Realidade Aumentada e Realidade Virtual como inovação no curso médico / Augmented Reality and Virtual Reality as innovation in the medical course / Realidad Aumentada y Realidad Virtual como innovación en el curso médico

Apesar do ensino da medicina ser um dos mais tradicionais, o conceito de educação médica tem se desenvolvido nos últimos séculos em paralelo à evolução da medicina. Uma reflexão sobre este processo é extremamente benéfica e esclarecedora, justamente nesta fase caracterizada pelo aumento de escolas médicas e de um profundo questionamento do paradigma curricular vigente na maior parte destas instituições

The relative age effect in under-17, under-20, and adult elite female soccer players.

To investigate the RAE in elite female soccer players, the absolute and relative birthdate distributions of players who disputed the Women's World Cup were assessed. Differences between observed and expected distributions were analyzed using chi-square and effect sizes. The birthdates of 1224 female soccer players were assessed in Under-17 (N = 336), Under-20 (N = 336) and adult (N = 552) categories. There was no significant RAE in adult category for different playing positions and players in general (including all playing positions per age category). There was significant RAE for midfielders and players in general with mainly small effect sizes for the U-17 and U-20. In both age categories, players born in Q1 were over-represented with the highest quartile ratio for midfielders. In regard of RAE and success defined by final ranking at the World Cup, we found no significant differences between the birthdate distributions of players who participated in either the group stages or finally the knockout phases. Coaches should consider this information to avoid bias in talent programs designed to promote and select female soccer players independently of their birthdates. Young female players should be encouraged to learn to play in different field positions before to reach high-level performance.

Nursing outcomes for patients with multiple traumas and impaired physical mobility: An integrative review.

PURPOSE: This research identifies nursing outcomes for patients with multiple traumas who present changes in physical mobility. METHODS: This was a thorough literature review, following Whittemore and Knafl's method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses´ guidelines (2005) and adopting the Oxford Center for Evidence-Based Classification Medicine-Levels of Evidence (2011). The literature search included databases from Virtual Health Library, Cochrane Library, Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, PubMed, SciVerse Scopus, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science. It was conducted between October and December 2019 and updated in April 2022. FINDINGS: Upon our first analysis of the 254 articles that could correlate to the present study, we concluded that 15 of them are of foremost relevance. The nursing outcomes found are correlated with skin care, position in hospital bed, pressure injury prevention, self-care assistance to bath, intimate, and oral hygiene, pain control, circulatory precaution, and impaired physical mobility assistance. All of these outcomes are directly or indirectly involved with the consequences of mobility impairment. CONCLUSIONS: The main nursing outcomes of our research identified for patients with multiple traumas were related to mobility, the consequences of immobility, self-care, and skin maintenance. In conclusion, this review highlights the importance of measuring outcomes related to the provision of nursing care. IMPLICATIONS FOR NURSING PRACTICE: The nursing outcomes classification provides results that can be used across the continuum of care to assess the patient's status after nursing interventions. It also allows for improved care for multiple trauma patients who have altered mobility, identifying the real needs of these patients.

OBJETIVO: Esta pesquisa propõe a identificação dos resultados de enfermagem para pacientes politraumatizados que apresentam alterações na mobilidade física. MÉTODOS: Trata-se de uma revisão minuciosa da literatura, seguindo o método de Whittemore e Knafl e as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2005) e adotando o Oxford Centre for Evidence-Based Classification Medicine - Levels of Evidence (2011). A busca na literatura incluiu bases de dados da Biblioteca Virtual em Saúde; Biblioteca Cochrane; Base de dados Excerpta Medica; Sistema de Análise e Recuperação de Literatura Médica Online; PubMed®; SciVerse Scopus; O Índice Cumulativo para Enfermagem e Literatura de Saúde Aliada; e Web of Science. As buscas foram realizadas entre outubro e dezembro de 2019 e atualizadas em abril de 2022. RESULTADOS: Em nossa primeira análise dos 254 artigos que poderiam se correlacionar com o presente estudo, concluímos que 15 deles são de maior relevância. Os resultados de enfermagem encontrados estão correlacionados aos cuidados com a pele, posição no leito hospitalar, prevenção de lesão por pressão, assistência ao autocuidado ao banho, higiene íntima e oral, controle da dor, precaução circulatória e assistência à mobilidade física prejudicada. Todos os resultados acima mencionados estão direta ou indiretamente envolvidos com as consequências do comprometimento da mobilidade. CONCLUSÕES: Os principais resultados de enfermagem de nossa pesquisa identificados para pacientes politraumatizados foram relacionados à mobilidade, consequências da imobilidade, autocuidado e manutenção da pele. Em conclusão, esta revisão destaca a importância de medir os resultados relacionados à prestação de cuidados de enfermagem. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A Classificação de Resultados de Enfermagem fornece resultados que podem ser usados ​​em todo o continuum de cuidados para avaliar o estado do paciente após intervenções de enfermagem. Também permite melhorar o atendimento aos politraumatizados que apresentam mobilidade alterada, identificando as reais necessidades desses pacientes.

