O objetivo do estudo foi realizar uma revisão narrativa da literatura para comparar os métodos visual e instrumental de seleção da cor dentária, correlacionando-os com o fator experiência e a educação continuada. Utilizou-se como base de dados a MEDLINE na qual foram aplicados os descritores "visualshade match", "color measurement", "spectrophotometer" e "tooth color determination". Os critérios de inclusão foram artigos publicados entre 2010 e 2020que abordassem uma análise comparativa entre as duas modalidades de seleção da cor dentária. Se enquadraram nos critérios de exclusão estudos que não contemplavam a temática abordada e aqueles publicados nos anos anteriores a 2010, além das revisões de literatura. No total, onze artigos foram selecionados para compor essa revisão. Os estudos demonstraram que o método instrumental apresentou maior confiabilidade e reprodutibilidade quando comparado ao método visual, isso se deve ao fato de a escolha de cor através de instrumentos eletrônicos proporcionar melhor precisão e atenuação da subjetividade. No que concerne a experiência como fator influenciador da seleção de cor, os estudos são controversos. Mesmo evidenciando melhor precisão, a estimativa instrumental apresenta limitações devido à dificuldade de aferição em função da convexidade da anatomia dentária. Desse modo, foi descrito que a associação de métodos é capaz de elevar a confiabilidade da escolha de cor, melhorando o resultado estético. Não houve consenso entre os estudos com relação à influência da experiência, no entanto, a educação continuada foi sugerida na literatura como alternativa para formar profissionais mais confiantes no processo de seleção de tonalidades(AU)
The goal of this study was to carry out a narrative review of the literature to compare the visual and instrumental methods of tooth color selection, correlating them with the experience factor and continuing education. MEDLINE was used as a database in which the descriptions such as "visual shade match", "color measurement", "spectrophotometer" and "tooth color determination" were applied. The inclusion criteria were articles published between 2010 and 2020 that addressed a comparative analysis between the two types of tooth color selection. The exclusion criteria included studies that did not contemplate the theme addressed and those published in the years prior to 2010, in addition to literature reviews. In total, eleven articles were selected to compose this review. Studies have shown that the instrumental method showed greater reliability and reproducibility when compared to the visual method, this is due to the fact that the color's choice through electronic instruments provides better precision and lessened subjectivity. Regarding experience as na influencing factor in color selection, studies are controversial. Even with better precision, the instrumental estimation has limitations due to the difficulty of measuring it due to the convexity of the dental anatomy. Thus, it was described that the association of the methods is able to increase the reliability of the color's choice, improving the aesthetic result. There was no consensus among the studies in regard to the experiment's influence, however, continuing education was suggested in the literature as an alternative in order to form more confident professionals when it comes to the shade selection process(AU)
Color , Esthetics, Dental , Spectrophotometry
Background and objective With the increasing incidence of cancer and the rise in the survival rates of cancer patients, more and more oncological candidates are being considered for admission to intensive care units (ICU). Several studies have demonstrated no difference in the outcomes of cancer patients compared to non-cancer patients. Our study aimed to describe and analyze the outcomes related to cancer patients in a polyvalent ICU. Methods We conducted a retrospective study of consecutive oncological patients admitted to a polyvalent ICU (2013-2017). Cox model and receiver operating characteristic (ROC) curve analysis were performed to analyze the results. Results A total of 236 patients were included in the study; the mean age of the patients was 53.5 ± 15.3 years, and 65% of them were male. The main cancer types were those related to the central nervous system (CNS; 31%), as well as gastrointestinal (18%), genitourinary (17%), and hematological (15%). Curative/diagnostic surgeries (49%) and sepsis/septic shock (17%) were the main reasons for admission. The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores in hematological patients vs. solid tumors were as follows: 30 vs. 20 and 63 vs. 38, respectively (p<0.005). Vasopressors, invasive mechanical ventilation (IMV), and renal replacement therapy (RRT) were used more widely in hematological patients compared to solid-tumor patients. Length of stay was longer in hematological patients vs. solid-tumor patients (12.8 vs. 7 days, p=0.002). The median overall survival in hematological patients was one month and that in solid-tumor patients was 5.8 months (p<0.005). The survival rate at six months was better than described in the existing literature (48 vs. 32.4%). Conclusion Both SAPS II and APACHE II scores were reasonably accurate in predicting mortality, demonstrating their value in cancer patients.
