Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 379
Filtrar
1.
Infect Control Hosp Epidemiol ; : 1-7, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34847983

RESUMO

OBJECTIVE: To assess experience, physical infrastructure, and capabilities of high-level isolation units (HLIUs) planning to participate in a 2018 global HLIU workshop hosted by the US National Emerging Special Pathogens Training and Education Center (NETEC). DESIGN: An electronic survey elicited information on general HLIU organization, operating costs, staffing models, and infection control protocols of select global units. SETTING AND PARTICIPANTS: The survey was distributed to site representatives of 22 HLIUs located in the United States, Europe, and Asia; 19 (86%) responded. METHODS: Data were coded and analyzed using descriptive statistics. RESULTS: The mean annual reported budget for the 19 responding units was US$484,615. Most (89%) had treated a suspected or confirmed case of a high-consequence infectious disease. Reported composition of trained teams included a broad range of clinical and nonclinical roles. The mean number of HLIU beds was 6.37 (median, 4; range, 2-20) for adults and 4.23 (median, 2; range, 1-10) for children; however, capacity was dependent on pathogen. CONCLUSIONS: Responding HLIUs represent some of the most experienced HLIUs in the world. Variation in reported unit infrastructure, capabilities, and procedures demonstrate the variety of HLIU approaches. A number of technical questions unique to HLIUs remain unanswered related to physical design, infection prevention and control procedures, and staffing and training. These key areas represent potential focal points for future evidence and practice guidelines. These data are important considerations for hospitals considering the design and development of HLIUs, and there is a need for continued global HLIU collaboration to define best practices.

2.
Dalton Trans ; 50(44): 16336-16342, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34734620

RESUMO

Reaction of bis(pinacolato)diboron with (6-Dipp)CuOtBu generates a ring-expanded N-heterocyclic carbene supported copper(I) boryl, (6-Dipp)CuBpin. This compound showed remarkable stability and was characterised by NMR spectroscopy and X-ray crystallography. (6-Dipp)CuBpin readily dechalcogenated a range of heterocumulenes such as CO2, isocyanates and isothiocyanates to yield (6-Dipp)CuXBpin (X = O, S). In the case of CO2 catalytic reduction to CO is viable in the presence of excess bis(pinacolato)diboron. In contrast, in the case of iso(thio)cyanates, the isocyanide byproduct of dechalcogenation reacted with (6-Dipp)CuBpin to generate a copper(I) borylimidinate, (6-Dipp)CuC(NR)Bpin, which went on to react with heterocumulenes. This off-cycle reactivity gives selective access to a range of novel boron-containing heterocycles bonded to copper, but precludes catalytic reactivity.

3.
ACS Catal ; 11(21): 13649-13659, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34777911

RESUMO

Noyori-Ikariya type [(arene)RuCl(TsDPEN)] (TsDPEN, sulfonated diphenyl ethylenediamine) complexes are widely used C=O and C=N reduction catalysts that produce chiral alcohols and amines via a key ruthenium-hydride intermediate that determines the stereochemistry of the product. Whereas many details about the interactions of the pro-chiral substrate with the hydride complex and the nature of the hydrogen transfer from the latter to the former have been investigated over the past 25 years, the role of the stereochemical configuration at the stereogenic ruthenium center in the catalysis has not been elucidated so far. Using operando FlowNMR spectroscopy and nuclear Overhauser effect spectroscopy, we show the existence of two diastereomeric hydride complexes under reaction conditions, assign their absolute configurations in solution, and monitor their interconversion during transfer hydrogenation catalysis. Configurational analysis and multifunctional density functional theory (DFT) calculations show the λ-(R,R)S Ru configured [(mesitylene)RuH(TsDPEN)] complex to be both thermodynamically and kinetically favored over its λ-(R,R)R Ru isomer with the opposite configuration at the metal. Computational analysis of both diastereomeric catalytic manifolds show the major λ-(R,R)S Ru configured [(mesitylene)RuH(TsDPEN)] complex to dominate asymmetric ketone reduction catalysis with the minor λ-(R,R)R Ru [(mesitylene)RuH(TsDPEN)] stereoisomer being both less active and less enantioselective. These findings also hold true for a tethered catalyst derivative with a propyl linker between the arene and TsDPEN ligands and thus show enantioselective transfer hydrogenation catalysis with Noyori-Ikariya complexes to proceed via a lock-and-key mechanism.

