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Enferm. actual Costa Rica (Online) ; (38): 1-17, Jan.-Jun. 2020. tab, graf
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1090083


Abstract The objective of this study is to translate and culturally adapt to European Portuguese "EBP Beliefs Scale for Educators" (EBPB-E), "EBP Implementation Scale for Educators" (EBPI-E) and "Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey" for Educators (OCRSIEP-E); and to provide preliminary validation data. The study was carried out in two phases: translation and transcultural adaptation; and preliminary validation in nursing educators of nine nursing schools in Portugal. Pre-final versions of the instruments were considered easy to understand. But, the participants suggested including the possibility of "I don't know" response and increasing the recall period in the EBPI-E. 68 educators participated in phase II. The α for EBPB-E, EBPI-E and OCRSIEP-E was 0.88, 0.95 and 0.94 and the corrected element-total correlations between the items and the total score ranged from 0.20 to 0.75, 0.59 to 0.84 and -0.06 to 0.78, respectively. Preliminary findings showed a strong internal consistency. It is concluded that other validation studies with more robust samples are needed to prove the reliability and validity of the instruments.

Resumen El objetivo de este estudio es traducir y adaptar culturalmente al portugués europeo "EBP Beliefs Scale for Educators" (EBPB-E), "EBP Implementation Scale for Educators" (EBPI-E) y "Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey" para docentes (OCRSIEP-E); y presentar datos preliminares de validación. El estudio se realizó en dos fases: traducción y adaptación transcultural; y validación preliminar en docentes de enfermería de nueve escuelas de enfermería de Portugal. Las versiones prefínales de los instrumentos se consideraron de fácil comprensión. Pero, los participantes sugirieron incluir la posibilidad de respuesta "no sé" y aumentar el período de recuerdo en el EBPI-E. 68 educadores participaron en la fase II. El α para EBPB-E, EBPI-E y OCRSIEP-E fue 0,88, 0,95 y 0,94 y las correlaciones elemento-total corregidas entre los ítems y la puntuación total variaron de 0,20 a 0,75, 0,59 a 0,84 y -0,06 a 0,78, respectivamente. Los hallazgos preliminares mostraron una fuerte consistencia interna. Se concluye que se necesitan otros estudios de validación con muestras más robustas para probar la confiabilidad y la validez de los instrumentos.

Resumo O objetivo deste estudo é traduzir e adaptar culturalmente o português europeu "Escala de Crenças EBP para Educadores" (EBPB-E), "Escala de Implementação EBP para Educadores" (EBPI-E) e "Cultura Organizacional e Prontidão para Integração em toda a Escola de Pesquisa Prática Baseada em Evidências" para profesores (OCRSIEP-E); e fornecer dados preliminares de validação. O estudo foi realizado em duas fases: tradução e adaptação transcultural; e validação preliminar em professores de enfermagem de nove escolas de enfermagem em Portugal. As versões prefinais dos instrumentos foram consideradas fáceis de entender. Porém, os participantes sugeriram incluir a possibilidade de resposta "não sei" e aumentar o período de recall no EBPI-E. 68 educadores participaram da fase II. O α para EBPB-E, EBPI-E e OCRSIEP-E foi de 0,88, 0,95 e 0,94 e as correlações elementototal corrigidas entre os itens e a pontuação total variaram de 0,20 a 0,75, 0,59 a 0,84 e -0,06 a 0,78, respetivamente. Os resultados preliminares mostraram uma forte consistência interna. Conclui-se que outros estudos de validação com amostras mais robustas são necessários para comprovar a confiabilidade e validade dos instrumentos.

