Cuidar da higiene pessoal: um autocuidado do domínio de atenção de enfermagem de reabilitação / Caring for personal hygiene: a self-care of the rehabilitation nursing care domain

Enquadramento: O AVC é uma das causas de maior mortalidade e morbilidade, resultando em incapacidades para as atividades de vida diária. A independência funcional é um dos fatores de maior relevo para o indivíduo; assim, o foco deste trabalho é o de compreender os ganhos em saúde nos doentes com o diagnóstico de enfermagem cuidar da higiene pessoal comprometido, após a intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação (EEER). A pergunta de partida, que constitui o fio condutor do presente projeto de investigação, é: "Que influência têm as intervenções do enfermeiro de reabilitação na independência funcional do doente com diagnóstico de enfermagem cuidar da higiene pessoal comprometido?". Objetivo: O presente estudo tem como objetivo geral identificar a influência dos cuidados de reabilitação na independência funcional do doente com o diagnóstico de enfermagem cuidar da higiene pessoal comprometido. Metodologia: O estudo insere-se no paradigma quantitativo de tipo descritivo - correlacional e longitudinal. A amostra (N=18) é não probabilística, do tipo acidental, e foi aplicada aos doentes acometidos com AVC e com diagnóstico de enfermagem cuidar da higiene pessoal comprometido que se encontravam internados na unidade de AVC num hospital da região norte de Portugal, e que foram alvo dos cuidados de enfermagem de reabilitação. Os dados foram recolhidos através do questionário sociodemográfico e clínico e do instrumento para a avaliação do nível de dependência funcional (Índice de Barthel). Resultados: Dos 18 doentes, constatou-se que, na admissão, 94.4% apresentavam dependência grave no autocuidado cuidar da higiene pessoal (score total). Na alta, 50.0% adquiriram estado de totalmente independência. Foram necessários 5 a 26 dias para a aquisição da independência. Conclusão: As intervenções do EEER nos doentes acometidos com AVC, com o diagnóstico de enfermagem de cuidar da higiene pessoal comprometido influenciam os ganhos em saúde, resultando numa diminuição da dependência funcional dos participantes, para o autocuidado cuidar da higiene pessoal.

Background: Stroke is one of the main causes of mortality and disability, in daily life activities. Functional independence is one of the most important factors for individuals; thus, the focus of this work is to understand health acquisitions in patients with the nursing diagnosis "compromised take care of personal hygiene", after the intervention of a rehabilitation nursing specialist. A question emerges, as a starting point which led to this research, is: "How influent is the role of rehabilitation nursing specialist in the functional independence in individuals with the nursing diagnosis "compromised take care of personal hygiene?". Goal: The general aim of this study is to identify the influence of rehabilitation care on the functional independence of patients with nursing diagnosis "compromised take care of personal hygiene". Methodology: This study is placed in a quantitative template, with descriptive study type ­ correlational and longitudinal. The sample (N=18) is non-probabilistic, of accidental tipology, and was performed using patients affected with stroke who had the nursing diagnosis "compromised take care of personal hygiene" admitted in the stroke unit in a hospital from the northern region of Portugal, who were having rehabilitation nursing health care. Data were collected using a sociodemographic and clinical questionnaire and also using a specific tool to assess the level of functional dependence (Barthel Index). Results: Of the 18 patients, it was found that, upon admission, 94.4% had severe self-care dependence on personal hygiene (total score). At the high, 50.0% acquired a state of complete independence. It took 5 to 26 days for the acquisition of independence. Conclusion: The intervention of Rehabilitation Nursing Specialist in patients who suffered stroke with the nursing diagnosis "compromised taking care of personal hygiene" brings improvements to their health, such as a decrease in functional dependence for the self-care "take care of personal hygiene".

High-trait anxious individuals show positive relationship between HRV and threat vigilance.

