Hyaluronic acid to manage radiotoxicities in gynecological cancer patients: a scoping review.

PURPOSE: This study aimed to map the use of hyaluronic acid (HA) in preventing and controlling radiotoxicity in women with gynecological cancer undergoing radiotherapy. METHODS: We conducted a scoping review of eight electronic databases: CINAHL, Cochrane CENTRAL, LILACS, PubMed, Scopus, Embase, LIVIVO, and the Web of Science Core Collection. In addition, a grey literature search was performed using Google Scholar and ProQuest Dissertations & Theses Global. A manual search was also identified additional references. The search was conducted on May 18, 2023. We included primary studies, reviews, and guidelines that discussed the use of HA to prevent and manage the toxicities resulting from gynecological radiotherapy. RESULTS: Eighteen studies were included in this scoping review, published between 2009 and 2022. There was heterogeneity in the use of HA, particularly in the method of application (moisturizing gel, vaginal ovules, spacer gel, and bladder instillations). Furthermore, the radiotoxicities varied among studies, encompassing, among others, vaginal atrophy, dryness, dyspareunia, telangiectasis, adhesions, vaginal stenosis, bleeding, hematuria, and bladder issues. Most studies addressed the potential benefits of HA in managing the signs and symptoms resulting from radiotherapy. CONCLUSION: HA has been utilized in clinical practice, in various formulations, for managing signs and symptoms in patients with gynecological cancer undergoing radiotherapy. However, further studies are necessary to thoroughly investigate the most effective method of HA application and its effectiveness in managing radiotoxicity.

Prevalence of PICC-related thrombosis in patients with hematological malignancies: a systematic review.

PURPOSE: To estimate the prevalence of peripherally inserted central catheter (PICC)-related venous thrombosis in patients with hematological malignancies. METHODS: A systematic review of observational studies that evaluated the occurrence of PICC-related venous thrombosis in children, adults, and older people with hematological malignancies was conducted. Searches were carried out on June 12th, 2023 on PubMed, CINAHL, Embase, Web of Science Core Collection, Scopus, and LILACS, and to gray literature on Google Scholar, and ProQuest Dissertations and Theses Global. Eligibility criteria were applied independently by two reviewers, first on the titles and abstracts on the Rayyan platform and then on the full text of eligible studies. Risk of bias was assessed by the JBI checklist. Data were summarized descriptively, and the meta-analysis was carried out using the MetaXL 5.3 software. The review followed JBI guidelines and PRISMA for reporting. RESULTS: In the 40 studies included, prevalence of PICC-related venous thrombosis was 9% in general, 9% in adults, and 6% in children with hematological malignancies. Most studies only evaluated cases of symptomatic thrombosis (n = 25; 64%). CONCLUSION: Patients with hematological malignancies using PICC have an estimated prevalence of PICC-related venous thrombosis of 9%, and this rate may be underestimated due to the consideration of mostly symptomatic cases.

Prevalence of adverse events in pronated intubated adult COVID-19 patients: A systematic review with meta-analysis.

AIM: To present the pooled estimated prevalence of adverse events in pronated intubated adult COVID-19 patients. DESIGN: A systematic review and meta-analysis. DATA SOURCES: This study used the Cochrane Library, CINAHL, Embase, LILACS, Livivo, PubMed, Scopus, and Web of Science databases as data sources. METHODS: The studies were meta-analysed using JAMOVI 1.6.15 software. A random-effects model was used to identify the global prevalence of adverse events, confidence intervals and the heterogeneity data. Risk of bias was assessed using the Joanna Briggs Institute tool, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Of the 7904 studies identified, 169 were included for full reading, and 10 were included in the review. The most prevalent adverse events were pressure injuries (59%), haemodynamic instability (23%), death (17%) and device loss or traction (9%). CONCLUSION: The most prevalent adverse events in mechanically ventilated pronated patients with COVID-19 are pressure injuries, presence of haemodynamic instability, death and device loss or traction. IMPLICATIONS FOR THE PATIENT CARE: The evidence identified in this review can help improve the quality and safety of patient care by helping to design care protocols to avoid the development of adverse events that can cause permanent sequelae in these patients. IMPACT: This systematic review addressed the adverse events related to prone position in intubated adult COVID-19 patients. We identified that the most prevalent adverse events in these patients were pressure injuries, haemodynamic instability, device loss or traction and death. The results of this review may influence the clinical practice of nurses who work in intensive care units and, consequently, the nursing care provided not only to COVID-19 patients but for all intubated patients due to other reasons in intensive care units. REPORTING METHOD: This systematic review adhered to the PRISMA reporting guideline. PATIENT OR PUBLIC CONTRIBUTION: As this is a systematic review, we analysed data from primary studies conducted by many researchers. Thus, there was no patient or public contribution in this review.