5.
Inorg Chem ; 60(21): 16256-16265, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34661399

RESUMO

A combined experimental and computational study of the structure and reactivity of two [RuZn2Me2] complexes, neutral [Ru(PPh3)(Ph2PC6H4)2(ZnMe)2] (2) and cationic [Ru(PPh3)2(Ph2PC6H4)(ZnMe)2][BArF4] ([BArF4] = [B{3,5-(CF3)2C6H3}4]) (3), is presented. Structural and computational analyses indicate these complexes are best formulated as containing discrete ZnMe ligands in which direct Ru-Zn bonding is complemented by weaker Zn···Zn interactions. The latter are stronger in 2, and both complexes exhibit an additional Zn···Caryl interaction with a cyclometalated phosphine ligand, this being stronger in 3. Both 2 and 3 show diverse reactivity under thermolysis and with Lewis bases (PnBu3, PCy3, and IMes). With 3, all three Lewis bases result in the loss of [ZnMe]+. In contrast, 2 undergoes PPh3 substitution with PnBu3, but with IMes, loss of ZnMe2 occurs to form [Ru(PPh3)(C6H4PPh2)(C6H4PPhC6H4Zn(IMes))H] (7). The reaction of 3 with H2 affords the cationic trihydride complex [Ru(PPh3)2(ZnMe)2(H)3][BArF4] (12). Computational analyses indicate that both 12 and 7 feature bridging hydrides that are biased toward Ru over Zn.

6.
Front Pediatr ; 9: 707648, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34631612

RESUMO

Objective: To identify psychosocial problems and self-esteem in children with growth hormone deficiency (GHD) and define the role of some clinical and sociodemographic determinants in the conceptualization of internalizing and externalizing problems as criteria for psychosocial functioning. Materials and Methods: A GHD sample (46 prepubescent children) was selected and compared to a matched control group (80 healthy children). Psychosocial functioning in children with GHD was investigated using Goodman's "Strengths and Difficulties Questionnaire (SDQ)." The study of children's self-esteem was carried out by the Dembo-Rubinstein method. Results: This study reveals that the GHD sample has more internalizing problems and lower self-esteem. Higher score and frequency of assessment in the abnormal score for "total difficulties," "emotional problem," and "peer problem" were found in children with GHD. The SDQ score and the frequency of assessment in the abnormal score for all SDQ scales in children with more pronounced growth deficit (height SDS < -3) did not exceed the same indicators in children with less growth retardation (-3 < height SDS < -2). A comparison of psychosocial features in children with isolated growth hormone deficiency and multiple pituitary hormones deficiency did not reveal differences in SDQ score and the frequency of assessment in the abnormal score for all SDQ scales. It was found that children with GHD have a reduced level of assertions, low self-esteem, and a weak discrepancy between the level of assertions and self-esteem. Some sociodemographic determinants (male gender, age < 9 years, and low family income) and clinical determinants (low compliance and suboptimal growth response after 1 year of rGHh therapy) have an impact on the overall assessment of psychological problems in children with GHD. The internalizing difficulties are associated with certain clinical determinants (growth status and treatment status) and sociodemographic determinants (female gender, age < 9 years). Conclusions: The identification of low self-esteem and the high SDQ score for scales "total difficulties," "emotional problems," and "peer problems" indicates psychosocial maladjustment and conceptualization of internalizing problems in children with GHD.