Selectively attending to threat-related stimuli in the environment, known as threat bias (TB), is a prominent feature of anxiety. Individuals with high anxiety also tend to show lower heart rate variability (HRV), a reflection of reduced parasympathetic cardiac control. Previous investigations have established associations between low HRV and various attentional processes that facilitate attention to threat, though these have primarily been conducted among non-anxious individuals. The current analysis, derived from a larger TB modification study, examined the relationship between TB and HRV among a young, nonclinical sample of individuals with either high or low trait anxiety (HTA, LTA, respectively; Mage  = 25.8, SD = 13.2, 61.3% female). Consistent with expectations, HTA (ß = -.18, p = .087) trended toward an association with higher threat vigilance. A significant moderation effect showed the relationship between HRV and threat vigilance was influenced by TA (ß = .42, p = .004). Simple slopes analysis revealed that for the LTA group, lower HRV trended toward higher threat vigilance (p = .123), consistent with expectations. However, this relationship was unexpectedly reversed for the HTA group, for whom higher HRV was a significant predictor of higher threat vigilance (p = .015). These results are interpreted within a cognitive control framework, in which regulatory ability, as assessed via HRV, may influence which cognitive strategy is employed when encountering threatening stimuli. Results suggest that HTA individuals with greater regulatory ability may employ a contrast avoidance mechanism, while those with reduced regulatory ability engage in cognitive avoidance.

The Dreamland: Validation of a Structured Dream Diary.

Validated instruments for the analysis of dream contents are still scarce. Therefore, the aim of this study was to validate the Dreamland Questionnaire (DL-Q) by comparing its results to those of the Hall and van de Castle Coding System (HVDC). Twenty-two participants voluntarily filled in a written dream report as well as our DL-Q questionnaire, in total 30 dreams were collected with both measures. Written reports were analyzed with the HVDC and results of the two instruments were compared using Pearson correlations. Results showed that correlations were high for dominant characters, pleasantness of dream content, and body-related experiences. However, some DL-Q items showed low correlations and others could not be compared directly, as the HVDC did not include the same set of items. The DL-Q showed satisfactory validity and reliability as a measure of dream criteria and may serve as an effective tool for diagnosis and evaluation and facilitate future clinical and research studies. Nevertheless, some items could not be compared as part of this study and should be validated in future investigations.

Monitorización terapéutica de la digoxinemia en pacientes con insuficiencia cardiaca: comparación entre dos métodos analíticos / Therapeutic drug monitoring of digoxin in cardiac heart failure outpatients: comparisons of two analytical methods

OBJETIVO: Comparar las dos técnicas analíticas más utilizadas en la determinación de la digoxinemia y verificar cuál de ellas atiende mejor las necesidades de la rutina de seguimiento clínico de los pacientes con insuficiencia cardíaca. MÉTODOS: En este trabajo fue investigado el perfil clínico y de laboratorio de 15 pacientes con insuficiencia cardiaca los cuales fueron atendidos en el Ambulatorio para pacientes con Insuficiencia Cardiaca del Hospital das Clínicas de la Universidad Federal de Goiás, Brasil. Las muestras de sangre de los pacientes fueron recogidas y analizadas por Inmunoensayo y Cromatografía Líquida de Alta Eficiencia acoplada a Espectrometría de Masas (LC-MS/MS). RESULTADOS: Los resultados del test "t" de Student (p = 0,05) mostraron que hubo diferencia significativa entre los dos métodos analíticos. Las concentraciones determinadas por inmunoensayo fueron mayores que las concentraciones determinadas por LC-MS/MS, ya que ese método analiza la digoxina y también sus metabolitos y substancias endógenas, mientras que el LC-MS/MS analiza solamente la molécula de digoxina. Por otro lado, ninguno de los pacientes, presentó datos clínicos relevantes sugestivos de intoxicación digitálica, a pesar de que varios fármacos con potencial de interacción estuvieron asociados al tratamiento. CONCLUSIONES: A partir de los resultados obtenidos puede concluirse que el método por LC-MS/MS se mostró más selectivo y específico, siendo una opción para la monitorización terapéutica de la digoxina, desde que se obtengan valores de referencia para la digoxinemia por LC-MS/MS

OBJECTIVE: To compare two analytical techniques used in the determination of plasma digoxin (LC-MS/MS and immunoassay) and to verify which one better answer the need of the clinical monitoring routine of patients with cardiac heart failure. METHOD: The clinical findings in 15 cardiac heart failure (CHF) out patients of the Cardiac Heart Service of the Goias Federal University Clinical Hospital were investigated. Blood samples of the patients were collected and analysed by Immunoassay and by Liquid Chromatography coupled to Mass Spectrometry (LC-MS/MS). RESULTS: The results of the statistic test (Studentp = 0,05) showed a significant difference between the analytical methods: immunoassay concentrations were higher than the concentrations determined by LC-MS/MS. The explanation may be because immunoassay methodmeasures digoxin plus other metabolites and endogenous substances,while the LC-MS/MS method measures only the digoxin molecule. None of the patients, showed relevant clinical data suggestive of digi-talis intoxication, even several drugs with potential interaction wereassociated with treatment. CONCLUSION: It was concluded, therefore, that LC-MS/MS me thod issafer, more selective and specific than immunoassay, being an option for therapeutic drug monitoring of digoxin, since the reference values would be obtain for digoxinemia by LC-MS/MS

Rosuvastatin slows the development of diastolic dysfunction in calcific aortic stenosis.

