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1.
PLoS One ; 16(8): e0255382, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34379648

RESUMO

To achieve herd immunity against COVID-19, it is crucial to know the drivers of vaccination intention and, thereby, vaccination. As the determinants of vaccination differ across vaccines, target groups and contexts, we investigate COVID-19 vaccination intention using data from university students from three countries, the Netherlands, Belgium and Portugal. We investigate the psychological drivers of vaccination intention using the 5C model as mediator. This model includes five antecedents of vaccination: Confidence, Complacency, Constraints, Calculation and Collective Responsibility. First, we show that the majority of students have a positive propensity toward getting vaccinated against COVID-19, though only 41% of students are completely acceptant. Second, using the 5C model, we show that 'Confidence' (ß = 0.33, SE = 03, p < .001) and 'Collective Responsibility' (ß = 0.35, SE = 04, p < .001) are most strongly related to students' COVID-19 vaccination intention. Using mediation analyses, we show that the perceived risk and effectiveness of the vaccine as well as trust in the government and health authorities indirectly relate to vaccination intention through 'Confidence'. The perceived risk of COVID-19 for one's social circle and altruism, the need to belong and psychopathy traits indirectly relate to vaccination intention through 'Collective Responsibility'. Hence, targeting the psychological characteristics associated with 'Confidence' and 'Collective Responsibility' can improve the effectiveness of vaccination campaigns among students.


Assuntos
COVID-19/prevenção & controle , Modelos Teóricos , Estudantes/psicologia , Vacinação/psicologia , Altruísmo , COVID-19/virologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/imunologia , Humanos , Risco , SARS-CoV-2/isolamento & purificação , Autoeficácia , Inquéritos e Questionários
2.
Rev Port Cardiol (Engl Ed) ; 40(6): 437-444, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34274085

RESUMO

INTRODUCTION AND AIMS: Catheter ablation has been shown to improve left ventricular (LV) ejection fraction (LVEF) in patients with atrial fibrillation (AF) and heart failure (HF). Our aim was to assess the impact of AF ablation on the outcome of patients with HF and LV systolic dysfunction. METHODS: We performed a retrospective observational cohort study of all patients with HF and LVEF <50% and with no apparent cause for systolic dysfunction other than AF who underwent catheter ablation in a tertiary referral center between July 2016 and November 2018. The primary endpoint was a ≥5% improvement in LVEF. Secondary endpoints included improvement in New York Heart Association (NYHA) class and reduction in LV end-diastolic diameter (LVEDD) and left atrial diameter (LAD). RESULTS: Of 153 patients who underwent AF ablation in this period, 22 (77% male, median age 61 [IQR 54-64] years) fulfilled the inclusion criteria. Median follow-up was 11.1 months (IQR 6.1-19.0). After ablation, median LVEF increased from 40% (IQR 33-41) to 58% (IQR 55-62) (p<0.01), mean NYHA class improved from 2.35±0.49 to 1.3±0.47 (p<0.001), and median LAD and LVEDD decreased from 48.0 (IQR 43.5-51.5) mm to 44 (IQR 40-49) mm (p<0.01) and from 61.0 (IQR 54.0-64.8) mm to 55.0 (52.2-58.0) mm (p<0.01), respectively. CONCLUSION: In patients with HF and LV systolic dysfunction, AF ablation is associated not only with improved functional status but also with favorable structural remodeling, including improvement in LVEF and decreases in LAD and LVEDD.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Fibrilação Atrial/cirurgia , Feminino , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
3.
Rev Port Cardiol (Engl Ed) ; 40(7): 465-471, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34274091

RESUMO

INTRODUCTION: Coronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case in Portugal. As such, we aimed to assess the effect on STEMI admissions and outcomes in Portuguese centers. METHODS: We conducted a single-center, observational, retrospective study including all patients admitted to our hospital due to STEMI between the date of the first SARS-CoV-2 case diagnosed in Portugal and the end of the state of emergency (March and April 2020). Patient characteristics and outcomes were assessed and compared with the same period of 2019. RESULTS: A total of 104 STEMI patients were assessed, 55 in 2019 and 49 in 2020 (-11%). There were no significant differences between groups regarding age (62±12 vs. 65±14 years, p=0.308), gender (84.8% vs. 77.6% males, p=0.295) or comorbidities. In the 2020 group, there was a significant decrease in the proportion of patients transported to the hospital in pre-hospital emergency medical transportation (38.2% vs. 20.4%, p=0.038), an increase in system delay (49 [30-110.25] vs. 140 [90-180] minutes, p=0.019), a higher Killip-Kimball class, with a decrease in class I (74.5% vs. 51%) and an increase in class III (1.8% vs. 8.2%) and IV (5.5% vs. 18.4%) (p=0.038), a greater incidence of vasoactive support (3.7% vs. 26.5%, p=0.001), invasive mechanic ventilation usage (3.6% vs. 14.3%, p=0.056), and an increase in severe left ventricular dysfunction at hospital discharge (3.6% vs. 16.3%, p=0.03). In-hospital mortality was 14.3% in the 2020 group and 7.3% in the 2019 group p=0.200). CONCLUSION: Despite a lack of significant variation in the absolute number of STEMI admissions, there was an increase in STEMI clinical severity and significantly worse outcomes during the SARS-CoV-2 pandemic. An increase in system delay, impaired pre-hospital care and patient fear of in-hospital infection can partially justify these results and should be the target of future actions in further waves of the pandemic.


