['Sandwich PhD': considerations for a successful experience abroad]. / Doutorado sanduíche: considerações para uma experiência de sucesso no exterior.

International PhD internship, named "Sandwich PhD" in Brazil is an opportunity to improve research abilities, to become known in academic area and to establish and/or increase work opportunities in an international context. In this article, we describe key factors regarding the planning and development of the "Sandwich PhD" as experienced by professors and students involved in the collaboration between the School of Nursing, University of São Paulo and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. We also present the participation of PhD students' network as an alternative to the "Sandwich PhD". An international experience, when well-planned and developed correctly, promotes students' personal and professional development and favors the internationalization of Brazilian graduate programs and research groups.

[Pain assessment and training: the impact on pain control after cardiac surgery]. / Treinamento e avaliação sistematizada da dor: impacto no controle da dor do pós-operatório de cirurgia cardíaca.

We analyzed the effects of training and the application of a form for the systematized assessment of pain control after cardiac surgery on pain intensity and supplementary use of morphine. Three patient groups underwent a non-randomized clinical trial with standardized analgesic prescription. In Group I, the nursing staff did not receive specific training regarding the assessment and management of pain, and patients were treated following the established protocol of the institution. In Groups II and III, the nursing staff received targeted training. In Group II the nursing staff used a form for the systematized assessment of pain, which was not used in Group III. Group II presented a lower intensity of pain and greater consumption of supplementary morphine compared to Groups I and II. Training associated with the systematized assessment form increased the chance of identifying pain and influenced nurses' decision-making process, thus promoting pain relief among patients.

[Disability related to chronic low back pain: prevalence and associated factors]. / Incapacidade relacionada à dor lombar crônica: prevalência e fatores associados.

Disability related to chronic low back pain (CLBP) is a complex and multidimensional phenomenon. The aim of the study was to identify the prevalence of disability and factors associated with disability outcome in 177 CLBP adults. Respondents were recruited from three health care service centers and answered questions from: Demographic Identification Form, Oswestry Disability Index, Chronic Pain Self-efficacy Scale, Tampa Scale Kinesiophobia, Beck Depression Inventory, and the Revised Piper Fatigue Scale. The prevalence of disability among the respondents was 65% (95% CI: 57.5 - 72.0), and disability was moderate to severe in 80.7% of them. The multiple regression model identified three factors as independently associated with disability: work situation, low self-efficacy and depression. The factors identified to be associated with disability are modifiable. Interventions such as work relocation, depression treatment and re-conceptualization of self-efficacy may have an important impact in preventing and reducing disability in chronic low back pain patients.

[Prevalence and comorbidity of pain and fatigue in women with breast cancer]. / Prevalência e comorbidade de dor e fadiga em mulheres com câncer de mama.

This study analyzed the prevalence and comorbidity of pain and fatigue in women with breast cancer. This is a cross-sectional study using a non-probabilistic sample of 182 women following outpatient treatment for breast cancer, who were interviewed from July 2006 to March 2007. Fatigue was assessed using the Piper Fatigue Scale, and divided into two categories (scores 0.1-4.9 and >5-10). Pain was assessed by the 0-10 scale, and categorized the same way as fatigue. Fatigue occurred in 94 women (51.6%), and was >5 in 44 (46.8%) of the women. Pain occurred in 86 women (47.2%), with scores >5 in 50 (58.1%). Fatigue and pain were correlated (r=0.38, p=0.003) and the comorbidity fatigue and pain was 38.3%. Intense pain increased fatigue (p=0.089) and intense fatigue increased pain (p=0.016). Both data are new in our area, and confirm the existence of a cluster of symptoms and the harms resulting from that comorbidity.

[Fatigue among nursing undergraduate students]. / Fadiga entre estudantes de graduação em enfermagem.

Fatigue among students may harm their learning. This study evaluated the fatigue of nursing undergraduate students and its relations to their graduation year, participation in extracurricular activities, people with whom they lived, depression and their body mass index (BMI)). The study had the participation of 189 (60.2%) students from the EEUSP, from which 96.2% were women with the average age of 21.6 years old, 80.9% lived with their parents, 43.9% performed extracurricular activities, 24.8% had varied BMI and 22.2% presented dysphoria or depression (Beck Depression Inventory). Fatigue was moderate/intense for 83.5% of the students (Piper Fatigue Scale--Revised and Fatigue Pictogram) and 59.8% reported moderate/intense impairment in their habitual activities. Fatigue presented a positive correlation to the graduation year, to the BMI and to depression (p < 0.001). The academic activity was the main cause of fatigue, whereas sleep and leisure were the most frequent strategies to handle it. Fatigue was significant and intense, but there was an irregularity between its frequency, magnitude and impact in the daily life activities.

