Impactos de incidentes de segurança do paciente na enfermagem: um olhar para a segunda vítima / Impacts of patient safety incidentes on nursing: a look at the second victim Impactos de incidentes de seguridad del paciente en enfermería: una mirada hacia la segunda víctima / Impacts of patient safety incidentes on nursing: a look at the second victim Impactos de incidentes de seguridad del paciente en enfermería: una mirada hacia la segunda víctima

Objetivo: compreender os impactos para os profissionais de enfermagem como segunda vítima de incidentes de segurança do paciente. Método: estudo qualitativo aprovado pelo comitê de ética em pesquisa, do tipo exploratório-descritivo, realizado com 20 profissionais de enfermagem em hospital universitário do Sul do Brasil, entre novembro de 2021 e janeiro de 2022, por meio de entrevistas semiestruturadas analisadas a partir da análise textual discursiva. Resultados: as categorias sentimentos das segundas vítimas, demonstrando a presença de sentimentos negativos, sendo o medo o mais recorrente; e, impacto na trajetória profissional e no ambiente de trabalho, questionando sua habilidade como um bom profissional e a escolha da profissão como sendo adequada permitiram compreender o impacto no profissional de enfermagem. Considerações finais: os impactos relacionaram-se ao sentimento de culpa pelo fato ocorrido, autojulgamento, julgamento pelos pares e pelo paciente, medo do desfecho ao paciente e das consequências para si e dúvidas quanto à sua habilidade e desempenho no trabalho.

Objective: to understand the impacts on nursing professionals as the second victim of patient safety incidents. Method: qualitative exploratory-descriptive study approved by the research ethics committee, carried out with 20 nursing professionals at a university hospital in southern Brazil, between November 2021 and January 2022, through semi-structured interviews analyzed from the discursive textual analysis. Results: the second victims' feelings categories, demonstrating the presence of negative feelings, with fear being the most recurrent; and impact on the professional path and on the work environment, questioning their ability as a good professional and the choice of profession as being adequate, allowed understanding the impact on the nursing professional. Final considerations: the impacts were related to the feeling of guilt for the fact that occurred, self-judgment, judgment by peers and by the patient, fear of the outcome for the patient and the consequences for himself, and doubts about his ability and performance at work.

Objetivo: comprender los impactos sobre los profesionales de enfermería como segunda víctima de los incidentes de seguridad del paciente. Método: estudio cualitativo, de tipo exploratorio-descriptivo, aprobado por el comité de ética en investigación, y realizado junto a 20 profesionales de enfermería de un hospital universitario del sur de Brasil, entre noviembre de 2021 y enero de 2022, a través de entrevistas semiestructuradas analizadas a partir del análisis textual discursivo. Resultados: las categorías de sentimientos de las segundas víctimas han permitido comprender el impacto sobre el profesional de enfermería: indican la presencia de sentimientos negativos, el miedo siendo el más recurrente; el impacto en la trayectoria profesional y en el ambiente de trabajo, ya que los enfermeros cuestionan su habilidad de buen profesional y si ha sido adecuada la elección de la profesión. Consideraciones finales: los impactos se relacionaron con el sentimiento de culpa por el hecho ocurrido, el juicio propio, el juicio de los pares y del paciente, el miedo al desenlace para el paciente y las consecuencias para él mismo, y las dudas sobre su capacidad y desempeño en el trabajo.

The striatum drives the ergogenic effects of caffeine.

Caffeine is one of the main ergogenic resources used in exercise and sports. Previously, we reported the ergogenic mechanism of caffeine through neuronal A2AR antagonism in the central nervous system [1]. We now demonstrate that the striatum rules the ergogenic effects of caffeine through neuroplasticity changes. Thirty-four Swiss (8-10 weeks, 47 ± 1.5 g) and twenty-four C57BL/6J (8-10 weeks, 23.9 ± 0.4 g) adult male mice were studied behaviorly and electrophysiologically using caffeine and energy metabolism was studied in SH-SY5Y cells. Systemic (15 mg/kg, i.p.) or striatal (bilateral, 15 µg) caffeine was psychostimulant in the open field (p < 0.05) and increased grip efficiency (p < 0.05). Caffeine also shifted long-term depression (LTD) to potentiation (LTP) in striatal slices and increased the mitochondrial mass (p < 0.05) and membrane potential (p < 0.05) in SH-SY5Y dopaminergic cells. Our results demonstrate the role of the striatum in the ergogenic effects of caffeine, with changes in neuroplasticity and mitochondrial metabolism.

Pediatric Liver Transplantation: Caregivers' Quality of Life.