Enfermería , Estudio de Validación , Educación en Enfermería , Práctica Clínica Basada en la Evidencia/métodos
Biotechnol Bioeng ; 117(8): 2571-2587, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32374413


The global market of butanol is increasing due to its growing applications as solvent, flavoring agent, and chemical precursor of several other compounds. Recently, the superior properties of n-butanol as a biofuel over ethanol have stimulated even more interest. (Bio)butanol is natively produced together with ethanol and acetone by Clostridium species through acetone-butanol-ethanol fermentation, at noncompetitive, low titers compared to petrochemical production. Different butanol production pathways have been expressed in Escherichia coli, a more accessible host compared to Clostridium species, to improve butanol titers and rates. The bioproduction of butanol is here reviewed from a historical and theoretical perspective. All tested rational metabolic engineering strategies in E. coli to increase butanol titers are reviewed: manipulation of central carbon metabolism, elimination of competing pathways, cofactor balancing, development of new pathways, expression of homologous enzymes, consumption of different substrates, and molecular biology strategies. The progress in the field of metabolic modeling and pathway generation algorithms and their potential application to butanol production are also summarized here. The main goals are to gather all the strategies, evaluate the respective progress obtained, identify, and exploit the outstanding challenges.

Nat Commun ; 11(1): 2144, 2020 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-32358542


The Saccharomycotina subphylum (budding yeasts) spans 400 million years of evolution and includes species that thrive in diverse environments. To study niche-adaptation, we identify changes in gene expression in three divergent yeasts grown in the presence of various stressors. Duplicated and non-conserved genes are significantly more likely to respond to stress than genes that are conserved as single-copy orthologs. Next, we develop a sorting method that considers evolutionary origin and duplication timing to assign an evolutionary age to each gene. Subsequent analysis reveals that genes that emerged in recent evolutionary time are enriched amongst stress-responsive genes for each species. This gene expression pattern suggests that budding yeasts share a stress adaptation mechanism, whereby selective pressure leads to functionalization of young genes to improve growth in adverse conditions. Further characterization of young genes from species that thrive in harsh environments can inform the design of more robust strains for biotechnology.

Saccharomycetales/metabolismo , Ascomicetos/genética , Ascomicetos/metabolismo , Biotecnología/métodos , Genoma Fúngico/genética , Filogenia , Saccharomyces cerevisiae/metabolismo , Proteínas de Saccharomyces cerevisiae/metabolismo
Rev Bras Ter Intensiva ; 32(1): 49-57, 2020 Mar.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32401978


OBJECTIVE: To characterize a cohort of acute-on-chronic liver failure patients in Intensive Care and to analyze the all-cause 28-day mortality risk factors assessed at ICU admission and day 3. METHODS: This was a retrospective cohort study of consecutive patients admitted to the intensive care unit between March 2013 and December 2016. RESULTS: Seventy-one patients were included. The median age was 59 (51 - 64) years, and 81.7% of patients were male. Alcohol consumption alone (53.5%) was the most frequent etiology of cirrhosis and infection (53.5%) was the most common acute-on-chronic liver failure precipitating event. At intensive care unit admission, the clinical severity scores were APACHE II 21 (16 - 23), CLIF-SOFA 13 (11 - 15), Child-Pugh 12 (10 - 13) and MELD 27 (20 - 32). The acute-on-chronic liver failure scores were no-acute-on-chronic liver failure: 11.3%; one: 14.1%; two: 28.2% and three: 46.5%; and the number of organ failures was one: 4.2%; two: 42.3%; three: 32.4%; four: 16.9%; and five: 4.2%. Liver transplantation was performed in 15.5% of patients. The twenty-eight-day mortality rate was 56.3%, and the in-ICU mortality rate was 49.3%. Organ failure at intensive care unit admission (p = 0.02; OR 2.1; 95%CI 1.2 - 3.9), lactate concentration on day 3 (p = 0.02; OR 6.3; 95%CI 1.4 - 28.6) and the international normalized ratio on day 3 (p = 0.03; OR 10.2; 95%CI 1.3 - 82.8) were independent risk factors. CONCLUSION: Acute-on-chronic liver failure patients presented with high clinical severity and mortality rates. The number of organ failures at intensive care unit admission and the lactate and international normalized ratio on day 3 were independent risk factors for 28-day mortality. We consider intensive care essential for acute-on-chronic liver failure patients and timely liver transplant was vital for selected patients.