[Relationship between trauma severity and analgesia standards used in traffic accident victims]. / Relação entre a gravidade do trauma e padrões de analgesia utilizados em acidentados de transporte.

This is a first-time study in Brazil, which identified the relations between the analgesic standard and trauma severity. To do this, an analysis was performed in a population of 200 traffic accident victims admitted for treatment at the emergency unit of a referral hospital for trauma care in the city of São Paulo. Trauma and lesion severity were characterized by anatomic severity indexes. Based on the analysis of the analgesic therapy, analgesia standards were constructed, founded on the World Health Organization analgesic scale. The results permitted to identify the statistic association between trauma severity and distinct analgesia standards. The dissemination of these findings could serve as the basis to design analgesia protocols in trauma and improve care quality, besides encouraging the development of studies in an area with so many knowledge gaps.

[Comorbidities between fatigue and depression in patients with colorectal cancer]. / Co-morbidade fadiga e depressão em pacientes com câncer colo-retal.

The objective of this study was to identify and characterize the comorbidities of fatigue and depression in colorectal cancer patients. A non-probabilistic sample of 154 outpatients (53% men; mean age 49.6 +/- 11.7 years; mean education 8.9 +/- 5.4 years). Fatigue was evaluated using the Revised Piper Fatigue Scale (min:0; max:10) and depression was evaluated using the Beck Depression Inventory (BDI) (min:0; max: 63). Fatigue was identified by 76 (49.4%) patients, and was intense (total score > or =6) for 19.7%. Scores compatible with depression (BDI >20) were found in 11 (7.1%) patients. Fatigue and depression were correlated (r = 0.395, p < 0.001). Comorbidities of moderate/severe fatigue and dysphoria/depression occurred in 12.3%. Fatigue was present in all patients with depression (100%) and depression occurred in 18% of patients with fatigue. Fatigue and depression are related phenomena. Comorbidities can be deleterious to the patient. Depression had a stronger effect on the occurrence of fatigue than the effect of fatigue on depression.

Analysis of the nature of Spiritual Pain in terminal patients and the resignification process through the relaxation, mental images and spirituality (RIME) intervention.

OBJECTIVE: To understand Spiritual Pain and the new meaning it takes on using the RIME intervention. SUBJECTS AND METHODS: Eleven terminally ill patients (n=11), treated at public hospitals, received care from six professionals trained for RIME application. The methods used were both qualitative, through phenomenology, and quantitative, based on the descriptive method, using the Wilcoxon Test. RESULTS: In the qualitative approach, six categories and eleven subcategories were found. The prevailing categories were: fear of dying by denying the severity of the clinical condition (n=5); fear of dying by realizing the severity of the clinical condition (n=5); fear of postmortem due to disintegration or feeling of non-existence, of being affectively forgotten (n=5). In the quantitative analysis, a statistically significant difference (p<0.0001) was noted. CONCLUSION: The results suggested that RIME promoted quality of life in the dying process, as well as more serenity and dignity in the face of death.

[Opioids and cognition in patients with chronic pain: a systematic review]. / Opióides e a cognição de doentes com dor crônica: revisão sistemática.

OBJECTIVE: The increasing use of opioids by patients suffering from chronic pain caused by different etiologies, and the possible effects of those substances on everyday activities, require careful evaluation of their effects. For this purpose, a systematic review was developed to assess the influence of opioids on the cognitive function in patients with chronic pain. METHODS: Eleven databases were analyzed using the following descriptors: opioids, opiates, narcotics, cognitive impairment, cognitive dysfunction, cognitive disorders and pain. The inclusion criteria were: clinical trials or case reports which included patients with chronic pain in treatment with opioids, cognitive assessment by specific tests and publication in English, Spanish or Portuguese. RESULTS: Sixteen surveys published between 1980 and 2004 met the criteria: six controlled trials, two randomized trials, and 10 studies of a lower scientific evidence level. All better quality controlled trials did not show cognitive impairment of patients under opioid therapy. CONCLUSION: These results must be confirmed by additional randomized trials including a greater number of patients with chronic pain.

Pharmacological analgesia in neonates undergoing cardiac surgery.