Purpose: The survival rate of pediatric patients undergoing liver transplantation has increased considerably. Despite this, the period after transplantation is still complex and poses several challenges to the recipient's family, which is responsible for care management. Recently, more attention has been paid to the impact of this complex procedure on the quality of life of caregivers. Hence, this study is aimed at assessing the quality of life of caregivers of patients who have undergone liver transplantation and the aspects that influence it. Methods: This was an observational and cross-sectional study. From November 2020 to January 2021, short-form-36 questionnaires and additional questions were given to the main caregivers of children and adolescents who underwent pediatric liver transplantation. Results: Thirty-eight questionnaires were completed and the results revealed a lower quality of life in comparison to Brazilian standards, primarily in the mental domains (41.8±14.1 vs. 51.1±2.8; p<0.001). It did not show a significant association with socioeconomic or transplant-related factors, but it did show a negative impact on parents' perception of the child's health. Parents who reported worse health status for their children had a lower mental quality of life (44.1±13.8 vs. 33.3±12.6; p<0.05). Conclusion: The caregivers of transplanted children have a lower quality of life than those of the local population. Psychological assistance should be routinely provided to parents for long-term follow-up to mitigate potential negative effects on the transplanted child's care.

Conhecimento de profissionais da saúde sobre segurança do paciente: revisão integrativa / Health professionals' knowledge about patient safety: an integrative review

Objetivo: Analisar na literatura o conhecimento dos profissionais da saúde sobre segurança do paciente. Métodos: Revisão integrativa com busca e seleção em cinco bases eletrônicas de dados: MEDLINE, CINAHL, Web of Science, LILACS e BDENF, utilizando descritores controlados e não controlados indexados nos vocabulários DeCS e MESH. Foram incluídos estudos primários, sem delimitação temporal ou de idioma e excluídos os duplicados, editoriais, teses e dissertações. Para análise e síntese, utilizou-se a classificação do nível de evidência baseadas nas recomendações do Oxford Centre for Evidence-based Medicine e os métodos descritivos.Resultados: Foram selecionados 11 artigos desenvolvidos em contexto nacional e internacional, de nível de evidência2C. O nível de conhecimentos gerais sobre segurança do paciente entre os profissionais de saúde foi considerado baixo, envolvendo limitações significativas no entendimento dos conceitos e definições, assim como na aplicação dos pressupostos teóricos na prática assistencial. Nas categorias investigadas,observou-se variação desse nível de conhecimento. Conclusão: Existem lacunas importantes no conhecimento de profissionais de saúde sobre segurança do paciente, que apresentam nível baixo de conhecimento. Destaca-se então,a educação permanente como uma estratégia para promover melhorias. Descritores: Segurança do paciente. Pessoal de saúde. Conhecimento. Enfermagem. Educação continuada.

Objective: To analyze, in the literature, health professionals' knowledge about patientsafety.Methods: An integrative review with searches and selection in five electronic databases: MEDLINE, CINAHL, Web of Science, LILACS and BDENF, using controlled and non-controlled descriptors indexed in the DeCS and MESH vocabularies. Primary studies with no time or language restrictions were included, with exclusion of duplicates, editorials, theses and dissertations. For analysis and synthesis purposes, the level of evidenceclassification based on the Oxford Centre for Evidence-based Medicinerecommendations and the descriptive methods was used. Results: Eleven articles with level of evidence2C and developed in the national and international contexts were selected. The level of general knowledge about patient safety among health professionals was considered low, involving significant limitations in the understanding of concepts and definitions, as well as in the application of theoretical assumptions in the care practice. Inthe categories investigated, certain variation of this knowledge level was observed. Conclusion: There are important gaps in health professionals' knowledge about patient safety, with the subjects presenting low knowledge levels. Therefore, permanent education stands out as a strategy to promote improvements. Descriptors: Patient Safety. Health Personnel. Knowledge. Nursing. Education Continuing

Support provided to nursing students in the face of patient safety incidents: a qualitative study.

OBJECTIVES: to identify the support provided to nursing students after a patient safety incident. METHODS: qualitative study developed with 23 students attending an undergraduate nursing program in southern Brazil. Data were collected between September and November 2021 and submitted to textual discursive analysis using the Iramuteq software. RESULTS: the students reported that mainly classmates and professors of the practical courses provided support. The students showed no knowledge of organizational support or protocols available to students who become second victims of such incidents. FINAL CONSIDERATIONS: the primary support sources available to nursing students involved in patient safety incidents were identified. Note that support provided to nursing students is still incipient both in Brazil and internationally. Hence, further studies are needed to address potential victims and support resources to mitigate this phenomenon.

Patient Safety Incidents and the second victim phenomenon among nursing students.

OBJECTIVE: To map the factors involved in incidents that harm patient safety and contribute to the second victim phenomenon among nursing students. METHOD: Qualitative, exploratory-descriptive study addressing 23 nursing students attending a Federal University in the South of Brazil. The interviews were analyzed using text and discoursive analysis. The Iramuteq software supported the processing of texts. RESULTS: Communication failures within the health staff, a lack of protocols and equipment that prioritize patient safety, and factors related to the teaching-learning process favor the occurrence of patient safety incidents and the second victim phenomenon among nursing students. CONCLUSION: Addressing the topic concerning patient safety in nursing programs can promote the patient safety culture by encouraging reporting and admitting the possibility of errors and learning from them, strategies that can mitigate second victim effects.

