Microcystin influence on soil-plant microbiota: Unraveling microbiota modulations and assembly processes in the rhizosphere of Vicia faba.

Microcystins (MCs) are frequently detected in cyanobacterial bloom-impacted waterbodies and introduced into agroecosystems via irrigation water. They are widely known as phytotoxic cyanotoxins, which impair the growth and physiological functions of crop plants. However, their impact on the plant-associated microbiota is scarcely tackled and poorly understood. Therefore, we aimed to investigate the effect of MCs on microbiota-inhabiting bulk soil (BS), root adhering soil (RAS), and root tissue (RT) of Vicia faba when exposed to 100 µg L-1 MCs in a greenhouse pot experiment. Under MC exposure, the structure, co-occurrence network, and assembly processes of the bacterial microbiota were modulated with the greatest impact on RT-inhabiting bacteria, followed by BS and, to a lesser extent, RAS. The analyses revealed a significant decrease in the abundances of several Actinobacteriota-related taxa within the RT microbiota, including the most abundant and known genus of Streptomyces. Furthermore, MCs significantly increased the abundance of methylotrophic bacteria (Methylobacillus, Methylotenera) and other Proteobacteria-affiliated genera (e.g., Paucibacter), which are supposed to degrade MCs. The co-occurrence network of the bacterial community in the presence of MCs was less complex than the control network. In MC-exposed RT, the turnover in community composition was more strongly driven by deterministic processes, as proven by the beta-nearest taxon index. Whereas in MC-treated BS and RAS, both deterministic and stochastic processes can influence community assembly to some extent, with a relative dominance of deterministic processes. Altogether, these results suggest that MCs may reshape the structure of the microbiota in the soil-plant system by reducing bacterial taxa with potential phytobeneficial traits and increasing other taxa with the potential capacity to degrade MCs.

Subacute Neurotoxicity as an Adverse Reaction to Ceftazidime: A Case Report.

Neurotoxicity associated with cephalosporins is an increasingly recognized complication, although among cephalosporins, ceftazidime is rarely reported for such an adverse reaction. Moreover, subacute, rather than acute, presentation of neurotoxicity associated with cephalosporins is rare. A 77-year-old female patient with stage 4 chronic renal disease was admitted due to cellulitis in her right lower limb, multiorgan dysfunction complicated by oliguric acute kidney injury, and a need for hemodialysis via a central venous catheter. On the 13th day after admission, she became febrile, and bacteremia associated with a central venous catheter was identified, which prompted the initiation of empirical antibiotic therapy with vancomycin and ceftazidime. After 13 days of antibiotic therapy with vancomycin and ceftazidime, the patient became confused, with temporal-spatial disorientation and myoclonus, especially in the upper limbs, with worsening renal function. Ceftazidime was discontinued, and the patient's condition improved with complete remission of symptoms on the 8th day after symptom onset. Neurotoxicity associated with ceftazidime is a rare but probably underdiagnosed adverse reaction. It is more frequent in elderly patients with previous neurological dysfunction and end-stage kidney disease and/or acute kidney injury, and it usually manifests soon after starting treatment. Early identification and monitoring of risk factors and symptoms should lead the physician to a rapid withdrawal of the offending drug.

Acute Aquatic Toxicity to Zebrafish and Bioaccumulation in Marine Mussels of Antimony Tin Oxide Nanoparticles.

Antimony tin oxide (Sb2O5/SnO2) is effective in the absorption of infrared radiation for applications, such as skylights. As a nanoparticle (NP), it can be incorporated into films or sheets providing infrared radiation attenuation while allowing for a transparent final product. The acute toxicity exerted by commercial Sb2O5/SnO2 (ATO) NPs was studied in adults and embryos of zebrafish (Danio rerio). Our results suggest that these NPs do not induce an acute toxicity in zebrafish, either adults or embryos. However, some sub-lethal parameters were altered: heart rate and spontaneous movements. Finally, the possible bioaccumulation of these NPs in the aquacultured marine mussel Mytilus sp. was studied. A quantitative analysis was performed using single particle inductively coupled plasma mass spectrometry (sp-ICP-MS). The results indicated that, despite being scarce (2.31 × 106 ± 9.05 × 105 NPs/g), there is some accumulation of the ATO NPs in the mussel. In conclusion, commercial ATO NPs seem to be quite innocuous to aquatic organisms; however, the fact that some of the developmental parameters in zebrafish embryos are altered should be considered for further investigation. More in-depth analysis of these NPs transformations in the digestive tract of humans is needed to assess whether their accumulation in mussels presents an actual risk to humans.