Assuntos
COVID-19 , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Feminino , Humanos , Masculino , Pandemias , Portugal/epidemiologia , Dados Preliminares , Estudos Retrospectivos , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
4.
Rev Port Cardiol ; 40(7): 465-471, 2021 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33849772

RESUMO

INTRODUCTION: Coronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case in Portugal. As such, we aimed to assess the effect on STEMI admissions and outcomes in Portuguese centers. METHODS: We conducted a single-center, observational, retrospective study including all patients admitted to our hospital due to STEMI between the date of the first SARS-CoV-2 case diagnosed in Portugal and the end of the state of emergency (March and April 2020). Patient characteristics and outcomes were assessed and compared with the same period of 2019. RESULTS: A total of 104 STEMI patients were assessed, 55 in 2019 and 49 in 2020 (-11%). There were no significant differences between groups regarding age (62±12 vs. 65±14 years, p=0.308), gender (84.8% vs. 77.6% males, p=0.295) or comorbidities. In the 2020 group, there was a significant decrease in the proportion of patients transported to the hospital in pre-hospital emergency medical transportation (38.2% vs. 20.4%, p=0.038), an increase in system delay (49 [30-110.25] vs. 140 [90-180] minutes, p=0.019), a higher Killip-Kimball class, with a decrease in class I (74.5% vs. 51%) and an increase in class III (1.8% vs. 8.2%) and IV (5.5% vs. 18.4%) (p=0.038), a greater incidence of vasoactive support (3.7% vs. 26.5%, p=0.001), invasive mechanic ventilation usage (3.6% vs. 14.3%, p=0.056), and an increase in severe left ventricular dysfunction at hospital discharge (3.6% vs. 16.3%, p=0.03). In-hospital mortality was 14.3% in the 2020 group and 7.3% in the 2019 group p=0.200). CONCLUSION: Despite a lack of significant variation in the absolute number of STEMI admissions, there was an increase in STEMI clinical severity and significantly worse outcomes during the SARS-CoV-2 pandemic. An increase in system delay, impaired pre-hospital care and patient fear of in-hospital infection can partially justify these results and should be the target of future actions in further waves of the pandemic.


Assuntos
COVID-19 , Hospitalização/estatística & dados numéricos , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Portugal/epidemiologia , Dados Preliminares , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
5.
BMJ Case Rep ; 14(4)2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853814

RESUMO

Eosinophilic granulomatosis with polyangiitis is an antineutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis with cardiac involvement in more than 60% of cases. Authors describe the case of a 48-year-old woman who presented with progressively worsening asthenia, dyspnoea and macular, non-painful, non-itchy cutaneous lesions. She had signs of congestion on clinical examination and a history of asthma and nasal polyps. Blood tests showed eosinophilia (11.2%), positive troponin I (9698 µg/L), elevated B-type natriuretic peptide (2047 pg/mL) and positive C reactive protein (6.68 mg/dL). Echocardiogram displayed moderate left ventricular enlargement, left ventricular ejection fraction of 28% and mild pericardial effusion. Levosimendan relieved the congestion. Additional testing confirmed positive antinuclear antibodies with ANCA-negative autoimmune pattern. Cardiac magnetic resonance showed severely depressed systolic function due to diffuse hypokinesia. Cardiac biopsy had intercellular oedema and eosinophilic infiltrate. Treatment with prednisolone and cyclophosphamide was started. This is a case of a rare disease presenting with life-threatening cardiac involvement.


