Family presence during resuscitation in emergency departments: professionals' attitudes in Brazil.

AIM: The study explored the views and attitudes of nurses and physicians on family presence during resuscitation in emergency departments in Brazil. BACKGROUND: International emergency associations endorse family presence during resuscitation; however, the extent to which it is practiced remains unclear, particularly in the Brazilian context. Research of emergency staff views and attitudes towards this practice is desirable so that actions can be identified to support families at the bedside. METHODS: A qualitative research was conducted. Thirty-two health professionals (11 physicians and 21 nurses) working in two emergency departments in southern Brazil were purposefully recruited in January 2015. In-depth interviews were conducted, and data were analysed using content analysis. FINDINGS: Nurses and physicians found family presence during resuscitation controversial and the general attitude towards this practice was negative. They reported that 'changes are needed' to adapt hospital infrastructures for family presence, and to train staff to respond to the information and emotional needs of families. DISCUSSION: Translating a family nursing framework into clinical practice involves the need for reassessing educational and management policies in clinical contexts. CONCLUSION: This research brings new understanding about the attitudes of some Brazilian nurses and physicians on the implementation of family presence during resuscitation and identifies the need to develop policies and strategies to improve family presence in emergency departments. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Hospital-based policies are required to improve family-centred care in emergency departments while providing a criterion of legality and safety to professionals to invite families to be present during invasive procedures. Also, family-focused education in health science degrees, continuing education and in the community is required.

First report of frequencies of Y chromosome microdeletions at a reproductive medicine center in Peru.

Objective: Y chromosome Microdeletions are the second genetic cause of infertility in men. Despite its importance for infertility treatment, there is no previous research in Peru. The aim of this study was to determine the frequencies and characteristics of Y chromosome microdeletions in a group of men who sought infertility consultation at a specialized reproductive medicine center in Peru. Methods: In this study, 201 semen samples were analyzed. The samples were obtained from Niu Vida's fertility program. Each seminal sample was analyzed according to the recommendations of the Laboratory Manual of the World Health Organization (WHO) 2010. A buccal swab and a 500 µL aliquot of seminal sample were used for the molecular study of Y chromosome microdeletions in each patient. The frequencies and the type of Y chromosome microdeletion in the AZFa, AZFb and AZFc regions were evaluated. Results: The prevalence of Y chromosome microdeletions in the AZF region was 6.45% in oligozoospermic and azoospermic patients, and a prevalence of 20% was observed specifically in azoospermic patients. No microdeletions of AZFb type were detected. A partial region microdeletion of AZFa was detected in a teratozoospermic patient with a normal sperm count. Conclusions: The study represents the first report on the incidence of Y chromosome microdeletions in Peru. Our results indicate a high prevalence of microdeletions in azoospermic patients compared to similar studies. It is suggested to assess the presence of AZFa microdeletions and to evaluate additional genetic markers in this region to identify specific mutations that may cause impaired sperm production and male infertility in the Peruvian male population.

[Needs of the family in the intensive care units: a review of the literature]. / Necesidades de la familia en las unidades de cuidados intensivos. Revisión de la literatura.

UNLABELLED: Admission to the Intensive Care Units (ICU) is perceived by both patients and their family as a stressful experience. This situation can cause shock, skepticism and anxiety in the patient's setting. OBJECTIVE: To analyze and present the needs of the family members of the critical patient. METHODOLOGY: A review was made of the literature in the following data bases: Pubmed, CINAHL, Cuiden and Cochrane Library. Furthermore, three journals specialized in Intensive Cares were reviewed. RESULTS: After including the articles that met the screening criteria, 30 articles were finally selected. Of these, 11 were reviews of the literature, 7 qualitative studies and 12 more were quantitative investigations. Four groups of needs in the families were identified after the analysis of these articles, these being cognitive, emotional, social and practical. DISCUSSION: One of the main needs of the family is to receive better information from the professionals followed by the need for closeness with the ill family member. This review proposes that, in order to cover these needs, the information should be protocolized and the visiting hours should be made flexible. Furthermore, incorporation of two familial evaluation tools, the genogram and ecomap, is proposed. CONCLUSIONS: This work has revealed the importance of having the Intensive Care nurses identify the needs of the family during the admission of the patient in the ICU in order to be able to provide help, support and counseling care that relieves the suffering of the families.