Health risk assessment of lake water contaminated with microcystins for fruit crop irrigation and farm animal drinking.

The health risks linked to the consumption of microcystin-accumulating crops have been increasing worldwide in toxic cyanobloom-occurring regions. The bioaccumulation of microcystins (MCs) in agricultural produce at environmentally realistic concentrations is poorly investigated. In this field study, we assessed the health risks of MCs in raw water used for irrigating fruit crops (bioaccumulation) and watering farm animals in the Lalla Takerkoust agricultural region (Marrakesh, Morocco). Thus, MCs were extracted from water and fruit samples and quantified by enzyme-linked immunosorbent assay in order to calculate the health risk indicators. MCs posed a high health-risk level to poultry and horses, with estimated daily intakes (EDI) being 14- and 19-fold higher than the recommended limits (3.1 and 2.3 µg MC-LR L-1), respectively. Furthermore, pomegranate posed the same level of risk, with EDI being 22- and 53-fold higher than the limit dose (0.04 µg MC-LR kg-1) for adults and children, respectively. There was an urgent need for guidelines regarding water use and management in MC-polluted areas, besides the setup of nature-based tools for toxin removal from raw water used in farming practices. Moreover, MCs could contaminate the human food chain, which implies further investigations of their potential accumulation in livestock- and poultry-based food.

Proteomics reveals multiple effects of titanium dioxide and silver nanoparticles in the metabolism of turbot, Scophthalmus maximus.

Titanium dioxide (TiO2) and silver (Ag) NPs are among the most used engineered inorganic nanoparticles (NPs); however, their potential effects to marine demersal fish species, are not fully understood. Therefore, this study aimed to assess the proteomic alterations induced by sub-lethal concentrations citrate-coated 25 nm ("P25") TiO2 or polyvinylpyrrolidone (PVP) coated 15 nm Ag NPs to turbot, Scophthalmus maximus. Juvenile fish were exposed to the NPs through daily feeding for 14 days. The tested concentrations were 0, 0.75 or 1.5 mg of each NPs per kg of fish per day. The determination of NPs, Titanium and Ag levels (sp-ICP-MS/ICP-MS) and histological alterations (Transmission Electron Microscopy) supported proteomic analysis performed in the liver and kidney. Proteomic sample preparation procedure (SP3) was followed by LC-MS/MS. Label-free MS quantification methods were employed to assess differences in protein expression. Functional analysis was performed using STRING web-tool. KEGG Gene Ontology suggested terms were discussed and potential biomarkers of exposure were proposed. Overall, data shows that liver accumulated more elements than kidney, presented more histological alterations (lipid droplets counts and size) and proteomic alterations. The Differentially Expressed Proteins (DEPs) were higher in Ag NPs trial. The functional analysis revealed that both NPs caused enrichment of proteins related to generic processes (metabolic pathways). Ag NPs also affected protein synthesis and nucleic acid transcription, among other processes. Proteins related to thyroid hormone transport (Serpina7) and calcium ion binding (FAT2) were suggested as biomarkers of TiO2 NPs in liver. For Ag NPs, in kidney (and at a lower degree in liver) proteins related with metabolic activity, metabolism of exogenous substances and oxidative stress (e.g.: NADH dehydrogenase and Cytochrome P450) were suggested as potential biomarkers. Data suggests adverse effects in turbot after medium/long-term exposures and the need for additional studies to validate specific biological applications of these NPs.

Swollen Finger - An Atypical Place for a Metastatic Lesion.