7.
JAMA Netw Open ; 4(9): e2126447, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34550382

RESUMO

Importance: Scalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in kindergarten through 12th grade settings. Objectives: To characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning. Design, Setting, and Participants: This pilot quality improvement program engaged 3 schools in Omaha, Nebraska, for weekly saliva polymerase chain reaction testing of staff and students participating in in-person learning over a 5-week period from November 9 to December 11, 2020. Wastewater, air, and surface samples were collected weekly and tested for SARS-CoV-2 RNA to evaluate surrogacy for case detection and interrogate transmission risk of in-building activities. Main Outcomes and Measures: SARS-CoV-2 detection in saliva and environmental samples and risk factors for SARS-CoV-2 infection. Results: A total of 2885 supervised, self-collected saliva samples were tested from 458 asymptomatic staff members (mean [SD] age, 42.9 [12.4] years; 303 women [66.2%]; 25 Black or African American [5.5%], 83 Hispanic [18.1%], 312 White [68.1%], and 35 other or not provided [7.6%]) and 315 students (mean age, 14.2 [0.7] years; 151 female students [48%]; 20 Black or African American [6.3%], 201 Hispanic [63.8%], 75 White [23.8%], and 19 other race or not provided [6.0%]). A total of 46 cases of SARS-CoV-2 (22 students and 24 staff members) were detected, representing an increase in cumulative case detection rates from 1.2% (12 of 1000) to 7.0% (70 of 1000) among students and from 2.1% (21 of 1000) to 5.3% (53 of 1000) among staff compared with conventional reporting mechanisms during the pilot period. SARS-CoV-2 RNA was detected in wastewater samples from all pilot schools as well as in air samples collected from 2 choir rooms. Sequencing of 21 viral genomes in saliva specimens demonstrated minimal clustering associated with 1 school. Geographical analysis of SARS-CoV-2 cases reported district-wide demonstrated higher community risk in zip codes proximal to the pilot schools. Conclusions and Relevance: In this study of staff and students in 3 urban public schools in Omaha, Nebraska, weekly screening of asymptomatic staff and students by saliva polymerase chain reaction testing was associated with increased SARS-CoV-2 case detection, exceeding infection rates reported at the county level. Experiences differed among schools, and virus sequencing and geographical analyses suggested a dynamic interplay of school-based and community-derived transmission risk. Collectively, these findings provide insight into the performance and community value of test-based SARS-CoV-2 screening and surveillance strategies in the kindergarten through 12th grade educational setting.


Assuntos
Teste para COVID-19/métodos , COVID-19/epidemiologia , Monitoramento Ambiental , Programas de Rastreamento , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas , População Urbana , Adolescente , Adulto , Microbiologia do Ar , COVID-19/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nebraska , Pandemias , Projetos Piloto , Reação em Cadeia da Polimerase , Medição de Risco , SARS-CoV-2 , Saliva , Professores Escolares , Estudantes , Águas Residuárias/virologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-34408261

RESUMO

BACKGROUND: Aerosol transmission of COVID-19 is the subject of ongoing policy debate. Characterizing aerosol produced by people with COVID-19 is critical to understanding the role of aerosols in transmission. OBJECTIVE: We investigated the presence of virus in size-fractioned aerosols from six COVID-19 patients admitted into mixed acuity wards in April of 2020. METHODS: Size-fractionated aerosol samples and aerosol size distributions were collected from COVID-19 positive patients. Aerosol samples were analyzed for viral RNA, positive samples were cultured in Vero E6 cells. Serial RT-PCR of cells indicated samples where viral replication was likely occurring. Viral presence was also investigated by western blot and transmission electron microscopy (TEM). RESULTS: SARS-CoV-2 RNA was detected by rRT-PCR in all samples. Three samples confidently indicated the presence of viral replication, all of which were from collected sub-micron aerosol. Western blot indicated the presence of viral proteins in all but one of these samples, and intact virions were observed by TEM in one sample. SIGNIFICANCE: Observations of viral replication in the culture of submicron aerosol samples provides additional evidence that airborne transmission of COVID-19 is possible. These results support the use of efficient respiratory protection in both healthcare and by the public to limit transmission.

