Adesão dos enfermeiros à prática segura na manipulação do cateter venoso periférico: Uma scoping review / Nurses adherence to safe practice in handling PVC: A scoping review

INTRODUÇÃO: As infeções associadas a cuidados de saúde contribuem para um aumento da morbilidade e mortalidade dos clientes. O Enfermeiro tem como função a identificação atempada de complicações. Uma dessas complicações é a infeção, que pode ser desencadeada por diversas intervenções, nomeadamente a introdução e manutenção do cateter venoso periférico (CVP), da qual o enfermeiro é responsável. Para assegurar a adesão dos enfermeiros às boas práticas no manuseamento do CVP, é essencial a existência de normas e a atualização profissional por via da formação. O estudo está integrado no projeto de investigação "Controlo das Infeções Associadas aos Cuidados de Saúde" do grupo NursID do CINTESIS. OBJETIVOS: Examinar e ampliar o conhecimento sobre as intervenções educacionais ou formativas promotoras da adesão dos enfermeiros à prática segura na manipulação do CVP. METODOLOGIA: Foi criado um protocolo de scoping review sustentado na metodologia de Joanna Briggs Institute que obedece aos critérios de elegibilidade com base na População (enfermeiros), Conceito (adesão à prática segura na manipulação do CVP) e Contexto (hospital). Foi construída a frase booleana de acordo com a base de pesquisa e descritores indexados. Posteriormente realizou-se a pesquisa nas bases de dados e literatura cinzenta, seguindo-se a seleção de artigos, realizada por dois investigadores independentes e por um terceiro, nas situações de falta de consenso. RESULTADOS: Após pesquisa obteve-se um total de 637 documentos, que após triagem de duplicados foram reduzidos para 440. Destes artigos, após análise de título e resumo e posterior leitura integral, obtiveram-se nove documentos. Os artigos selecionados apresentaram-nos, cada um, um programa constituído por intervenções promotoras de adesão a uma prática segura no manuseamento do CVP, resultando todos eles numa melhoria de práticas de enfermagem e/ou na redução de infeção relacionada com o dispositivo. As intervenções transversais a todos os estudos selecionados cingiam-se a quatro grandes grupos: Educação/ Formação; Treino; Feedback; Avaliação/ Auditorias. Sendo estas a base para um programa de sucesso na promoção da adesão. CONCLUSÃO: Com a presente scoping review foi possível evidenciar as principais intervenções promotoras de adesão à prática segura na manipulação do CVP, ou seja, foi possível alcançar o objetivo proposto. O que permite um contributo na ampliação do conhecimento sobre a temática e ainda uma possível melhoria da segurança nos cuidados ao CVP. No entanto, trata-se de um tema que carece de mais evidência, pois a atenção está mais direcionada para o CVC, negligenciando-se a infeção decorrente do CVP.

INTRODUCTION: Healthcare-associated infections contribute to an increase in client morbidity and mortality. It is the nurses' role to identify complications in a timely manner. Infection is one of these complications, and can be triggered by various interventions, namely the introduction and maintenance of the peripheric venous catheter (PVC), which is the nurse's responsibility. To ensure the nurses' adherence to good practices in handling the PVC, the existence of norms and professional training is essential. This study is integrated in the group "NurID: Inovation & Development in Nursing" ­ CINTESIS-FMUP. OBJECTIVES: Examining and amplifying the knowledge about educational or formative interventions that promote the nurse's adherence to safe practice in handling CVP. METHODOLOGY: A scoping review protocol sustained in the Joanna Briggs Institute methodology that obeys to eligibility criteria based on the population (nurses), concept (adherence to safe practice in handling the PVC) and context (hospital) was created. The Boolean phase was built according to the search base and indexed descriptors. Subsequently, the search was carried out in the databases and grey literature, followed by the selection of articles, carried out by two independent investigators and by a third, in situations with lack of consensus. RESULTS: After researching, a total of 637 documents were obtained, which after screening for duplicates was reduced to 440. Of these articles, after title and abstract analysis and subsequent integral reading, nine documents were obtained. Each of the selected articles presented a program consisting of interventions that promote safe practices in handling the PVC, all of which resulted in an improvement in nursing practices and/or the reduction of infection related to the device. Cross-cutting interventions for all the selected articles were limited to four large groups: Education/Training; Training; Feedback; Assessment/Audits. These are the base to a successful program that promotes the adherence. CONCLUSIONS: With this scoping review the main interventions promoting adherence to safe practice in handling the PVC were highlighted, which means the proposed objective was fulfilled. Enabling a contribution to the expansion of knowledge on the subject and a possible improvement in the safety in caring for the PVC. However, this topic needs further evidence, as attention is more focused on the CVC neglecting the infection resulting from the PVC.

Acute Parotitis: A Rare Complication of Fine Needle Aspiration in Warthin Tumour.