Acrometastasis, referring to metastases located distal to the elbow and knee, is a rare observation. The most common primary cancer site is the lungs, followed by colorectal, breast and genitourinary tract locations. We present a case of a 54-year-old woman with a 25-pack-year smoking history, chronic obstructive pulmonary disease and squamous cell carcinoma of the lung diagnosed at age 50. Upon physical examination, in the distal phalanx of the fourth finger of the right hand, there was a hypervascularized swelling, purplish and painful. Distal amputation of the fourth finger was performed with pathological anatomy compatible with acrometastasis of primary squamous cell carcinoma of the lung. Clinicians should be aware of this type of metastasis because it is sometimes difficult to distinguish from tuberculous dactylitis and other types of osteomyelitis in patients with undiagnosed cancer. The presence of acrometastasis confers a poor prognosis. LEARNING POINTS: Acrometastasis is a rare presentation of bone metastases.The diagnosis of acrometastasis is a challenge, due to the large number of differential diagnoses and the difficulty in detecting them early.The presence of acrometastasis confers a poor prognosis.

Transcriptomic Profile of the Cockle Cerastoderma edule Exposed to Seasonal Diarrhetic Shellfish Toxin Contamination.

Bivalves constitute an important source of proteins for human consumption, but some accumulate biotoxins such as diarrhetic shellfish toxins (DSTs), constituting a risk to human health. The cockle Cerastoderma edule is one of the most important species harvested in the Portuguese coast but also one of the most affected species due to recurrent DSTs exposure. However, little is known regarding the effects of the toxins produced by blooming dinoflagellates on C. edule. Herein, we explore the Differentially Expressed Genes (DEGs) of two tissues (gills and digestive gland) from wild cockles sampled in Portugal, through their whole transcriptomic response in two different seasons (exposed and not exposed to DSTs). The de novo transcriptome assembly returned 684,723 contigs, N50 of 1049, and 98.53% completeness. Altogether, 1098 DEGs were identified, of which 353 DEGs were exclusive for the digestive gland, 536 unique for the gills and 209 DEGs were common. Among DEGs were identified known DSTs-biomarkers including glutathione peroxidase, glutathione S-transferase, superoxide dismutase, cytochrome P450, ABC transporters, actin and tubulin-related proteins, Heat shock proteins and complement C1Q-like proteins. This study provides the first transcriptomic profile of C. edule, giving new insights about its molecular responses under different environmental conditions of DSTs exposure.

Comparison of Sample Preparation Methods for Shotgun Proteomic Studies in Aquaculture Species.

Proteomics has been recently introduced in aquaculture research, and more methodological studies are needed to improve the quality of proteomics studies. Therefore, this work aims to compare three sample preparation methods for shotgun LC-MS/MS proteomics using tissues of two aquaculture species: liver of turbot Scophthalmus maximus and hepatopancreas of Mediterranean mussel Mytilus galloprovincialis. We compared the three most common sample preparation workflows for shotgun analysis: filter-aided sample preparation (FASP), suspension-trapping (S-Trap), and solid-phase-enhanced sample preparations (SP3). FASP showed the highest number of protein identifications for turbot samples, and S-Trap outperformed other methods for mussel samples. Subsequent functional analysis revealed a large number of Gene Ontology (GO) terms in turbot liver proteins (nearly 300 GO terms), while fewer GOs were found in mussel proteins (nearly 150 GO terms for FASP and S-Trap and 107 for SP3). This result may reflect the poor annotation of the genomic information in this specific group of animals. FASP was confirmed as the most consistent method for shotgun proteomic studies; however, the use of the other two methods might be important in specific experimental conditions (e.g., when samples have a very low amount of protein).

Role of Rhizospheric Microbiota as a Bioremediation Tool for the Protection of Soil-Plant Systems from Microcystins Phytotoxicity and Mitigating Toxin-Related Health Risk.