9.
J Occup Environ Hyg ; 18(9): 430-435, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34383620

RESUMO

Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were assessed using an ingestible, wireless-transmission thermometer while performing patient care tasks common to a high-level isolation unit setting in powered air purifying respirator (PAPR)-level. The objective was to determine the potential for occupational health hazard due to heat stress in an environmentally controlled unit. Maximum core temperatures of the six participants ranged from 37.4 °C (99.3 °F) to 39.9 °C (103.8°F) during the 4-hr shift; core temperatures of half (n = 3) of the participants exceeded 38.5 °C (101.3 °F), the upper core temperature limit. Future investigations are needed to identify other heat stress risks both in and outside of controlled units. The ongoing COVID-19 pandemic offers unique opportunities for field-based research on risks of heat stress related to personal protective equipment in healthcare workers that can lead to both short- and long-term innovations in this field.


Assuntos
Temperatura Corporal/fisiologia , COVID-19/epidemiologia , Transtornos de Estresse por Calor/etiologia , Isolamento de Pacientes , Equipamento de Proteção Individual/efeitos adversos , Adulto , Índice de Massa Corporal , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Pandemias , Projetos Piloto , SARS-CoV-2
10.
Bioanalysis ; 2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34289743

RESUMO

Aim: Evaluation of suitable pharmacokinetic properties is critical for successful development of IgG-based biotherapeutics. The prolonged half-lives of IgGs depend on the intracellular trafficking function of neonatal Fc receptor, which rescues internalized IgGs from lysosomal degradation and recycles them back to circulation. Results: Here, we developed a novel cell-based assay to quantify recycling of monoclonal antibodies in a transwell culture system that uses a cell line that stably expresses human neonatal Fc receptor. We tested seven therapeutic antibodies and showed that the recycling output of the assay strongly correlated with the clearance in humans. Conclusion: This recycling assay has potential application as a pharmacokinetic prescreening tool to facilitate development and selection of IgG-based candidate therapeutic monoclonal antibodies.

11.
Clin Infect Dis ; 2021 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-34318871

RESUMO

Emerging infectious disease epidemics require a rapid response from health systems; however, evidence-based consensus guidelines are generally absent early in the course of events. Formed in 2017 by five high-level isolation units spanning three continents, the experience of the Global Infectious Disease Preparedness Network (GIDPN) early in the course of COVID-19 provides a model for accelerating best practice development and improving decision-making in health emergencies. The network served as a platform for real-time, open and transparent information-sharing during unknowns of an active outbreak by clinicians caring for patients, by researchers conducting clinical trials and transmission and infection prevention studies, and by teams advising local and national policymakers. Shared knowledge led to earlier adoption of some treatment modalities as compared to most peer institutions and to implementation of protocols prior to incorporation into national guidelines. GIDPN and similar networks are integral in enhancing preparedness for and response to future epidemics/pandemics.

12.
JBI Evid Synth ; 19(6): 1354-1361, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-34111044

RESUMO

OBJECTIVE: The aim of the review is to critically appraise and synthesize quantitative and qualitative evidence on the barriers and facilitators to general practitioners participating in implementation research for the purposes of evaluating translation of evidence into practice. INTRODUCTION: General practice is a distinct medical specialty that requires its own specific research; therefore, general practitioner participation in research is key in translating new knowledge into practice. However, recruiting general practitioners to research as participants is challenging. Understanding general practitioner behavior in relation to their participation in implementation research is critical. INCLUSION CRITERIA: Implementation studies that include general practitioners in primary health care settings will be considered. This review will consider quantitative, qualitative, and mixed methods studies from developed countries investigating barriers and facilitators to general practitioners participating in implementation research. METHODS: The review will be conducted in accordance with JBI methodology for mixed methods systematic reviews. The main databases accessed will be MEDLINE and Scopus, and include studies published in English between 2008 and the present. Two independent reviewers will read and screen relevant articles, assess for quality, extract study characteristics, and synthesize data. This review is taking an integrated approach involving transformed quantitative data. Primary outcome measures will include study details and outcomes related to the research question. Qualitative and transformed quantitative data will be mapped to the Theoretical Domains Framework at extraction phase. Synthesis will include identified barriers and facilitators categorized using the Theoretical Domains Framework indicators to provide future research and implementation recommendations for recruiting general practitioners to implementation research. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42020176759).