The process of giving information to families in intensive care units: A narrative review. / El proceso de información a los familiares en las unidades de cuidados intensivos: una revisión narrativa.

AIM: Information is one of the most important needs of families of critical patients. Healthcare professionals also identify the great value of communication with families to reduce their anxiety and stress. Despite this, families may feel inadequately informed, causing added suffering. The purpose of this study is to provide an understanding of both families' and healthcare professionals' perspectives on information giving within intensive care units (ICU). METHOD: A narrative review was conducted using MEDLINE, CINAHL, PsycINFO databases and the Cochrane Library to identify studies published in either English or Spanish from 2002 to 2018. RESULTS: 47 studies were included, and five categories were identified: 1)"the need to know"; 2)family satisfaction with the information received; 3)impact of information on families' experiences in the ICU; 4)nurses and physicians' perceptions of information transmission, and 5)information process in the ICU. CONCLUSIONS: Providing honest and truthful information to the families of critical patients is essential to reduce family anxiety and increase family control, although this often appears to be inadequately accomplished by staff. Interdisciplinary involvement in information giving may be beneficial for both families and ICU professionals. This review brings new understanding about the process of information to families of ICU patients and it can be used to improve the quality and humanization of care in the ICUs.

[The transitional survivorship in breast cancer: a narrative review]. / La supervivencia de transición en el cáncer de mama. Una revisión narrativa.

AIM: This paper presents a review undertaken to explore the experiences of patients and families in the transition to breast cancer survivorship. BACKGROUND: The "transitional survivorship" is defined as the period immediately after the end of treatment. During this period, breast cancer survivors aim to return to their "new normality", but this time can be full of physical, emotional and social challenges for which the women may not feel prepared. REVIEW: A narrative review was conducted in the databases MEDLINE, CINAHL, PSYCHINFO and CancerLit for the period 2000-2010. The search terms "breast cancer", "transition", "survivorship", "family: and "experience" were combined. RESULTS: The main emerging categories that explained the experiences of breast cancer survivors during the "transitional survivorship" were "new normality", the sense of loss, uncertainty about the future, loneliness and self-transcendence. CONCLUSION: . This review shows the importance of knowing the experiences of women with breast cancer during the transitional survivorship in order to meet their needs during this stage of the illness, so as to facilitate their transition into the next phase of survival. There is a lack of knowledge about the experiences of families during this stage of survival and the impact of family relationship on the transitional experiences of breast cancer survivors. Therefore, it seems relevant to focus on this area in future exploratory studies.

The absence of the family in emergency care contributes to suffering in patients and family members. / La ausencia familiar en la atención de urgencia conlleva sufrimiento en pacientes y familiares.

AIM: To understand what the absence of the family during emergency care means to adult patients and their families to. METHOD: A grounded theory study was conducted in two emergency units of two public hospitals in southern Brazil. From October 2016 to February 2017, 15 interviews with patients and 15 with family members were carried out. The data were analyzed following the comparative method. RESULTS: The patients and families experienced the absence of the family in emergency care as a process of suffering caused by the separation of patient and family; they did not understand the reasons for family exclusion, and were resigned to the situation. CONCLUSION: Urgent care per se entails suffering in patients and their relatives; this suffering intensifies when the family is separated and cannot accompany the patient during emergency care. These results show the need to develop health strategies and policies that contribute to the comprehensive care of patients and families in hospital emergency units.

Plant-derived flavanol (-)epicatechin mitigates anxiety in association with elevated hippocampal monoamine and BDNF levels, but does not influence pattern separation in mice.

Flavanols found in natural products such as cocoa and green tea elicit structural and biochemical changes in the hippocampus, a brain area important for mood and cognition. Here, we evaluated the outcome of daily consumption of the flavanol (-)epicatechin (4 mg per day in water) by adult male C57BL/6 mice on measures of anxiety in the elevated plus maze (EPM) and open field (OF). Furthermore, pattern separation, the ability to distinguish between closely spaced identical stimuli, considered to be mediated by the hippocampal dentate gyrus (DG), was tested using the touchscreen. To investigate mechanisms through which (-)epicatechin may exert its effects, mice were injected with bromodeoxyuridine (50 mg kg(-1)) to evaluate adult hippocampal neurogenesis. In addition, monoaminergic and neurotrophin signaling pathway proteins were measured in tissue derived from subject cortices and hippocampi. Flavanol consumption reduced anxiety in the OF and EPM. Elevated hippocampal and cortical tyrosine hydroxylase, downregulated cortical monoamine oxidase-A levels, as well as increased hippocampal brain-derived neurotrophic factor (BDNF) and pro-BDNF support the flavanol's anxiolytic effects. In addition, elevated pAkt in hippocampus and cortex was observed. (-)Epicatechin ingestion did not facilitate touchscreen performance or DG neurogenesis, suggesting a non-neurogenic mechanism. The concurrent modulation of complementary neurotrophic and monoaminergic signaling pathways may contribute to beneficial mood-modulating effects of this flavanol.