Frequent toxic cyanoblooms in eutrophic freshwaters produce various cyanotoxins such as the monocyclic heptapeptides microcystins (MCs), known as deleterious compounds to plant growth and human health. Recently, MCs are a recurrent worldwide sanitary problem in irrigation waters and farmland soils due to their transfer and accumulation in the edible tissues of vegetable produce. In such cases, studies about the persistence and removal of MCs in soil are scarce and not fully investigated. In this study, we carried out a greenhouse trial on two crop species: faba bean (Vicia faba var. Alfia 321) and common wheat (Triticum aestivum var. Achtar) that were grown in sterile (microorganism-free soil) and non-sterile (microorganism-rich soil) soils and subjected to MC-induced stress at 100 µg equivalent MC-LR L-1. The experimentation aimed to assess the prominent role of native rhizospheric microbiota in mitigating the phytotoxic impact of MCs on plant growth and reducing their accumulation in both soils and plant tissues. Moreover, we attempted to evaluate the health risk related to the consumption of MC-polluted plants for humans and cattle by determining the estimated daily intake (EDI) and health risk quotient (RQ) of MCs in these plants. Biodegradation was liable to be the main removal pathway of the toxin in the soil; and therefore, bulk soil (unplanted soil), as well as rhizospheric soil (planted soil), were used in this experiment to evaluate the accumulation of MCs in the presence and absence of microorganisms (sterile and non-sterile soils). The data obtained in this study showed that MCs had no significant effects on growth indicators of faba bean and common wheat plants in non-sterile soil as compared to the control group. In contrast, plants grown in sterile soil showed a significant decrease in growth parameters as compared to the control. These results suggest that MCs were highly bioavailable to the plants, resulting in severe growth impairments in the absence of native rhizospheric microbiota. Likewise, MCs were more accumulated in sterile soil and more bioconcentrated in root and shoot tissues of plants grown within when compared to non-sterile soil. Thereby, the EDI of MCs in plants grown in sterile soil was more beyond the tolerable daily intake recommended for both humans and cattle. The risk level was more pronounced in plants from the sterile soil than those from the non-sterile one. These findings suggest that microbial activity, eventually MC-biodegradation, is a crucial bioremediation tool to remove and prevent MCs from entering the agricultural food chain.

Pancreatic Cancer and Primary Sjögren's Syndrome: A Case Report.

Primary Sjögren syndrome (SS) is a chronic inflammatory systemic autoimmune disease with a high risk of malignancy development, namely, lymphoproliferative neoplasms. Few studies also reported a high risk of solid cancers; however, the coexistence of primary SS and pancreatic cancer has been rarely described. In this paper, we aim to describe a case of a 59-year-old woman who was an active smoker with sicca symptoms and symmetrical polyarthritis and was diagnosed with primary SS two years before the development of metastatic pancreatic adenocarcinoma. Despite institution of chemotherapy, the patient succumbed to the malignancy. Besides that, we explore the link between primary SS and solid cancers including the main predictors of malignancy and the role of primary SS as a paraneoplastic syndrome. Patients with primary SS should be closely monitored for malignancy, not only for hematological cancer, but also for solid tumors. Further research is necessary to understand which are the predictors of cancer proliferation in primary SS patients.

Protective Role of Native Rhizospheric Soil Microbiota Against the Exposure to Microcystins Introduced into Soil-Plant System via Contaminated Irrigation Water and Health Risk Assessment.

Microcystins (MCs) produced in eutrophic waters may decrease crop yield, enter food chains and threaten human and animal health. The main objective of this research was to highlight the role of rhizospheric soil microbiota to protect faba bean plants from MCs toxicity after chronic exposure. Faba bean seedlings were grown in pots containing agricultural soil, during 1 month under natural environmental conditions of Marrakech city in Morocco (March-April 2018) and exposed to cyanobacterial extracts containing up to 2.5 mg·L-1 of total MCs. Three independent exposure experiments were performed (a) agricultural soil was maintained intact "exposure experiment 1"; (b) agricultural soil was sterilized "exposure experiment 2"; (c) agricultural soil was sterilized and inoculated with the rhizobia strain Rhizobium leguminosarum RhOF34 "exposure experiment 3". Overall, data showed evidence of an increased sensitivity of faba bean plants, grown in sterilized soil, to MCs in comparison to those grown in intact and inoculated soils. The study revealed the growth inhibition of plant shoots in both exposure experiments 2 and 3 when treated with 2.5 mg·L-1 of MCs. The results also showed that the estimated daily intake (EDI) of MCs, in sterilized soil, exceeded 2.18 and 1.16 times the reference concentrations (0.04 and 0.45 µg of microcysin-leucine arginine (MC-LR). Kg-1 DW) established for humans and cattle respectively, which raises concerns about human food chain contamination.