Instrumentos de medida para avaliação do conhecimento de estudantes de Enfermagem sobre segurança do paciente / Measurement instruments to evaluate Nursing students' knowledge about patient safety / Instrumentos de medición para evaluar los conocimientos de los estudiantes de Enfermería sobre la seguridad del paciente

Objetivo: Analisar as evidências científicas relacionadas aos instrumentos utilizados para avaliar o conhecimento de estudantes de enfermagem sobre Segurança do Paciente. Métodos: Revisão integrativa realizada nas bases de dados MEDLINE, CINAHL, WOS, LILACS e BDENF. A amostra foi composta por 11 estudos primários, publicados entre os anos de 2008 a 2017, nos idiomas português, espanhol ou inglês e que responderam à questão de pesquisa. Resultados: Houve predomínio de estudos transversais, no idioma inglês. O instrumento mais utilizado para avaliação do conhecimento em segurança do paciente foi o Health Professional Education in Patient Safety Survey (H-PEPSS). Dentre os fatores que limitaram o processo de aprendizagem destacou-se a inexperiência dos alunos. Simulações clínicas e aproximação precoce com o tema representaram as intervenções que favorecem o desenvolvimento do conhecimento e de competências. Conclusão: A avaliação do conhecimento em segurança do paciente pode auxiliar no desenvolvimento de programas e ensino, bem como refletir diretamente na qualidade da assistência, surgindo, assim, a necessidade da criação, adaptação e validação de instrumentos de medida. (AU)

Objective: To analyze the scientific evidence related to the instruments used to evaluate nursing students' knowledge about patient safety. Methods: Integrative review performed in the electronic databases MEDLINE, CINAHL, WOS, LILACS and BDENF. The sample consisted of 11 primary studies, published between the years 2008 and 2017, in Portuguese, Spanish or English, and which answered the research question. Results: There studies were predominant cross-sectional, and in English. The synthesis of knowledge was divided into three categories: The use of measurement instruments to assess knowledge in patient safety; Interventions that contribute to learning about patient safety; Factors that limit learning about patient safety. Conclusion: The assessment of patient safety knowledge can assist in the development of programs and teaching, as well as directly reflect on the quality of care, thus arising the need for the creation, adaptation and validation of instruments measure. (AU)

Objetivo: Analizar las evidencias científicas relacionadas con los instrumentos utilizados para evaluar el conocimiento de estudiantes de enfermería sobre seguridad del paciente. Métodos: Revisión integrativa realizada en las bases electrónicas de datos MEDLINE, CINAHL, WOS, LILACS y BDENF. La muestra consistió en 11 estudios primarios publicados entre los años 2008 a 2017, en portugués, español o Inglés y que respondieron a la pregunta de investigación. Resultados: Hubo predominios de estudios transversales, en el idioma inglés. La síntesis del conocimiento se dividió en tres categorías: el uso de instrumentos de medida para la evaluación del conocimiento en seguridad del paciente; Intervenciones que contribuyen al aprendizaje sobre Seguridad del paciente; Factores que limitan el aprendizaje sobre seguridad del paciente. Conclusión: La evaluación de los conocimientos sobre seguridad del paciente puede ayudar en el desarrollo de programas y docencia, así como reflejar directamente la calidad de la atención, surgiendo así la necesidad de la creación, adaptación y validación de instrumentos la medida. (AU)

Adverse events of metronidazole and amoxicillin: Retrospective analysis of a large data set of five randomized clinical trials.

AIM: To evaluate the frequency of side effects associated with intake of metronidazole (MTZ) + amoxicillin (AMX) in periodontal treatment, and to explore associations between these events and patients' features. MATERIALS AND METHODS: Data of five randomized clinical trials testing MTZ + AMX adjunctive to mechanical therapy were evaluated. Volunteers answered an adverse event questionnaire. RESULTS: Information from 656 subjects was assessed. The frequency of side effects in the antibiotic- and placebo-treated groups ranged from 1.0% to 17.7% and 0.9% to 13.7%, respectively. The events more frequently observed in the antibiotic than in the placebo group were diarrhoea and metallic taste (p < .05). Diabetes significantly raised the odds of a patient reporting discomfort (odds ratio [OR] = 2.6), diarrhoea (OR = 4.0), weakness (OR = 6.0) and excessive sleepiness (OR = 2.9). In systemically healthy volunteers, using antibiotics 3 months post-mechanical treatment (healing phase) (OR = 3.0), being a woman (OR = 3.9) and aged ≤49 (OR = 4.5) significantly increased the chances of reporting adverse events. CONCLUSIONS: The occurrence of side effects during MTZ + AMX treatment ranged from uncommon (1%) to very common (17.7%). The main factors raising the chances of a patient reporting adverse events were diabetes and taking antibiotics in the healing phase, instead of in the active phase of treatment. Patients ≤ 49 years old and females also tend to report more side effects.