Os cuidados paliativos na visão de internos de um curso de medicina: estudo transversal / Palliative care from the perspective of internal medicine students: a cross-cross study / Cuidados paliativos desde la perspectiva de estudiantes de medicina: un estudio transversal

Este estudo teve por objetivo verificar o conhecimento de estudantes de medicina sobre cuidados paliativos em saúde durante a sua formação. Método: Estudo transversal com 58 participantes dentre um universo de 200 internos de medicina dos quatro últimos períodos da graduação (internato médico) de uma instituição de ensino superior brasileira privada sem fins lucrativos, que tem um currículo integrado com o uso intensivo de metodologias ativas de ensino-aprendizagem. Foi utilizado um questionário, enviado por meio eletrônico e que foi baseado no instrumento americano "Physician's End-of-Life Care Attitude Scale". A coleta de dados ocorreu no terceiro trimestre de 2020 e os dados foram analisados por meio da estatística descritiva simples. Resultados: Participaram 58 estudantes, entre 20 e 34 anos, sendo 72% mulheres. Apenas 15,5% se consideraram competentes em dar notícias ruins. Quanto ao manejo clínico, 65,5% necessitaram maior supervisão ou instrução básica na dispneia terminal. Na decisão de retirada do suporte ventilatório de um paciente incapaz de decidir por si, 74,1% se preocuparam com questões legais e profissionais e 77,6% com questões éticas. Em relação ao pensamento sobre a morte do paciente, 67,2% se manifestaram ansiosos ou desconfortáveis. 80% dos estudantes classificaram como importante ou muito importante abordar a temática dos cuidados paliativos durante o internato. Conclusão: Os estudantes expressaram graus variados de conhecimento acerca do tema. Manifestaram maior segurança no manejo dos principais sintomas clínicos. Observou-se que o tema morte provoca certo grau de angústia e desconforto nos estudantes, que consideram necessário o conhecimento sobre cuidados paliativos.

This study aimed to verify the knowledge of medical students about palliative health care during their training. Method: Cross-sectional study with 200 medical students from the last four periods of graduation (medical internship) at a private, non-profit Brazilian higher education institution, which has an integrated curriculum with the intensive use of active teaching-learning methodologies. A questionnaire was used, sent electronically and based on the American instrument "Physician's End-of-Life Care Attitude Scale". Data collection took place in the third quarter of 2020 and the data were analyzed using simple descriptive statistics. Results: 58 students, aged between 20 and 34 years old, 72% of whom were women. in terminal dyspnea. In the decision to withdraw ventilatory support from a patient unable to decide for himself, 74.1% were concerned with legal and professional issues and 77.6% with ethical issues. Regarding the thought about the patient's death, 67.2% expressed anxiety or discomfort. 80% of the students classified it as important or very important to address the topic of palliative care during the internship. Conclusion: The students expressed varying degrees of knowledge about the topic. They showed greater confidence in the management of the main clinical symptoms. It was observed that the theme of death causes a certain degree of anguish and discomfort in students.

Este estudio tuvo como objetivo verificar el conocimiento de los estudiantes de medicina sobre los cuidados paliativos en salud durante su formación. Método: Estudio transversal con 200 estudiantes de medicina de los últimos cuatro períodos de graduación (internado médico) en una institución de educación superior brasileña privada, sin fines de lucro, que tiene un plan de estudios integrado con el uso intensivo de metodologías activas de enseñanza-aprendizaje. Se utilizó un cuestionario, enviado electrónicamente y basado en el instrumento estadounidense "Physician's End-of-Life Care Attitude Scale". La recolección de datos se realizó en el tercer trimestre de 2020 y los datos se analizaron mediante estadística descriptiva simple. Resultados: 58 estudiantes, con edades entre 20 y 34 años, de los cuales el 72% eran mujeres. En la decisión de retirar el soporte ventilatorio a un paciente incapaz de decidir por sí mismo, el 74,1% se preocupó por cuestiones legales y profesionales y El 77,6% con problemas éticos. En cuanto al pensamiento sobre la muerte del paciente, el 67,2% manifestó ansiedad o malestar. El 80% de los estudiantes calificaron como importante o muy importante abordar el tema de cuidados paliativos durante la pasantía. Conclusión: Los estudiantes expresaron diversos grados de conocimiento sobre el tema. Mostraron mayor confianza en el manejo de los principales síntomas clínicos. Se observó que el tema de la muerte provoca cierto grado de angustia y malestar en los estudiantes.

Identifying patient safety competences among anesthesiology residents: systematic review

Abstract Introduction and objective Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and reduces costs. Moreover, while analyzing the area of anesthesiology, one can realize the epidemiological changes, increased complexity and number of procedures, and the adoption of a new matrix of essential skills mandatory for residents of anesthesiology in Brazil. Thus, it is relevant to identify current patient safety competences among anesthesiology residents. Methods A systematic review was elaborated using PubMed, SciELO, BVS, Cochrane Library, LILACS and CAPES databases with the descriptors "anesthesiology", "patient safety", "residency" and "competence". Results and conclusions Thirteen articles published in the past 10 years were analyzed. The articles depicted competences grouped into three categories: knowledge (identification, prevention and management of adverse events; use of correct and up-to-date information; understanding of human factors; and continuous learning), skills (efficient communication; teamwork; leadership; decision-making; and self-confidence), and attitude (management of stress and fatigue; and infection control). All these skills can be developed and assessed through simulation and active learning methods, profiting from a multidisciplinary approach. Studies also reveal that residents perform poorly in certain patient safety domains due to lack of effective in-depth understanding, appreciation of the topic and ineffective teaching. As a result, greater investment in the topic is needed by teaching and health institutions and researchers.