BACKGROUND AND AIM OF THE STUDY: The study aims were to test the effect of rosuvastatin on the progression of left ventricular (LV) diastolic function in patients with aortic stenosis (AS), and to evaluate the use of beta-natriuretic-peptide (BNP) as a marker of diastolic dysfunction in this condition. METHODS: Sixty-one hypercholesterolemic, consecutive new referrals with moderate AS were administered rosuvastatin (Crestor) 20 mg/day for 18 months, while a further 60 subjects with normal cholesterol levels remained untreated. The LV diastolic function was determined using conventional Doppler echocardiography, tissue Doppler imaging (TDI); BNP plasma levels were monitored when subjects entered the study and then assessed prospectively at six-month intervals until the study end. RESULTS: After an 18-month (mean 73 +/- 24 weeks) period of treatment with rosuvastatin (Tx group), patients showed a significantly better diastolic function than untreated subjects (uTx group), as indicated by an isovolumic relaxation time (IVRT) (Tx 102.0 +/- 42.8 versus 97.2 +/- 19.1; p < 0.001; uTx 99.7 +/- 21.7 versus 95.2 +/- 21.8 ms; p = 0.032), E/A ratio (Tx 1.0 +/- 0.6 versus 0.9 +/- 0.3, p = 0.52; uTx 1.2 +/- 0.40 versus 0.9 +/- 0.30 versus, p = 0.006), and E/E' ratio (Tx 11.4 +/- 1.5 versus 11.4 +/- 1.8, p = 0.19; uTx 15.4 +/- 1.2 versus 12.3 +/- 1.5, p < 0.001). Similarly, at study end, plasma levels of BNP were significantly lower in the Tx group than in the uTx group [median (1st-3rd quartiles): 37.0 pg/ml (20.1-65.2 pg/ml) versus 57.1 pg/ml (46.9-98.2 pg/ml); p = 0.017]. CONCLUSION: The results of this prospective follow up study of asymptomatic patients showed that rosuvastatin treatment delays the progression of diastolic dysfunction in moderate AS when assessed using hemodynamic echocardiographic parameters or by the release of plasma physiological markers. Hence, the benefits of statin treatment in AS, which are known to affect the valve endothelium, also extend to changes affecting myocardial function itself.

Relationship of PON1 192 and 55 gene polymorphisms to calcific valvular aortic stenosis.

INTRODUCTION AND OBJECTIVES: Paraoxonases may exert anti-atherogenic action by reducing lipid peroxidation. Previous studies examined associations between polymorphisms in the paraoxonase 1 (PON1) gene and development of coronary artery disease (CAD), with inconsistent results. Given the similarities in clinical and pathophysiological risk factors of CAD and calcific aortic valve stenosis (CAVS), we postulated a link between PON1 alleles and CAVS progression. METHODS: We investigated the association between PON1 55 and 192 single nucleotide polymorphisms (SNPs), their enzyme activity, and CAVS progression assessed by aortic valve area and transvalvular peak velocity in 67 consecutive patients with moderate CAVS and 251 healthy controls. RESULTS: PON1 paraoxonase activity was higher in CAVS patients (P<0.001). The PON1 genotype Q192R SNP (P=0.03) and variant allele (R192) (P=0.01) frequencies differed between CAVS patients and controls. Significant association existed between PON1 enzyme activity, phenotypic effects of PON1 192 genotype polymorphisms, and CAVS progression, but not between PON1 55 and high-density lipoprotein (P=0.44) or low-density lipoprotein cholesterol (P=0.12), between 192 genotype and high-density lipoprotein (P=0.24) or low-density lipoprotein cholesterol (P=0.52). CONCLUSION: The PON1 genotype Q192R SNP has an important effect on CAVS disease progression. This study helps outline a genotype-phenotype relationship for PON1 in this unique population.

Analysis of variability and reproducibility of echocardiography measurements in valvular aortic valve stenosis.