Small ; 16(28): e1907661, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32462808


Non-Newtonian nanofluids present outstanding features in terms of energy transfer and conductivity with high application in numerous areas. In this work, non-Newtonian nanofluids based on carbon dots (Cdots) functionalized with ionic liquids (ILs) are developed. The nanofluids are produced using a simple, single-step method where the raw materials for the Cdots synthesis are glucose and waste biomass (chitin from crab shells). The use of ILs as both reaction media and functionalization molecules allows for the development of a new class of nanofluids, where the ILs on the Cdots surface represent the base-fluid. Here, the well-known benign IL 1-butyl-3-methylimidazolium chloride ([Bmim]Cl) and a novel home-made IL (1-tosylate-3-methyl-imidazolium triflate) [Tmi][Trif] are used. The nanofluids obtained from both substrates show, apart from high conductivity and viscosity, light absorption, and good wettability, an appealing thermal sensitivity behavior. This thermal sensitivity is preserved even when applied as thin films on glass slides and can be boosted using the surface plasmon resonance effect. The results reported demonstrate that the new Cdots/IL-based nanofluids constitute a versatile and cost-effective route for achieving high-performance thermosensitive non-Newtonian sustainable nanofluids with tremendous potential for the energy coatings sector and heat transfer film systems.

Nat Commun ; 11(1): 1881, 2020 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-32312967


Cells maintain reserves in their metabolic and translational capacities as a strategy to quickly respond to changing environments. Here we quantify these reserves by stepwise reducing nitrogen availability in yeast steady-state chemostat cultures, imposing severe restrictions on total cellular protein and transcript content. Combining multi-omics analysis with metabolic modeling, we find that seven metabolic superpathways maintain >50% metabolic capacity in reserve, with glucose metabolism maintaining >80% reserve capacity. Cells maintain >50% reserve in translational capacity for 2490 out of 3361 expressed genes (74%), with a disproportionately large reserve dedicated to translating metabolic proteins. Finally, ribosome reserves contain up to 30% sub-stoichiometric ribosomal proteins, with activation of reserve translational capacity associated with selective upregulation of 17 ribosomal proteins. Together, our dataset provides a quantitative link between yeast physiology and cellular economics, which could be leveraged in future cell engineering through targeted proteome streamlining.

Biosíntesis de Proteínas , Proteómica , Saccharomyces cerevisiae/metabolismo , Reactores Biológicos , Ingeniería Celular , Fermentación , Regulación Fúngica de la Expresión Génica , Glucosa/metabolismo , Redes y Vías Metabólicas , Nitrógeno/metabolismo , Procesamiento Proteico-Postraduccional , Proteoma/metabolismo , Proteínas Ribosómicas/metabolismo
Transl Oncol ; 13(4): 100760, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32247264


Although screening has reduced mortality rates for colorectal cancer (CRC), about 20% of patients still carry metastases at diagnosis. Postsurgery chemotherapy is toxic and induces drug resistance. Promising alternative strategies rely on repurposing drugs such as aspirin (ASA) and metformin (MET). Here, tumor spheroids were generated in suspension by primary CRCs and metastatic lymph nodes from 11 patients. These spheroids presented a heterogeneous cell population including a small core of CD133+/ESA+ cancer stem cells surrounded by a thick corona of CDX2+/CK20+ CRC cells, thus maintaining the molecular hallmarks of the tumor source. Spheroids were exposed to ASA and/or MET at different doses for up to 7 days to assess cell growth, migration, and adhesion in three-dimensional assays. While ASA at 5 mM was always sufficient to mitigate cell migration, the response to MET was patient specific. Only in MET-sensitive spheroids, the 5 mM ASA/MET combination showed an effect. Interestingly, CRCs from diabetic patients daily pretreated with MET gave a very low spheroid yield due to reduced cancer cell survival. This study highlights the potential of ASA/MET treatments to modulate CRC spreading.

