Rita de Cassia Gengo e Silva

A combined oral contraceptive containing drospirenone changes neither endothelial function nor hemodynamic parameters in healthy young women: a prospective clinical trial

BACKGROUND Combined oral contraceptives (COCs) may lead to a rise in cardiovascular disease risk, possibly associated with changes in blood pressure and endothelial function. STUDY DESIGN The objective was to evaluate the impact of COC containing 20 mcg of ethinylestradiol (EE) and 3 mg of drospirenone (DRSP) on the arterial endothelial function, systolic and diastolic blood pressure (SBP and DBP , respectively), heart rate (HR), cardiac output (CO) and total peripheral resistance (TPR) of healthy young women. Of the 71 women in the study, 43 were evaluated before the introduction of COC and after 6 months of its use (case group) and 28, COC nonusers, were assessed for the same parameters at the same time interval (control group). RESULTS No significant changes in endothelium-dependent and endothelium-independent functions or in measures of SBP, DBP, HR, CO and TPR caused by COC use were observed in the case group (p>.05 for all variables) or in the control group. CONCLUSION These data suggest COC with 20 mcg EE and 3 mg DRSP does not alter arterial endothelial function or hemodynamic parameters in healthy young women.

Vascular Reactivity Is Impaired and Associated With Walking Ability in Patients With Intermittent Claudication

We verified whether vascular reactivity is impaired and whether there is any association between vascular reactivity, walking ability, and peripheral artery disease (PAD) severity in patients with intermittent claudication (IC). We studied 63 patients and 17 age- and sex-matched volunteers without PAD. Vascular reactivity was evaluated in the brachial artery during reactive hyperemia (flow-mediated dilation [FMD]) and after a sublingual single dose of nitroglycerin (nitroglycerin-induced vasodilation [NID]). Walking ability was verified by a 6-minute walk test. Vascular reactivity and walking ability were significantly worse in patients with IC compared with control participants. The ankle–brachial index correlated with FMD, NID, as well as total and pain-free distances. The NID and walking ability progressively decreased as PAD severity increased. Walking ability correlated with NID but not with FMD. In patients with IC, vascular reactivity is impaired and is related to the severity of PAD and to walking ability.

Defining Characteristics of Decreased Cardiac Output: A Literature Review

OBJECTIVE.  The study aims to proceed a literature review of defining characteristics (DCs) of decreased cardiac output (DCO). METHODS.  Medline database was used to perform this study. The descriptors used were “low cardiac output” and “nursing diagnosis.” RESULTS.  Seventy-nine DCs were identified. Among them, 28 have already been approved by NANDA-I. Some data from microcirculation assessment such as high levels of serum lactate and decreased oxygen venous saturation were identified as indicators of this nursing diagnosis. CONCLUSIONS.  Some of the approved DCs were identified through literature review but others seem to be new as they have not been cited in the NANDA-I classification. PRACTICAL IMPLICATIONS.  Further content and clinical validations are needed to confirm if data from microcirculation might be considered as DCs of DCO. OBJETIVO.  Realizar uma revisao da literatura das caracteristicas definidoras (CD) do Debito Cardiaco Diminuido (DCD). METODOS.  A base de dados do Medline foi utilizada neste estudo. Os descritores utilizados foram “baixo debito cardiaco” e “diagnostico de enfermagem”. RESULTADOS.  Foram identificadas 79 CD. Dentre estas, 28 ja estavam contidas na classificacao de diagnosticos da NANDA-I. Alguns dados referentes a avaliacao da microcirculacao como os niveis de lactato aumentados e diminuicao da saturacao venosa de oxigenio foram identificados como indicadores deste diagnostico. CONCLUSOES.  Algumas CD aprovadas pela NANDA-I foram identificadas na revisao da literatura, entretanto, outras parecem ser novas, uma vez que nao encontram-se citadas nesta classificacao. IMPLCIACOES PARA PRATICA.  Novos estudos de validacao de conteudo e clinica devem ser realizados para confirmar se os dados sobre a microcirculacao podem ser considerados como CD do DCD.

Aspectos relevantes para identificação da claudicação intermitente

Intermittent claudication (IC) is one of the defining characteristics approved by NANDA International (NANDA-I) for the nursing diagnosis, Ineffective Peripheral Tissue Perfusion. For the correct identification of this defining feature, the nurse must know the clinical characteristics and have specific data collection skills. The aim of this article was to highlight aspects relevant to the identification of IC during the assessment and physical exam performed by the nurse. Based on specific guidelines and other publications on the subject, we described the clinical characteristics of IC and its differentiation from other phenomena that have nociceptive effects on lower limbs. Questionnaires were applied for the traceability of IC, for changes in physical examination, which may accompany the symptom and evaluation through the ankle-brachial index.Intermittent claudication (IC) is one of the defining characteristics approved by NANDA International (NANDA-I) for the nursing diagnosis, Ineffective Peripheral Tissue Perfusion. For the correct identification of this defining feature, the nurse must know the clinical characteristics and have specific data collection skills. The aim of this article was to highlight aspects relevant to the identification of IC during the assessment and physical exam performed by the nurse. Based on specific guidelines and other publications on the subject, we described the clinical characteristics of IC and its differentiation from other phenomena that have nociceptive effects on lower limbs. Questionnaires were applied for the traceability of IC, for changes in physical examination, which may accompany the symptom and evaluation through the ankle-brachial index.