Resumo Objetivo Conhecer a perceção do risco individual de infeção HIV; avaliar conhecimentos sobre infeção HIV; conhecer atitudes face ao uso do preservativo em função do sexo; conhecer o embaraço na aquisição, negociação e uso do preservativo em função do sexo, independentemente de preservativo masculino ou feminino. Métodos Estudo analítico-transversal. Amostra não probabilística constituída por 102 estudantes de Enfermagem. Instrumentos: questionário sociodemográfico e perceção do risco; teste de conhecimentos; escala de embaraço no uso do preservativo; escala de atitudes face ao uso do preservativo. Resultados A perceção do risco de infeção HIV é favorável/muito favorável para mais de 50% dos jovens e não estatisticamente diferente entre sexos (X2= 2,213; GL= 4, p= 0,697). Dos jovens inquiridos, 86,3% nunca fez teste HIV e 86,1% não se recorda de qualquer campanha de prevenção. O teste de conhecimentos teve resultado global de 83,7%. A dimensão médico-científica mostrou os resultados mais baixos (77,8%). O embaraço na aquisição do preservativo é superior nas inquiridas comparativamente com os inquiridos (t= -2,08; p= 0,04). A atitude face ao uso do preservativo não é significativamente diferente em função do sexo (t= -1,20; p= 0,23). Conclusão Os estudantes têm boa perceção do risco de infeção de HIV, mas baixa adesão à realização do teste e a maioria não se recorda da última campanha de prevenção. Os conhecimentos revelados são elevados, mas necessitam de ser incrementados na dimensão médico-científica. As estudantes revelam mais embaraço do que os estudantes face ao preservativo, porém, as atitudes manifestadas são idênticas. Programas formativos continuam imprescindíveis.
Resumen Objetivo Conocer la percepción del riesgo individual de infección por VIH. Evaluar los conocimientos sobre infección por VIH. Conocer las actitudes ante el uso del preservativo en función del sexo. Conocer el nivel de vergüenza en la adquisición, negociación y uso de preservativos en función del sexo, tanto preservativos masculinos como femeninos. Métodos Estudio analítico transversal. Muestra no probabilística, formada por 102 estudiantes de enfermería. Instrumentos: cuestionario sociodemográfico y percepción del riesgo, prueba de conocimientos, escala de vergüenza en el uso de preservativos, escala de actitudes ante el uso de preservativos. Resultados La percepción del riesgo de infección por VIH es favorable/muy favorable para más del 50 % de los jóvenes y no es estadísticamente diferente entre sexos (X2= 2,213; GL= 4, p= 0,697). De los jóvenes encuestados, el 86,3 % nunca realizó una prueba de VIH y el 86,1 % no recuerda ninguna campaña de prevención. El resultado global de la prueba de conocimientos fue del 83,7 %. La dimensión médico-científica tuvo los resultados más bajos (77,8 %). La vergüenza en la adquisición de preservativos es superior en las encuestadas en comparación con los encuestados (t= -2,08; p= 0,04). La actitud ante el uso del preservativo no es significativamente diferente en función del sexo (t= -1,20; p= 0,23). Conclusión Los estudiantes tienen una buena percepción del riesgo de infección por VIH, pero una baja adherencia a la realización de pruebas y la mayoría no recuerda la última campaña de prevención. Los conocimientos revelados son altos, pero necesitan aumentar en la dimensión médico-científica. Las estudiantes revelan más vergüenza que los estudiantes ante el preservativo, pero las actitudes manifestadas son idénticas. Los programas educativos continúan siendo imprescindibles.