Assuntos
Síndrome de Churg-Strauss , Granulomatose com Poliangiite , Insuficiência Cardíaca , Anticorpos Anticitoplasma de Neutrófilos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Humanos , Pessoa de Meia-Idade , Doenças Raras , Volume Sistólico , Função Ventricular Esquerda
6.
Arq Bras Cardiol ; 116(2): 219-226, 2021 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33656068

RESUMO

BACKGROUND: Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection. OBJECTIVE: This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension. METHODS: This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A. Group B included 205 patients without PH who underwent HT. Pulmonary hemodynamics were evaluated before HT, as well as 1 week after and 1 year after HT. Survival was compared between the groups. In this study, a p value < 0.05 was considered statistically significant. RESULTS: After treatment with sildenafil but before HT, PVR (-39%) and sPAP (-10%) decreased significantly. sPAP decreased after HT in both groups, but it remained significantly higher in group A vs. group B (40.3 ± 8.0 mmHg vs 36.5 ± 11.5 mmHg, p=0.022). One year after HT, sPAP was 32.4 ± 6.3 mmHg in group A vs 30.5 ± 8.2 mmHg in group B (p=0.274). The survival rate after HT at 30 days (97% in group A versus 96% in group B), at 6 months (87% versus 93%) and at one year (80% vs 91%) were not statistically significant (Log-rank p=0.063). After this first year, the attrition rate was similar among both groups (conditional survival after 1 year, Log-rank p=0.321). CONCLUSION: In patients with severe PH pre-treated with sildenafil, early post-operative hemodynamics and prognosis are numerically worse than in patients without PH, but after 1 year, the medium to long-term mortality proved to be similar. (Arq Bras Cardiol. 2021; 116(2):219-226).


Assuntos
Transplante de Coração , Hipertensão Pulmonar , Hemodinâmica , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Estudos Retrospectivos , Citrato de Sildenafila/uso terapêutico , Resultado do Tratamento
7.
Intern Emerg Med ; 2021 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-33713285

RESUMO

Admission hyperglycemia (AH) is associated with worse prognosis in patients with acute myocardial infarction (AMI). Controversy remains whether the impact of AH differs among patients previously diagnosed with diabetes mellitus (DM). We retrospectively evaluated consecutive patients admitted in a coronary care unit with AMI, from 2006 to 2014. Patients were divided into 4 groups: patients without known DM with admission glycemia (AG) ≤ 143 mg/dL (group 1), patients without known DM with AG > 143 mg/dL (group 2), known DM with AG ≤ 213 mg/dL (group 3), and known DM with AG > 213 mg/dL (group 4). Primary outcome was defined as all-cause mortality during follow-up. A total of 2768 patients were included: 1425 in group 1, 426 in group 2, 593 in group 3, and 325 in group 4. After a median follow-up of 5.6 years, 1047 (37.8%) patients reached primary outcome. After multivariate analysis, group 4 was associated with the worst prognosis (HR 3.103, p < 0.001) followed by group 3 (HR 1.639, p = 0.002) and group 2 (HR 1.557, p = 0.039), when compared to group 1. When groups were stratified by type of AMI, patients in group 2 had a worse prognosis than patients in group 3 in the case of non-ST-segment elevation AMI. AH is associated with higher all-cause mortality in patients with AMI, irrespective of previous diabetic status.

8.
Rev Port Cardiol ; 40(6): 437-444, 2021 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33640240

RESUMO

INTRODUCTION AND AIMS: Catheter ablation has been shown to improve left ventricular (LV) ejection fraction (LVEF) in patients with atrial fibrillation (AF) and heart failure (HF). Our aim was to assess the impact of AF ablation on the outcome of patients with HF and LV systolic dysfunction. METHODS: We performed a retrospective observational cohort study of all patients with HF and LVEF <50% and with no apparent cause for systolic dysfunction other than AF who underwent catheter ablation in a tertiary referral center between July 2016 and November 2018. The primary endpoint was a ≥5% improvement in LVEF. Secondary endpoints included improvement in New York Heart Association (NYHA) class and reduction in LV end-diastolic diameter (LVEDD) and left atrial diameter (LAD). RESULTS: Of 153 patients who underwent AF ablation in this period, 22 (77% male, median age 61 [IQR 54-64] years) fulfilled the inclusion criteria. Median follow-up was 11.1 months (IQR 6.1-19.0). After ablation, median LVEF increased from 40% (IQR 33-41) to 58% (IQR 55-62) (p<0.01), mean NYHA class improved from 2.35±0.49 to 1.3±0.47 (p<0.001), and median LAD and LVEDD decreased from 48.0 (IQR 43.5-51.5) mm to 44 (IQR 40-49) mm (p<0.01) and from 61.0 (IQR 54.0-64.8) mm to 55.0 (52.2-58.0) mm (p<0.01), respectively. CONCLUSION: In patients with HF and LV systolic dysfunction, AF ablation is associated not only with improved functional status but also with favorable structural remodeling, including improvement in LVEF and decreases in LAD and LVEDD.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações , Função Ventricular Esquerda
9.
Medicine (Baltimore) ; 100(3): e23987, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545989