UNLABELLED: The objectives of this study were to verify the frequency of pharmacological analgesia and the occurrence of postoperative pain in neonates undergoing cardiac surgery. METHODS: This is a cross-sectional study and data were collected from 30 medical charts of neonates who underwent cardiac surgery in a private hospital in the city of São Paulo. RESULTS: The majority (96.6%) of neonates received analgesia: 18 (60.0%) received continuous analgesics, five (16.7%) received intermittent drugs, and six (20.0%) received a combination of continuous and intermittent analgesics. Fentanyl citrate was continuously administered to 24 (80.0%) neonates. Intermittent dipyrone and morphine was administered to ten (33.3%) and one (3.3%) neonates, respectively. Pain registers were observed in 17 (56.7%) medical charts and the occurrence of pain among neonates who received analgesics was 53.4%. CONCLUSION: There was no efficacy in pharmacological postoperative pain control in the neonates included in this study.

[Relationship between model of analgesia and injured body part in trauma patients]. / Relação entre o padrão de analgesia e região corpórea em pacientes de trauma.

Little attention has been paid to the injured regarding pain management in the emergency room. This study aims at identifying relationships between the analgesia model and the body part most severely and frequently injured in traffic accident victims. For the data collection, medical records of 200 patients hospitalized at a reference hospital for trauma victims in the city of São Paulo, Brazil, were used. Analyzing the relationship between standard analgesia and the most severely injured body part, it was possible to confirm the association of significance between these two variables, as well as for the body part most frequently injured. The results provide elements for the creation of trauma analgesia protocols.

[Pain similarities and differences in the chest syndromes: systematic literature review]. / Semelhancas e diferenças da dor nas síndromes torácicas: revis_ao sistemática da literatura.

Clinical conditions that present chest pain should be its causes quickly and precisely diagnosed. The objective of this study was to identify the existence of specific and common pain characteristics in acute myocardial infarction, angina, pericarditis, dissected thoracic aorta, and esophagus conditions. A systematic literature search was carried out using descriptors related to pain and chest syndromes. The following databases were searched for articles published between 1996 and November, 2005: Caribbean and Latin American in Health Sciences Literature (LILACS), Medical Literature and Retrieval System On Line (MEDLINE), Nursing Database (BDEnf), Pan-American Health Organization Database (PAHO), World Health Organization Library Database (WHOLIS), and Cochrane Library, between 1966 and November of 2005. No conclusive studies on the characterization of chest pain diagnosis were found.

[Publications on pain and nursing diagnosis in a Brazilian database]. / Publicações sobre dor e diagnóstico de enfermagem em uma base de dados brasileira.

The practical utilization of nursing diagnostics and interventions during professional practice and the analysis of the scientific production on diagnosis can help outline published knowledge. The objective of this study was to identify references related to the diagnosis of pain by nurses in a Brazilian nursing database (BDEnf). A systematic literature survey was carried out by electronic search, using the combination of the words "pain" and "nursing diagnosis". A total number of 21 references were found until December, 2006. Eighteen references were included in the study. In 12 studies, pain was one of the diagnoses found in articles that aimed making diagnosis in different populations. It was concluded that the studies included in that nursing database show that pain diagnosis by nurses has become a trend in the nurses' clinical practice.

[Alteration in attention and cancer pain treatment]. / Alteração na atenção e o tratamento da dor do câncer.

Cognitive impairment can negatively impact daily routine. This fact encouraged the elaboration of this study, which analyzed the impact of pain treatment with opioids on attention. Patients were divided into groups that were given (n=14) and were not given opioids (n=12). Three interviews were conducted to assess attention using the Trail Making Test and the Digit Span Test. The groups were homogeneous regarding socio-demographic variables, pain and depression; they were not homogeneous regarding the Karnofsky scale and the use of adjuvant analgesics. The patients in treatment without opioids had better performance in the Digit Span Test-reverse order, in the second assessment (p = 0.29); no differences were observed on the Trail Making Test. The observed impairments were limited, but while new studies do not confirm the findings, patients, professionals and caregivers must be alert about the possible deleterious effects of opioids on the cognitive function.

[Prevalence and characterization of chronic pain among the elderly living in the community]. / Prevalência e caracterização da dor crônica em idosos não institucionalizados.