OMICs Approaches in Diarrhetic Shellfish Toxins Research.

Diarrhetic shellfish toxins (DSTs) are among the most prevalent marine toxins in Europe's and in other temperate coastal regions. These toxins are produced by several dinoflagellate species; however, the contamination of the marine trophic chain is often attributed to species of the genus Dinophysis. This group of toxins, constituted by okadaic acid (OA) and analogous molecules (dinophysistoxins, DTXs), are highly harmful to humans, causing severe poisoning symptoms caused by the ingestion of contaminated seafood. Knowledge on the mode of action and toxicology of OA and the chemical characterization and accumulation of DSTs in seafood species (bivalves, gastropods and crustaceans) has significantly contributed to understand the impacts of these toxins in humans. Considerable information is however missing, particularly at the molecular and metabolic levels involving toxin uptake, distribution, compartmentalization and biotransformation and the interaction of DSTs with aquatic organisms. Recent contributions to the knowledge of DSTs arise from transcriptomics and proteomics research. Indeed, OMICs constitute a research field dedicated to the systematic analysis on the organisms' metabolisms. The methodologies used in OMICs are also highly effective to identify critical metabolic pathways affecting the physiology of the organisms. In this review, we analyze the main contributions provided so far by OMICs to DSTs research and discuss the prospects of OMICs with regard to the DSTs toxicology and the significance of these toxins to public health, food safety and aquaculture.

Effectiveness of simulation in teaching immunization in nursing: a randomized clinical trial.

OBJECTIVE: to evaluate the effectiveness of the clinical simulation on the cognitive performance of nursing students in adult immunization scenarios in the context of Primary Health Care. METHOD: a controlled and randomized pre-test and post-test clinical trial applied to random intervention and control groups. 34 undergraduate nursing students were selected and divided into two groups: classes with active participation of students and skills training (control); and classes with active participation of students, skills training, and clinical simulation (intervention). RESULTS: the students in the intervention group performed better than those in the control group in the four assessments of cognitive performance, with statistical significance in the assessments of immediate (p=0.031) and late (1-20 days) (p=0.031) knowledge. CONCLUSION: from the simulation, students learn more in the short and medium terms. The information learned is retained for longer and the students are better prepared for the professional practice. Universal Trial Number: u1111-1195-2580.

Physiological and Metabolic Responses of Marine Mussels Exposed to Toxic Cyanobacteria Microcystis aeruginosa and Chrysosporum ovalisporum.