RESUMO

ABSTRACT: The use of beta-blockers (BB) in the context of ST-segment elevation myocardial infarction (STEMI) was a universal practice in the pre-reperfusion era. Since then, evidence of their use for secondary prevention after STEMI is scarce. Our aim is to determine treatment results associated with BB therapy after a STEMI at 1-year follow-up in a contemporary nationwide cohort.A prospective analysis involving 49 national centers, including patients admitted with STEMI, enrolled between October 2010 and September 2019 was conducted. The primary outcome was defined as the composite of all-cause mortality or hospital re-admission for a cardiovascular (CV) cause in the first year after STEMI. The patients were distributed into 2 groups, depending on whether they received therapy with BB at hospital discharge or not (BB and NB group, respectively).A total of 3145 patients were included in the analysis, of which 2526 (80.3%) in the BB group. A total of 12.2% of patients reached the primary outcome. Regarding the univariate Cox regression analysis, the BB group presented lower mortality or re-admission for CV cause at 1-year follow-up [hazard ratio (HR) 0.69, confidence interval (CI) 95% 0.55-0.87, P = .001]. However, after adjustment for significant covariates, this association was lost (HR 0.73, CI 95% 0.51-1.04, P = .081). In patients with preserved (HR 0.73, CI 95% 0.51-1.04, P = .081) and mid-range (HR 1.01, CI 95% 0.64-1.61, P = .959) left ventricular ejection fraction (LVEF), the primary outcome was similar between the 2 groups, while in patients with reduced LVEF, the BB group presented a better prognosis, with fewer patients reaching the primary outcome (HR 0.431, CI 95% 0.262-0.703, P = .001).BB universal therapy after STEMI has not proved useful, but it seems to be beneficial in patients with reduced LVEF.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Prevenção Secundária/estatística & dados numéricos , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Portugal , Estudos Prospectivos , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/prevenção & controle , Resultado do Tratamento
10.
Arq. bras. cardiol ; 116(2): 219-226, fev. 2021. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1153005

RESUMO

Resumo Fundamento A resistência vascular pulmonar elevada ainda é um grande problema na seleção de candidatos ao transplante cardíaco. Objetivo Nosso objetivo foi avaliar o efeito da administração de sildenafila pré-transplante cardíaco em pacientes com hipertensão pulmonar fixa. Métodos O estudo retrospectivo, de centro único, incluiu 300 candidatos a transplante cardíaco consecutivos tratados entre 2003 e 2013. Destes, 95 pacientes tinham hipertensão pulmonar fixa e, dentre eles, 30 pacientes foram tratados com sildenafila e acabaram passando pelo transplante, formando o Grupo A. O Grupo B incluiu 205 pacientes sem hipertensão pulmonar que passaram pelo transplante cardíaco. A hemodinâmica pulmonar foi avaliada antes do transplante, 1 semana e 1 ano após o transplante. A taxa de sobrevivência foi comparada entre os grupos. Neste estudo, um P valor < 0,05 foi considerado estatisticamente significativo. Resultados Após o tratamento com sildenafila, mas antes do TxC, a RVP (-39%) e a PAPs (-10%) diminuíram significativamente. A PAPs diminuiu após o TxC em ambos os grupos, mas permaneceu significativamente alta no grupo A em relação ao grupo B (40,3 ± 8,0 mmHg versus 36,5 ± 11,5 mmHg, P=0,022). Um ano após o TxC, a PAPs era 32,4 ± 6,3 mmHg no Grupo A versus 30,5 ± 8,2 mmHg no Grupo B (P=0,274). O índice de sobrevivência após o TxC 30 dias (97% no grupo A versus 96% no grupo B), 6 meses (87% versus 93%) e um ano (80% versus 91%) após o TxC não foi estatisticamente significativo (Log-rank P=0,063). Depois do primeiro ano, o índice de mortalidade era similar entre os dois grupos (sobrevivência condicional após 1 ano, Log-rank p=0,321). Conclusão Nos pacientes com HP pré-tratados com sildenafila, a hemodinâmica pós-operatória inicial e o prognóstico são numericamente piores em pacientes sem HP, mas depois de 1 ano, a mortalidade em médio e longo prazo são semelhantes. (Arq Bras Cardiol. 2021; 116(2):219-226)