Clinical validation of nursing diagnosis fatigue (00093) in women in the immediate hospital postpartum period.

OBJECTIVE: To perform clinical validation of nursing diagnosis fatigue (00093) in women in the immediate postpartum hospital. METHOD: This is a methodological and clinical validation study of the diagnostic accuracy of nursing diagnosis fatigue (00093) components in women in the immediate postpartum hospital period. Data were collected with women in the immediate postpartum hospital. Sensitivity and specificity accuracy measures, positive and negative predictive values of the aforementioned nursing diagnosis were investigated. RESULTS: The sample consisted of 153 women in the immediate postpartum period hospitalized in the rooming-in ward, with a mean age of 27 years, whose defining characteristic with statistical significance was tiredness. CONCLUSION: The defining characteristics of tiredness and pain and related factor sleep deprivation presented high prevalence and high values of fatigue (00093) accuracy measures, being validated. Thus, it is believed that this study will contribute to clinical practice nurses in the correct identification of postpartum hospital fatigue, a frequent phenomenon in this population that causes much damage throughout the puerperium period. Additionally, it will corroborate the immediate conduct aiming at good outcome.

Content analysis of the nursing diagnosis "Excess fluid volume (00026)" in renal patients.

OBJECTIVE: To analyze the content of the conceptual and operational definitions of the related factors, associated condition and defining characteristics of the nursing diagnosis "Excess fluid volume (00026)" in hemodialysis renal patients. METHODS: Methodological study, of the content analysis type, with 49 specialists who reached a score equal to or greater than 5, according to Fehring's criteria. Thirty elements were evaluated for relevance, clarity, and precision. The experts' profile was analyzed using descriptive statistics, and the binomial test analyzed the agreement between them in relation to the terms. RESULTS: The main validated indicators were "Oliguria", "Anasarca", "Paroxysmal nocturnal dyspnea", "Dyspnea", "Change in blood pressure", "Edema", "Ingestion greater than elimination" and "Increased central venous pressure". This shows that this phenomenon is present in this population. CONCLUSION: 29 elements were validated for relevance, clarity, and precision. This result clarifies the terms that make up the phenomenon, providing a better understanding of the concept; and assists in the accurate diagnostic proposition.

Reações adversas do montelucaste no tratamento da asma pediátrica: uma revisão integrativa da literatura / Adverse reactions of montelukast in the treatment of pediatric asthma: an integrative literature review / Reacciones adversas de montelukast en el tratamiento del asma pediátrico: una revisión integrativa de la literatura

Buscou-se analisar as reações adversas do montelucaste quando prescrito para o tratamento da asma pediátrica. Revisão integrativa da literatura utilizando as bases de dados: U.S. National Library of Medicine (PubMed), Biblioteca Virtual da Saúde (BVS), SCOPUS e Business Source Complete (EBSCO), empregando os descritores: "asthma", "pediatric", "montelukast" e "adverse effects", unidos pelo booleano "AND''. Incluíram-se artigos na íntegra; publicados nos últimos 5 anos; redigidos em português, inglês ou espanhol; pesquisados em humanos e com uma relação com o nosso objetivo. Excluíram-se os que se enquadravam em nossos critérios de exclusão.Foram identificados 53 artigos, dos quais 11 compuseram a amostra final desta revisão. A exposição ao montelucaste foi associada a uma chance 2 vezes maior de reações neuropsiquiátricas em um dos artigos analisados, porém os estudos ainda não forneceram uma explicação fisiopatológica em comum. Reações neuropsiquiátricas foram as de maior prevalência, representando mais de 90% da amostra.

We analyzed the adverse reactions of montelukast when prescribed for the treatment of pediatric asthma. This is an integrative literature review using the databases: U.S. National Library of Medicine (PubMed), Virtual Health Library (BVS), SCOPUS and Business Source Complete (EBSCO), using the descriptors: "asthma", "pediatric", "montelukast" and "adverse effects", connected by the Boolean " AND''. Articles in full were included, published in the last 5 years, written in Portuguese, English or Spanish, researched in humans and related to our objective. Those that met our exclusion criteria were excluded. Fifty-three articles were identified, of which 11 comprised the final sample of this review. Exposure to montelukast was associated with a 2-fold greater chance of neuropsychiatric reactions in one of the articles analyzed, but the studies have not yet provided a common pathophysiological explanation. Neuropsychiatric reactions were the most prevalent, representing more than 90% of the sample.

Se intentó analizar las reacciones adversas de montelukast cuando se prescribe para el tratamiento del asma pediátrica. Revisión integrativa de la literatura usando las bases de datos: U.S. National Library of Medicine (PubMed), Virtual Health Library (BVS), SCOPUS y Business Source Complete (EBSCO), utilizando los descriptores: "asma", "pediátrico", "montelukast" y "efectos adversos", unidos por el booleano " Y". Se incluyeron artículos completos, publicados en los últimos 5 años, escritos en portugués, inglés o español, investigados en humanos y relacionados con nuestro objetivo. Se excluyeron aquellos que cumplieron con nuestros criterios de exclusión. Se identificaron cincuenta y tres artículos, de los cuales 11 constituyeron la muestra final de esta revisión. La exposición a montelukast se asoció con una probabilidad 2 veces mayor e reacciones neurosiquiátricas en uno de los artículos analizados, pero los estudios aún no han proporcionado una explicación fisiopatológica común. Las reacciones neurosiquiátricas fueron las más prevalentes, representando más del 90% de la muestra