Validação de conteúdo das atuais e de novas características definidoras do diagnóstico de enfermagem débito cardíaco diminuído

Objective: To validate the content defining characteristics of the currently approved and of those identified through reviewing the literature, for the nursing diagnosis: decreased cardiac output. Methods: Is a content validation study using the model proposed by Fehring. The defining characteristics were validated by 18 experts (eight doctors and ten nurses), using the five points Likert scale and according to the following classification: scores higher than 0.80 were considered as the main features; those with weight between 0, 50 and 0.79 as secondary; and, those with average less than or equal to 0.50 as irrelevant. Results: Of 79 defining characteristics investigated, 38 (48.1%) were validated, among which 17 were present in NANDA-I, and 41 (51.9%) were considered as irrelevant to this diagnosis, of these, eight are listed in NANDA-I. Conclusion: The defining characteristics currently listed in the NANDA-I classification taxonomy do not completely cover the nursing diagnosis: decreased cardiac output.Objective: To validate the content defining characteristics of the currently approved and of those identified through reviewing the literature, for the nursing diagnosis: decreased cardiac output. Methods: Is a content validation study using the model proposed by Fehring. The defining characteristics were validated by 18 experts (eight doctors and ten nurses), using the five points Likert scale and according to the following classification: scores higher than 0.80 were considered as the main features; those with weight between 0, 50 and 0.79 as secondary; and, those with average less than or equal to 0.50 as irrelevant. Results: Of 79 defining characteristics investigated, 38 (48.1%) were validated, among which 17 were present in NANDA-I, and 41 (51.9%) were considered as irrelevant to this diagnosis, of these, eight are listed in NANDA-I. Conclusion: The defining characteristics currently listed in the NANDA-I classification taxonomy do not completely cover the nursing diagnosis: decreased cardiac output.

Um estudo comparativo sobre a identificação dos riscos ocupacionais por trabalhadores de enfermagem de duas Unidades Básicas de Saúde do município de São Paulo

Os riscos ocupacionais do trabalho de enfermagem em Unidades Basicas de Saude (UBS) nao tem sido frequentemente abordados, o que nos estimulou a realizar este estudo com os objetivos de comparar a percepcao dos trabalhadores deenfermagem de duas UBS sobre esses riscos e estabelecer um paralelo sobre os problemas de saude relacionados com a suaexposicao. Os dados foram coletados atraves da entrevista e analisados segundo suas frequencias relativa e absoluta ecoeficientes de risco. Os maiores coeficientes de risco estao relacionados a exposicao aos riscos biologicos. Conclui-se que os trabalhadores tem dificuldade em apreender a genese dos riscos ocupacionais.

Limitação funcional e claudicação intermitente: impacto das medidas de pressão arterial

BACKGROUND Arterial hypertension is an important risk factor for Lower-Limb Occlusive Arterial Disease (LLOAD). However, the correlation between blood pressure and pulse pressure (PP) with LLOAD severity and functional impairment resulting from this disease is not well established in the Brazilian population. OBJECTIVE To verify whether there is a correlation between blood pressure, PP, LLOAD severity and functional capacity in patients with symptomatic LLOAD. METHODS A total of 65 patients (62.2 + 8.1 years, 56.9% males) were evaluated. They were divided into two groups: normal (A) and high (B) blood pressure. LLOAD severity was assessed using the ankle-brachial index (ABI) and functional capacity by the total and pain-free walking distance at the 6-minute walking test (6MWT). RESULTS Group A consisted of 17 (26.1%) patients. The systolic (SBP), diastolic blood pressure (DBP), and PP were, respectively, 125.4 ±11.7, 74.5 ± 9.1 and 50.9 ± 10.0 mmHg in group A and 160.7 ± 19.6, 90.0 ± 12.2 and 70.7 ± 20.2 mmHg in group B. The ABI was significantly lower in group B (0.66 ± 0.12 vs. 0.57 ± 0.13, p <0.05). SBP and PP correlated with LLOAD severity and the distances walked at the 6MWT. Patients with PP > 40 mmHg walked shorter distances. CONCLUSION SBP and PP significantly correlated with the distances walked in the 6MWT, suggesting they are clinical markers of functional capacity impairment in patients with symptomatic LLOAD.