Abstract Background Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection. Objective This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension. Methods This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A. Group B included 205 patients without PH who underwent HT. Pulmonary hemodynamics were evaluated before HT, as well as 1 week after and 1 year after HT. Survival was compared between the groups. In this study, a p value < 0.05 was considered statistically significant. Results After treatment with sildenafil but before HT, PVR (-39%) and sPAP (-10%) decreased significantly. sPAP decreased after HT in both groups, but it remained significantly higher in group A vs. group B (40.3 ± 8.0 mmHg vs 36.5 ± 11.5 mmHg, p=0.022). One year after HT, sPAP was 32.4 ± 6.3 mmHg in group A vs 30.5 ± 8.2 mmHg in group B (p=0.274). The survival rate after HT at 30 days (97% in group A versus 96% in group B), at 6 months (87% versus 93%) and at one year (80% vs 91%) were not statistically significant (Log-rank p=0.063). After this first year, the attrition rate was similar among both groups (conditional survival after 1 year, Log-rank p=0.321). Conclusion In patients with severe PH pre-treated with sildenafil, early post-operative hemodynamics and prognosis are numerically worse than in patients without PH, but after 1 year, the medium to long-term mortality proved to be similar. (Arq Bras Cardiol. 2021; 116(2):219-226)

11.
Texto & contexto enferm ; 30: e20200111, 2021. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1252272

RESUMO

ABSTRACT Objective: to identify and analyze in the literature the use of the mobile simulation strategy for health professionals and for the community. Method: a scoping review based on the procedures recommended by the Joanna Briggs Institute. The search databases were the following: PubMed, CINAHL via EBSCO, Scopus, LILACS, Portugal's Open Access Scientific Repository and CAPES Dissertations Database. The guiding question was the following: What contributions of the mobile simulation have been identified and assessed in the training processes of health professionals and of the community? There was no limitation regarding publication year, and nine studies were selected. Results: 2011 had the highest number of publications on this theme, most of them coming from the United States. It was evidenced that the mobile simulation contributed to the training of health professionals and community-dwelling individuals, favored the development of the professionals' clinical competencies, and proved to be an effective tool to take training to remote zones. Conclusion: mobile simulation is a modality that contributes to the development of the simulated practice regarding the active teaching method; however, it is still little explored, and expanding the perspectives of its implementation emerges as a challenge.


RESUMEN Objetivo: identificar y analizar en la literatura el uso de la estrategia da simulación móvil para profesionales de la salud y para la comunidad. Método: revisión sistemática exploratoria basada en los procedimientos recomendados por el Instituto Joanna Briggs. Las bases de datos de la búsqueda fueron las siguientes: PubMed, CINAHL via EBSCO, Scopus, LILACS, Repositorio Científico de Acceso Abierto de Portugal y Base de datos de Tesis de Capes. La pregunta guía fue la siguiente: ¿qué contribuciones de la simulación móvil se han identificado y evaluado en los procesos de formación de profesionales de la salud y de la comunidad? No hubo restricciones con respecto al año de publicación, y se seleccionó un total de nueve estudios. Resultados: el año 2011 obtuvo la mayor cantidad de publicaciones sobre la temática, la mayoría proveniente de los Estados Unidos. Quedó evidenciado que la simulación móvil contribuyó a la formación de profesionales de la salud y de residentes de la comunidad, favoreció el desarrollo de competencias clínicas de los profesionales y demostró ser una herramienta efectiva para acercar la capacitación a zonas remotas. Conclusión: la simulación móvil es una modalidad que contribuye al desarrollo de la práctica simulada en cuanto al método de enseñanza activa; sin embargo, sigue siendo poco explorada, y ampliar las perspectivas de su implementación se configura como un desafío.


RESUMO Objetivo: identificar e analisar na literatura a utilização da estratégia da simulação móvel para profissionais de saúde e para a comunidade. Método: revisão de escopo baseada nos procedimentos recomendados pelo Instituto Joanna Briggs. As bases de busca foram: PubMed, CINAHL via EBSCO, Scopus, LILACS, Repositório Científico de Acesso Aberto de Portugal e Banco de Teses da Capes. A pergunta norteadora foi: quais contribuições da simulação móvel têm sido identificadas e avaliadas nos processos de formação de profissionais de saúde e da comunidade? Não se delimitou ano de publicação e foram selecionados nove estudos. Resultados: o ano de 2011 obteve o maior número de publicações sobre a temática, a maioria proveniente dos Estados Unidos. Evidenciou-se que a simulação móvel contribuiu para a formação de profissionais da saúde e pessoas da comunidade, favoreceu o desenvolvimento de competências clínicas dos profissionais e revelou-se como uma ferramenta efetiva para levar treinamento e capacitações para zonas remotas. Conclusão: a simulação móvel é uma modalidade que contribui para o desenvolvimento da prática simulada enquanto método de ensino ativo; entretanto, ainda é pouco explorada, e configura-se como um desafio ampliar as perspectivas de sua implementação.