[Effectiveness of family interventions in nursing homes. A systematic review]. / Efectividad de las intervenciones familiares en centros geriátricos. Una revisión sistemática.

The process of nursing home placement can be a stressful event for both the dependent elderly person and the family. During admission, especially the first few months, the family may suffer feelings of loss, sadness, failure and guilt. In this context, support and guidance from health professionals are essential to address the needs of residents and families through effective interventions. The aim of this systematic review is to identify the most effective interventions to help families during the process of institutionalization of a relative in a nursing home. Two types of family interventions were identified: those that focused on family-staff relationship and those that focused on family support groups, the latter being the most effective. On the other hand, most interventions have an individualistic approach, focusing on the primary caregiver. Finally, there is a shortage of quality studies that present the results of family interventions in the geriatric field and also a lack of such studies in the Spanish context.

Candida albicans exoglucanase as a reporter gene in Schizosaccharomyces pombe.

The Candida albicans XOG1 gene, previously shown to be a good reporter gene in Saccharomyces cerevisiae and C. albicans, was tested in Schizosaccharomyces pombe. Unlike the budding yeast, S. pombe does not produce exoglucanase activity and hence this system would be applicable to any given strain of this organism. The XOG1 gene was located under the control of the nmt1 promoter and its functionality could be demonstrated even at high temperatures (37 degrees C). The exoglucanase activity can be measured both in vivo and in vitro by either a simple biochemical reaction (on cells or media) or by flow cytometry, because the cells remain viable after the assay.

Survival of Staphylococcus aureus in oral administration liquid medicaments and influence of count medium on survival.

The survival of Staphylococcus aureus was studied in 30 oral administration liquid medicaments (15 syrups and 15 solutions) to determine the effectiveness of the preservatives, the influence of the culture medium used in the enumeration of the surviving microorganisms, and the loss of the enzyme coagulase, phosphatase, DNase (deoxyribonuclease), and thermonuclease. Samples were inoculated with 6.3-6.5 x 10(5) viable cells per milliliter and were stored at room temperature for 60 days. Aliquots were taken for analysis at 0, 15, 22, 30, and 60 days after samples were inoculated. The enumeration of S. aureus was made by most probable number method (MPN) with six liquid culture media: triptone soy (TS), TS with 10% NaCl (TSS), TS and TSS with 0.2% catalase, Mannitol salt, and Tellurite-mannitol-glycine. The survival of S. aureus was lower in solutions than in syrups, decreased with the storage time, and depended on the culture medium utilized in the enumeration. Nonselective media were more sensitive than selective ones; that is, a better percentage of recovery was achieved with TS and the catalase medium. The preservative was effective in 93.3% of the samples. Coagulase was the most stable enzyme and phosphatase, DNase, and thermonuclease disappeared during the storage period.

[Instruments for the assessment of the needs of family members of patients in intensive care units: a systematic review]. / Instrumentos para la valoración de las necesidades de los familiares de pacientes ingresados en cuidados intensivos: una revisión sistemática.

The hospitalisation of a family member in an intensive care unit is a stressful event for the rest of the family members. During hospitalisation, the family suffers situations of fear, uncertainty and tiredness, and focuses on the medical evolution of their ill member. In this context, support and attention from health care professionals through the assessment of the needs of the family are crucial. There are different instruments for the assessment of a family's needs. This systematic review aims to identify these questionnaires and to critically analyse their characteristics, so as to offer professionals valid and reliable questionnaires that they can use when caring for families in critical units.

[Dependence and the caring family: reflections for a family approach]. / Dependencia y familia cuidadora: reflexiones para un abordaje familiar.