Patient Safety Incidents and the second victim phenomenon among nursing students / Los incidentes de seguridad del paciente y el fenómeno de la segunda víctima entre estudiantes de enfermeira / Incidentes de segurança do paciente e o fenômeno da segunda vítima entre estudantes de enfermagem

ABSTRACT Objective: To map the factors involved in incidents that harm patient safety and contribute to the second victim phenomenon among nursing students. Method: Qualitative, exploratory-descriptive study addressing 23 nursing students attending a Federal University in the South of Brazil. The interviews were analyzed using text and discoursive analysis. The Iramuteq software supported the processing of texts. Results: Communication failures within the health staff, a lack of protocols and equipment that prioritize patient safety, and factors related to the teaching-learning process favor the occurrence of patient safety incidents and the second victim phenomenon among nursing students. Conclusion: Addressing the topic concerning patient safety in nursing programs can promote the patient safety culture by encouraging reporting and admitting the possibility of errors and learning from them, strategies that can mitigate second victim effects.

RESUMEN Objetivo: mapear los factores que participan en incidentes que fragilizan la seguridad de los pacientes y que colaboran para el fenómeno de la segunda víctima entre los estudiantes de enfermería. Método: estudio de abordaje cualitativo, de carácter exploratorio y descriptivo, realizado en 23 estudiantes de enfermería de una Universidad Federal del sur de Brasil. Las entrevistas fueron analizadas a través del análisis textual discursivo. El software Iramuteq auxilió en el procesamiento de los textos. Resultado: las fallas en la comunicación entre el equipo de la salud; la ausencia de protocolos y de equipamientos que den prioridad a la seguridad del paciente; y, los factores relacionados al proceso de enseñanza y aprendizaje, favorecen la ocurrencia de incidentes de seguridad del paciente y corroboran el fenómeno de la segunda víctima entre estudiantes de enfermería. Conclusión: la incorporación de la temática sobre seguridad del paciente, en el curso de enfermería, puede auxiliar a desarrollar una cultura de seguridad del paciente al incentivar la cultura del relato, admitir la posibilidad del error e incentivar el aprendizaje; y, partiendo de este, crear estrategias que puedan auxiliar a mitigar los efectos de la segunda víctima.

RESUMO Objetivo: mapear os fatores envolvidos em incidentes que fragilizam a segurança dos pacientes e que colaboram para o fenômeno da segunda vítima entre os estudantes de enfermagem. Método: estudo de abordagem qualitativa, de caráter exploratório-descritivo, realizado com 23 estudantes de enfermagem de uma Universidade Federal do Sul do Brasil. As entrevistas foram analisadas através da análise textual discursiva. O software Iramuteq auxiliou no processamento dos textos. Resultado: falhas na comunicação entre a equipe de saúde, ausência de protocolos e de equipamentos que priorizem a segurança do paciente e os fatores relacionados ao processo de ensino-aprendizagem favorecem a ocorrência de incidentes de segurança do paciente e corroboram para o fenômeno da segunda vítima entre estudantes de enfermagem. Conclusão a incorporação da temática sobre segurança do paciente no curso de enfermagem pode auxiliar o desenvolvimento de uma cultura de segurança do paciente, ao incentivar a cultura do relato, admitir a possibilidade do erro e o aprendizado a partir dele, estratégias que podem propiciar na mitigação dos efeitos da segunda vítima.

Support provided to nursing students in the face of patient safety incidents: a qualitative study / Soporte a los estudiantes de enfermería delante de incidentes de seguridad del paciente: investigación cualitativa / Suporte aos estudantes de enfermagem diante de incidentes de segurança do paciente: pesquisa qualitativa

ABSTRACT Objectives: to identify the support provided to nursing students after a patient safety incident. Methods: qualitative study developed with 23 students attending an undergraduate nursing program in southern Brazil. Data were collected between September and November 2021 and submitted to textual discursive analysis using the Iramuteq software. Results: the students reported that mainly classmates and professors of the practical courses provided support. The students showed no knowledge of organizational support or protocols available to students who become second victims of such incidents. Final Considerations: the primary support sources available to nursing students involved in patient safety incidents were identified. Note that support provided to nursing students is still incipient both in Brazil and internationally. Hence, further studies are needed to address potential victims and support resources to mitigate this phenomenon.

RESUMEN Objetivos: conocer el soporte ofrecido al estudiante de enfermería después de un incidente de seguridad del paciente. Métodos: investigación cualitativa, desarrollada en el curso de licenciatura de enfermería en el Sur de Brasil, con 23 estudiantes. Los datos fueron recolectados entre septiembre y noviembre de 2021 y sometidos al análisis textual discursivo, con la utilización del software Iramuteq. Resultados: los estudiantes relataron que recibieron apoyo principalmente de los compañeros y profesores de las materias del campo de práctica; también, ellos demostraron no conocer ningún tipo de soporte organizacional, protocolo o apoyo cuando son por segunda vez víctimas de esos incidentes. Consideraciones Finales: se identificaron las principales fuentes de apoyo, cuando el estudiante de enfermería se envuelve en incidentes de seguridad del paciente. Se destaca la insipiencia de los recursos de soporte ofrecidos al estudiante de enfermería, tanto en el ámbito nacional como internacional; así, es necesario realizar más investigaciones dirigidas a esas potenciales víctimas e proporcionar recursos de soporte para mitigar ese fenómeno.