Coping espiritual/religioso e fim de vida: revisão sistemática / Spiritual/religious coping and end-of-life: systematic review / Coping espiritual/religioso y fin de vida: revisión sistemática

Introdução: A espiritualidade/religiosidade é considerada uma dimensão essencial nas boas práticas em cuidados paliativos, principalmente durante a fase de terminalidade. Esses pacientes, assim como seus familiares, fazem uso de estratégias de coping espiritual/religioso. Objetivo:O objetivo desta revisão é mostrar a relação entre o coping espiritual/religioso e o processo de terminalidade. Método: A metodologia aplicada foi a revisão sistemática e utilizou PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Virtual em Saúde (BVS), PsycINFO e Scientific Electronic Library Online (SciELO) como bases de dados. Resultado: Foram capturados 96 artigos e sete foram selecionados para análise. Tais artigos abordaram questões de apego, tipos de coping, significado da doença e dificuldades de mensuração da espiritualidade/religiosidade. Conclusão: Os estudos demonstram que o coping espiritual/religioso influencia na qualidade da morte durante o processo de terminalidade.

Introduction: Spirituality/religiosity is considered an essential dimension in good practices in palliative care, especially during the terminal phase. Patients, as well as their families, make use of spiritual/religious coping strategies. Objective: The purpose of this review was to highlight the relationship between spiritual/religious coping and terminality. Method: The method applied was a systematic review that used PUBMED, LILACS, BVS, PSYCINFO and SCIELO as databases. Results: In total, 96 articles were captured and seven were selected for analysis. These articles addressed issues about attachment, types of coping, meaning of the illness and difficulties in measuring spirituality/religiosity. Conclusion:Studies indicate that spiritual/religious coping influences the quality of death during the dying process.

Introducción: La espiritualidad/religiosidad es considerada una dimensión esencial de las buenas prácticas en cuidados paliativos, principalmente durante la fase de terminalidad. Esos pacientes, así como sus familiares, utilizan estrategias de coping espiritual/religioso. Objetivo: El objetivo de esta revisión es evidenciar la relación entre el coping espiritual/religioso y el proceso de terminalidad. Método: La metodología aplicada fue la revisión sistemática que utilizó PUBMED, LILACS, BVS, PSYCINFO y SCIELO como bases de datos. Resultados: Fueron capturados 96 artículos y siete seleccionados para análisis. Tales artículos abordaron cuestiones sobre apego, tipos de coping, significado de la enfermedad y dificultades de mensuración de la espiritualidad/religiosidad. Conclusiones: Los estudios indican que el coping espiritualidad/religiosidad influye en la calidad de muerte durante el proceso de terminalidad.

Identifying patient safety competences among anesthesiology residents: systematic review.

INTRODUCTION AND OBJECTIVE: Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and reduces costs. Moreover, while analyzing the area of anesthesiology, one can realize the epidemiological changes, increased complexity and number of procedures, and the adoption of a new matrix of essential skills mandatory for residents of anesthesiology in Brazil. Thus, it is relevant to identify current patient safety competences among anesthesiology residents. METHODS: A systematic review was elaborated using PubMed, SciELO, BVS, Cochrane Library, LILACS and CAPES databases with the descriptors "anesthesiology", "patient safety", "residency" and "competence". RESULTS AND CONCLUSIONS: Thirteen articles published in the past 10 years were analyzed. The articles depicted competences grouped into three categories: knowledge (identification, prevention and management of adverse events; use of correct and up-to-date information; understanding of human factors; and continuous learning), skills (efficient communication; teamwork; leadership; decision-making; and self-confidence), and attitude (management of stress and fatigue; and infection control). All these skills can be developed and assessed through simulation and active learning methods, profiting from a multidisciplinary approach. Studies also reveal that residents perform poorly in certain patient safety domains due to lack of effective in-depth understanding, appreciation of the topic and ineffective teaching. As a result, greater investment in the topic is needed by teaching and health institutions and researchers.

Accuracy of delirium risk factors in adult intensive care unit patients.

OBJECTIVE: To assess the accuracy measurements for predisposing and precipitating Risk Factors for delirium in an adult Intensive Care Unit. METHOD: Cohort, prospective study with patients over 18 who had been hospitalized for over 24 hours and were able to communicate. The patients were assessed once a day until the onset of delirium or permanence in the Intensive Care Unit. Instruments were employed to track delirium, characterize the sample, and identify the risk factors. Descriptive statistics was employed for sample characterization and accuracy tests for risk factors. RESULTS: The included patients amounted to 102, 31 of which presented delirium. The predisposing predictive risk factors were hypoalbuminemia, American Society of Anesthesiology over three, severity, altered tissue perfusion, dehydration, and being a male, whereas precipitating predictive factors were physical restraint, infection, pharmacological agent, polypharmacy, anemia, altered renal function, dehydration, invasive devices, altered tissue perfusion and altered quality and quantity of sleep. CONCLUSION: An accurate identification of predisposing and precipitating risk factors may contribute to planning preventive measures against delirium.

Individual and interactive effects of chronic anthropogenic disturbance and rainfall on taxonomic, functional and phylogenetic composition and diversity of extrafloral nectary-bearing plants in Brazilian Caatinga.