Dressing to prevent surgical site infection in adult patients with cancer: a systematic review with meta-analysis.

PURPOSE: To identify the most effective dressing for application to surgical wounds with primary closure to prevent surgical site infection (SSI) in adult patients with cancer undergoing elective surgeries. METHODS: This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, with online searches conducted in the CINHAL, Cochrane Central, LILACS, PubMed, Scopus, Embase, Livivo, and Web of Science databases. An additional search was conducted in gray literature using Google Scholar. The risk of bias was assessed using RoB 2.0. The certainty of evidence was evaluated using the Grading of Recommendations Assessment and Development and Evaluation, and the results were synthesized in a descriptive manner and using meta-analysis. RESULTS: Eleven randomized clinical trials were conducted to compare different types of dressing-silver dressing with absorbent dressing (n = 3), mupirocin dressing with paraffin/no dressing (n = 1), honey-based dressing with absorbent dressing (n = 1), vitamin E and silicone-containing dressing with absorbent dressing (n = 1), and negative pressure wound therapy with absorbent dressing (n = 4)-and compare the usage duration of absorbent dressing (n = 1). Nine trials presented a low risk of bias, and two were classified as having uncertain bias. Compared with absorbent dressing, silver dressing did not reduce the risk of developing any type of SSI in 894 clinical trial participants (risk relative RR: 0.72; 95% confidence interval [CI] [0.44, 1.17] p = 0.18). Compared with absorbent dressing, negative pressure wound therapy did not reduce the risk of developing any type of SSI in the 1041 participants of two clinical trials (RR 0.68; 95% CI [0.31, 1.26] p = 0.22). The certainty of evidence of the three meta-analyses was considered low or very low for the prevention of SSI. We believe that this low certainty of evidence can be improved by conducting new studies in the future. CONCLUSION: There is no evidence regarding which dressing is the most effective in preventing SSI in adult patients with cancer.

Possible influence of shipping emissions on metals in size-segregated particulate matter in Guanabara Bay (Rio de Janeiro, Brazil).

In the world of growing maritime fleets, ships powered by fossil fuels are being widely used that are responsible for atmospheric emissions such as particulate matter (PM). When inhaled, these can cause serious injury to the body and affect internal organs, because the particle size is on a tiny scale. The International Convention for the Prevention of Pollution from Ships (MARPOL) regulates the standards for emissions from marine diesel engines. However, although they pose risks to human health and the environment, the metals present in PM are not covered by Brazilian national current legislation. This study is based on the results of sampling of PM in the atmosphere of Guanabara Bay, Rio de Janeiro, Brazil, by means of the MOUDI cascade impactor, followed by acid opening of the collected PM and subsequent chemical analysis by ICP-MS for the determination of Ba, Ca, Cd, Co, Cu, Cr, Fe, Mg, Mn, Ni, Pb, V, and Zn. In coarse particles, the mean values ranged from 0.11 ng m-3 for Ba to 24.9 ng m-3 for Fe; in fine particles, from 0.07 ng m-3 for Co to 25.0 ng m-3 for Fe; and in ultrafine particles, from 0.11 ng m-3 for Ba to 9.71 ng m-3 for Fe. Finally, the nanoparticles (Ba and Ca) were not detected and the maximum value obtained was 5.32 ng m-3 for Mn.

Dressings for the central venous catheter to prevent infection in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis.