Salivary gland tumours are a group of neoplasms with considerable heterogeneity regarding their histology and biological behaviour. Warthin tumour (WT) is the second most common benign parotid tumour. Options for tissue diagnosis include fine needle aspiration (FNA) and ultrasound-guided core needle biopsy. Complications related to FNA are rare. We present the case of a 49-year-old man admitted with parotitis after FNA and discuss management and an alternative investigative approach when WT is strongly suspected. LEARNING POINTS: Warthin tumour (WT) can be clinically suspected based on location (parotid gland tail), cystic texture, patient sex (male) and age (fifth and sixth decades of life), after exclusion of features related to malignancy.Complications of fine-needle aspiration (FNA) for WT diagnosis are rare and most commonly include haemorrhage, facial nerve injury, cellulitis at the needle puncture site and, less frequently, parotitis.When diagnosing tumours strongly suspected of being WT, the clinician should avoid routine FNA and instead use combined imaging studies.

Proximal-type epithelioid sarcoma-unusual presentation: unilateral vulvar mass.

Epithelioid sarcoma of the vulva is a very rare malignant soft tissue tumour, usually initially asymptomatic, which simulates a variety of benign lesions, leading to diagnosis only at later stages. Prognosis is generally poor. We report a case of a 55-year-old postmenopausal woman, who presented with rapid growth of an asymptomatic mass located in the left labia majora. Biopsy of the lesion revealed features characteristic of proximal-type epithelioid sarcoma. Ganglionar, adrenal, pulmonary and hepatic metastases were found at thoracoabdominopelvic CT scan. During hospitalisation, the patient's clinical condition suffered rapid deterioration and she died on the 16th day of admission.

Fetal vulvar cysts with spontaneous resolution.

Congenital anomalies of the external genitalia occur in 2-3 per 100 infants. These anomalies might bring variable degrees of morbidity to the infant and often constitute diagnostic challenges for health professionals. We present a case report of a fetus with bilateral vulvar cysts diagnosed during the third trimester ultrasound. The cysts spontaneously regressed before birth and the newborn showed no genital anomalies at birth.

A comprehensive assessment of the transcriptome of cork oak (Quercus suber) through EST sequencing.

BACKGROUND: Cork oak (Quercus suber) is one of the rare trees with the ability to produce cork, a material widely used to make wine bottle stoppers, flooring and insulation materials, among many other uses. The molecular mechanisms of cork formation are still poorly understood, in great part due to the difficulty in studying a species with a long life-cycle and for which there is scarce molecular/genomic information. Cork oak forests are of great ecological importance and represent a major economic and social resource in Southern Europe and Northern Africa. However, global warming is threatening the cork oak forests by imposing thermal, hydric and many types of novel biotic stresses. Despite the economic and social value of the Q. suber species, few genomic resources have been developed, useful for biotechnological applications and improved forest management. RESULTS: We generated in excess of 7 million sequence reads, by pyrosequencing 21 normalized cDNA libraries derived from multiple Q. suber tissues and organs, developmental stages and physiological conditions. We deployed a stringent sequence processing and assembly pipeline that resulted in the identification of ~159,000 unigenes. These were annotated according to their similarity to known plant genes, to known Interpro domains, GO classes and E.C. numbers. The phylogenetic extent of this ESTs set was investigated, and we found that cork oak revealed a significant new gene space that is not covered by other model species or EST sequencing projects. The raw data, as well as the full annotated assembly, are now available to the community in a dedicated web portal at http://www.corkoakdb.org. CONCLUSIONS: This genomic resource represents the first trancriptome study in a cork producing species. It can be explored to develop new tools and approaches to understand stress responses and developmental processes in forest trees, as well as the molecular cascades underlying cork differentiation and disease response.

Blood pressure and heart rate variability complexity analysis in pregnant women with hypertension.

BACKGROUND: In this work, we perform a comparative analysis of blood pressure and heart rate variability complexity during pregnancy between normal, hypertensive, and preeclamptic women. METHODS AND RESULTS: A total of 563 short electrocardiographic (10 min) records were obtained from 217 pregnant women (135 normal, 55 hypertensive, and 27 preeclamptic) during several gestational ages in sitting position. We used a mixed unbalanced model for the longitudinal statistical analysis and besides the conventional spectral analysis, we applied Lempel-Ziv complexity, sample entropy, approximated entropy, and detrended fluctuation analysis in the complexity measurement. CONCLUSIONS: The obtained results revealed significant differences between pathological and normal states with important considerations related to pregnancy adaptability and evolution as well as the relationship of complexity and blood pressure with factors such as maternal age, familial history of diabetes or hypertension, and parity.

Relationship between heart rate variability indexes and common biochemical markers in normal and hypertensive third trimester pregnancy.

BACKGROUND: In this study, we explored the correlations between heart rate variability indexes and some biochemical markers during the third trimester of normal, hypertensive, and preeclamptic pregnancies. METHODS AND RESULTS: The obtained indexes are associated with complexity and spectral variables calculated from short electrocardiographic records. CONCLUSIONS: Including all the subjects in the analysis, we found that complexity indexes are positively related with hemoglobin concentration in the pathologic group and uric acid blood levels whereas low frequency (LF) was negatively correlated with uric acid and creatinine concentration as well as positively correlated with platelet levels. The LF was the only spectral region with significant correlation. Through an independent analysis of groups, only significant correlations were found in normal and preeclamptic groups between LF and uric acid concentration and in normal and hypertensive groups for LF and creatinine blood levels.

