The effect of epidural analgesia on postpartum urinary incontinence: a systematic review.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is common during pregnancy and in the postpartum period. Some women appear to recover their usual urinary function but in others UI persists, playing an important role in women's quality of life. Even though postpartum UI seems to have a multifactorial etiology, pregnancy, vaginal delivery, birth weight and parity are recognized as risk factors. This systematic review aims to evaluate the effect of one particular potential risk factor, epidural analgesia, on the development of postpartum UI in women with vaginal delivery. METHODS: PubMed, Cochrane and Scopus were searched for "epidural analgesia," "epidural anesthesia" or "epidural" and "urinary incontinence." All studies published until 31 July 2020 were considered. A total of 393 studies were identified, and 23 studies were included in the systematic review. RESULTS: From the total 23 articles included in this review, 21 showed a non-significant association between epidural analgesia and postpartum UI. One study found that the risk of postpartum SUI and any type of UI was significantly, but only slightly, increased in women with epidural analgesia. Another study showed a protective effect but was lacking control for important confounders. CONCLUSION: There appears to be no association between epidural analgesia and postpartum UI. Therefore, pregnant women should not fear epidural analgesia because of a possible increased risk of UI.

Language assessment in awake brain surgery: the Portuguese adaptation of the Dutch linguistic intraoperative protocol (DuLIP).

Awake brain surgery, combined with neurophysiological evaluation and intraoperative mapping, is one of the preferential lines of treatment when approaching low-grade gliomas. Speech and language assessment is used while applying Direct Electrical Stimulation (DES) and during the resection of a lesion/tumour, as it allows to establish related eloquent areas and optimise the extent of the resection and avoid impairments. Patients need to be assessed pre, intra and post-surgery, but in under resourced countries such as Portugal, there are still no standardised and validated tools to conduct this type of evaluation. To address this need, the tasks of the Dutch Linguistic Intraoperative Protocol (DuLIP) were adapted to European Portuguese, and the resulting materials were standardised for a group of 144 Portuguese participants. For each task, the impact of age, gender and schooling were measured. The resulting Portuguese version of the DuLIP (DuLIP-EP) consists of 17 tasks, including phonological, syntactic, semantic, naming and articulatory tests. No significant differences were found between male and female participants. However, schooling influenced phonological and syntactic fluency, object naming and verb generation. Schooling and age had a significant impact on semantic fluency and reading with semantic odd word out tasks. This is the first contribution to the standardisation of a tool that can be used during an awake brain surgery in Portugal, which includes a new phonological odd word out task that is not currently available in the Dutch version.

Removal of a mixture of pharmaceuticals sulfamethoxazole and diclofenac from water streams by a polyamide nanofiltration membrane.

Wastewater treatment plants are not specially designed to remove pharmaceutically active compounds (PhACs), since these substances are toxic and bio-refractory. This paper aims to investigate and optimize the performance of the Trisep TS80 nanofiltration (NF) membrane for the removal of a mixture of two of the most detected PhACs in municipal wastewaters worldwide, sulfamethoxazole and diclofenac. Several NF tests were carried out to study the rejections of these contaminants both spiked in demineralized water, filtrated water taken from Mondego River and secondary effluent coming from a municipal wastewater treatment plant. Among the several studied operating variables, pH was the one that most affected the contaminant rejection and membrane permeability. In the case of synthetic effluent, an applied pressure of 10 bar and pH 7 were determined as the best operating conditions, which allowed almost total chemical oxygen demand retention and a global contaminant rejection of 96.3% to be achieved. The application of different water matrices (river water and secondary municipal effluent) had no relevant impact on process efficiency. Vibrio fischeri luminescence inhibition tests revealed that treatment by nanofiltration reduced acute toxicity of all studied effluents.

Nursing Interventions in the Perioperative Pathway of the Patient with Breast Cancer: A Scoping Review.