Ageing and dependence, which are closely interrelated, are currently challenging the "family potential for care" and posing the dilemma of whether the family can provide an answer to these new situations where assistance is called for. Elderly dependants have long-term care needs, which are sometimes of great complexity. In order to correctly carry out this care it is necessary to have the necessary training, and this must be done under the supervision and with the support of suitable professionals. Otherwise, the consequences for the person receiving the care will be an additional factor of tension placed on the family model of care. The so-called "caregiver burden" has an impact on the family caregivers and on the family, social and economic environment, as well as on their own health. An integrated approach to care, focused on the family, could enhance the autonomy of these caring families and to some extent alleviate their limitations and suffering.

[Cognitive performance in patients with coronary heart disease and cardiovascular risk factors in Chile]. / Rendimiento cognitivo en pacientes chilenos con cardiopatia coronaria y factores de riesgo cardiovascular.

INTRODUCTION: Cardiovascular risk factors (CRF) are related to long-term cognitive impairment. Coronary heart disease (CHD) has been associated with bad cognitive performance in an inconsistent way. AIM. To measure the cognitive performance in Chilean patients with diverse CRF, with and without CHD. SUBJECTS AND METHODS: Cross-sectional study of the cognitive performance of three groups of patients older than sixty years, without history of stroke: with CHD and high CRF (CHD-hCRF) (n = 62), with high CRF but without CHD (hCRF) (n = 57), and non hypertensive non diabetic (NHND) (n = 25). RESULTS: Higher age, lower education and been men were significantly associated with cognitive impairment in the total sample. There were no differences in the proportion of cognitive impairment and age between the groups. The CHD group had a predominance of men and a higher proportion of high cholesterol and periphery vascular disease than the other groups. The NHND group was more educated than the other groups. After adjusting for years of education and sex there were no significant differences in the neuropsychological performance and depression scales between the groups, been the coronary group significantly more functionally impaired. CONCLUSIONS: Isolated CHD is not associated with worse cognitive performance in patients, but it is related with greater systemic vascular damage and functional impairment in patients without history of stroke.

Heterotrophic bacterial populations in the mineral waters of thermal springs in Spain.

The microbiological quality and heterotrophic bacterial populations of 26 thermal mineral water springs in Spain were studied. In most of the springs the number of viable aerobes was less than 10(3) cfu ml-1 and the number of sporulated bacteria less than 10(2) cfu ml-1. No significant differences were found in the counts obtained with Plate Count Agar (PCA) and PCA diluted 1:10 and incubated at 22 degrees, 37 degrees and 45 degrees C. Total coliforms were found in 14 springs, faecal streptococci in three, spores of sulphite-reducing Clostridium and Pseudomonas aeruginosa in seven. Neither Escherichia coli nor Staphylococcus aureus were found. A total of 665 strains were isolated and 85.4% of these identified; 329 were Gram-positive and 239 were Gram-negative. The genera most prevalent present in the springs were Pseudomonas (in 92.3%), Bacillus (65.4%), Enterobacter, Micrococcus and Staphylococcus (50%), Acinetobacter (42.3%), Arthrobacter (38.4%), Clostridium (27%) and Xanthomonas (23%). Gram-negative bacteria predominated in the mesothermal springs and Gram-positive bacteria in the hyper- and hypothermal springs. The most common Gram-negative rod species isolated were Ps. fluorescens, Ps. aeruginosa, Ps. putida, Ent. agglomerans, Ent. sakazakii, Ac. calcoaceticus and Ent. amnigenus.

Microbiological quality of pharmaceutical raw materials.

A total of 115 samples of pharmaceutical raw materials (excipients) were analysed: 36 lactose, 27 talc, 19 corn starch, 18 arabic gum, 8 gelatin, 3 gelatinized starch, 3 cellulose and one tragacanth gum. 69.9% of the samples showed less than 10(2) bacteria/g (mean = 23.2 cfu/g) and 95.2% less than 10(2) fungi/g (mean = 4.92 cfu/g). Arabic and tragacanth gum were the most contaminated products by bacteria and fungi, respectively. Pregelatinized starch, cellulose and lactose were the least contaminated excipients. In none of the samples Escherichia coli or Salmonella-Shigella were detected; however, strains of Enterobacter, Serratia and Proteus were isolated from 10 samples of 5 different excipients. Only 5 samples did not comply with the microbiological standards as established by the European Pharmacopoeia and USP.