Abstract Objective To investigate the perception of individual risk of HIV infection; to assess knowledge about HIV infection; to learn about condom use attitudes according to gender; to investigate embarrassment about obtaining, negotiating and using condoms according to gender, whether male or female condom. Method This was an analytical cross-sectional study. A non-probabilistic sample was assembled consisting of 102 nursing students. Instruments: sociodemographic and risk perception questionnaire; knowledge test; scale of embarrassment about condom use; condom attitudes scale. Results Perception of risk of HIV infection is favorable/very favorable for more than 50% of young people and there was no statistical difference between the sexes (X 2=2.213; GL= 4, p= 0.697). Of the participants, 86.3% had never been tested for HIV and 86.1% did not recall any HIV prevention campaign. The global result of the knowledge test was 83.7%. The medical-scientific dimension presented the lowest results (77.8%) Embarrassment about obtaining condoms was higher among the women than men (t=-2.08; p=0.04). Attitude towards using condoms was not significantly different between the genders (t= -1.20; p= 0.23). Conclusion The students had a good perception of the risk of HIV infection, but presented low adherence to HIV testing and most did not remember the last prevention campaign. They presented having a high level of knowledge, but they need to improve their knowledge in the medical-scientific dimension. Female students were more embarrassed than the male students about condoms, however, the attitudes towards them were identical. Educational programs continue to be essential.
Humans , Male , Female , Adolescent , Adult , Students, Nursing , HIV Infections/prevention & control , Condoms , Health Risk Behaviors , Cross-Sectional Studies , Surveys and Questionnaires
Enquadramento: Nas situações em que o doente tem manifestações de retenção urinária (RU), nem sempre o exame físico é conclusivo, recorrendo o enfermeiro, frequentemente, a cateterismo urinário, incorrendo o doente a riscos associados a esta intervenção, como a infeção do trato urinário. Objetivo: Validar o conteúdo de um protocolo de enfermagem de avaliação e diagnóstico de RU no adulto, com recurso à ultrassonografia vesical, para utilização pelos enfermeiros portugueses. Metodologia: Estudo metodológico, com a opinião de peritos através da técnica Delphi e do Modelo de Fehring adaptado ao contexto cultural. Resultados: Obteve-se a validação do protocolo na primeira ronda da técnica Delphi, com a participação de 42 peritos (IVC = 0,90). Na segunda ronda da técnica Delphi, com 26 peritos, objetivou-se aperfeiçoar o protocolo (IVC = 0,88). Conclusão: A validação do presente protocolo representa um incremento no conhecimento em enfermagem. Considera-se que o instrumento é um suporte teórico e prático, promotor da qualidade dos cuidados de enfermagem.
Background: In situations where the patient manifests urinary retention (UR), the physical examination is often inconclusive. Consequently, urinary catheterization is often the alternative procedure, leading to risks associated with this procedure for the patient, like urinary tract infection. Objective: To validate the content of a nursing protocol for the evaluation and diagnosis of UR in adults, with the support of the bladder scan, for use by Portuguese nurses. Methodology: Methodological study, with the opinion of experts through the Delphi technique and the Fehring Model, adapted to the cultural context. Results: Validation of the protocol was achieved in the first round of the Delphi technique, with the participation of 42 experts (CVI = 0.90). The second round of the Delphi technique, with 26 experts, aiming at improving the protocol, obtained a CVI = 0.88. Conclusion: The validation of this protocol represents an improvement in nursing knowledge. The instrument is considered a theoretical and practical means to support the promotion of nursing care quality.
Marco contextual: En situaciones en las que el paciente tiene episodios de retención urinaria (RU), el examen físico no siempre es concluyente. El enfermero utiliza a menudo el sondaje urinario, una intervención que conlleva riesgos asociados para el paciente, tales como infección del tracto urinario. Objetivo: Validar el contenido de un protocolo de enfermería de evaluación y diagnóstico de la RU en el adulto, para lo cual se recurrió a la ecografía vesical, con el fin de que lo utilicen los enfermeros portugueses. Metodología: Estudio metodológico, con la opinión de expertos a través de la técnica Delphi y del Modelo Fehring adaptado al contexto cultural. Resultados: La validación del protocolo se obtuvo en la primera ronda de la técnica Delphi, con la participación de 42 expertos (IVC = 0,90). La segunda ronda de la técnica Delphi, con 26 expertos, tuvo como objetivo perfeccionar el protocolo (IVC = 0,88). Conclusión: La validación del presente protocolo supone un aumento de los conocimientos de enfermería. Se considera que el instrumento es un apoyo teórico y práctico para promover la calidad de la atención de enfermería.