BACKGROUND: Doppler echocardiography is the most frequent method for detecting and evaluating the severity of valvular aortic stenosis. The aim of this study was to assess the variability and reproducibility of echocardiographic parameters including aortic valve area (AVA), peak aortic jet velocity (V(max)), velocity ratio (V(LVOT)/V(max)), peak gradient (G(max)) and mean gradient (G(mean)) in aortic stenosis (AS) patients. METHODS: Doppler echocardiograms were obtained from 150 randomly selected patients (56.7% male; mean age 73 +/- 9 years) with asymptomatic moderate aortic valve stenosis. The echocardiographic measurements were performed by two independent level III (expert) blinded observers. To assess intra-observer variability, we evaluated parameters of AS progression at two different times (mean of two weeks after the first examination). RESULTS: For intra-observer variability (observer 1), the variation and reproducibility coefficients were, respectively, 1.88% and 0.16 m/s for V(max), 2.08% and 0.14 for V(LVOT)/V(max) 2.05% and 0.18 cm2 for AVA, 3.89% and 5.18 mmHg for G(max) and 7.87% and 6.30 mmHg for G(mean). For inter-observer variability, the variation and reproducibility coefficients were, respectively, 2.00% and 0.14 m/s for V(max), 2.91% and 0.14 for V(LVOT)/V(max), 7.67% and 0.16 cm2 for AVA, 8.53% and 7.06 mmHg for G(mean) and 3.90% and 5.58 mmHg for G(max). Both intra- and inter-observer studies showed excellent intraclass correlation coefficients (ICC) for all echocardiographic parameters (ICC ranged from 0.943 to 0.990 for intra-observer variability and from 0.955 to 0.992 for interobserver variability). CONCLUSION: Doppler echocardiographic measurements of AVA, V(max), G(max) and G(mean) are highly reproducible when performed by expert observers. Of all echocardiographic parameters, V(max) and V(LVOT)/V(max) showed the best variability and reproducibility, and thus constitute reliable tools for clinical and research purposes in aortic stenosis diagnosis and follow-up.

Acute toxicity of Brosimum gaudichaudii Trécul. root extract in mice: determination of both approximate and median lethal doses / Toxicidade aguda de extrato de raízes de Brosimum gaudichaudii Trécul. em camundongos: determinação da dose letal aproximada e da dose letal mediana

The Brosimum gaudichaudii Trécul. (BG) Moraceae, with a high frequency inregions of the Brazilian cerrado (shrubland) and popularly known as “mamacadela”, holds photosensitizing furocoumarins. The BG’s main therapeutic use is the treatment of vitiligo, a skin depigmentation disease that takes hold of approximately 1-2 % of the world population. There is one product on the marketplace (Viticromin®), for which there is no scientifi c research availableabout its experimental toxicity, in spite of its proven clinical effi cacy. Therefore, the development of acute pre-clinical toxicity trials has been proposed (approximate lethal dose, ALD, and median lethal dose, LD50) of the BG root exsudate in laboratory animals. Male, albino mice weighing between 25 and 30 g, in good sanitation conditions have been used. The mice received water and food ad libitum. The BG powder was mixed in 0.9% saline solution and 0.5% cremophor and was administered po and ip. The LD50 was obtained through the Lichtfi eld and Wilcoxon (1949) method. A public domain software was used for the calculations. Ten mice/dose were used - 6 groups for each administration via, including the control group - and the number of deaths within up to 14 days was considered; the control group received an emulsion made up by 0.9 saline solution and 0.5% cremophor. Before establishing the LD50 and aiming at reducing the number of animals used, the DLA was determined when 1 animal per dose was used (the next dose always 50% higher than the previous dose), until identifying the dose that led to the death of 1 animal. Thus, the DLA po was 3750 mg/kg and the DLA ip, 2920 mg/kg. The LD50 po was 3517.54 mg/ kg and the LD50 ip was 2871.76 mg/kg. The product was considered as of being of low toxicity, taking into account only the single dose acute toxicity.