RESUMO Objetivos: conhecer o suporte ofertado ao estudante de enfermagem após um incidente de segurança do paciente. Métodos: pesquisa qualitativa, desenvolvida com 23 estudantes de um curso de bacharelado de enfermagem do Sul do Brasil. Os dados foram coletados entre setembro e novembro de 2021 e submetidos à análise textual discursiva, com a utilização do software Iramuteq. Resultados: os estudantes relataram que receberam apoio principalmente dos colegas e professores das disciplinas do campo de prática, mas demonstraram desconhecer qualquer tipo de suporte organizacional, protocolo ou apoio quando se encontram na condição de segunda vítima desses incidentes. Considerações Finais: foram identificadas as principais fontes de apoio quando o estudante de enfermagem se envolve em incidentes de segurança do paciente. Destaca-se a incipiência dos recursos de suporte oferecidos a esse estudante, tanto nacional como internacionalmente, sendo prementes mais pesquisas direcionadas a essas potenciais vítimas, bem como recursos de suporte para mitigar esse fenômeno.

Segurança do paciente: compreensão de estudantes de enfermagem, medicina e direito acerca do erro assistencial ao paciente / Patient safety: what nursing, medicine and law students understand about patient care errors / Seguridad del paciente: comprensión de los estudiantes de enfermería, medicina y derecho sobre los errores en la atención al paciente

Objetivo: analisar o nível de compreensão dos estudantes de graduação em enfermagem, medicina e direito sobre o erro assistencial e a sua relação com a segurança do paciente. Metodologia: estudo quantitativo com delineamento transversal, realizado com 117 estudantes de uma universidade federal do sul do Brasil. A coleta de dados foi realizada através da aplicação da Escala do Erro Assistencial, elaborada e validada pelos autores do estudo. A análise dos dados foi realizada com auxílio de software estatístico, por meio da estatística descritiva e teste Kruskal-Wallis, com realização do post hoc, para verificar diferenciação de respostas dos três grupos de estudantes pesquisados. Resultados: em comparação com os demais cursos do estudo, os estudantes de enfermagem mostraram maior desenvolvimento sobre os pilares que favorecem a cultura de segurança do paciente. Conclusão: faz-se necessário a abordagem das questões referentes ao erro assistencial nos cursos pesquisados visando aprimorar a assistência e realizando um cuidado de qualidade.

Objective: to analyze the level of understanding of undergraduate students in nursing, medicine and law about care errors and their relationship with patient safety. Methods: Quantitative study with a cross-sectional design, conductedwith 117 students from a Federal University of Southern Brazil. Data collection was performed through the application of the Assistance Error Scale, elaborated,and validated by the study authors. Data analysis was performed with the aid of statistical software, using descriptive statistics and the Kruskal-Wallis test, with post hoc performance, to verify differentiation of responses of the three groups of students surveyed. Results: In comparison with the other courses in the study, nursing students showed greater development on the pillars that favor the patient safety culture. Conclusion: As a result, it is necessary to address issues related to care errors in the courses surveyed toimprove care and provide quality care.

Objetivo: analizar el nivel de comprensión de los estudiantes de pregrado en enfermería, medicina y derecho sobre los errores asistenciales y su relación con la seguridad del paciente. Metodología: Estudio cuantitativo con un diseño transversal, realizado con 117 estudiantes de una Universidad Federal del Sur de Brasil. La recolección de datos se realizó mediante la aplicación de la Escala de Error de Asistencia, elaborada y validada por los autores del estudio. El análisis de los datos se realizó con ayuda de software estadístico, utilizando estadística descriptiva y la prueba de Kruskal-Wallis, con pruebas post hoc, para verificar la diferenciación en las respuestas de los tres grupos de estudiantes encuestados. Resultados: En comparación con los demás cursos del estudio, los estudiantes de enfermería mostraron un mayor desarrollo en los pilares que favorecen la cultura de seguridad del paciente. Conclusión: Como resultado, es necesario abordar las cuestiones relacionadas con los errores de atención en los cursos encuestados para mejorar la atención y brindar una atención de calidad.

Zinc Plasma Status and Sensory Perception in Nondialysis Chronic Kidney Disease Patients.