Cells ; 9(4)2020 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-32340136


Regenerative strategies for human articular cartilage are still challenging despite the presence of resident progenitor cell population. Today, many efforts in the field of regenerative medicine focus on the use of platelet derivatives due to their ability to reactivate endogenous mechanisms supporting tissue repair. While their use in orthopedics continues, mechanisms of action and efficacy need further characterization. We describe that the platelet lysate (PL) is able to activate chondro-progenitor cells in a terminally differentiated cartilage tissue. Primary cultures of human articular chondrocytes (ACs) and cartilage explants were set up from donor hip joint biopsies and were treated in vitro with PL. PL recruited a chondro-progenitors (CPCs)-enriched population from ex vivo cartilage culture, that showed high proliferation rate, clonogenicity and nestin expression. CPCs were positive for in vitro tri-lineage differentiation and formed hyaline cartilage-like tissue in vivo without hypertrophic fate. Moreover, the secretory profile of CPCs was analyzed, together with their migratory capabilities. Some CPC-features were also induced in PL-treated ACs compared to fetal bovine serum (FBS)-control ACs. PL treatment of human articular cartilage activates a stem cell niche responsive to injury. These facts can improve the PL therapeutic efficacy in cartilage applications.

Mar Drugs ; 18(4)2020 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-32244516


In the last decades, the use of algae in biotechnology and food industries has experienced an exponential growth. Codium tomentosum is a green macroalgae with high biotechnological potential, due to its rich lipidome, although few studies have addressed it. This study aimed to investigate the seasonal changes in lipid and pigment profiles of C. tomentosum, as well as to screen its antioxidant activity, in order to evaluate its natural plasticity. Samples of C. tomentosum were collected in two different seasons, early-autumn (September/October) and spring (May), in the Portuguese coast (wild samples), and in a land-based integrated multitrophic aquaculture (IMTA) system (IMTA samples). Total lipid extracts were analysed by LC-MS, GC-MS, and HPLC, and antioxidant activity was screened through free radical scavenging potential against DPPH and 2,20-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) radicals. Wild samples showed a high seasonal variability, modifying their lipidome and pigment profiles according to environmental shifts, while IMTA samples showed a relatively stable composition due to early-stage culturing in controlled conditions. The lipids that contributed the most to seasonal discrimination were glycolipids (monogalactosyl diacylglycerol - MGDG and digalactosyl diacylglycerol - DGDG) and the lyso forms of phospholipids and glycolipids. Lipid extracts showed antioxidant activity ranging from 61 ± 2 to 115 ± 35 µmol Trolox g-1 of lipid extract in DPPH assay and from 532 ± 73 to 927 ± 92 µmol Trolox g-1 of lipid extract in ABTS assay, with a more intense antioxidant activity in wild spring samples. This study revealed that wild specimens of C. tomentosum presented a higher plasticity to cope with seasonal environmental changes, adjusting their lipid, pigment, and bioactivity profiles, while IMTA samples, cultured under controlled conditions, displayed more stable lipidome and pigment compositions.

Nat Commun ; 11(1): 1949, 2020 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-32327653


Genetic diversity of Mycobacterium tuberculosis affects immune responses and clinical outcomes of tuberculosis (TB). However, how bacterial diversity orchestrates immune responses to direct distinct TB severities is unknown. Here we study 681 patients with pulmonary TB and show that M. tuberculosis isolates from cases with mild disease consistently induce robust cytokine responses in macrophages across multiple donors. By contrast, bacteria from patients with severe TB do not do so. Secretion of IL-1ß is a good surrogate of the differences observed, and thus to classify strains as probable drivers of different TB severities. Furthermore, we demonstrate that M. tuberculosis isolates that induce low levels of IL-1ß production can evade macrophage cytosolic surveillance systems, including cGAS and the inflammasome. Isolates exhibiting this evasion strategy carry candidate mutations, generating sigA recognition boxes or affecting components of the ESX-1 secretion system. Therefore, we provide evidence that M. tuberculosis strains manipulate host-pathogen interactions to drive variable TB severities.