Assuntos
Medicina Geral , Clínicos Gerais , Atenção à Saúde , Humanos , Atenção Primária à Saúde , Revisões Sistemáticas como Assunto
13.
Chemistry ; 27(52): 13221-13234, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34190374

RESUMO

The addition of PPh2 H, PPhMeH, PPhH2 , P(para-Tol)H2 , PMesH2 and PH3 to the two-coordinate Ni0 N-heterocyclic carbene species [Ni(NHC)2 ] (NHC=IiPr2 , IMe4 , IEt2 Me2 ) affords a series of mononuclear, terminal phosphido nickel complexes. Structural characterisation of nine of these compounds shows that they have unusual trans [H-Ni-PR2 ] or novel trans [R2 P-Ni-PR2 ] geometries. The bis-phosphido complexes are more accessible when smaller NHCs (IMe4 >IEt2 Me2 >IiPr2 ) and phosphines are employed. P-P activation of the diphosphines R2 P-PR2 (R2 =Ph2 , PhMe) provides an alternative route to some of the [Ni(NHC)2 (PR2 )2 ] complexes. DFT calculations capture these trends with P-H bond activation proceeding from unconventional phosphine adducts in which the H substituent bridges the Ni-P bond. P-P bond activation from [Ni(NHC)2 (Ph2 P-PPh2 )] adducts proceeds with computed barriers below 10 kcal mol-1 . The ability of the [Ni(NHC)2 ] moiety to afford isolable terminal phosphido products reflects the stability of the Ni-NHC bond that prevents ligand dissociation and onward reaction.

14.
Faraday Discuss ; 229(0): 422-442, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34075917

RESUMO

The hydroformylation of 1-hexene with 12 bar of 1 : 1 H2/CO in the presence of the catalytic system [Rh(acac)(CO)2]/PPh3 was successfully studied by real-time multinuclear high-resolution FlowNMR spectroscopy at 50 °C. Quantitative reaction progress curves that yield rates as well as chemo- and regioselectivities have been obtained with varying P/Rh loadings. Dissolved H2 can be monitored in solution to ensure true operando conditions without gas limitation. 31P{1H} and selective excitation 1H pulse sequences have been periodically interleaved with 1H FlowNMR measurements to detect Rh-phosphine intermediates during the catalysis. Stopped-flow experiments in combination with diffusion measurements and 2D heteronuclear correlation experiments showed the known tris-phosphine complex [RhH(CO)(PPh3)3] to generate rapidly exchanging isomers of the bis-phosphine complex [Rh(CO)2(PPh3)2] under CO pressure that directly enter the catalytic cycle. A new mono-phosphine acyl complex has been identified as an in-cycle reaction intermediate.

16.
Am J Emerg Med ; 47: 253-257, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33965895

RESUMO

INTRODUCTION: As a result of the COVID-19 pandemic and highly contagious nature of SARS-CoV-2, emergency departments (EDs) have been forced to implement new measures and protocols to minimize the spread of the disease within their departments. The primary objective of this study was to determine if the implementation of a designated COVID-19 cohort area (hot zone) within a busy ED mitigated the dissemination of SARS-CoV-2 throughout the rest of the department. METHODS: In an ED of a tertiary academic medical center, with 64,000 annual visits, an eight room pod was designated for known COVID-19 or individuals with high suspicion for infection. There was a single entry and exit for donning and doffing personal protective equipment (PPE). Health care workers (HCW) changed gowns and gloves between patients, but maintained their N-95 mask and face shield, cleaning the shield with a germicidal wipe between patients. Staffing assignments designated nurses and technicians to remain in this area for 4 h, where physicians regularly moved between the hot zone and rest of the ED. Fifteen surface samples and four air samples were taken to evaluate SARS-CoV-2 contamination levels and the effectiveness of infection control practices. Samples were collected outside of patient rooms in 3 primary ED patient care areas, the reception area, the primary nurses station, inside the cohort area, and the PPE donning and doffing areas immediately adjacent. Samples were recovered and analyzed for the presence of the E gene of SARS-CoV-2 using RT-PCR. RESULTS: SARS-CoV-2 was not detected on any surface samples, including in and around the cohort area. All air samples outside the COVID-19 hot zone were negative for SARS-CoV-2, but air samples within the cohort area had a low level of viral contamination. CONCLUSION: A designated COVID-19 cohort area resulted in no air or surface contamination outside of the hot zone, and only minimal air, but no surface contamination, within the hot zone.