The decrease in average hospitalisation time and the increase in outpatient surgery in some types of breast cancer represent gains for the reduction of the negative impact of hospitalisation in women with breast cancer but are also a challenge for the organisation of nursing care to prepare women for surgery, reduce anxiety about the interventions, and ensure continuity of care in the postoperative period. The aim of this study is to identify nursing interventions present in the care provided to patients with breast cancer during the perioperative period. A scoping review was the method chosen to answer the research question: What are the specialised nursing interventions in the perioperative pathway of the patient with breast cancer? Inclusion and exclusion criteria were defined for the articles that were identified in the CINAHL and MEDLINE databases; later, additional sources were identified from the list of bibliographic references for each selected study. The final bibliographical sample consisted of seven articles, which allowed the identification of three key moments of nursing interventions in the perioperative period of patients with breast cancer: the preoperative consultation, the reception of the patient in the operating room, and the postoperative consultation. Factors such as psychological, emotional, and spiritual support, communication and patient-centred care, health education and surgical safety, and the definition of a perioperative pathway for these patients contribute significantly to patients' satisfaction and the improvement of their quality of life. The results of this study make it possible to establish recommendations for practise and for research, increasing the range of nurses' actions.

Diferenças geracionais em enfermagem: o envolvimento e significado atribuído ao trabalho pelos enfermeiros de um hospital / Generational differences in nursing: the involvement and meaning attributed to work by nurses in a hospital

Os desafios atuais propostos aos enfermeiros gestores têm evoluído no sentido da análise individual dos profissionais e do alinhamento dos objetivos individuais dos enfermeiros com os objetivos da unidade de cuidados e da organização em geral. Contudo, as diferenças geracionais são frequentemente acusadas de estar na origem de divergências de ideais, de problemas de comunicação e de um conflito latente que compromete o desempenho da equipa e a qualidade dos cuidados prestados pelo que o seu estudo, no âmbito da Enfermagem, é da máxima relevância. Foi, assim, desenvolvido um estudo quantitativo, observacional e descritivotransversal com o objetivo de analisar as diferenças geracionais dos enfermeiros no que respeita ao significado atribuído ao trabalho e ao seu envolvimento profissional. Aplicamos um questionário constituído pelas Escala de Significados Atribuídos ao Trabalho (ESAT) e Escala de Envolvimento no Trabalho (UWES) a uma amostra de 385 enfermeiros de um hospital da região de Lisboa e Vale do Tejo. Os resultados evidenciam ligeiras diferenças geracionais no significado atribuído ao trabalho, embora não sejam estatisticamente significativas. No entanto, é a Geração Baby Boomer quem maior significado atribui ao seu trabalho. Esta geração foi também identificada como a geração com maior envolvimento profissional nas três dimensões de Vigor, Dedicação e Absorção, seguida da Geração X e, por fim, da Geração Y. Evidenciaram-se ainda relações positivas e significativas entre o significado atribuído ao trabalho e o envolvimento profissional dos enfermeiros, com evidência de maior correlação entre as gerações mais antigas. Estes resultados podem contribuir para a gestão das unidades de saúde, desenhando uma abordagem diferente aos enfermeiros de cada geração, fortalecendo a equipa no seu global, promovendo o envolvimento dos enfermeiros no conjunto organizacional e preparando o caminho para as novas gerações.

The current challenges proposed to nurse managers have evolved towards the individual analysis of the professionals and the alignment of the nurses' individual objectives with the objectives of the care unit and the organization in general. However, generational differences are often accused of being the source of divergences of ideals, of communication problems and of a latent conflict that compromises the performance of the team and the quality of the care provided so that its study, in the scope of Nursing, is maximum relevance. Thus, a quantitative, observational and descriptive-cross-sectional study was developed with the aim of analysing the generational differences of nurses with regard to the meaning attributed to work and their professional engagement. We applied a questionnaire consisting of the Meanings Attributed to Work Scale and the Work Engagement Scale (UWES) to a sample of 385 nurses from a hospital in the region of Lisbon and Vale do Tejo. The results show slight generational differences in the meaning attributed to the work, although they are not statistically significant. However, it is the Baby Boomer generation that gives the most meaning to their work. This generation was also identified as the generation with the greatest professional engagement in the three dimensions of Vigor, Dedication and Absorption, followed by Generation X and, finally, Generation Y. There were also positive and significant correlations between the meaning attributed to work and the professional engagement of nurses, with evidence of a greater correlation between older generations. These results can contribute to the management of health units, by enabling a different approach to nurses of each generation, strengthening the team as a whole, promoting the engagement of nurses in the organizational set and paving the way for new generations.