Citosol/inmunología , Interleucina-1beta/metabolismo , Mycobacterium tuberculosis/patogenicidad , Transducción de Señal/inmunología , Tuberculosis Pulmonar/inmunología , Animales , Proteínas Bacterianas/genética , Células Cultivadas , Citocinas/metabolismo , Femenino , Genoma Bacteriano/genética , Humanos , Evasión Inmune , Inmunomodulación , Inflamasomas/inmunología , Macrófagos/inmunología , Macrófagos/microbiología , Masculino , Ratones , Mutación , Mycobacterium tuberculosis/clasificación , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Filogenia , Polimorfismo de Nucleótido Simple , Tuberculosis Pulmonar/microbiología , Virulencia/genética
Forensic Sci Int Genet ; 46: 102262, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32088644


X-chromosome markers have been proved to be decisive both complementing and solving kinship analysis, particularly when autosomal markers are not able to produce adequate likelihood ratios between different hypothesis. On the other hand, Pereira et al., (2012) have demonstrated that 32 Insertion/Deletion (InDel) markers located on the X-Chromosome have a very important power of discrimination in human populations, being a novel tool in the forensic and population fields. So, the aim of the present work was testing the forensic and population genetic efficiency of the 32 X-InDel polymorphisms in the Spanish population, and subsequently build an allele/haplotype frequencies database. To accomplish this objective, a total of 555 samples comprising male individuals from 13 Spanish regions were analysed for the above mentioned 32 X-InDels in two independent laboratories. A pairwise FST analysis was performed in order to understand if the studied Spanish sub-populations present significant differences among them, detecting possible population substructure. Also, linkage disequilibrium analyses were computed to investigate the presence of association between markers in the Spanish population. After Bonferroni correction, the absence of significant differences among the studied regions supports a global Spanish population database. Concerning LD, besides previously reported linked markers MID356-MID357 and MID3690-MID3719-MID2089, we also detected significant association between MID3703-MID3774, even after Bonferroni correction. Finally, after computing allele and haplotype frequencies, forensic efficiency parameters were calculated (PDmales = 99.999976 %; PDfemales = 99.99999999998 %). Mean exclusion chance values for duos were 0.999 and trios 0.99999. These results reinforce the suitability of the 32 X-InDels marker set both in identification and kinship studies.

Trends Parasitol ; 36(4): 325-336, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32035818


Mosquito-borne diseases represent a major threat to humankind. Recently, the incidence of malaria has stopped decreasing while that of dengue is increasing exponentially. Alternative mosquito-control methods are urgently needed. The sterile insect technique (SIT) has seen significant developments recently and may play an important role. However, testing and implementing SIT for vector control is challenging, and a phased conditional approach (PCA) is recommended, that is, advancement to the next phase depends on completion of activities in the previous one. We herewith present a PCA to test the SIT against mosquitoes within an area-wide-integrated pest-management programme, taking into account the experience gained with plant and livestock pests and the recent developments of the technique against mosquitoes.

J Viral Hepat ; 27(7): 715-720, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32096268