PURPOSE: To identify the most effective dressing for covering long-term central venous catheter exit site to prevent catheter-related infections and skin irritation in patients undergoing hematopoietic stem cell transplantation. METHODS: Systematic Review. The search was performed in the following electronic databases: CINAHL, Cochrane Library CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science. Google Scholar was used for the gray literature search. RESULTS: Seven studies were included which tested different arrangements of dressings: sterilized gauze and adhesive tape with a transparent polyurethane film (n = 2), transparent polyurethane film with a different replacement interval frequency (n = 2), transparent polyurethane film with and without chlorhexidine released continuously by the dressing at the site of intravascular catheter insertion (n = 2), and dressings vs. no dressings (n = 1). The meta-analysis for catheter-related infection prevention showed no difference between type of dressing (RR 1.76, [95% CI 0.82; 3.75], I2 0%) and for the replacement frequency at different intervals (RR 1.04, [95% CI 0.67; 1.61], I2 0%). The meta-analysis for skin irritation evaluated the transparent polyurethane film replacement frequency and indicated that a longer dressing replacement interval (10 to 15 days) reduces the risk of developing this outcome (RR 0.71, 0.52; 0.96, 95% CI, I2 24%). CONCLUSIONS: Regarding the type of the dressing, there is no evidence indicating the best dressing. Although there is no evidence available for the ideal replacement frequency, the risk to develop skin irritation is reduced in longer dressing replacements intervals.

Nursing interventions in autologous stem cell transplantation for autoimmune diseases.

AIMS: To identify clinical symptoms and nursing interventions for stem cell therapy in autoimmune diseases. DESIGN: This is a retrospective, cross-sectional study. METHODS: This study was undertaken with patients diagnosed with type 1 diabetes or multiple sclerosis, undergoing autologous haematopoietic stem cell transplantation from January 2004 - December 2018. Data were registered in a questionnaire, taken during the conditioning regimen comprising cyclophosphamide and rabbit anti-thymocyte globulin. Descriptive statistics and Fisher's exact test were used for data analysis. RESULTS: There were 68 and 23 patients in the multiple sclerosis and type 1 diabetes groups respectively. Skin rash, nausea, vomiting and fever were more frequent and diverse in the type 1 diabetes group. Steroids were used as prophylaxis for anti-thymocyte globulin-associated allergic reactions in 97% of multiple sclerosis patients. Most of the identified symptoms and nursing interventions were more associated with one or other disease group (p < .05) and were more frequent in the type 1 diabetes group. CONCLUSION: Patients with autoimmune diseases who underwent stem cell therapy present differences in their repertoire of adverse events and require disease-specific nursing actions. IMPACT: Our results may enable nurses to establish transplant and disease-specific guidelines to improve prevention and management of adverse events and therefore optimize patient care and therapeutic success.

Application of microemulsions as coating in fresh cut strawberries.

The objective of this study was to evaluate microemulsions as a protective coating for fresh cut (FC) strawberries. The effectiveness of the coating was evaluated by physicochemical, fungal deterioration, and sensorial analysis. The fruits were processed and submitted to different treatments: control (T1); microemulsion with citronella oil (T2); pure microemulsion (T3); microemulsion with avocado oil (T4), and emulsion containing Tween® 20 and avocado oil in water (T5). The loss of mass, deterioration by fungi, color, and anthocyanin content were evaluated. Sensory analysis was carried out for appearance, brightness, color, and odor. Of all the evaluated coatings, conservation of FC strawberries was the highest with T5, wherein the evaluated sample exhibited reduced loss of mass and deterioration by fungi, minimal changes in physical appearance, and highest anthocyanin content. The avocado oil-containing microemulsion reduced deterioration by fungi, while the microemulsion with citronella essential oil maintained tonality of the fruits and preserved anthocyanins. This study has significantly contributed to the limited literature-based information available about MEs in the food.

Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients: A pilot randomised controlled trial.