Nursing Diagnosis , Urinary Retention , Ultrasonography , Validation Study , Nursing Assessment
OBJECTIVE: Treatment limitation, as well as do-not-resuscitate (DNR) directives, are difficult but important to improve patients' quality of life and minimize dysthanasia. We aimed to study the approach to withholding, withdrawal, and DNR decisions, patients' characteristics, and process documentation in a general Intensive Care Unit (ICU) in Portugal. METHODS: A retrospective analysis of data regarding the limitation of treatment decisions collected from previously-designed forms and complemented by medical record consultation. RESULTS: A total of 1602 patients were admitted to the ICU between 2011 and 2016. DNR decisions were documented in 127 cases (7.9%). Patients with treatment limitations were older and had higher Simplified Acute Physiology Score II. The most frequent diagnosis preceding these decisions was sepsis (52.0%, n = 66); the most common main reason for limiting treatment was a poor prognosis of acute illness. Of the patients to whom a DNR was implemented, 117 (92.1%) died in the ICU (40.1% of the total number of ICU deaths), and hospital mortality was 100%. Participants in these decisions, as well as types of treatment withdrawn and their respective timings, were not registered in medical records. CONCLUSION: Treatment limitation and DNR decisions were relatively common, in line with other Southern European studies, but behind Northern European and North American centers. Patients with these limitations were older and more severely ill than patients without such decisions. Documentation of these processes should be clear and detailed, either in specific forms or computerized clinical records; there is room for improvement in this area.
Intensive Care Units/organization & administration , Medical Records , Resuscitation Orders , Withholding Treatment/standards , Aged , Aged, 80 and over , Decision Making , Female , Hospital Mortality , Humans , Length of Stay , Male , Middle Aged , Portugal , Quality of Life , Retrospective Studies , Sepsis/mortality
SUMMARY OBJECTIVE Treatment limitation, as well as do-not-resuscitate (DNR) directives, are difficult but important to improve patients' quality of life and minimize dysthanasia. We aimed to study the approach to withholding, withdrawal, and DNR decisions, patients' characteristics, and process documentation in a general Intensive Care Unit (ICU) in Portugal. METHODS A retrospective analysis of data regarding the limitation of treatment decisions collected from previously-designed forms and complemented by medical record consultation. RESULTS A total of 1602 patients were admitted to the ICU between 2011 and 2016. DNR decisions were documented in 127 cases (7.9%). Patients with treatment limitations were older and had higher Simplified Acute Physiology Score II. The most frequent diagnosis preceding these decisions was sepsis (52.0%, n = 66); the most common main reason for limiting treatment was a poor prognosis of acute illness. Of the patients to whom a DNR was implemented, 117 (92.1%) died in the ICU (40.1% of the total number of ICU deaths), and hospital mortality was 100%. Participants in these decisions, as well as types of treatment withdrawn and their respective timings, were not registered in medical records. CONCLUSION Treatment limitation and DNR decisions were relatively common, in line with other Southern European studies, but behind Northern European and North American centers. Patients with these limitations were older and more severely ill than patients without such decisions. Documentation of these processes should be clear and detailed, either in specific forms or computerized clinical records; there is room for improvement in this area.
RESUMO OBJETIVO Decisões de limitação terapêutica (DLT) e de não reanimação (DNR) são difíceis, mas importantes, visando melhorar a qualidade de vida dos doentes e minimizar distanásia. O objetivo deste estudo foi avaliar a abordagem das DNR e DLT, as características dos doentes e a documentação dessas decisões numa Unidade de Cuidados Intensivos Polivalente (Ucip) em Portugal. MÉTODOS Análise retrospectiva dos dados referentes a DLT e DNR, recolhidos a partir de formulários previamente elaborados e complementados por consulta de processo clínico. RESULTADOS Um total de 1.602 doentes foi internado na Ucip entre 2011 e 2016. DNR foi documentada em 127 casos (7,9%). Doentes com DLT eram mais velhos e tinham um Simplified Acute Physiology Score II mais elevado. O diagnóstico mais frequente que precedeu essas decisões foi sepse (52,0%, n=66); A razão mais comum para limitar o tratamento foi mau prognóstico da doença aguda. Dos doentes nos quais a DNR foi implementada, 117 (92,1%) morreram na Ucip (40,1% do total de óbitos na Ucip) e a mortalidade hospitalar foi de 100%. Os intervenientes nessas decisões, bem como os tipos de tratamento retirados, não foram rotineiramente registrados. CONCLUSÃO As DLT e DNR foram relativamente comuns, em consonância com outros estudos do sul da Europa, mas atrás dos centros do norte da Europa e da América do Norte. Os doentes com essas limitações eram mais velhos e mais gravemente doentes. A documentação dessas decisões deve ser clara e detalhada, seja em formulários específicos, seja em registros clínicos informatizados. Há espaço para melhorias nessa área.
