement of targets]. / L'importanza di una terapia ipolipemizzante intensiva dopo sindrome coronarica acuta: cambiare il paradigma per migliorare il raggiungimento dei target.

BACKGROUND: Despite the availability of effective lipid-lowering drugs, only few high-risk patients attain their LDL cholesterol (LDL-C) guideline-recommended risk-based goal because of underprescription of combination therapy. We present an 18-month experience with variation of prescription protocols after publication of the 2019 ESC/EAS guidelines for the management of dyslipidemias. METHODS: Overall, 621 consecutive patients hospitalized for acute coronary syndrome at Mauriziano Hospital in Turin, Italy, between January 2020 and June 2021 were enrolled. Lipid-lowering therapy recommended at discharge was registered to evaluate how many patients received statin monotherapy, statin plus ezetimibe combination or triple therapy with high-intensity statin plus ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i). At 6-month follow-up, the reduction in LDL-C, adverse events, compliance and cardiovascular recurrences was analyzed. RESULTS: Of 621 patients enrolled, 7 died during hospitalization. During the entire study period, 33% of patients received statin monotherapy, 50% were discharged on statin-ezetimibe combination, and PCSK9i (evolocumab) was prescribed to 17% of patients. Between April 2020 and June 2021, when new recommendations were introduced into clinical practice, 20% of patients received evolocumab, 56% combination therapy and only 24% were discharged on statin monotherapy. At the beginning of observation, evolocumab was prescribed to 3% of patients hospitalized for acute coronary syndrome, while at the end of the study period 27% of patients were discharged on PCSK9i, with an increase of the prescription rate by 759%; in the same period, prescription of statin monotherapy decreased by 75%. At 6-month follow-up, LDL-C reduction was 77% in patients treated with PCSK9i vs 48% in patients taking statin-ezetimibe combination therapy (p<0.001). All patients on evolocumab reached the guideline-directed goals and a low rate of adverse events was reported, mainly represented by local injection site reactions. Six patients experienced acute coronary syndrome recurrence; only one of them was treated with evolocumab. CONCLUSION: Prescription of intensive lipid-lowering therapy after acute coronary syndrome, eventually with introduction of PCSK9i during hospitalization or at discharge, leads to attainment of guideline-recommended goals for all patients, with a low incidence of adverse events and optimal compliance.

Avaliaçao da secreçao salivar nao-estimulada em pacientes reumáticos com xerostomia pelo teste de Saxon / Evaluation of non-stimulated salivar secretion in rheumatic patients with xerostomia by saxon test

Objetivo: Avaliar a medida da secreçao salivar nao-estimulada em controles normais e em pacientes reumatológicos através do teste de Saxon. Métodos: O teste de Saxon foi realizado em 193 indivíduos normais e em 92 pacientes reumatológicos com xerostomia (síndrome de Sjögren [SS] primária, n = 22, SS secundária, n = 19, doenças do conjuntivo sem SS, n = 51). Foram excluídos os indivíduos e em uso de medicaçao que alterasse a secreçao salivar. Quatro gazes foram colocadas em recipiente plástico fechado e pesadas em balança de precisao. Solicitou-se aos pacientes que 1) deglutissem a saliva existente na cavidade oral; 2) mastigassem as gazes durante 2 minutos, sem deglutir. Findo esse período, as gazes eram repesadas no frasco original. A diferença de peso foi tomada como a medida de secreçao salivar na unidade de tempo. Resultados: Nos controles, encontramos secreçao salivar média = 4,94 + ou - 1,98g, com limite mínimo do normal de 1,6g para pessoas até 60 anos, e 0,7g para acima dessa idade. Pacientes com SS primária tiveram valores de 1,51 + ou - 1,41g e os com SS secundária, de 3,35 + ou - 2,68g, com diferenças estatisticamente significantes em relaçao aos controles e entre si mesmos. Nao houve diferenças significativas, por outro lado, entre os controles e os pacientes com doenças do conjuntivo sem SS. A especificidade do método foi de 96 por cento e sensibilidade foi de 54 por cento considerando-se os valores de normalidade citados acima. Conclusoes: O teste de Saxon é um elemento diagnóstico de considerável especificidade para o rastreamento de xerostomia e SS, na dependência dos valores normais conforme a idade