Direct-acting antiviral drugs (DAAs) have recently changed the paradigm of hepatitis C therapy, significantly improving treatment response rates, patient life expectancy and quality of life. In Portugal, sofosbuvir (SOF) and SOF/ledipasvir (SOF/LDV) were fully reimbursed by the National Health System since early 2015 and generalized use of interferon-free DAA based regimens became current practice. During 2016, the remaining DAAs were sequentially added and covered by the same health access policy. The Portuguese Study Group of Hepatitis and HIV Co-infection (GEPCOI) collected data from 15 clinical centres in Portugal, pertaining to the HCV treatment experience with DAA regimens. A cohort of 2133 patients was analysed, representing one of the largest DAA treated HCV/HIV co-infected individuals. The global sustained virologic response (SVR) achieved was 95% in this real-life cohort setting. Linear regression analysis showed significant differences in treatment response rates when using SOF plus ribavirin (RBV) combination in genotype 2 or 3 infected individuals (P < .002) and in those with liver cirrhosis (P < .002). These findings corroborate that early treatment is mandatory in HIV/HCV co-infected patients, as response rates may be negatively influenced by higher fibrosis stages and suboptimal DAA regimens. The current national Portuguese health policy should continue to promote wider treatment access and individualized therapy strategies, aiming at the elimination of HCV infection in this high-risk co-infected population.

J Med Imaging Radiat Sci ; 51(2): 235-240, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31956061


INTRODUCTION/BACKGROUND: Medical imaging education programs across Europe, despite their variability, include clinical practice as a guarantee of quality because learning in a clinical context is more effective and allows for constructive qualification of students. Learning in a clinical simulation context is a strategy to promote simulated clinical experience and assure patient safety. In this work, a learning experience, consisting of simulating a pacemaker implantation, implemented over 3 years with students pursuing the Medical Imaging and Radiotherapy degree at the University of Aveiro was evaluated. METHODS: A pacemaker implantation simulation with fluoroscopic support was performed with students (third year) pursuing the Medical Imaging and Radiotherapy degree at the Simulation Centre of our institution over 3 years (2016, 2017-2018), addressing all the simulation phases. An operating theater, video recording system, high-fidelity full-body manikin with remote control and monitoring, anesthesia, and fluoroscopic C-arm imaging equipment were used for the simulation. After the simulation activity, students completed a questionnaire evaluated the importance of this learning experience for their educational process. RESULTS: Overall, the mean score results were consistent, even considering the three independent groups (one for each academic year). Students considered this experience valuable for their education, strongly agreeing that the simulation environment helped their learning process and allowed them to acquire, consolidate, and deepen knowledge. Furthermore, they considered that it impressed on them the necessity to continue to improve their learning, and that they would like to participate in other simulation scenarios. DISCUSSION/CONCLUSION: This simulation activity was a valuable experience for the learning process of the students because it facilitated the acquisition and consolidation of knowledge. It also allowed the students to be aware of the importance of being engaged in their own education. The results were highly consistent over the 3 years, reinforcing the positive feedback from this experience.

Rev. enferm. atenção saúde ; 9(1): 113-126, jan./jul. 2020. tab.
Artículo en Inglés, Portugués | BDENF - Enfermería | ID: biblio-1118005


Objetivo: identificar os conhecimentose habilidades de enfermeiros para a prática baseada em evidência e suas práticas de pesquisa. Método: estudo realizado com 41 enfermeiros da Estratégia Saúde da Família, no Sul do Brasil. A coleta de dados ocorreu por questionário, roteiro de questões auxiliares e grupo focal, após a aprovação do Comitê de Ética e Pesquisa. Para análise utilizou-se estatística descritiva e análise de conteúdo temática. Resultados: foi identificado que os enfermeiros carecem de conhecimentos e habilidades para produzir e utilizar estudos científicos. A experiência clínica é o principal balizador das ações, enquanto a preferência do paciente nas tomadas de decisões revelou-se como o elemento menos considerado entre os pilares da prática baseada em evidência. Conclusão: ainda é um desafio desenvolver a prática baseada em evidência, tencionando reflexões acerca do processo de formação profissional e da ênfase que a pesquisa tem na graduação e nos serviços de saúde (AU).

Objective:To identify nurses' knowledge and skills for evidence-based practice and their research practices. Methods: study conducted with 41 nurses from the Family Health Strategy, in southern Brazil. Data collection occurred through a questionnaire, script of auxiliary questions and focus group, after approval by the Ethics and Research Committee. Descriptive statistics and thematic content analysis were used for analysis. Results: it was identified that nurses lack knowledge and skills to produce and use scientific studies. Clinical experience is the main marker of actions, while patient preference in decision making has proved to be the least regarded element among the pillars of evidence-based practice. Conclusion: It is still a challenge to develop evidence-based practice, intending to reflect on the process of vocational training and the emphasis that research has on undergraduate and health services (AU).