Toxic cyanobacterial blooms are a major contaminant in inland aquatic ecosystems. Furthermore, toxic blooms are carried downstream by rivers and waterways to estuarine and coastal ecosystems. Concerning marine and estuarine animal species, very little is known about how these species are affected by the exposure to freshwater cyanobacteria and cyanotoxins. So far, most of the knowledge has been gathered from freshwater bivalve molluscs. This work aimed to infer the sensitivity of the marine mussel Mytilus galloprovincialis to single as well as mixed toxic cyanobacterial cultures and the underlying molecular responses mediated by toxic cyanobacteria. For this purpose, a mussel exposure experiment was outlined with two toxic cyanobacteria species, Microcystis aeruginosa and Chrysosporum ovalisporum at 1 × 105 cells/mL, resembling a natural cyanobacteria bloom. The estimated amount of toxins produced by M. aeruginosa and C. ovalisporum were respectively 0.023 pg/cell of microcystin-LR (MC-LR) and 7.854 pg/cell of cylindrospermopsin (CYN). After 15 days of exposure to single and mixed cyanobacteria, a depuration phase followed, during which mussels were fed only non-toxic microalga Parachlorella kessleri. The results showed that the marine mussel is able to filter toxic cyanobacteria at a rate equal or higher than the non-toxic microalga P. kessleri. Filtration rates observed after 15 days of feeding toxic microalgae were 1773.04 mL/ind.h (for M. aeruginosa), 2151.83 mL/ind.h (for C. ovalisporum), 1673.29 mL/ind.h (for the mixture of the 2 cyanobacteria) and 2539.25 mL/ind.h (for the non-toxic P. kessleri). Filtering toxic microalgae in combination resulted in the accumulation of 14.17 ng/g dw MC-LR and 92.08 ng/g dw CYN. Other physiological and biochemical endpoints (dry weight, byssus production, total protein and glycogen) measured in this work did not change significantly in the groups exposed to toxic cyanobacteria with regard to control group, suggesting that mussels were not affected with the toxic microalgae. Nevertheless, proteomics revealed changes in metabolism of mussels related to diet, specially evident in those fed on combined cyanobacteria. Changes in metabolic pathways related with protein folding and stabilization, cytoskeleton structure, and gene transcription/translation were observed after exposure and feeding toxic cyanobacteria. These changes occur in vital metabolic processes and may contribute to protect mussels from toxic effects of the toxins MC-LR and CYN.

Empathizing and systemizing profiles of Brazilian and Portuguese nursing undergraduates.

AIM: To analyze the empathizing and systemizing profiles of Brazilian and Portuguese nursing undergraduates. BACKGROUND: Empathy is a fundamental skill for nursing practice and should be analyzed during the student's education. METHODS: Descriptive study with cross-sectional design. Participants were 968 undergraduate students, including 215 (22.2%) Brazilians from a university in the state of São Paulo and 753 (77.8%) Portuguese students from a higher education institution in central Portugal. The Portuguese and Brazilian versions of the Empathizing/Systemizing Quotient have good internal consistency and reliability. ETHICAL CONSIDERATIONS: In Brazil, approval for the study was obtained from the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing (protocol 191/2016) and in Portugal, from the Ethics Committee of the Health Sciences Research Unit: Nursing, Coimbra Higher School of Nursing (protocol P362-09/2016). RESULTS: Most (86%) participants were female and aged between 20 and 24 years. In the general profile analysis between both groups, the domains "Social Skills," "Contents," and "Processes" scored higher. Gender differences exist for the feeling of empathy and systemizing, as women scored better on the short version of the Empathy Quotient and men on the Systemizing Quotient. CONCLUSION: As demonstrated in the domain scores for "Social Skills," "Contents," and "Processes," the undergraduate nursing students analyzed have the ability to deal intuitively and spontaneously with social situations; they are also characterized as methodical people, who like to follow rules, and experience practice better than theory, and the women have a higher empathetic level than men, who in turn are more systemizing.

Effectiveness of simulation in teaching immunization in nursing: a randomized clinical trial / Eficácia da simulação no ensino de imunização em enfermagem: ensaio clínico randomizado / Eficacia de la simulación en la enseñanza de inmunización en la enfermería: ensayo clínico aleatorio

Objective: to evaluate the effectiveness of the clinical simulation on the cognitive performance of nursing students in adult immunization scenarios in the context of Primary Health Care. Method: a controlled and randomized pre-test and post-test clinical trial applied to random intervention and control groups. 34 undergraduate nursing students were selected and divided into two groups: classes with active participation of students and skills training (control); and classes with active participation of students, skills training, and clinical simulation (intervention). Results: the students in the intervention group performed better than those in the control group in the four assessments of cognitive performance, with statistical significance in the assessments of immediate (p=0.031) and late (1-20 days) (p=0.031) knowledge. Conclusion: from the simulation, students learn more in the short and medium terms. The information learned is retained for longer and the students are better prepared for the professional practice. Universal Trial Number: u1111-1195-2580