BACKGROUND: In patients with short-term percutaneous central venous catheter (CVC), it is recommended that a dressing be applied to the catheter insertion site to prevent catheter-related infections. OBJECTIVES: The objective of this study was to assess the feasibility of a randomised controlled trial to compare the efficacy of chlorhexidine-impregnated dressing with that of polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients with short-term percutaneous CVC. METHODS: One hundred fifteen patients with a CVC were randomised to chlorhexidine-impregnated gel dressing (chlorhexidine gel group) or transparent polyurethane dressing (polyurethane group) between April and December 2014. Feasibility outcomes included data on eligibility, recruitment, missing data, and protocol violation. The primary outcome measure of efficacy was the presence of colonisation with the same microorganism in both the skin swab around catheter insertion site and the catheter tip. RESULTS: Of 526 patients assessed for eligibility, 411 (78%) did not meet inclusion criteria, and 115 (22%) were randomised. Among participants of both groups, there were 14 missing primary outcomes of which 10 were due to failure to collect the catheter tip (a protocol violation). The final sample had 47 and 54 individuals in the chlorhexidine and polyurethane groups, respectively. Skin and catheter tip were colonised by the same microorganism for 13% of the participants in the chlorhexidine group and 8% in the polyurethane group, although the difference was not statistically significant (p = 0.51). There were no differences between the two groups for catheter tip colonisation, skin site colonisation, catheter insertion site infection, catheter-related bloodstream infection, skin irritation, and the number of unplanned dressing changes. CONCLUSIONS: Our preliminary results found that a large randomised controlled trial would be feasible. This study provides valuable information that can be used to design more robust studies to prevent infection among patients with short-term percutaneous CVC when using either chlorhexidine or polyurethane dressing.

Bond strength of adhesive systems to sound and demineralized dentin treated with bioactive glass ceramic suspension.

OBJECTIVE: The objective of this study was to evaluate the effect of a Biosilicate®, associated with dentin adhesive system, on microtensile bond strength (µTBS) to sound and demineralized dentin. MATERIALS AND METHODS: Eighty sound-extracted molars had their middle occlusal dentin exposed. In forty teeth, dentin was artificially demineralized (pH cycling). Sound and demineralized dentin teeth were separated into four groups (n = 10), according to the substrate treatment before restoration: Group 1-total-etching adhesive Adper TM Single bond 2 (ASB) + Biosilicate®, Group 2-ASB (without Biosilicate®), Group 3-AdheSE self-etching adhesive system (AdSE) + Biosilicate®, and Group 4-AdSE (without Biosilicate®). Each tooth was restored with a hybrid composite and stored in water at 37 °C for 6 months. After water aging, teeth were cut in sticks (≈ 1 mm2 cross-sectional area) and all samples were submitted to µTBS test. The fracture modes of the samples were analyzed by stereomicroscopy. The representatively fractured samples were observed by scanning electron microscopy. Representative samples of each group were analyzed on energy dispersive X-ray spectrometry (EDX). The µTBS and Ca-P ratio values were analyzed by 2-way ANOVA, Bonferroni, and Tukey test, respectively, p < .05. RESULTS: ASB + Biosilicate® presented the highest µTBS values (p < .05), and lowest µTBS values (p < .05) were found in AdSE Group. There was no statistical difference (p < .05) on µTBS when substrates were compared, except for Group 2. The fracture pattern analysis showed prevalence of adhesive fractures in all groups. CONCLUSION: Biosilicate® enhanced bond strength of self-etching and etch-and-rinse adhesives to sound and demineralized dentin. CLINICAL RELEVANCE: Bioactive glass ceramic suspension could be recommended to be used to improve the dentin bond strengths of the total-etching and self-etching adhesives after acid-etching and priming.

The effect of proanthocyanidins and chlorhexidine on the bond strength of glass fiber posts to root dentin.

In this study, the influence of different irrigant solutions applied before cementation on the bond strength (BS) of glass fiber posts to root dentin was evaluated. Thirty endodontically treated maxillary canines of similar length were selected and divided into 3 groups (n = 10) according to the irrigant solution used before post cementation: 1% sodium hypochlorite (NaOCl; control), 2% chlorhexidine (CHX), or a 6.5% grape seed extract (GSE) cross-linking agent. After cementation of the posts, the roots were transversely sectioned to create 2 discs (2 mm) for each of the root thirds: coronal, middle, and apical. These discs were submitted to push-out tests (0.5 mm/min) to evaluate the BS between the glass fiber posts and the root dentin. Statistical analysis was performed by a 2-way analysis of variance and a Tukey test (P < 0.05). The failure mode was evaluated in all specimens. Both the CHX and GSE groups presented significantly higher BS values than the control group in all root thirds (P < 0.05). The values of the GSE group were significantly higher than those of the CHX group in all thirds except the apical third (P < 0.05). In the control group, the BS value was highest in the cervical third. There was no significant difference in the BS values between the cervical and middle thirds when CHX was used (P > 0.05); however, the BS value diminished significantly in the apical third (P < 0.05). The highest BS value in the GSE group was found in the middle third. The results showed that the use of either GSE or CHX before adhesive cementation improved the BS of glass fiber posts to root dentin.