OBJECTIVE: The aim of this study was to evaluate the association between zinc plasma levels and sensory perception in patients with chronic kidney disease (CKD). METHODS: A cross-sectional study with 21 nondialysis CKD patients (11 men, 51.1 ± 7.1 years, body mass index 27.9 ± 7.1 kg/m2, estimated glomerular filtration rate 32.7 ± 19.9 mL/min) and 22 non-CKD volunteers (10 men, 49.8 ± 8.3 years, body mass index 28.5 ± 5.4 kg/m2) was conducted. Blood samples were collected to obtain plasma for zinc analysis. Anthropometric and biochemical parameters, as well as food intake and salivary flow rate, were also evaluated. Taste sensory perception for sweet, acidic, bitter, and salty flavors was determined by the "three-drop method," with 4 concentrations of the 4 basic tastes. RESULTS: As expected, zinc plasma levels were significantly lower in CKD patients (70.1 ± 19.2ug/dL) when compared with the control group participants (123.2 ± 24.6 µg dL) (P ˂ .0001). The bitter taste perception was lower in the CKD group (p˂0.0001). Our findings showed that sensitivity to sour (P = .047), salty (P = .03), and bitter tastes was significantly lower in participants with lower zinc plasma levels. Also, bitter taste sensitivity was lower in participants with less zinc intake (P = .038). When grouping control subjects and CKD patients, significant correlations were observed between zinc plasma levels and the number of correct answers for bitter taste (r = 0.49, P = .001), number of correct answers for salty taste (r = 0.30, P = .048), and total score of correct answers (r = 0.30, P = .044). CONCLUSIONS: Reduced zinc plasma levels in nondialysis CKD patients may be associated with lower perception of bitter, sour, and salty tastes and strategies to restore these levels are crucial due many factors, including food preferences and intake.

Characterization of the sand fly fauna in Barbalha, one of the municipalities with the highest leishmaniasis rates in Brazil.

Leishmaniases are a complex of sand fly-borne diseases that are considered a public health issue in several countries. Brazil presents high leishmaniases rates. The South of Ceará State, known as Cariri region, shows worrying statistics mainly on American tegumentary leishmaniasis. In Barbalha, which is one of the municipalities in this region, there is still a lack of studies regarding the local phlebotomine (Diptera: Psychodidae) fauna in order to help clarify the high rates. This study aimed to characterize such fauna by capturing sand flies with light traps during a four-year period. A total of 3730 sand flies were captured, of which 37.8% were females. Fourteen species were found: 13 of the Lutzomyia genus and one of the Brumptomyia genus. Of the Lutzomyia species, four were proven and five had potential involvement in leishmaniasis transmission. Lutzomyia longipalpis was the most common species (66.97%). This predominance, especially in the urban area, indicates its epidemiological importance and adaptation to environmental conditions modified by human activity. In fact, further studies are still required to accurately determine the behavioral features of these vectors in order to guide public health measurements towards its control and prevention.

Análise reflexiva sobre a segurança do paciente no contexto hospitalar e da atenção primária / Reflective analysis on patient safety in the hospital context and primary care

Objetivo: discutir sobre a segurança do paciente no contexto hospitalar e da atenção primária à saúde. Metodologia: estudo reflexivo sobre a temática segurança do paciente a nível primário e a nível hospitalar. Na construção desse trabalho, foi realizado inicialmente um levantamento da literatura acerca do tema, o que possibilitou uma análise contextualizada, além da percepção das autoras a respeito do assunto abordado. Resultados: evidenciou-se que a segurança do paciente deve ser inserida ainda no currículo de formação dos estudantes da área da saúde. No contexto hospitalar ressalta-se a importância da educação permanente entre os colaboradores, proporcionando assim uma cultura de segurança do paciente. Na atenção primária devem ser trabalhados os conceitos básicos para sensibilizar a equipe de saúde sobre a aplicabilidade do tema nesse contexto. Considerações finais: possibilitou a reflexão sobre o fenômeno da segurança do paciente nos dois ambientes de atenção à saúde, mostrando que ainda é mais abordado no âmbito hospitalar e que na atenção primária à saúde foi observada uma a escassez de produções científicas relacionadas a temática.

Objective: to discuss patient safety in the hospital and primary health care context. Methodology: this is a reflective study on the topic of patient safety at the primary level and at the hospital level. In the construction of this work, a survey of the literature on the subject was initially carried out, which enabled a contextualized analysis, in addition to the authors' perception of the subject addressed. Results: it became evident that patient safety should be included in the training curriculum for students in the health area. In the hospital context, the importance of continuing education among employees is emphasized, thus providing a culture of patient safety. In primary care, the basic concepts must be worked on to sensitize the health team about the applicability of the theme in this context. Final considerations: made it possible to reflect on the phenomenon of patient safety in the two healthcare environments, showing that it is still more addressed in the hospital environment and that in primary health care there was a shortage of scientific productions related to the theme.