Objetivo: avaliar a eficácia da simulação clínica no desempenho cognitivo de estudantes de enfermagem em cenários de imunização de adultos no contexto da Atenção Primária à Saúde. Método: ensaio clínico controlado e randomizado do tipo pré-teste e pós-teste aplicado a grupo intervenção e grupo controle aleatórios. Foram selecionados 34 estudantes de graduação em enfermagem, divididos em dois grupos: exposição dialogada e treino de habilidades (controle) e exposição dialogada, treino de habilidades e simulação clínica (intervenção). Resultados: os estudantes do grupo intervenção apresentaram melhores desempenhos, em relação ao grupo controle, nas quatro avaliações de desempenho cognitivo, com significância estatística nas avaliações de conhecimento imediato (p = 0,031) e tardio 1 - 20 dias (p = 0,031). Conclusão: a partir da simulação, os estudantes aprendem mais em curto e médio prazo. As informações aprendidas ficam retidas por mais tempo e os estudantes são mais bem preparados para a atuação profissional. Universal Trial Number: u1111-1195-2580

Objetivo: evaluar la eficacia de la simulación clínica en el desempeño cognitivo de estudiantes de enfermería en escenarios de inmunización de adultos en el contexto de la Atención Primaria de Salud. Método: ensayo clínico controlado y aleatorizado previo y posterior a la prueba aplicado a grupos de intervención y de control aleatorios. Se seleccionaron 34 estudiantes universitarios de enfermería y se los dividió en dos grupos: exposición dialogada y entrenamiento de habilidades (control) y exposición dialogada, entrenamiento de habilidades y simulación clínica (intervención). Resultados: los estudiantes del grupo de intervención presentaron un mejor desempeño en relación al grupo de control, en las cuatro evaluaciones de desempeño cognitivo, con significación estadística en las evaluaciones de conocimiento inmediato (p = 0,031) y tardío 1 - 20 días (p = 0,031). Conclusión: a partir de la simulación, los estudiantes aprenden más a corto y mediano plazo. La información aprendida se retiene durante más tiempo y los estudiantes están mejor preparados para el desempeño profesional. Universal Trial Number: u1111-1195-2580

Self-confidence in the care of critically ill patients: before and after a simulated intervention / Autoconfianza en el cuidado del paciente crítico: antes y después de intervención simulada / Autoconfiança no cuidado ao paciente crítico: pré e pós-intervenção simulada

ABSTRACT Objective: To evaluate the self-confidence of nurses in the care of critically ill patients, before and after a simulated intervention. Method: A quasi-experimental study was carried out with 103 nurses who participated in a workshop on the care of critically ill patients in the first semester of 2016. A clinical simulation pedagogical instrument was used throughout the event, and self-confidence was assessed by the Portuguese version of the Self-confidence Scale (SCSvp). Results: Most participants reported not being prepared to provide first care to critically ill patients, which was carried out during care practice. The participants presented a significant increase in self-confidence after the simulated intervention (p<0.001) in the cardiac, neurological, and respiratory dimensions. Conclusion: Simulation has proved to be an effective strategy for the development of individuals' self-confidence, which contributes to the improvement of skills required for professional practice.

RESUMEN Objetivo: Verificar la autoconfianza del enfermero en la atención del paciente crítico antes y después de una intervención simulada. Método: Estudio cuasi-experimental, realizado con 103 enfermeros que participaron de un workshop de atención al paciente crítico en el primer semestre de 2016. Fue utilizada la herramienta pedagógica de simulación clínica durante todo el evento, y la autoconfianza fue verificada mediante Self-Confident Scale, versión portuguesa (SCSvp). Resultados: La mayoría de los sujetos consideró no estar preparado para brindar la primera atención al paciente crítico, afirmando haberlo realizado durante la práctica asistencial. Los participantes expresaron aumento significativo de autoconfianza luego de la intervención simulada (p<0,001) en las dimensiones cardíaca, neurológica y respiratoria. Conclusión: La simulación ha demostrado ser una estrategia eficaz para desarrollar la autoconfianza del individuo, factor que contribuye al crecimiento de las competencias exigidas para el ejercicio profesional.