Assuntos
COVID-19/prevenção & controle , COVID-19/transmissão , Serviço Hospitalar de Emergência , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , COVID-19/epidemiologia , Luvas Protetoras , Pessoal de Saúde , Humanos , Quartos de Pacientes , Equipamento de Proteção Individual , Roupa de Proteção , Dispositivos de Proteção Respiratória , SARS-CoV-2 , Manejo de Espécimes , Centros de Atenção Terciária
17.
J Neuroinflammation ; 18(1): 113, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985529

RESUMO

BACKGROUND: Sex and age are emerging as influential variables that affect spinal cord injury (SCI) recovery. Despite a changing demographic towards older age at the time of SCI, the effects of sex or age on inflammation remain to be elucidated. This study determined the sex- and age-dependency of the innate immune response acutely after SCI. METHODS: Male and female mice of ages 4- and 14-month-old received T9 contusion SCI and the proportion of microglia, monocyte-derived macrophages (MDM), and neutrophils surrounding the lesion were determined at 3- and 7-day post-injury (DPI) using flow cytometry. Cell counts of microglia and MDMs were obtained using immunohistochemistry to verify flow cytometry results at 3-DPI. Microglia and MDMs were separately isolated using fluorescence-activated cell sorting (FACS) at 3-day post-injury (DPI) to assess RNA expression of 27 genes associated with activation, redox, and debris metabolism/clearance. RESULTS: Flow cytometry revealed that being female and older at the time of injury significantly increased MDMs relative to other phagocytes, specifically increasing the ratio of MDMs to microglia at 3-DPI. Cell counts using immunohistochemistry revealed that male mice have more total microglia within SCI lesions that can account for a lower MDM/microglia ratio. With NanoString analyses of 27 genes, only 1 was differentially expressed between sexes in MDMs; specifically, complement protein C1qa was increased in males. No genes were affected by age in MDMs. Only 2 genes were differentially regulated in microglia between sexes after controlling for false discovery rate, specifically CYBB (NOX2) as a reactive oxygen species (ROS)-associated marker as well as MRC1 (CD206), a gene associated with reparative phenotypes. Both genes were increased in female microglia. No microglial genes were differentially regulated between ages. Differences between microglia and MDMs were found in 26 of 27 genes analyzed, all expressed higher in MDMs with three exceptions. Specifically, C1qa, cPLA2, and CD86 were expressed higher in microglia. CONCLUSIONS: These findings indicate that inflammatory responses to SCI are sex-dependent at both the level of cellular recruitment and gene expression.