Evaluation of phosphinoamidoester-derived Pd catalysts in the asymmetric allylic alkylation reaction: theoretical studies and mechanistic insights.

Two simple hemilabile P,O-coordinating phosphinoamidoester ligands 6a and 6b were synthesized and studied in the Pd(0)-catalyzed asymmetric allylic alkylation of rac-1,3-diphenylpropenyl acetate affording a highest ee of 83% ee with 6a. To gain an insight into the actual mechanism of this catalytic reactions, which had previously been investigated with a first generation family of P,O-coordinating phosphinoamido-alcohol ligands-4a and 4b-a semiempirical computational study was carried out with the Pd-allyl complexes formed from both 4a and 6a including Hitchcock's phosphinoamido-alcohol ligand 5 (R(1)= H, R(2)= Ph). The results of this study substantiate a working model that has previously been proposed for this reaction using hemilabile P,O-coordinating phosphinoamido-type ligands.

Isomeric furanosesquiterpenes from the Portuguese marine sponge Fasciospongia sp.

This paper reports the chemical study of a sample of Fasciospongia sp. collected along the Atlantic Portuguese coast. Three new isomeric furanosesquiterpenes, isomicrocionin-3 ( 1), (-)-microcionin-1 ( 2), and (-)-isomicrocionin-1 ( 3), were isolated along with the known (-)- ent-pallescensin A ( 4) and (-)-pallescensin-1 ( 5) from the ethyl acetate-soluble portion of the methanolic extract. The structures of the new compounds were elucidated by extensive spectroscopic studies. (-)-Microcionin-1 ( 2) tested positive against several Gram-negative bacteria.

The opposing effects of the flavonoids isoquercitrin and sissotrin, isolated from Pterospartum tridentatum, on oral glucose tolerance in rats.

The effect of an aqueous extract of Pterospartum tridentatum on the blood glucose levels of normal Wistar rats was investigated in a situation of oral glucose challenge. The extract at 300 mg/kg showed an antihyperglycaemic effect in the first 30 min after glucose challenge but then the blood glucose levels rose above those of the control group, indicating the presence of compounds with different effects on glucose tolerance. Nine compounds of isoflavone and flavonol skeletons were identified in the extract by HPLC-ESI-MS(n), four of them being identified for the first time in this species. The isoflavone sissotrin and the flavonol derivative, isoquercitrin, were selected for the oral glucose tolerance test. Isoquercitrin (100 mg/kg) showed time-dependent antihyperglycaemic activity by delaying the post-oral glucose load glycaemic peak at 30 min, as did the sodium-dependent glucose transporter inhibitor phloridzin (100 mg/kg). In contrast, sissotrin (100 mg/kg) showed an opposite effect, impairing glucose tolerance. In conclusion, these preliminary results indicate that the effect of the extract on blood glucose may be either antihyperglycaemic or hyperglycaemic. Additionally, as far as is known, these are the first in vivo results on the acute antihyperglycaemic potential of isoquercitrin.

Direct identification and quantitative determination of costunolide and dehydrocostuslactone in the fixed oil of Laurus novocanariensis by 13C-NMR spectroscopy.

The fixed oil of Laurus novocanariensis (previously L. azorica) contains mostly glycerides together with minor non-saponifiable compounds. The direct identification and quantitative determination of costunolide and dehydrocostuslactone, two sesquiterpene lactones components of the oil that exhibit biological activities, is described. The analysis was carried out using 13C-NMR spectroscopy (signal acquisition with inverse gated decoupling of protons; diglyme as internal standard) without separation, derivatisation or any sample preparation.

Flavonoids of an extract of Pterospartum tridentatum showing endothelial protection against oxidative injury.

Pterospartum tridentatum is a Leguminosae that grows spontaneously in Portugal. The flowers are used in popular medicine for the treatment of throat irritation conditions and in herbal mixtures for diabetes. Diabetic vascular complications are due, among other reasons, to increased oxidative stress and for that reason antioxidants are believed to be beneficial for the diabetic patient. The flower water extract of this herbal drug showed dose-dependent protective effect of cultured human endothelial cells against oxidative injury induced by H2O2, at concentrations > or =0.3 mg/ml. This water extract, after liquid-liquid and chromatographic fractionation afforded one new isoflavone (5,5'-dihydroxy-3'-metoxi-isoflavone-7-O-beta-glucoside) and three other known isoflavones (prunetin, genistin and sissotrin). The structural characterisation of isolated compounds was achieved by UV, NMR and MS analysis. The flavonol glycoside isoquercitrin was also identified in the extract by HPLC analysis. Isoquercitrin is one of the active antioxidant principles of the extract since it showed dose-dependent protective effect against oxidative injury at concentrations > or =0.3 mM. Isoflavones were inactive at the same concentrations. The results suggest that the water extract of this herbal drug may prevent or reduce the development of diabetic vascular complications.