Chronic anthropogenic disturbance (CAD) and climate change represent two of the major threats to biodiversity globally, but their combined effects are not well understood. Here we investigate the individual and interactive effects of increasing CAD and decreasing rainfall on the composition and taxonomic (TD), functional (FD) and phylogenetic diversity (PD) of plants possessing extrafloral nectaries (EFNs) in semi-arid Brazilian Caatinga. EFNs attract ants that protect plants against insect herbivore attack and are extremely prevalent in the Caatinga flora. EFN-bearing plants were censused along gradients of disturbance and rainfall in Catimbau National Park in north-eastern Brazil. We recorded a total of 2243 individuals belonging to 21 species. Taxonomic and functional composition varied along the rainfall gradient, but not along the disturbance gradient. There was a significant interaction between increasing disturbance and decreasing rainfall, with CAD leading to decreased TD, FD and PD in the most arid areas, and to increased TD, FD and PD in the wettest areas. We found a strong phylogenetic signal in the EFN traits we analysed, which explains the strong matching between patterns of FD and PD along the environmental gradients. The interactive effects of disturbance and rainfall revealed by our study indicate that the decreased rainfall forecast for Caatinga under climate change will increase the sensitivity of EFN-bearing plants to anthropogenic disturbance. This has important implications for the availability of a key food resource, which would likely have cascading effects on higher trophic levels.

Exposure of pediatric emergency patients to imaging exams, nowadays and in times of covid-19: an integrative review / Exposição de pacientes da emergência pediátrica a exames de imagem, na atualidade e em tempos de covid-19: uma revisão integrativa

ABSTRACT Objective: To analyze literature data about unnecessary exposure of pediatric emergency patients to ionizing agents from imaging examinations, nowadays and during times of COVID-19. Data sources: Between April and July 2020, articles were selected using the databases: Virtual Health Library, PubMed and Scientific Electronic Library Online. The following descriptors were used: [(pediatrics) AND (emergencies) AND (diagnostic imaging) AND (medical overuse)] and [(Coronavirus infections) OR (COVID-19) AND (pediatrics) AND (emergencies) AND (diagnostic imaging)]. Inclusion criteria were articles available in full, in Portuguese or English, published from 2016 to 2020 or from 2019 to 2020, and articles that covered the theme. Articles without adherence to the theme and duplicate texts in the databases were excluded. Data synthesis: 61 publications were identified, of which 17 were comprised in this review. Some imaging tests used in pediatric emergency departments increase the possibility of developing future malignancies in patients, since they emit ionizing radiation. There are clinical decision instruments that allow reducing unnecessary exam requests, avoiding over-medicalization, and hospital expenses. Moreover, with the COVID-19 pandemic, there was a growing concern about the overuse of imaging exams in the pediatric population, which highlights the problems pointed out by this review. Conclusions: It is necessary to improve hospital staff training, use clinical decision instruments and develop guidelines to reduce the number of exams required, allowing hospital cost savings; and reducing children's exposure to ionizing agents.

RESUMO Objetivo: Analisar dados da literatura sobre exposição desnecessária de pacientes da emergência pediátrica a agentes ionizantes dos exames de imagem, na atualidade e em tempos de COVID-19. Fontes de dados: Entre abril e julho de 2020 ocorreu a seleção dos artigos, utilizando-se as bases de dados: Biblioteca Virtual em Saúde, PubMed e Scientific Electronic Library Online. Utilizaram-se os descritores: [(pediatrics) AND (emergencies) AND (diagnostic imaging) AND (medical overuse)] e [(Coronavirus infections) OR (COVID-19) AND (pediatrics) AND (emergencies) AND (diagnostic imaging)]. Incluíram-se artigos disponíveis na íntegra, em português ou inglês, publicados no período de 2016 a 2020 ou de 2019 a 2020, e artigos que contemplassem o tema. Excluiu-se artigos sem aderência com a temática e textos duplicados. Síntese dos dados: Identificaram-se 61 publicações, sendo 17 utilizadas para a elaboração desta revisão. Alguns exames de imagem utilizados nos Setores de Urgência e Emergência (SUEs) pediátricos, por emitirem radiação ionizante, aumentam a possibilidade de desenvolver malignidades futuras nas crianças. Destarte, há instrumentos de decisão clínica que possibilitam diminuir requisições de exames desnecessários, evitando a sobremedicalização e os gastos hospitalares. Ademais, com a pandemia da COVID-19, cresceu a preocupação com o uso excessivo de exames de imagem na população pediátrica, o que reafirma a problematização deste estudo. Conclusões: Veem-se como necessárias a capacitação da equipe hospitalar, a utilização de instrumentos de decisão clínica e a confecção de protocolos que possam avaliar a singularidade da criança. Isso permitirá reduzir o número de exames requeridos, possibilitando economia de custos hospitalares e redução da exposição de crianças a agentes ionizantes.