Análise da produção científica sobre infecção de sítio cirúrgico: uma revisão integrativa / Analysis of scientific production of surgical site infection: an integrative review

Objetivo: Analisar a produção científica relacionada às medidas de prevenção e controle da infecção de sítio cirúrgico. Metodologia: Revisão integrativa cujo levantamento bibliográfico foi realizado em seis bases. Os critérios de inclusão foram: artigos em português, inglês e espanhol na íntegra e on-line, publicados no período de 2012 a 2017. O critério de exclusão foi: artigos repetidos em diferentes bases. Apenas seis estudos atenderam às exigências. Resultado: Os estudos selecionados permitiram a identificação de medidas de prevenção e controle de ISC, porém destacaram a necessidade da elaboração de protocolos de qualidade baseados em evidências, padronização das rotinas estabelecidas nas instituições e educação permanente dos profissionais. Conclusão: Enfatiza-se a importância da prática baseada em evidências e de programas de educação permanente para a capacitação desses profissionais com a finalidade de prevenir a infecção de sítio cirúrgico.

Objective: to analyze the scientific production related to the prevention methods and infection control to surgical site. Methodology: this is an integrative review which the bibliographic research was made in six virtual libraries. The inclusion criteria were: articles in Portuguese, English and Spanish fully available online, published in the 2012-2017 period. The exclusion criteria were: repeated articles in different bases. Only six studies met the requirements. Results: The selected studies allowed the identification of a number of measures for prevention and control of ISC; however, it was highlighted the needing for developing quality protocols based on evidence, standardization of routines established in institutions and continuing education of professionals. Conclusion: It is emphasized the importance of evidence-based practice and permanent educational programs implementations for the professional capacitation in order to combat to surgical wound infection.

Non-AIDS-related comorbidities in people living with HIV-1 aged 50 years and older: The AGING POSITIVE study.

OBJECTIVE: To characterize the profile of non-AIDS-related comorbidities (NARC) in the older HIV-1-infected population and to explore the factors associated with multiple NARC. METHODS: This was a multicentre, cross-sectional study including HIV-1-infected patients aged ≥50 years, who were virologically suppressed and had been on a stable antiretroviral therapy (ART) regimen for at least 6 months. A multiple regression model explored the association between demographic and clinical variables and the number of NARC. RESULTS: Overall, 401 patients were enrolled. The mean age of the patients was 59.3 years and 72.6% were male. The mean duration of HIV-1 infection was 12.0 years and the median exposure to ART was 10.0 years. The mean number of NARC was 2.1, and 34.7% of patients had three or more NARC. Hypercholesterolemia was the most frequent NARC (60.8%), followed by arterial hypertension (39.7%) and chronic depression/anxiety (23.9%). Arterial hypertension and diabetes mellitus were the most frequently treated NARC (95.6% and 92.6% of cases, respectively). The linear regression analysis showed a positive relationship between age and NARC (B=0.032, 95% confidence interval 0.015-0.049; p=0.0003) and between the duration of HIV-1 infection and NARC (B=0.039, 95% confidence interval 0.017-0.059; p=0.0005). CONCLUSIONS: A high prevalence of NARC was found, the most common being metabolic, cardiovascular, and psychological conditions. NARC rates were similar to those reported for the general population, suggesting a larger societal problem beyond HIV infection. A multidisciplinary approach is essential to reduce the burden of complex multi-morbid conditions in the HIV-1-infected population.

Glomerular filtration rate change during chronic hepatitis C treatment with Sofosbuvir/Ledipasvir in HCV/HIV Coinfected patients treated with Tenofovir and a boosted protease inhibitor: an observational prospective study.

INTRODUCTION: Concomitant use of ledipasvir and boosted protease inhibitors (PIs) may increase the risk of tenofovir (TDF) nephrotoxicity, since both these drugs increase TDF levels. Our aim was to evaluate glomerular filtration rate (eGFR) evolution during HCV treatment with sofosbuvir/ledipasvir (SOF/LDV) in HCV/HIV coinfected patients, according to their antiretroviral treatment (ARV). METHODS: Observational prospective study of HCV/HIV coinfected patients treated with SOF/LDV. eGFR evolution was evaluated during and 12 weeks after HCV treatment. Patients were categorized in three groups based on ARV regimen: non TDF, non-boosted TDF and TDF + boosted PI. RESULTS: We included 273 patients: 145 were receiving a non-TDF regimen, 78 a non-boosted TDF scheme and 50 were receiving TDF + boosted PI. We observed a statistically significant decrease in eGFR during treatment in all groups (non TDF p = 0.03, 95%CI [0.23-3.86], non-boosted TDF p < 0.01, 95%CI [3.36-7.44], TDF + PI p = 0.01, 95%CI [1.09-7.53]). The decrease was more pronounced in those receiving unboosted TDF (- 5.40 ml/min/1.73m2), but differences in eGFR decrease between the three groups were small and not statistically different (p = 0.06). eGFR decrease was greater in patients treated for 24 weeks (p = 0.009) and in cirrhotic patients (p = 0.036). At the end of follow up a recovery of eGFR was observed in all groups. CONCLUSION: We observed a significant decrease in eGFR during treatment in all study groups, that was small and reversible after SOF/LDV discontinuation. TDF was not associated with an increase in renal toxicity.