18.
J Clin Nurs ; 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33942940

RESUMO

AIMS AND OBJECTIVES: This discursive paper provides a call to action from an international collective of Indigenous nurse academics from Australia, Canada, Aotearoa New Zealand and the USA, for nurses to be allies in supporting policies and resources necessary to equitably promote Indigenous health outcomes. BACKGROUND: Indigenous Peoples with experiences of colonisation have poorer health compared to other groups, as health systems have failed to address their needs and preferences. Achieving health equity will require leadership from Indigenous nurses to develop and implement new systems of care delivery. However, little is known about how Indigenous nurses influence health systems as levers for change. DESIGN: A Kaupapa Maori case study design. METHODS: Using a Kaupapa Maori case study methodology, coupled with expert Indigenous nursing knowledge, we developed a consensus on key themes. Themes were derived from three questions posed across the four countries. Themes were collated to illustrate how Indigenous nurses have provided nursing leadership to redress colonial injustices, contribute to models of care and enhance the Indigenous workforce. RESULTS: These case studies highlight Indigenous nurses provide strong leadership to influence outcomes for Indigenous Peoples. Five strategies were noted across the four countries: (1) Indigenous nationhood and reconciliation as levers for change, (2) Indigenous nursing leadership, (3) Indigenous workforce strategies, (4) Development of culturally safe practice and Indigenous models of care and (5) Indigenous nurse activism. CONCLUSIONS: In light of 2020 declared International Year of the Nurse and Midwife, we assert Indigenous nurses' work must be visible to support development of strategic approaches for improving health outcomes, including resources for workforce expansion and for implementing new care models. RELEVANCE TO CLINICAL PRACTICE: Curating strategies to promote Indigenous nurse leaders around the world is essential for improving models of healthcare delivery and health outcomes for Indigenous Peoples.

19.
Arch Gynecol Obstet ; 304(3): 791-805, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33847794

RESUMO

BACKGROUND: The impact of cancer diagnosis and treatment on sexual quality of life (SQoL) is a well-established survivorship issue for gynaecological cancer survivors (GCS), yet little is known on how to intervene. PURPOSE: The aim of this systematic review was to identify the factors explaining the variability in SQoL for GCS. METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and the software Covidence. Electronic databases Scopus, Web of Science, PUBMED and CINAHL were searched for original research on GCS published between 2002 and 2018. We performed a two-stage screening process against selection criteria and quality assessment of individual studies. The Salutogenic Theory and the PRECEDE-PROCEED model were used as theoretical frameworks to identify and categorise factors. RESULTS: The initial search yielded 3,505 articles resulting in a total of 46 studies used to examine the association between factors of SQoL and gynaecological cancers. Our findings suggested that SQoL varies across subgroups based on age, menopausal status, relationship status, and treatment modality. Protective factors included clinicians' knowledge and confidence, preventive medical approach, risk and needs assessment, patient-clinician communication, relationship quality, psychosocial support, symptom management, accessibility of psychosexual care, and self-efficacy in the rediscovery of sexuality. CONCLUSION: Despite the high incidence and long-term impact of sexual health issues on quality of life, supportive care needs are not being met. A better understanding of the evidence base around the factors of SQoL can help health professionals take steps to protect and improve SQoL in GCS.


Assuntos
Sobreviventes de Câncer/psicologia , Neoplasias dos Genitais Femininos/psicologia , Qualidade de Vida/psicologia , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/psicologia , Austrália , Feminino , Humanos , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia
20.
Curr Treat Options Infect Dis ; : 1-12, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33841050

RESUMO

Purpose of review: Prior outbreaks of respiratory viruses have demonstrated the need for adequate personal protective equipment (PPE) for healthcare workers, particularly filtering facepiece respirators (FFR). Due to shortfalls of PPE during the SARS CoV-2 pandemic, the need for FFR decontamination and reuse (FFR-DR) strategies is paramount. This paper aims to discuss primary decontamination strategies, with an in-depth analysis of ultraviolet germicidal irradiation (UVGI), arriving at the decontamination strategy utilized at the Nebraska Medical Center (NMC). Methods: Review of the primary literature in regard to FFR-DR as well as a synopsis of the current protocol for FFR-DR at NMC. Recent findings: UVGI demonstrates effective decontamination of multiple pathogens-including several human respiratory viruses-while maintaining mask integrity and filtering capacity. UVGI was associated with degradation of strap integrity at higher doses than that utilized for decontamination or with reuse beyond 20 times. Summary: UVGI effectively decontaminates N95 FFRs without significant reduction to fit or strap integrity and can be employed as a strategy for FFR-DR in times of emergency.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...