Content analysis of the nursing diagnosis "Excess fluid volume (00026)" in renal patients / Análisis de contenido del diagnóstico de enfermería "Volumen de líquido excesivo (00026)" en pacientes renales / Análise de conteúdo do diagnóstico de enfermagem "Volume de líquido excessivo (00026)" em pacientes renais

ABSTRACT Objective: To analyze the content of the conceptual and operational definitions of the related factors, associated condition and defining characteristics of the nursing diagnosis "Excess fluid volume (00026)" in hemodialysis renal patients. Methods: Methodological study, of the content analysis type, with 49 specialists who reached a score equal to or greater than 5, according to Fehring's criteria. Thirty elements were evaluated for relevance, clarity, and precision. The experts' profile was analyzed using descriptive statistics, and the binomial test analyzed the agreement between them in relation to the terms. Results: The main validated indicators were "Oliguria", "Anasarca", "Paroxysmal nocturnal dyspnea", "Dyspnea", "Change in blood pressure", "Edema", "Ingestion greater than elimination" and "Increased central venous pressure". This shows that this phenomenon is present in this population. Conclusion: 29 elements were validated for relevance, clarity, and precision. This result clarifies the terms that make up the phenomenon, providing a better understanding of the concept; and assists in the accurate diagnostic proposition.

RESUMEN Objetivo: Analizar el contenido de las definiciones conceptuales y operacionales de los factores relacionados, condición asociada y características definidoras del diagnóstico de enfermería "Volumen de líquido excesivo (00026)" en pacientes renales hemodialíticos. Métodos: Estudio metodológico, del tipo análisis de contenido, con 49 especialistas que alcanzaron puntuación igual o mayor a 5, segundo criterios de Fehring. Treinta elementos fueron evaluados cuanto a la relevancia, claridad y precisión. El perfil de los especialistas fue analizado por medio de la estadística descriptiva, y la prueba binomial analizó concordancia entre ellos en relación a los términos. Resultados: Los principales indicadores validados fueron "Oliguria", "Anasarca", "Disnea paroxística nocturna", "Disnea", "Alteración en la presión arterial", "Edema", "Ingestión mayor que la eliminación" y "Aumento de la presión venosa central". Eso evidencia que tal fenómeno está presente en esa población. Conclusión: Fueron validados cuanto a la relevancia, claridad y precisión, 29 elementos. Ese resultado clarifica los términos que componen el fenómeno, confiriendo una mejor comprensión del concepto; y auxilia en la proposición diagnóstica cuidada.

RESUMO Objetivo: Analisar o conteúdo das definições conceituais e operacionais dos fatores relacionados, condição associada e características definidoras do Diagnóstico de Enfermagem "Volume de líquido excessivo (00026)" em pacientes renais hemodialíticos. Métodos: Estudo metodológico, do tipo análise de conteúdo, com 49 especialistas que atingiram pontuação igual ou maior a cinco, segundo critérios de Fehring. Trinta elementos foram avaliados quanto à relevância, clareza e precisão. O perfil dos especialistas foi analisado por meio da estatística descritiva, e o teste binomial analisou concordância entre eles em relação aos termos. Resultados: Os principais indicadores validados foram "Oligúria", "Anasarca", "Dispneia paroxística noturna", "Dispneia", "Alteração na pressão arterial", "Edema", "Ingestão maior que a eliminação" e "Aumento da pressão venosa central". Isso evidencia que tal fenômeno está presente nessa população. Conclusão: Foram validados quanto à relevância, clareza e precisão, 29 elementos. Esse resultado clarifica os termos que compõem o fenômeno, conferindo uma melhor compreensão do conceito; e auxilia na proposição diagnóstica acurada.

Seasonality and bait type driving the diversity of dung beetle (Scarabaeidae: Scarabaeinae) communities in urban remnants of the Atlantic Forest

ABSTRACT Describing dung beetle communities in tropical forest remnants located in disturbed/urbanized and conserved areas can provide information about the functioning of these ecosystems and support conservation plans. This study aimed to verify the effect of seasons and bait type on dung beetle communities in remnants of the Atlantic Forest in order to describe their composition and diversity parameters. The study was carried out during both the rainy and dry seasons in periurban and urban remnants. Eighteen pitfall traps baited with feces, carrion, and injured millipedes were established in each site. A total of 3501 individuals and 23 species were recorded. Urban remnant presented higher abundance of individuals in the dry season. On the other hand, in periurban remnant the higher abundance was verified in the rainy season. The diversity was higher in the rainy season in both sites. In urban remnant, Coprophanaeus ensifer was found to be generalist regarding its choice of bait (feces and carrion). The use of injured millipedes as bait allowed the record of the predatory species Deltochilum alpercata. Among the types of bait used, the injured millipedes proved to be very effective, capturing a greater diversity of dung beetles during the rainy season in both remnants, and allowed the collection of specialized, necrophages, and generalists species. Therefore, we propose the use of mixed-bait sampling designs in inventories and surveys to increase the chances of sampling species with different traits or dietary preferences, which are often rare in collections.

Accuracy of delirium risk factors in adult intensive care unit patients / Exactitud de los factores de riesgo de delírium en pacientes de una unidad de cuidados intensivos de adultos / Acurácia dos fatores de risco para delirium em paciente de unidade de terapia intensiva adulto

Abstract Objective: To assess the accuracy measurements for predisposing and precipitating Risk Factors for delirium in an adult Intensive Care Unit. Method: Cohort, prospective study with patients over 18 who had been hospitalized for over 24 hours and were able to communicate. The patients were assessed once a day until the onset of delirium or permanence in the Intensive Care Unit. Instruments were employed to track delirium, characterize the sample, and identify the risk factors. Descriptive statistics was employed for sample characterization and accuracy tests for risk factors. Results: The included patients amounted to 102, 31 of which presented delirium. The predisposing predictive risk factors were hypoalbuminemia, American Society of Anesthesiology over three, severity, altered tissue perfusion, dehydration, and being a male, whereas precipitating predictive factors were physical restraint, infection, pharmacological agent, polypharmacy, anemia, altered renal function, dehydration, invasive devices, altered tissue perfusion and altered quality and quantity of sleep. Conclusion: An accurate identification of predisposing and precipitating risk factors may contribute to planning preventive measures against delirium.