Analysis of Brazilian publications on distance education in nursing: integrative review / Análisis de las publicaciones nacionales sobre educación a distancia en enfermería: revisión integradora / Análise das publicações nacionais sobre educação a distância em enfermagem: revisão integrativa

ABSTRACT Objective: To analyze the publications that focus on distance education in nursing in Brazil from 2010 to 2016. Method: Integrative review of the literature with data collection in June 2016 in the following databases: LILACS, MEDLINE via PUBMED, CINAHL and SCOPUS. For the data analysis and interpretation, the thematic categorization was chosen. Results: We selected 18 articles for discussion, whose textual analysis permitted the construction of three thematic categories: use of virtual technologies for distance education in nursing; construction of virtual learning environments with the aid of virtual technologies for distance education in nursing; and evaluation of the learning process through virtual technologies for distance education of nurses. Conclusion: Distance Education stands out as an effective teaching-learning strategy in this type of education in Brazilian nursing, focused mainly on the improvement and complement of traditional teaching.

RESUMEN Objetivo: analizar las publicaciones que enfocan la educación a distancia en Enfermería en Brasil de 2010 a 2016. Método: Revisión integradora de la literatura con colecta de datos en el mes de junio de 2016 en las siguientes bases de datos: LILACS, MEDLINE vía PUBMED, CINAHL y SCOPUS. Para análisis e interpretación de los datos se optó por la categorización temática. Resultados: Fueron seleccionados 18 artículos para discusión, cuyas análisis textuales permitieron la construcción de 3 categorías temáticas: uso de las tecnologías virtuales en educación a distancia en enfermería; construcción de ambientes virtuales de aprendizaje con auxilio de tecnologías virtuales en educación a distancia en enfermería; y evaluación del proceso de aprendizaje por intermedio de las tecnologías virtuales en educación a distancia de enfermeros. Conclusión: EAD se evidencia como una estrategia efectiva de enseñanza-aprendizaje en educación a distancia en enfermería brasileña, orientada principalmente para el perfeccionamiento y complemento de la enseñanza tradicional.

RESUMO Objetivo: analisar as publicações que enfocam a educação a distância na enfermagem no Brasil de 2010 a 2016. Método: Revisão integrativa da literatura com coleta de dados no mês de junho de 2016 nas seguintes bases de dados: LILACS, MEDLINE via PUBMED, CINAHL e SCOPUS. Para análise e interpretação dos dados, optou-se pela categorização temática. Resultados: Selecionados 18 artigos para discussão, cujas análises textuais permitiram a construção de três categorias temáticas: uso das tecnologias virtuais na educação a distância na enfermagem; construção de ambientes virtuais de aprendizagem com auxílio de tecnologias virtuais na educação a distância na enfermagem; e avaliação do processo de aprendizagem por intermédio das tecnologias virtuais na educação a distância de enfermeiros. Conclusão: a EAD evidencia-se como uma estratégia efetiva de ensino-aprendizagem nesta modalidade de educação na enfermagem brasileira, voltada principalmente para o aperfeiçoamento e complemento do ensino tradicional.

Analysis of Brazilian publications on distance education in nursing: integrative review.

OBJECTIVE: To analyze the publications that focus on distance education in nursing in Brazil from 2010 to 2016. METHOD: Integrative review of the literature with data collection in June 2016 in the following databases: LILACS, MEDLINE via PUBMED, CINAHL and SCOPUS. For the data analysis and interpretation, the thematic categorization was chosen. RESULTS: We selected 18 articles for discussion, whose textual analysis permitted the construction of three thematic categories: use of virtual technologies for distance education in nursing; construction of virtual learning environments with the aid of virtual technologies for distance education in nursing; and evaluation of the learning process through virtual technologies for distance education of nurses. CONCLUSION: Distance Education stands out as an effective teaching-learning strategy in this type of education in Brazilian nursing, focused mainly on the improvement and complement of traditional teaching.

A importância do uso precoce de hialuronidase no tratamento de oclusão arterial por preenchimento de ácido hialurônico / The importance of the early use of hyaluronidase in the treatment of arterial occlusion resulting from hyaluronic acid based cutaneous filling

A isquemia cutânea é um dos eventos adversos vasculares decorrentes da aplicação de ácido hialurônico, causada por embolia arterial. A aplicação precoce de hialuronidase representará o sucesso da degradação e reversão do quadro que pode ser grave e causar danos ao paciente. Relatam-se casos com suspeita de oclusão arterial no qual foi realizada degradação com hialuronidase em diferentes períodos. Tal análise permitiu observar que o tempo de degradação e a eficácia do procedimento relacionam-se com tempo de intervenção

Cutaneous ischemia, caused by arterial embolism, is one of the vascular adverse events resulting from the application of hyaluronic acid. Early application of hyaluronidase will lead to the successful degradation and reversal of the condition ­ which might be severe and cause harm to the patient. The authors report cases with suspected arterial occlusion in which degradation was performed with hyaluronidase at different timepoints. This analysis has evidenced that the degradation time and the procedure's effectiveness are correlated to the intervention timepoint.