Assuntos
Humanos , Adulto , Educação em Saúde , Simulação , Simulação de Paciente , Pessoal de Saúde , Participação da Comunidade , Treinamento por Simulação
12.
Texto & contexto enferm ; 30: e20200130, 2021. graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1252283

RESUMO

ABSTRACT Objective: to know the perception of nursing professionals about the in situ strategy in continuing education in intensive care. Method: a descriptive, exploratory and qualitative study, conducted with 15 nursing professionals from an Intensive Care Unit. Data was collected from December 2018 to February 2019, by means of semi-structured interviews, after in situ simulations that occurred in the work environment and involving two settings, one on septic shock and the other, cardiorespiratory arrest. For analysis, the collective subject discourse technique was applied using a software program. Results: from the 15 nursing professionals participating in the study, eight were nurses and seven were nursing technicians. Their age varied from 23 to 56 years old and their time in intensive care ranged from two months to 17 years. The in situ simulation was perceived as an opportunity to update and acquire professional knowledge, skills and competencies, especially for those without experience, favoring the gain of self-confidence, communication, decision-making and clinical reasoning. The simulated in situ strategy was also portrayed as a possibility of training in the professional practice and in real time, unlike traditional training, and also, as a safe environment to make mistakes of diverse magnitudes because it is a training setting. Conclusion: the professionals understand the in situ simulation as being valid for professional update and practical learning in a safe setting.


RESUMEN Objetivo: conocer la percepción de los profesionales de Enfermería sobre la estrategia de la simulación in situ en la educación permanente en cuidados intensivos. Método: estudio descriptivo, exploratorio y cualitativo, realizado con 15 profesionales de Enfermería de una Unidad de Cuidados Intensivos. Los datos se recolectaron entre diciembre de 2018 y febrero de 2019 por medio de entrevistas semiestructurada, después de simulaciones in situ que tuvieron lugar en el ámbito laboral e incluyeron dos situaciones hipotéticas, una sobre shock séptico y otra, sobre parada cardiorrespiratoria. Para el análisis se aplicó la técnica del Discurso del Sujeto Colectivo con el uso de un programa de software. Resultados: de los 15 profesionales de Enfermería que participaron del estudio, ocho eran enfermeros y siete técnicos de enfermería. La edad varió entre 23 y 56 años y la experiencia en cuidados intensivos osciló entre dos meses y 17 años. La simulación in situ se percibió como oportunidad de actualización y adquisición de conocimientos, habilidades y competencias profesionales, principalmente para quienes carecían de experiencia, favoreciendo así una mejoría en los niveles de autoconfianza, comunicación, toma de decisiones y raciocinio clínico. La estrategia simulada in situ también se representó como una posibilidad de capacitación en la práctica profesional y en tiempo real, a diferencias de sistemas tradicionales de capacitación e, incluso, como un ámbito seguro para cometer errores de diversas magnitudes, por tratarse de una situación de entrenamiento. Conclusión: los profesionales perciben la estrategia de la simulación in situ como válida para la actualización profesional y el aprendizaje práctico en un ámbito seguro.


RESUMO Objetivo: conhecer a percepção dos profissionais de enfermagem sobre a estratégia da simulação in situ na educação permanente em terapia intensiva. Método: estudo descritivo, exploratório, qualitativo, realizado com 15 profissionais de enfermagem de uma Unidade de Terapia Intensiva. Os dados foram coletados de dezembro de 2018 a fevereiro de 2019, por meio de entrevista semiestruturada, após as simulações in situ ocorridas no ambiente de trabalho e que envolveram dois cenários, um sobre choque séptico e outro, parada cardiorrespiratória. Para a análise aplicou-se a técnica Discurso do Sujeito Coletivo com o emprego de um software. Resultados: dos 15 profissionais de enfermagem participantes do estudo, oito eram enfermeiros e sete técnicos de enfermagem. A idade variou de 23 a 56 anos e o tempo de atuação em terapia intensiva oscilou de dois meses a 17 anos. A simulação in situ foi percebida como uma oportunidade de atualização e aquisição de conhecimentos, habilidades e competências profissionais, principalmente para aqueles sem experiência, favorecendo o ganho de autoconfiança, a comunicação, a tomada de decisão e o raciocínio clínico. A estratégia simulada in situ também foi retratada como possibilidade de treinamento na prática profissional e em tempo real, diferentemente de treinamentos tradicionais e, ainda, como um ambiente seguro para cometer erros de várias magnitudes por se configurar um cenário de treinamento. Conclusão: os profissionais percebem a estratégia da simulação in situ como válida para a atualização profissional e aprendizado prático em ambiente seguro.