Prophylaxis for mucositis induced by ambulatory chemotherapy: systematic review.

AIM: The aim of this study was to perform a systematic review of clinical trials covering interventions used as prophylaxis for oral mucositis induced by ambulatory antineoplastic chemotherapy. BACKGROUND: Oral mucositis in patients undergoing chemotherapy is a side effect that can impact the quality of treatment and can interfere with eating and therapeutic adherence. DESIGN: Quantitative systematic review. DATA SOURCES: Relevant databases were searched, from January 2002-July 2013, by using the combination of the keywords mucositis, stomatitis, neoplasms, antineoplastic agents, drug therapy, prevention and control and chemotherapy. REVIEW METHODS: Two researchers independently read the titles and abstracts from every cross-reference. The quality of the included studies was analysed by the Jadad Scale and the Cochrane Collaboration Risk of Bias Tool. Data were extracted from the selected studies with a data collection form developed specifically for this purpose. RESULTS: Of the 23 controlled clinical trials that were identified in this study, five articles evaluated the use of oral cryotherapy to prevent oral mucositis and three studies analysed the prophylactic use of glutamine. Interventions of protocols for oral care, palifermin, allopurinol and chlorhexidine were evaluated by two articles each. Interventions of zinc sulphate, amifostine, chewing gum, sucralfate, recombination human intestinal trefoil factor, kefir and vitamin E were evaluated by one article each. CONCLUSION: There is strong evidence that cryotherapy can prevent oral mucositis arising from ambulatory treatment with 5-flurouracil chemotherapy. Other interventions, although showing positive results in preventing oral mucositis, require further study to confirm their conclusions.

Surgical count process for prevention of retained surgical items: an integrative review.

AIMS AND OBJECTIVES: To analyse the evidence reported in the literature concerning the surgical count process for surgical sponges, surgical instruments and sharps and to identify knowledge gaps for future research on the surgical count process. BACKGROUND: The surgical count process stands out among the practices advocated by the World Health Organization to ensure surgical safety. The literature indicates that this practice should be performed in all surgical processes. However, surgical items are still retained. DESIGN: Integrative review. METHODS: The literature search was conducted in the PubMed, CINAHL and LILACS databases and included studies on the surgical count process published in English, Spanish and Portuguese from January 2003-December 2013. RESULTS: A total of 28 primary studies were included in the sample, allowing the knowledge on the surgical count process to be summarised and grouped into three categories: risk factors for retained surgical items, how the surgical count process should be performed in the intraoperative period and the accompanying technologies that collaborate to improving the manual count process. CONCLUSIONS: The correct implementation of the surgical count process by the perioperative nurse may contribute to preventing retained surgical items, thereby improving surgical patient safety. RELEVANCE TO CLINICAL PRACTICE: Nurses can use this review to assist in decision-making directed towards preparing, updating and implementing a reliable system for the surgical count process based on recent evidence because the perioperative nurse plays a key role in the implementation of this practice in health services.

The relationship between solvent use and BTEX concentrations in occupational environments.

Indoor air quality is an increasing concern; it causes significant damage to health because it is recycled in confined environments for extended periods of time. Among the pollutants found in these environments, benzene, toluene, ethylbenzene, and xylenes (BTEX) are known for their potential toxic, mutagenic, and carcinogenic effects. This study monitored the BTEX concentrations in paint, carpentry, and varnish workplaces and evaluated the potential to cause adverse health effects on workers in these environments. Twenty samples were collected in workplaces, 20 samples were collected outside the area, and eight samples were taken of the products used. Samples were collected using coconut shell cartridges, and chemical analyses were performed by gas chromatography with mass spectrometry. Toluene presented higher indoor concentrations and indoor and outdoor ratios, indicating that the paint and varnish workplaces had significant BTEX sources. The highest benzene and toluene concentrations were obtained from the paint workshop, and higher concentrations of ethylbenzene and xylenes were obtained in the varnish workshop. The highest non-carcinogenic risks were obtained for m + p-xylenes in the varnish work place, and the second highest non-carcinogenic risk was also determined for the same workshop.