Humans , Male , Female , Aged , Aged, 80 and over , Medical Records , Resuscitation Orders , Withholding Treatment/standards , Intensive Care Units/organization & administration , Portugal , Quality of Life , Retrospective Studies , Hospital Mortality , Sepsis/mortality , Decision Making , Length of Stay , Middle Aged
ABSTRACT Objective: Degenerative disc disease is a common problem that could require surgical treatment. The aim of this study was to compare clinical outcomes, complications and benefits associated with intersomatic fusions by the MI-TLIF, PLIF and PLF techniques. Methods: A total of 212 patients were retrospectively reviewed. All patients underwent the same pre- and postoperative clinical evaluations using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and SF-36. Follow-ups were performed for at least one year. Inpatient days, complications, blood loss and operative times were equally quantified. Results: Estimated blood loss for MI-TLIF was statistically lower compared to the amount of blood recovered by Cell Saver device on PLIF and PLF groups. Mean surgical time for MI-TLIF were not significantly different compared to PLIF and PLF groups. Inpatient days were significantly lower in the MI-TLIF group, with an average decrease of one day. Four complications were recorded in the PLIF group, 2 in the PLF group, and one in the MI-TLIF group. Analysis of the clinical parameters revealed post-operative improvements at all time points, with the most statistically significant differences occurring at the first six months. Better results were achieved with the MI-TLIF technique. Conclusions: Compared to more invasive techniques, MI-TLIF showed fewer complications, less blood loss and shorter hospitalization times. Longer operative times in this group can be explained by the greater technical complexity and incipient learning curves. Interbody fusion by PLIF, PLF and MI-TLIF provided good clinical outcomes, but faster recovery was obtained with less invasive techniques. Level of evidence: III; Type of study: Retrospective comparative case study.
RESUMO Objetivo: O objetivo deste estudo foi comparar resultados clínicos, complicações e benefícios associados às fusões intersomáticas pelas técnicas MI-TLIF, PLIF e PLF. Métodos: 212 doentes foram revistos retrospectivamente. Todos os doentes foram submetidos ao mesmo método de avaliação clínica pré e pós-operatória usando o índice de incapacidade Oswestry (ODI), o Score visual analógico para a dor (VAS) e a escala SF-36. Os follow-ups foram realizados durante o período de um ano. O tempo de internamento, complicações, perdas sanguíneas e tempos operatórios também foram contabilizados. Resultados: As perdas sanguíneas estimadas para o grupo MI-TLIF foram estatisticamente inferiores comparativamente com a quantidade de sangue recuperada pelo sistema "Cell Saver" nos grupos PLIF e PLF. O tempo médio de cirurgia para o MI-TLIF não apresentou diferenças estatísticas comparativamente aos grupos PLIF e PLF. O tempo de internamento foi significativamente inferior no grupo MI-TLIF, apresentando uma diminuição média de um dia. Quatro complicações foram registradas no grupo PLIF, duas no grupo PLF e uma no grupo MI-TLIF. A análise dos parâmetros clínicos revelou melhorias pós-operatórias em todos os grupos, com diferenças mais acentuadas nos primeiros seis meses. Conclusão: comparativamente com as técnicas mais invasivas, o MI-TLIF demonstrou uma menor taxa de complicações, menos perdas sanguíneas e menor tempo de internamento. Os tempos operatórios superiores neste grupo, podem ser explicados pela maior complexidade técnica e curvas de aprendizagem incipientes. Os doentes operados pelas técnicas PLIF, PLF e MI-TLIF apresentaram excelentes resultados clínicos, porém as técnicas menos invasivas, associam-se a uma recuperação mais rápida. Nível de evidencia: III. Tipo de estudo: Estudo comparativo retrospetivo.