The purpose of this cross-sectional study was to determine the prevalence of chronic pain in elderly municipal employees (n = 451) in Londrina, Paraná State, Brazil, and to characterize the pain in relation to: location, intensity, duration of episode, periodicity, and most frequent time of day. Data were collected using home interviews. Chronic pain was defined as lasting > six months and the elderly were defined as > or = 60 years of age. Overall prevalence of chronic pain was 51.44%, involving mostly the back (21.73%) and lower limbs (21.5%). Back pain was described as daily (31.63%), continuous, or lasting 1-6 hours (19.39%), mild (50%), and without a specific time of day (56.12%). Pain in the lower limbs was described as daily (42.27%), of variable duration (32.99%) or continuous (22.68%), mild (53.61%), and without a specific time of day (48.45%). The study showed a high prevalence of chronic pain in the elderly, with characteristics that can interfere in their quality of life, causing unnecessary suffering.

[Chronic pain and the belief in self-efficacy]. / Dor crônica e a crença de auto-eficácia.

The treatment of chronic pain patients includes beliefs, attitudes, values and behavior modifications. Dysfunctional beliefs about pain and management can become the central problem and determine the treatment's outcome. Among the important beliefs for the management of chronic pain, self-efficacy deserves to be highlighted. The concept of self-efficacy, developed by Bandura, is the belief on the individual ability to perform successfully certain tasks or behaviors in order to produce a desired outcome. This study is a critical review of the literature on the belief of self-efficacy related to chronic pain and about the methods to assess self-efficacy. Studies listed in Medline (1992 to 2002), Lilacs and Dedalus (the entire databases) were analyzed. The key words were pain and self-efficacy, dor and auto-eficácia.

[Asessment and measurement of psychosocial variables: a challenge for nursing research and attention]. / Avaliação e mensuração de variáveis psicossociais: desafio para pesquisa e clínica de enfermagem.

Assessment and measurement of psychosocial variables are challenging. These constructs are complex, and there is distrust as to the validity of using standardized instruments Jor their measurement. There is a large variety of instruments and much confusion regarding the terms used to describe the validity and reliability tests. This paper adopts the theoretical reference of psychometrics. Its purpose is to update knowledge on general and psychometric characteristics of instruments for the assessment of subjective phenomena, to establish a parallel between similar terms, and to present a guide for choosing instruments. The enhancement of measurement instruments will improve nursing research and attention.

[Validation of the Survey of Pain Attitudes-Professionals]. / Validação do Inventário de Atitudes frente à Dor Crônica-Profissionais.

Beliefs can influence the way people interpret events and behavior towards them. The aim of this study was validating an instrument to identify professionals' beliefs/attitudes towards chronic pain. The Survey of Pain Attitudes-Professionals (IAD-Profissionais), adapted from the Survey of Pain Attitude-Brief used for patients (SOPA-B), was answered by 75 professionals from Pain Clinics (mean age = 42.8 years; mean years since graduation = 16 years; physicians = 58.7%; physical therapists = 14.7%; with specialization courses = 42.7%; with Master's Degree/PhD = 26.7%. The Survey of Pain Attitude-Professionals was validated with 20 items; the factorial analysis confirmed 6 domains (emotion, control, disability, solicitude, medical cure and harm). The reliability of the domains ranged from 0.567 to 0.807 (Cronbach's alpha). An instrument is available to help organizing educative actions.

Escala de Calidez en Enfermería (ECAE): construcción y validación empírica / Escala de Calor Humano em Enfermagem (ECHE): construção e validação empírica / Nursing Warmth Scale (NWS): Development and empirical validation

Objetive: To construct and validate the Nursing Warmth Scale (NWS) through the development of a standardized measurement of nurses' warmth, perceived from the perspective of patients, and identify the behaviors and factors associated with this feeling of warmth. Materials and methods: The NWS was developed following the scale construction methodology under a triphasic model. The construction of items was elaborated based on the results of a previously published integrative review that consolidated the construct and the related variables. A qualitative phase was also incorporated to evaluate the latent variable. Content validity was assessed with 10 expert judges. An item try-out was conducted with 476 patients in health institutions. Exploratory factor analysis ­through the common factor method and oblique rotation­ was used for the item reduction process. Results: The construct "Nursing Warmth" was established after the theoretical and empirical phases of the study. The literature review and interviews with 23 patients and 25 nursing professionals provided a set of behaviors divided into 2 categories: verbal and nonverbal behaviors. Exploratory factor analysis allowed identifying 5 factors and 35 items. The reliability was estimated through Cronbach's alpha. The identified factors are: F1-Nonverbal connection-relationship with the other (0.943), F2-Empathy (0.909), F3-Verbal connection-relationship with the other (0.914), F4-Inclusion (0.858), and F5-Confidence (0.852). The Tucker-Lewis Index was 0.901. Conclusions: The NWS demonstrates evidence of reliability and validity. This tool may be useful in clinical settings and for teaching and research addressing interpersonal nursing skills.