RESUMEN Objetivo: Evaluar las medidas de exactitud de los factores de riesgo predisponentes y precipitantes del delírium en pacientes de una Unidad de Cuidados Intensivos de adultos. Método: Estudio de cohorte prospectivo en pacientes mayores de 18 años con más de 24 horas de hospitalización y capaces de comunicarse, evaluados una vez al día hasta el desarrollo de delírium o estancia en la Unidad de Cuidados Intensivos. Se utilizaron instrumentos para seguir el delírium, caracterizar la muestra y identificar los factores de riesgo. Se utilizaron estadísticas descriptivas para caracterizar la muestra y pruebas de exactitud para los factores de riesgo. Resultados: Se incluyeron 102 pacientes y 31 presentaron delírium. Se identificaron los factores de riesgo predictivos predisponentes: hipoalbuminemia, puntuación de la American Society of Anesthesiology superior a tres, gravedad, cambios en la perfusión tisular, deshidratación y sexo masculino. Los factores de riesgo precipitantes fueron: restricción física, infección, agente farmacológico, polifarmacia, anemia, cambio de la función renal, deshidratación, dispositivos invasivos, cambios en la perfusión tisular y cambios en la calidad y cantidad del sueño. Conclusión: La identificación exacta de los factores de riesgo predisponentes y precipitantes puede ayudar a planificar medidas preventivas contra el delírium.

RESUMO Objetivo: Avaliar as medidas de acurácia dos Fatores de Risco predisponentes e precipitantes para o delirium em pacientes em Unidade de Terapia Intensiva adulto. Método: Estudo de coorte prospectivo em pacientes maiores de 18 anos, mais de 24 horas de internação, capazes de se comunicar, avaliados uma vez ao dia, até desenvolvimento do delirium ou permanência na Unidade de Terapia Intensiva. Utilizou-se instrumentos para rastreio do delirium, caracterização da amostra e identificação dos fatores de risco. Estatística descritiva para caracterização da amostra e testes de acurácia aos fatores de risco. Resultados: Incluídos 102 pacientes e 31 apresentaram delirium, identificado fatores de risco preditivos predisponentes: hipoalbuminemia, American Society of Anestesiology maior que três, gravidade, alteração da perfusão tissular, desidratação e sexo masculino, já os preditivos precipitantes: restrição física, infecção, agente farmacológico, polifarmácia, anemia, alteração da função renal, desidratação, dispositivos invasivos, alteração da perfusão tissular e alteração na qualidade e quantidade do sono. Conclusão: Identificação acurada dos fatores de risco predisponentes e precipitantes podem auxiliar no planejamento de medidas preventivas ao delirium.

Clinical validation of nursing diagnosis fatigue (00093) in women in the immediate hospital postpartum period / Validación clínica del diagnóstico de enfermería fatiga (00093) en mujeres en el puerperio hospitalario inmediato / Validação clínica do diagnóstico de enfermagem fadiga (00093) em mulheres no pós-parto hospitalar imediato

ABSTRACT Objective: To perform clinical validation of nursing diagnosis fatigue (00093) in women in the immediate postpartum hospital. Method: This is a methodological and clinical validation study of the diagnostic accuracy of nursing diagnosis fatigue (00093) components in women in the immediate postpartum hospital period. Data were collected with women in the immediate postpartum hospital. Sensitivity and specificity accuracy measures, positive and negative predictive values of the aforementioned nursing diagnosis were investigated. Results: The sample consisted of 153 women in the immediate postpartum period hospitalized in the rooming-in ward, with a mean age of 27 years, whose defining characteristic with statistical significance was tiredness. Conclusion: The defining characteristics of tiredness and pain and related factor sleep deprivation presented high prevalence and high values of fatigue (00093) accuracy measures, being validated. Thus, it is believed that this study will contribute to clinical practice nurses in the correct identification of postpartum hospital fatigue, a frequent phenomenon in this population that causes much damage throughout the puerperium period. Additionally, it will corroborate the immediate conduct aiming at good outcome.

RESUMEN Objetivo: Realizar la validación clínica del diagnóstico de enfermería fatiga (00093) en mujeres en el posparto inmediato hospitalario. Método: Se trata de un estudio metodológico, de tipo validación clínica, de precisión diagnóstica de los componentes del diagnóstico de enfermería fatiga (00093) en mujeres en el puerperio hospitalario inmediato. La recolección de datos se realizó con mujeres en el hospital de posparto inmediato. Se investigaron medidas de precisión de sensibilidad y especificidad, valores predictivos positivo y negativo del referido diagnóstico de enfermería. Resultados: La muestra estuvo constituida por 153 mujeres en puerperio inmediato hospitalizadas en sala de alojamiento conjunto, con una edad promedio de 27 años, cuya característica definidora con significación estadística fue la fatiga. Conclusión: Las características definitorias de cansancio y dolor y el factor relacionado con la privación del sueño tuvieron una alta prevalencia y altos valores de precisión de las medidas de fatiga (00093), en proceso de validación. Así, se cree que este estudio contribuirá a los enfermeros de la práctica clínica en la correcta identificación de la fatiga posparto hospitalaria, un fenómeno frecuente en esta población que causa mucho daño a lo largo del puerperio. Además, se corroborará en la conducción inmediata apuntando a un buen desenlace.