Assuntos
Humanos , Simulação , Enfermagem , Educação Continuada , Educação em Enfermagem , Unidades de Terapia Intensiva , Simulação de Doença
13.
Sensors (Basel) ; 20(24)2020 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-33302494

RESUMO

The estimation of the parameters of an odour source is of high relevance for multiple applications, but it can be a slow and error prone process. This work proposes a fast particle filter-based method for source term estimation with a mobile robot. Two strategies are implemented in order to reduce the computational cost of the filter and increase its accuracy: firstly, the sampling process is adapted by the mobile robot in order to optimise the quality of the data provided to the estimation process; secondly, the filter is initialised only after collecting preliminary data that allow limiting the solution space and use a shorter number of particles than it would be normally necessary. The method assumes a Gaussian plume model for odour dispersion. This models average odour concentrations, but the particle filter was proved adequate to fit instantaneous concentration measurements to that model, while the environment was being sampled. The method was validated in an obstacle free controlled wind tunnel and the validation results show its ability to quickly converge to accurate estimates of the plume's parameters after a reduced number of plume crossings.

14.
JACC Basic Transl Sci ; 5(11): 1149-1162, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33294743

RESUMO

Pulmonary arterial hypertension (PAH) is a rare, chronic disease of the pulmonary vasculature that is associated with poor outcomes. Its pathogenesis is multifactorial and includes micro-RNA (miRNA) deregulation. The understanding of the role of miRNAs in PAH is expanding quickly, and it is increasingly difficult to identify which miRNAs have the highest translational potential. This review summarizes the current knowledge of miRNA expression in PAH, discusses the challenges in miRNA analysis and interpretation, and highlights 4 promising miRNAs in this field (miR-29, miR-124, miR-140, and miR-204).

15.
Life Sci Alliance ; 3(12)2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33097557

RESUMO

Ischemic heart disease has been associated with an impairment on intercellular communication mediated by both gap junctions and extracellular vesicles. We have previously shown that connexin 43 (Cx43), the main ventricular gap junction protein, assembles into channels at the extracellular vesicle surface, mediating the release of vesicle content into target cells. Here, using a comprehensive strategy that included cell-based approaches, animal models and human patients, we demonstrate that myocardial ischemia impairs the secretion of Cx43 into circulating, intracardiac and cardiomyocyte-derived vesicles. In addition, we show that ubiquitin signals Cx43 release in basal conditions but appears to be dispensable during ischemia, suggesting an interplay between ischemia-induced Cx43 degradation and secretion. Overall, this study constitutes a step forward for the characterization of the signals and molecular players underlying vesicle protein sorting, with strong implications on long-range intercellular communication, paving the way towards the development of innovative diagnostic and therapeutic strategies for cardiovascular disorders.

16.
Rev Lat Am Enfermagem ; 28: e3329, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32813782

RESUMO

OBJECTIVE: develop and validate a video on bed bathing directed to nursing professionals and students. METHOD: the video was based on the literature and presents the definition of bed bath, indications for its performance, steps to perform it, and potential complications. Nursing professors and nurses validated it. They assessed the pertinence of content, clarity, and language of the video scenes. The Delphi Technique was used in this phase. After recording, three nursing professors, along with undergraduate nursing students from a public university, assessed the educational video. The professors first watched the video and suggested changes, and then the students watched the video after the changes were implemented. RESULTS: six rounds were needed for experts to validate the video script using the Delphi Technique. After the video recording, undergraduate students considered the video of easy understanding. CONCLUSION: the video script was composed of four topics and was validated by experts after six rounds. The video was assessed by the professors and nursing undergraduate students, who considered the topics and the video as a whole as apprehensible. This study is expected to contribute to professional training and improvement of the knowledge and skills of nursing students.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Banhos , Humanos , Gravação em Vídeo
17.
Eur Geriatr Med ; 11(5): 813-820, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32557249