O Brosimum gaudichaudii Trécul. (BG) família Moraceae, é largamente distribuído nas regiões de cerrado doBrasil e é popularmente conhecido como “mamacadela” e possui, na sua composição química, furocumarinas fotossensibilizantes. O principal uso terapêutico do BG é no tratamento do vitiligo, uma doença despigmentante da pele com prevalência de aproximadamente 1-2% da populaçãomundial. Há um produto no mercado (Viticromin®), que é comercializado com tal fi nalidade, havendo poucos dados disponíveis acerca da toxicidade experimental, ao lado de eficácia clínicacomprovada. Portanto, o desenvolvimento de estudos de toxicidade pré-clínica foi proposto (dose letal aproximada, DLA e dose letal mediana, DL50) para o exsudato da raiz de BG em animais de laboratório. Foram utilizados camundongos machos, albinos, pesando entre 25 e 30 g, em boas condições sanitárias, recebendo água e ração ad libitum. O pó de BG foi suspenso em solução salina 0,9% com 0,5% de cremofor e administrado p.o. (gavage) e intraperitonealmente. A DL50 foi obtida através do método de regressão linear de Lichtfi eld & Wilcoxon (1949), utilizando um software de domínio público. Foram formados 6 grupos de 10 animais para cada via de administração, incluindo grupo controle, e o número de mortes foi observado durante 14 dias; o grupo controle recebeu uma emulsão de solução salina 0,9% com 0,5% de cremofor. Antes de estabelecer a DL50 e visando reduzir o número de animais utilizados, determinou-se a DLA,utilizando 1 animal por dose (a próxima dose 50% maior do que a dose anterior), até identifi car a dose letal para 1 animal. Assim, a DLA p.o. foi de 3750 mg/kg e a DLA i.p., 2920 mg/kg. A DL50 p.o. foi de 3517,54 mg/kg e a DL50 i.p. foi 2871,76 mg/kg. O produto foi considerado possuir baixa toxicidade, considerando apenas uma dose neste ensaio de toxicidade aguda.

New cardiovascular biomarkers: clinical implications in patients with valvular heart disease.

Valvular heart disease (VHD) is characterized by an ongoing, inflammatory cellular response which results in a left ventricular hemodynamic stress change in response to valvulopathy. The current inflammatory hypothesis suggests that as the heart valve disease progresses the inflammatory cytokine response is activated causing continuation of deleterious effects on the heart and vasculature. This can lead to progression of heart failure and left ventricular dysfunction. Over the last 10 years, a number of biologically active molecules, termed biomarkers, have been discovered in VHD. These can be used to detect the progression and pathogenesis of heart failure and to assess the severity of inflammation (e.g., C-reactive protein). Brain natriuretic peptide (BNP) can diagnose underlying cardiac systolic and diastolic dysfunction. In high-risk patients BNP is also considered to be a useful tool for assisting in the diagnosis and monitoring the progression of VHD. Patients with symptomatic VHD benefit from aortic valve surgery; however, management in the absence of symptoms remains challenging. While the lack of symptoms can delay aortic valve replacement, unselected premature aortic valve replacement may be associated with unbalanced risks of cardiac surgery. This review summarizes the current and emerging clinical and potential research application of specific biomarkers of VHD.

Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis.

OBJECTIVES: The objective of this study was to test the effect of a 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitor on the progression of moderate to severe aortic stenosis as measured by echocardiography. BACKGROUND: Recent retrospective studies support the hypothesis that statins slow the progression of aortic stenosis. METHODS: We performed an open-label, prospective study evaluating 121 consecutive patients with asymptomatic moderate to severe aortic stenosis (aortic valve area > or = 1.0 cm2; mean age 73.7 +/- 8.9 years; 57 men and 64 women), treated with and without rosuvastatin according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. Echocardiographic, serum lipid, and inflammatory markers were measured at baseline and every 6 months for 18 months. RESULTS: Sixty-one patients (50.4%) with elevated LDL (159.7 +/- 33.4 mg/dl), aortic valve velocity (3.65 +/- 0.64 m/s), and aortic valve area (1.23 +/- 0.42 cm2) received rosuvastatin (20 mg/day), and 60 (49.6%) with a normal LDL (118.6 +/- 37.4 mg/dl), aortic valve velocity (3.62 +/- 0.61 m/s), and aortic valve area (1.20 +/- 0.35 cm2) received no statin. During a mean follow-up of 73 +/- 24 weeks, the change in aortic valve area in the control group was -0.10 +/- 0.09 cm2/year versus -0.05 +/- 0.12 cm2/year in the rosuvastatin group (p = 0.041). The increase in aortic valve velocity was 0.24 +/- 0.30 m/s/year in the control group and 0.04 +/- 0.38 m/s/year in the rosuvastatin group (p = 0.007). There was significant improvement in serum lipid and echocardiographic measures of aortic stenosis in the statin group. CONCLUSIONS: Prospective treatment of aortic stenosis with rosuvastatin by targeting serum LDL slowed the hemodynamic progression of aortic stenosis. This is the first prospective study that shows a positive effect of statin therapy for this disease process. (Rosuvastatin Affecting Aortic Valve Endothelium; http://www.clinicaltrials.gov/ct/show/NCT00114491?order = 1; NCT0014491).