RESUMO Objetivo: Realizar a validação clínica do diagnóstico de enfermagem fadiga (00093) em mulheres no pós-parto hospitalar imediato. Método: Trata-se de estudo metodológico, do tipo validação clínica, de acurácia diagnóstica dos componentes do diagnóstico de enfermagem fadiga (00093) em mulheres no pós-parto hospitalar imediato. A coleta de dados foi realizada junto a mulheres no pós-parto imediato hospitalar. Foram investigadas as medidas de acurácias de sensibilidade e especificidade, valores preditivos positivos e negativos do referido diagnóstico de enfermagem. Resultados: A amostra foi composta por 153 mulheres no pós-parto imediato internadas na enfermaria de alojamento conjunto, com idade média de 27 anos, cuja característica definidora com significância estatística foi cansaço. Conclusão: As características definidoras cansaço e dor e o fator relacionado privação de sono apresentaram alta prevalência e altos valores de medidas de acurácia para fadiga (00093), sendo validadas. Assim, acredita-se que este estudo contribuirá para os enfermeiros da prática clínica na identificação correta da fadiga pós-parto hospitalar, um fenômeno frequente nesta população que causa muitos prejuízos em todo período do puerpério. Além disso, corroborará na condução imediata visando bom desfecho.

Plastome evolution in the Caesalpinia group (Leguminosae) and its application in phylogenomics and populations genetics.

MAIN CONCLUSION: The chloroplast genomes of Caesalpinia group species are structurally conserved, but sequence level variation is useful for both phylogenomic and population genetic analyses. Variation in chloroplast genomes (plastomes) has been an important source of information in plant biology. The Caesalpinia group has been used as a model in studies correlating ecological and genomic variables, yet its intergeneric and infrageneric relationships are not fully solved, despite densely sampled phylogenies including nuclear and plastid loci by Sanger sequencing. Here, we present the de novo assembly and characterization of plastomes from 13 species from the Caesalpinia group belonging to eight genera. A comparative analysis was carried out with 13 other plastomes previously available, totalizing 26 plastomes and representing 15 of the 26 known Caesalpinia group genera. All plastomes showed a conserved quadripartite structure and gene repertoire, except for the loss of four ndh genes in Erythrostemon gilliesii. Thirty polymorphic regions were identified for inter- or intrageneric analyses. The 26 aligned plastomes were used for phylogenetic reconstruction, revealing a well-resolved topology, and dividing the Caesalpinia group into two fully supported clades. Sixteen microsatellite (cpSSR) loci were selected from Cenostigma microphyllum for primer development and at least two were cross-amplified in different Leguminosae subfamilies by in vitro or in silico approaches. Four loci were used to assess the genetic diversity of C. microphyllum in the Brazilian Caatinga. Our results demonstrate the structural conservation of plastomes in the Caesalpinia group, offering insights into its systematics and evolution, and provides new genomic tools for future phylogenetic, population genetics, and phylogeographic studies.

Conceptual and operational definition of the components of the nursing diagnosis hypothermia (00006) in the perioperative period.

OBJECTIVE: to construct the conceptual and operational definitions of the defining and conceptual characteristics of the related factors of the nursing diagnosis (ND) hypothermia (00006) of NANDA-I, 2015-2017, in adult patients in the perioperative period. METHOD: an integrative literature review in the Medical Literature Analysis and Retrieval System Online, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and in Latin & American Literature in Health Sciences databases. RESULTS: 2,041 articles were found, 95 selected for reading in full and 24 used to construct such definitions. Gay literature was also explored to ensure robustness to the elucidation of topics not found in articles. CONCLUSION: such definitions will assist nurses in surgical practice in information collection, in accurate determination of the referred ND, in teaching and in future research related to this theme, as well as in the next validation stages of such ND to the referred population.

Chemotherapy in focus: A meta-analysis confronts immunotherapy in the treatment of advanced melanoma.

This study aimed to analyze the efficacy of the monoclonal antibodies ipilimumab, nivolumab, and pembrolizumab when compared with conventional chemotherapy in the treatment of advanced melanoma. Three authors made the search independently and five articles matched the eligibility criteria. A fourth expert confirmed their quality (κ = 1). The meta-analysis for overall survival and 12-month overall survival was impaired due to remarkably high heterogeneity (I2 = 91 % and 86 %, respectively). However, chemotherapy showed benefits on 24-months overall survival (RR = 1.60; IC95 %: 1.29, 1.98; p < 0.0001). The interruption by toxicity outcome showed no significant differences between therapies. Some studies used monoclonal antibodies in monotherapy or in combination and some groups of participants showed heterogeneity, which made the analysis difficult. Given the exorbitant costs of monoclonal antibodies in low and middle-income countries, the evidence of its benefits is limited when considering the replacement of conventional therapy with immunotherapy in public health systems.