Instruments used in the assessment of expectation toward a spine surgery: an integrative review.

OBJECTIVE: To identify and describe the instruments used to assess patients' expectations toward spine surgery. METHOD: An integrative review was carried out in the databases PubMed, CINAHL, LILACS and PsycINFO. RESULTS: A total of 4,402 publications were identified, of which 25 met the selection criteria. Of the studies selected, only three used tools that had confirmed validity and reliability to be applied; in five studies, clinical scores were used, and were modified for the assessment of patients' expectations, and in 17 studies the researchers developed scales without an adequate description of the method used for their development and validation. CONCLUSION: The assessment of patients' expectations has been methodologically conducted in different ways. Until the completion of this integrative review, only two valid and reliable instruments had been used in three of the selected studies. OBJETIVO: Identificar e descrever os instrumentos usados para avaliar a expectativa dos pacientes diante do tratamento cirúrgico da coluna vertebral. MÉTODO: Revisão Integrativa realizada nas bases de dados PubMed, CINAHL, LILACS e PsycINFO. RESULTADOS: Identificamos 4.402 publicações, das quais 25 atenderam aos critérios de seleção. Dos estudos selecionados, apenas em três os autores utilizaram instrumentos que possuíam validade e confiabilidade confirmadas para serem aplicados; em cinco estudos foram utilizados escores clínicos, modificados para a avaliação das expectativas dos pacientes, e em dezessete os pesquisadores elaboraram escalas sem adequada descrição do método usado para o seu desenvolvimento e validação. CONCLUSÃO: A avaliação das expectativas dos pacientes tem sido metodologicamente conduzida de diferentes maneiras. Até a finalização desta revisão integrativa, apenas dois instrumentos, válidos e confiáveis, haviam sido utilizados em três dos estudos selecionados.

Association of vitamin E with rapid thawing on goat semen.

The aim of this study was to evaluate the effects of vitamin E associated with rapid thawing on cryopreserved goat semen. Two bucks were used and eight ejaculates per animal were collected using artificial vagina. Semen was diluted with the following treatments: BIOXCELL (control), BIOXCELL + Equex (sodium lauryl sulphate) and BIOXCELL + vitamin E 100 µM. Semen was packaged into 0.25 mL straws and cooled at 5°C for 1 hour. Freezing was performed in liquid nitrogen vapor (-155°C) during 15 minutes. Then, the straws were immersed in liquid nitrogen (-196°C). Straws were thawed at 38°C/60 seconds or at 60°C/7 seconds with immediate sperm analysis. Hypoosmotic swelling test was performed adding a 20 µL aliquot of thawed semen to 1 mL of hypoosmotic solution (100 mOsm · Kg(-1)) followed by incubation during 60 minutes in water bath (38°C). Vitamin E did not affect any studied parameters (P > 0.05). Nevertheless, defrosting rate of 60°C/7 seconds improved sperm membrane functional integrity (P < 0.05). Current knowledge about goat semen cryopreservation is not sufficient to ensure high post-thawing recovery rates; thus, this study brings important data about using antioxidants and different thawing rates on cryopreservation process.

Lean and/or Six Sigma for process optimization in the perioperative period: an integrative review.

OBJECTIVE: To analyze the evidence on the influence of Lean and/or Six Sigma for process optimization in the perioperative period. METHODS: Integrative review carried out in the MEDLINE (PubMed), Web of Science, EMBASE, CINAHL, Scopus and LILACS databases on the use of Lean and/or Six Sigma to optimize perioperative processes. The studies included were analyzed in three thematic categories: flow of surgical patients, work process and length of stay. RESULTS: The final sample consisted of ten studies, which covered all operative periods. Lean and/or Six Sigma make a significant contribution to optimizing perioperative processes. FINAL CONSIDERATIONS: Lean and/or Six Sigma optimize perioperative processes to maximize the achievement of system stability indicators, making it possible to identify potential problems in order to recognize them and propose solutions that can enable the institution of patient-centered care.

Safety, Efficacy, and Immunogenicity of Therapeutic Vaccines for Patients with High-Grade Cervical Intraepithelial Neoplasia (CIN 2/3) Associated with Human Papillomavirus: A Systematic Review.