RESUMO Objetivo: Verificar a autoconfiança do enfermeiro no atendimento ao paciente crítico pré e pós-intervenção simulada. Método: Estudo quase experimental realizado com 103 enfermeiros que participaram de um workshop de atendimento ao paciente crítico no primeiro semestre de 2016. Foi utilizada a ferramenta pedagógica de simulação clínica em todo o evento, e a autoconfiança foi verificada pela Self-Confidence Scale, versão portuguesa (SCSvp). Resultados: A maior parte dos sujeitos julgou não estar preparada para prestar o primeiro atendimento ao paciente crítico, afirmando tê-lo realizado durante a prática assistencial. Os participantes apresentaram aumento significativo de autoconfiança após a intervenção simulada (p <0,001) nas dimensões cardíacas, neurológica e respiratória. Conclusão: A simulação tem-se mostrado uma estratégia eficaz para o desenvolvimento da autoconfiança do indivíduo, o que contribui para o acréscimo das competências exigidas para o exercício profissional.

Self-confidence in the care of critically ill patients: before and after a simulated intervention.

OBJECTIVE: To evaluate the self-confidence of nurses in the care of critically ill patients, before and after a simulated intervention. METHOD: A quasi-experimental study was carried out with 103 nurses who participated in a workshop on the care of critically ill patients in the first semester of 2016. A clinical simulation pedagogical instrument was used throughout the event, and self-confidence was assessed by the Portuguese version of the Self-confidence Scale (SCSvp). RESULTS: Most participants reported not being prepared to provide first care to critically ill patients, which was carried out during care practice. The participants presented a significant increase in self-confidence after the simulated intervention (p<0.001) in the cardiac, neurological, and respiratory dimensions. CONCLUSION: Simulation has proved to be an effective strategy for the development of individuals' self-confidence, which contributes to the improvement of skills required for professional practice.

Construction of hypermedia to support the systematization of the nursing care education. / Construção de hipermídia para apoio ao ensino da sistematização da assistência de enfermagem.

OBJECTIVE: To describe the process of hypermedia construction to support the teaching of the Systematization of the Nursing Care (SNC). METHOD: Methodological research of educational technology development. The hypermedia construction stages were conducted from February 2015 to March 2016 and integrated theoretical studies, focus group with professors and educational technology development process in the light of the referential Theory of Significant Learning. RESULTS: Hypermedia consists of interactive content and shows a splash screen with a concept map that guides a free way of learning about four structuring aspects in the SNC learning: concept, history and benefits; ethical-legal aspects; operationalization; and nursing process: steps and technical integration in nursing. CONCLUSIONS: It was concluded that it is essential that the educational technologies are built from a pedagogical rationale to support your incorporation into educational environments.

Quality of life and ethics: A concept analysis.

BACKGROUND:: In health, ethics is an essential aspect of practice and care and guarantees a better quality of life for patients and their caregivers. OBJECTIVE:: To outline a conceptual analysis of quality of life and ethics, identifying attributes, contexts and magnitudes for health. METHOD:: A qualitative design about quality of life and ethics in health, considering the evolutionary approach in order to analyse the concept. To collect the data, a search was done using the keywords ethic*, quality of life and health. After, in total, 152 studies were found, finalizing seven relevant studies for the proposed concept analysis. FINDINGS AND DISCUSSION:: Of seven studies analysed, their main results were shown by means of antecedents, consequences and attributes of the concepts. The three final attributes that synthesize the concept of quality of life and ethics in health were highlighted: Ethics dilemmas and quality of life; Human ethics and quality of life; and Ethics of care and quality of life. In fact, the attributes and context clearly reveal that ethics and quality of life influence the ability to solve ethical dilemmas, guarantee human ethics in healthcare and impact ethics in healthcare for the production of effective health policies and care that encompasses professional quality of life as well. CONCLUSION:: The magnitude of ethical knowledge in each professional discipline permits cultivating a solidary attitude and developing the willingness to improve healthcare. The right to access, dignity and respect in care delivery are rooted in behaviours and are spontaneously applied in practice to the extent that they play an ethical role.