RESUMEN Objetivo: La enfermedad degenerativa del disco es un problema común que puede requerir tratamiento quirúrgico. El objetivo de este estudio fue comparar resultados clínicos, complicaciones y beneficios asociados a las fusiones intersomáticas mediante las técnicas MI-TLIF, PLIF y PLF. Métodos: Un total de 212 pacientes fue evaluado retrospectivamente. Todos los pacientes fueron sometidos a las mismas evaluaciones clínicas pre y postoperatorias utilizando el Índice de Discapacidad de Oswestry (ODI), Escala visual analógica (EVA) y SF-36. Los seguimientos se realizaron durante al menos uno año. Los días de hospitalización, las complicaciones, la pérdida de sangre y los tiempos operatorios también se cuantificaron. Resultados: La pérdida de sangre estimada para MI-TLIF fue estadísticamente inferior en comparación con la cantidad de sangre recuperada por el dispositivo Cell Saver en los grupos PLIF y PLF. El tiempo quirúrgico promedio para MI-TLIF no fue significativamente diferente en comparación con los grupos PLIF y PLF. Los días de internación fueron significativamente inferiores en el grupo MI-TLIF, con una disminución promedio de uno día. Se registraron cuatro complicaciones en el grupo PLIF, dos en el grupo PLF y una en el grupo MI-TLIF. El análisis de los parámetros clínicos reveló mejorías postoperatorias en todos los puntos del tiempo, con las diferencias estadísticamente más significativas ocurriendo en los primeros seis meses. Se obtuvieron mejores resultados con la técnica MI-TLIF. Conclusiones: En comparación con las técnicas más invasivas, MI-TLIF mostró menos complicaciones, menos pérdida de sangre y tiempos de internación más cortos. Los tiempos operativos superiores en este grupo se pueden explicar por la mayor complejidad técnica y las curvas de aprendizaje incipientes. La fusión intersomática por PLIF, PLF y MI-TLIF proporcionó buenos resultados clínicos, pero se obtuvo una recuperación más rápida con técnicas menos invasivas. Nivel de evidencia: III. Tipo de Estudo: Estudio comparativo retrospectivo.
Humans , Minimally Invasive Surgical Procedures , Spinal Diseases , Spine/surgery , Blood Loss, Surgical
To evaluate the accumulation of trace elements (TE) by vegetables produced in the vicinity of abandoned pyrite mines, eighteen different small farms were selected near three mines from the Portuguese sector of the Iberian Pyrite Belt (São Domingos, Aljustrel and Lousal). Total and bioavailable As, Cu, Pb, and Zn concentrations were analyzed in the soils, and the same TE were analyzed in three different vegetables, lettuce (Lactuca sativa), coriander (Coriandrum sativum), and cabbage (Brassica oleracea), collected at the same locations. The soils were contaminated with As, Cu, Pb, and Zn, since their total concentrations exceeded the considered soil quality guideline values for plant production in the majority of the sampling sites. The maximum total concentrations for those TE were extremely high in some of the sampling sites (e.g. 1,851 mg As kg(-1) in São Domingos, 1,126 mg Cu kg(-1) in Aljustrel, 4,946 mg Pb kg(-1) in São Domingos, and 1,224 mg Zn kg(-1) in Aljustrel). However, the soils were mainly circumneutral, a factor that contributes to their low bioavailable fractions. As a result, generally, the plants contained levels of these elements characteristic of uncontaminated plants, and accumulation factors for all elements <1, typical of excluder plants. Furthermore, the estimated daily intake (EDI) for Cu and Zn, through the consumption of these vegetables, falls below the recommended upper limit for daily intake of these elements. The sampling site that stood out from the others was located at São João de Negrilhos (Aljustrel), where bioavailable Zn levels were higher, a consequence of the slight acidity of the soil. Therefore, the Zn content in vegetables was also higher, characteristic of contaminated plants, emphasizing the risk of Zn entering the human food chain via the consumption of crops produced on those soils.
Food Contamination/analysis , Soil Pollutants/analysis , Trace Elements/analysis , Vegetables/chemistry , Environmental Monitoring , Iron , Mining , Sulfides