Despite the knowledge that HPV is responsible for high-grade CIN and cervical cancer, little is known about the use of therapeutic vaccines as a treatment. We aimed to synthesize and critically evaluate the evidence from clinical trials on the safety, efficacy, and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade CIN associated with HPV. A systematic review of clinical trials adhering to the PRISMA 2020 statement in MEDLINE/PubMed, Embase, CENTRAL Cochrane, Web of Science, Scopus, and LILACS was undertaken, with no data or language restrictions. Primary endpoints related to the safety, efficacy, and immunogenicity of these vaccines were assessed by reviewing the adverse/toxic effects associated with the therapeutic vaccine administration via histopathological regression of the lesion and/or regression of the lesion size and via viral clearance and through the immunological response of individuals who received treatment compared to those who did not or before and after receiving the vaccine, respectively. A total of 1184 studies were identified, and 16 met all the criteria. Overall, the therapeutic vaccines were heterogeneous regarding their formulation, dose, intervention protocol, and routes of administration, making a meta-analysis unfeasible. In most studies (n = 15), the vaccines were safe and well tolerated, with clinical efficacy regarding the lesions and histopathological regression or viral clearance. In addition, eleven studies showed favorable immunological responses against HPV, and seven studies showed a positive correlation between immunogenicity and the clinical response, indicating promising results that should be further investigated. In summary, therapeutic vaccines, although urgently needed to avoid progression of CIN 2/3 patients, still present sparse data, requiring greater investments in a well-designed phase III RCT.

Comparison of 2 methods for sterilization of filtering facepiece respirators worn for extended periods during the COVID-19 pandemic: An experimental laboratory study.

BACKGROUND: During the COVID-19 pandemic, there was a shortage of filtering facepiece respirators (FFR), leading to prolonged use and reuse of FFRs. METHODS: FFRs were collected in 3 hospitals after extended use (up to 15 or 30days). We assessed the physical characteristics and filtration levels of worn FFRs, before sterilization. Respirators that achieved at least 94% filtration of aerosol particles, nasal clip still attached, had no tears, had preserved elastic bands, and had no dirt were randomized to receive or not receive cleaning before being submitted to hydrogen peroxide plasma gas sterilization. RESULTS: A total of 1,055 FFRs were collected. Over 85% of them exhibited secured nose clips, preserved strap elasticity, and no tears. However, more than 78% of samples contained dirt, leaving only 101 (19.6%) eligible to undergo sterilization. After sterilization, none of the FFRs in either group achieved minimum filtration, although 72% without cleaning and 80% with cleaning had filtration between 90.0% and 93.9%. DISCUSSION: A large proportion of FFRs were ineligible for sterilization due to factors unrelated to health care (eg, dirt from makeup). CONCLUSIONS: Prolonged reuse of FFRs significantly reduced aerosol filtration efficiency. Eligible FFRs did not maintain 94% filtration after sterilization with or without cleaning.

Teaching-Learning Programs to Prevent and Control Infections Related to Long-Term Central Venous Access Device in Cancer Patients: A Systematic Review.

OBJECTIVES: To evaluate the effectiveness of teaching-learning programs for cancer patients and/or their caregivers or family in preventing and controlling infections associated with long-term central venous access devices. DATA SOURCES: This systematic review used the CINAHL, Cochrane Library, EMBASE, LILACS, and MEDLINE via PubMed portal, Scopus, and Web of Science. Google Scholar was used for the gray literature search. The included studies were analyzed, and the obtained data were qualitatively synthesized. The risk of bias was assessed using Cochrane tools: RoB 2 and ROBINS-I. The certainty of the evidence was evaluated using the GRADE. The review protocol was registered in PROSPERO (CRD42021267530). CONCLUSION: The teaching-learning programs were implemented through theoretical-practical and theoretical dimensions in five and two studies, respectively. The risk of bias in the studies was low, moderate, severe, and high in one, three, two, and one of them, respectively. The certainty was very low. Teaching-learning programs on central venous access devices care for cancer patients and/or their caregivers or families could be effective in reducing infection rates. IMPLICATIONS FOR NURSING PRACTICE: This systematic review addressed the teaching-learning programs for preventing and controlling infections associated with long-term central venous access devices. We identified that the most programs were effective in reducing the infection rates. The results may influence the clinical practice of oncology nurses, and consequently, the educational strategies and methods provided not only to these patients but for caregivers and families.