Carga de trabalho de enfermagem: preditor de infecção relacionada à assistência à saúde na terapia intensiva?

Objective To analyze the influence of nursing workload on the occurrence of healthcare associated infection (HAI) in patients in the intensive care unit (ICU), according to type of treatment. Method Retrospective cohort study developed in nine ICUs in São Paulo, Brazil, from September to December 2012. Nursing workload was measured by the Nursing Activities Score (NAS). The Students t and Fishers exact tests and logistic regressions were used in the analyses. Results The sample was composed of 835 patients (54.3±17.3 years; 57.5% male), of which 12.5% acquired HAI in the ICU. The NAS of the patients admitted for clinical treatment was 71.3±10.9, and for surgery 71.6±9.2. Length of stay in ICU and severity were predictive factors for occurrence of HAI in patients admitted to the unit for clinical or surgical treatment, and male sex only for surgical patients. When considering the admissions independent of type of treatment, in addition to the variables mentioned above, index of comorbidities also remained in the regression model. The NAS was not a predictive factor of HAI. Conclusion Nursing workload did not influence occurrence of HAI in the patients included in this study.Objetivo Analizar la influencia de la carga de trabajo de enfermeria en caso de infeccion hospitalaria (IH) en pacientes en la Unidad de Cuidados Intensivos (UCI) segundo tipo de tratamiento. Metodo Estudio retrospectivo de cohorte realizado en nueve unidades de cuidados intensivos, en Sao Paulo, Brasil, de septiembre a diciembre de 2012. La carga de trabajo de enfermeria se midio por lo Nursing Activities Score (NAS). Las pruebas t de Student, test exacto de Fisher y regresiones logisticas fueron utilizados. Resultados La muestra fue de 835 pacientes (54,3±17,3 anos; 57,5% hombres), entre los cuales el 12,5% adquirio IH. El NAS de pacientes admitidos a tratamiento clinico fue de 71,3±10,9 y quirurgico, 71,6±9,2. La duracion de la estancia en la unidad y la gravedad fueron factores predictivos de la ocurrencia de IH en pacientes ingresados en la UCI para el tratamiento medico o quirurgico y los hombres solo para los pacientes quirurgicos. Al considerar las admisiones independientes del tipo de tratamiento, indice de comorbilidad tambien se mantuvo en el modelo de regresion. El NAS no fue predictivo de IH. Conclusion La carga de trabajo de enfermeria ejerce ninguna influencia sobre la ocurrencia de IH en los pacientes analizados.Objetivo Analisar a influencia da carga de trabalho de enfermagem na ocorrencia de infeccao relacionada a assistencia a saude (IRAS) em pacientes na Unidade de Terapia Intensiva (UTI), segundo o tipo de tratamento. Metodo Estudo de coorte retrospectivo desenvolvido em nove UTI em Sao Paulo, Brasil, de setembro a dezembro de 2012. A carga de trabalho de enfermagem foi mensurada pelo Nursing Activities Score (NAS). Os testes T-Student, Exato de Fisher e regressoes logisticas foram utilizados nas analises. Resultados A casuistica foi composta por 835 pacientes (54,3±17,3 anos; 57,5% do sexo masculino), dentre os quais 12,5% adquiriram IRAS na UTI. O NAS dos pacientes admitidos para tratamento clinico foi de 71,3±10,9 e para cirurgico, 71,6±9,2. O tempo de permanencia na unidade e a gravidade foram fatores preditivos para ocorrencia de IRAS em pacientes admitidos nas UTI para tratamento clinico ou cirurgico e o sexo masculino apenas para pacientes cirurgicos. Ao considerar as admissoes independentes do tipo de tratamento, alem das variaveis citadas, o indice de comorbidades tambem permaneceu no modelo de regressao. O NAS nao foi fator preditivo de IRAS. Conclusao A carga de trabalho de enfermagem nao exerceu influencia na ocorrencia de IRAS nos pacientes deste estudo.