RESUMO

PURPOSE: An individualized approach should be taken regarding the use of novel oral anticoagulants (NOAC) in frail and older patients with atrial fibrillation (AF). We hypothesized that there would be a high proportion of underdosed patients among an older and frail population, where bleeding risk is higher. METHODS: We retrospectively analyzed patients admitted to an Internal Medicine ward with a previous diagnosis of AF and discharged with a NOAC (n = 327). We compared survival and incidence of dosing-related events (stroke, systemic embolism, and major bleeding) at 1-year between inappropriately underdosed patients (dose reduction without a formal indication) and the rest of the population. RESULTS: A total of 167 patients (51%) received a reduced dose despite lacking formal criteria for dose reduction. Before adjustment, underdosed patients, in comparison with non-underdosed patients, had a higher mortality at 1 year (HR = 1.6, 95% CI 1.2-2.1, p = 0.003) and a higher combined stroke, systemic embolism, and major bleeding event rate at 1-year (HR = 3.2, 95% CI 1.3-8.0, p = 0.015). After adjustment, combined stroke, systemic embolism, and major bleeding event rate was higher in underdosed patients (HR 3.7, 95% CI 1.1-12.3, p = 0.030), but survival was not different in the adjusted model (HR 1.4, 95% CI 0.9-2.1, p = 0.110). CONCLUSIONS: Underdosed patients have a significant survival disadvantage and this may be due to clinician prescription bias, since this difference does not remain after adjusting for confounders. Combined stroke, systemic embolism, and major bleeding event rate was higher in underdosed patients.

18.
Rev Lat Am Enfermagem ; 28: e3286, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32578750

RESUMO

OBJECTIVE: to develop and validate with a panel of experts a scenario of maternal-child clinical simulation, related to humanized childbirth and birth. METHOD: methodological study based on the Jeffries framework and standardized guides of the International Nursing Association for Clinical Simulation in Learning, which used analysis with descriptive statistics for general aspects of adherence to the aforementioned guide and inferential statistics for validating the checklist of actions through the Intraclass Correlation Coefficient (ICC). RESULTS: the scenario contains learning objectives, necessary resources, prebriefing and debriefing of guidelines, description of the simulated situation, participants and roles, and checklist of expected actions. The validation obtained an agreement level above 80% in all aspects evaluated by 31 experts, highlighting realism of the environment and setting, vital sign parameters, alignment with scientific literature and encouragement of critical thinking and problem solving. In addition, the checklist of actions was validated with 0.899 agreement among experts, statistically analyzed by the ICC and Cronbach's alpha 0.908 (95% confidence interval). CONCLUSION: the simulated scenario on humanized childbirth and birth can strengthen the articulation between women's and children's health disciplines, and was validated by experts.


Assuntos
Parto Obstétrico/educação , Educação em Enfermagem , Humanismo , Parto , Treinamento por Simulação , Adulto , Lista de Checagem , Humanos
19.
BMC Cardiovasc Disord ; 20(1): 301, 2020 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-32560700

RESUMO

BACKGROUND: A key strategy for the primary prevention of cardiovascular disease (CVD) is the use of risk prediction algorithms. We aimed to investigate the predictive ability of SCORE (Systematic COronary Risk Estimation) and PCE (Pooled Cohort Equations) systems for atherosclerotic CVD (ASCVD) risk in Portugal, a low CVD risk country, at the 10-year landmark and at a longer, 15-year follow-up. METHODS: The SCORE and PCE 10-year risk estimates were calculated for 455 and 448 patients, respectively. Discrimination was assessed by Harrell's C-statistic. Calibration was analyzed by standardized incidence ratios (SIR). RESULTS: During the 10-year follow-up, 7 fatal ASCVD events (the SCORE outcome) and 32 any ASCVD events (the PCE outcome) occurred. The SCORE system showed good discrimination (C-statistic 0.83), while the PCE showed poor discrimination (C-statistic 0.62). Calibration was similar for both systems, according to SIR: SCORE, 0.3 (95% CI 0.1-0.7); PCE, 0.5 (95% CI 0.4-0.7). Globally, both 10-year fatal ASCVD risk and any ASCVD risk were overestimated in the overall population and men. However, the risk was underestimated by both systems in women. Despite an overestimation of 15-year fatal ASCVD by SCORE, the 15-year any ASCVD observed incidence was 1.8 times the 10-year incidence among men and 1.4 times among women. This acceleration of CVD risk was more relevant in the lowest classes of ASCVD risk. CONCLUSION: In this prospective, contemporary, Portuguese cohort, the SCORE had better discriminatory power and similar calibration compared to PCE. However, both risk scores underestimated 10-year ASCVD risk in women.


Assuntos
Algoritmos , Aterosclerose/epidemiologia , Técnicas de Apoio para a Decisão , Fatores de Risco de Doenças Cardíacas , Adulto , Idoso , Aterosclerose/diagnóstico , Aterosclerose/mortalidade , Aterosclerose/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Prevenção Primária , Estudos Prospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo
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