Objetivo: identificar el conocimiento y las habilidades de las enfermeras para la práctica basada en evidencia y sus prácticas de investigación. Método: estudio realizado con 41 enfermeras de la Estrategia de Salud Familiar, el sur de Brasil. La recolección de datos se realizó por cuestionario, un guión de preguntas auxiliares y un grupo focal, después de la aprobación del Comité de Ética e Investigación. Las estadísticas descriptivas y el análisis de contenido temático se utilizaron para el análisis. Resultados: enfermeras carecen de conocimientos y habilidades para producir y utilizar estudios científicos. La experiencia clínica es el principal marcador de acciones, mientras que la preferencia del paciente ha revelado el elemento menos considerado entre de la práctica. Conclusión:es desafiante desarrollar prácticas basadas en evidencia, con la intención de reflexionar sobre el proceso de capacitación vocacional y el énfasis que la investigación tiene en los servicios de pregrado y de salud (AU).

Humanos , Masculino , Femenino , Atención Primaria de Salud , Investigación en Enfermería , Conocimientos, Actitudes y Práctica en Salud , Enfermería Basada en la Evidencia , Enfermeras y Enfermeros
A A Pract ; 14(4): 109-111, 2020 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-31876559


The adequate titration of hypnotic agents can be achieved using processed electroencephalogram (pEEG) monitors. pEEG monitors with a spectrogram, such as bilateral bispectral index (BIS), are useful because they can show different signatures that suggest the effect of a given drug on brain activity. Multimodal general anesthesia is based on a combination of hypnotic and antinociceptive agents. We report a case of awareness in a patient monitored with bilateral BIS during multimodal general anesthesia. This case illustrates the limitations of the index and the value of the spectrogram in the assessment of hypnosis.

Analgésicos/administración & dosificación , Anestesia General/métodos , Hipnóticos y Sedantes/administración & dosificación , Anciano , Analgésicos/efectos adversos , Anestesia General/efectos adversos , Concienciación , Quimioterapia Combinada/efectos adversos , Electroencefalografía , Humanos , Hipnóticos y Sedantes/efectos adversos , Monitorización Neurofisiológica Intraoperatoria , Masculino , Monitoreo Fisiológico
Rev. bras. ter. intensiva ; 31(4): 561-570, out.-dez. 2019. tab
Artículo en Portugués | LILACS-Express | LILACS | ID: biblio-1058048


RESUMO O programa de transplante de fígado teve início em nosso centro em 1992, e pacientes em pós-operatório de transplante hepático ainda são admitidos à unidade de terapia intensiva. Uma curva de aprendizado do médico intensivista teve então início, com aquisição de habilidades e estabelecimento de uma prática específica. Contudo, muitos dos conceitos se modificaram com o tempo, o que conduziu a uma melhora nos cuidados proporcionados a esses pacientes. A abordagem prática varia entre diferentes centros de transplante de fígado, segundo especificidades locais. Assim, ensejamos apresentar nossa prática para estimular o debate entre diferentes equipes dedicadas, o que tem potencial de permitir a introdução de novas ideias e, possivelmente, melhorar o padrão de cuidados em cada instituição.

ABSTRACT The liver transplant program in our center started in 1992, and post-liver transplant patients are still admitted to the intensive care unit. For the intensive care physician, a learning curve started then, skills were acquired, and a specific practice was established. Throughout this time, several concepts changed, improving the care of these patients. The practical approach varies between liver transplant centers, according to local specificities. Hence, we wanted to present our routine practice to stimulate the debate between dedicated teams, which can allow the introduction of new ideas and potentially improve each local standard of care.