Clinical reasoning in undergraduate nursing education: a scoping review

OBJETIVO Este estudio tuvo como objetivo analizar el estado actual del conocimiento sobre razonamiento clinico en la ensenanza durante el licenciado en enfermeria. METODO Revision sistematica de blanco mediante estrategia de busqueda aplicada en la base de datos MEDLINE y analisis del material recuperado con extraccion de los datos por dos revisores independientes. Los datos extraidos fueron analizados y sintetizados de forma narrativa. RESULTADOS De las 1380 citaciones recuperadas en la busqueda, fueron mantenidas 23 para la revision, y sus contenidos fueron sintetizados en cinco categorias: 1) la experiencia de desarrollar el pensamiento critico/razonamiento clinico/proceso de toma de decision; 2) estrategias de ensenanza relacionadas con el desarrollo del pensamiento critico/razonamiento clinico/proceso de toma de decision; 3) medicion de variables relacionadas con el pensamiento critico/razonamiento clinico/proceso de toma de decision; 4) relacion de variables involucradas en el pensamiento critico/razonamiento clinico/proceso de toma de decision; y 5) modelos teoricos de desarrollo del pensamiento critico/razonamiento clinico/proceso de toma de decision por estudiantes. CONCLUSION El mayor desafio para desarrollar el conocimiento acerca de la ensenanza del razonamiento clinico parece ser obtener consistencia entre las perspectivas teoricas acerca del desarrollo de razonamiento clinico y las metodologias, metodos y procedimientos en las iniciativas de investigacion en este campo.OBJETIVO Este estudo teve como objetivo analisar o estado atual do conhecimento sobre raciocinio clinico no ensino de graduacao em enfermagem. METODO Revisao sistematica de escopo mediante estrategia de busca aplicada na base de dados MEDLINE, e analise do material recuperado com extracao dos dados por dois revisores independentes. Os dados extraidos foram analisados e sintetizados de forma narrativa. RESULTADOS Das 1380 citacoes recuperadas na busca, foram mantidas 23 para a revisao, e seus conteudos foram sintetizados em cinco categorias: 1) a experiencia de desenvolver o pensamento critico/raciocinio clinico/processo de tomada de decisao; 2) estrategias de ensino relacionadas ao desenvolvimento do pensamento critico/raciocinio clinico/processo de tomada de decisao; 3) mensuracao de variaveis relacionadas ao pensamento critico/raciocinio clinico/processo de tomada de decisao; 4) relacionamento de variaveis envolvidas no pensamento critico/raciocinio clinico/processo de tomada de decisao; e 5) modelos teoricos de desenvolvimento do pensamento critico/raciocinio clinico/processo de tomada de decisao por estudantes. CONCLUSAO O maior desafio para desenvolver o conhecimento sobre o ensino do raciocinio clinico parece ser obter consistencia entre as perspectivas teoricas sobre o desenvolvimento de raciocinio clinico e as metodologias, metodos e procedimentos nas iniciativas de pesquisa neste campo.OBJECTIVE This study aimed at analyzing the current state of knowledge on clinical reasoning in undergraduate nursing education. METHODS A systematic scoping review through a search strategy applied to the MEDLINE database, and an analysis of the material recovered by extracting data done by two independent reviewers. The extracted data were analyzed and synthesized in a narrative manner. RESULTS From the 1380 citations retrieved in the search, 23 were kept for review and their contents were summarized into five categories: 1) the experience of developing critical thinking/clinical reasoning/decision-making process; 2) teaching strategies related to the development of critical thinking/clinical reasoning/decision-making process; 3) measurement of variables related to the critical thinking/clinical reasoning/decision-making process; 4) relationship of variables involved in the critical thinking/clinical reasoning/decision-making process; and 5) theoretical development models of critical thinking/clinical reasoning/decision-making process for students. CONCLUSION The biggest challenge for developing knowledge on teaching clinical reasoning seems to be finding consistency between theoretical perspectives on the development of clinical reasoning and methodologies, methods, and procedures in research initiatives in this field.

Distances walked in the six-minute walk test: suggestion of defining characteristic for the nursing diagnosis Ineffective Peripheral Tissue Perfusion

Distances walked in walking tests are important functional markers, although they are not accepted as defining characteristics of Ineffective Peripheral Tissue Perfusion. The aims of this study were to verify the distances participants with and without this nursing diagnosis walked in the six-minute walk test and if these measures may be considered defining characteristics of this phenomenon. Participants with (group A; n=65) and without (group B; n=17) this nursing diagnosis were evaluated regarding physical examination, vascular function and functional capacity. Participants of group A seemed to have worse vascular function and functional capacity compared with those of group B. Pain-free travelled distance was predictive of the nursing diagnosis. These results are important for the refinement of this diagnosis. In conclusion, this study provides evidences that the distances walked in the six-minute walk test may be considered defining characteristics of Ineffective Peripheral Tissue Perfusion.Distances walked in walking tests are important functional markers, although they are not accepted as defining characteristics of Ineffective Peripheral Tissue Perfusion. The aims of this study were to verify the distances participants with and without this nursing diagnosis walked in the six-minute walk test and if these measures may be considered defining characteristics of this phenomenon. Participants with (group A; n=65) and without (group B; n=17) this nursing diagnosis were evaluated regarding physical examination, vascular function and functional capacity. Participants of group A seemed to have worse vascular function and functional capacity compared with those of group B. Pain-free travelled distance was predictive of the nursing diagnosis. These results are important for the refinement of this diagnosis. In conclusion, this study provides evidences that the distances walked in the six-minute walk test may be considered defining characteristics of Ineffective Peripheral Tissue Perfusion.