Objetivo: construir y validar la Escala de Calidez de Enfermería (ECAE) mediante el desarrollo de una medida estandarizada de la calidez de la enfermería desde la perspectiva de los pacientes, además de identificar los comportamientos y factores asociados con la calidez. Materiales y métodos: la ECAE fue desarrollada según la metodología de construcción de escalas y empleando un modelo trifásico. La construcción de ítems se elaboró con los resultados de una revisión integrativa previamente publicada, que consolidó el constructo y las variables relacionadas. Se incorporó además una fase cualitativa con el fin de evaluar la variable latente. La validez de contenido fue testeada con 10 jueces expertos. Se realizó la validación de los ítems con 476 pacientes de instituciones de salud. Para el proceso de reducción de ítems se utilizó el análisis factorial exploratorio, mediante el método de factores comunes y rotación oblicua. Resultados: luego de las fases teórica y empírica del estudio, se estableció el constructo "Calidez en Enfermería". La revisión de la literatura y las entrevistas a 23 pacientes y 25 profesionales en enfermería proporcionaron un conjunto de comportamientos divididos en dos categorías: conductas verbales y conductas no verbales. El análisis factorial exploratorio identificó 5 factores y 35 ítems. La confiabilidad se estimó con Alfa de Cronbach. Los factores identificados son: F1-Conexión no verbal (0,943), F2-Empatía (0,909), F3-Conexión verbal (0,914), F4-Inclusión (0,858) y F5-Confianza (0,852). El índice de Tucker-Lewis fue de 0,901. Conclusiones: la ECAE demuestra evidencias de confiabilidad y validez. Esta herramienta puede ser útil en el ámbito clínico y en la enseñanza e investigación de habilidades interpersonales en Enfermería.

Objetivo: construir e validar a Escala de Calor Humano em Enfermagem (ECHE) mediante o desenvolvimento de uma medida padronizada do calor humano da enfermagem sob a perspectiva dos pacientes, além de identificar os comportamentos e fatores associados com o calor humano. Materiais e métodos: a ECHE foi desenvolvida de acordo com a metodologia de construção de escalas e utilizando um modelo trifásico. A construção dos itens foi elaborada com os resultados de uma revisão integrativa publicada previamente, que consolidou o construto e as variáveis relacionados. Uma fase qualitativa também foi incorporada para avaliar a variável latente. A validade do conteúdo foi testada com 10 juízes especialistas. Os itens foram validados com 476 pacientes de instituições de saúde. Para o processo de redução de itens, foi utilizada a análise fatorial exploratória por meio do método fatorial comum e da rotação oblíqua. Resultados: após as fases teórica e empírica do estudo, foi estabelecido o construto "calor humano em enfermagem". A revisão da literatura e as entrevistas com 23 pacientes e 25 profissionais de enfermagem forneceram um conjunto de comportamentos divididos em duas categorias: comportamentos verbais e não verbais. A análise fatorial exploratória identificou cinco fatores e 35 itens. A confiabilidade foi estimada com o alfa de Cronbach. Os fatores identificados são F1-Conexão não verbal (0,943), F2-Empatia (0,909), F3-Conexão verbal (0,914), F4-Inclusão (0,858) e F5-Confiança (0,852). O índice de Tucker-Lewis foi de 0,901. Conclusões: a ECHE demonstra evidência de confiabilidade e validade. Essa ferramenta pode ser útil no cenário clínico e no ensino e pesquisa de habilidades interpessoais em Enfermagem.

[Chronic pain beliefs: validation of the survey of pain attitudes for the Portuguese language]. / Crenças em dor crônica: validação do Inventário de Atitudes frente à Dor para a língua portuguesa.

This study validated the Survey of Pain Attitudes--brief version (SOPA) for the Portuguese language. Sixty-nine Brazilian patients were evaluated. Patients were female (71%), the mean age was 50.8 years (+/-15.4), the mean schooling was 7.4 years (+/-4.8), and the most frequent pain etiologies were: musculoskeletal (39.1%), cancer-related (34.8%), and neuropathic (20.3%). Factorial analysis produced seven domains (Control, Harm, Disability, Medical Cure, Emotion, Medication, Solicitude), as in the original instrument. Indices of reliability tests (mu Chronbach) ranged from .55 to .89, values that are accepted as moderate and good. The Portuguese language version showed conceptual equivalence to the English language version. The availability of SOPA-brief version in Portuguese may contribute for the improvement of research and clinical practices on chronic pain.