Percepção de estudantes de enfermagem sobre o Laboratório de Enfermagem como estratégia de ensino

Este estudo tem por objetivo conhecer a percepção de estudantes de enfermagem quanto aos aspectos físicos, pedagógicos e humanos referentes ao laboratório de enfermagem no processo ensino-aprendizagem. Trata-se de um estudo quantitativo, transversal, não experimental. A pesquisa foi realizada com 85 alunos. Um total de 58,8% dos alunos avaliou a estrutura física como ruim ou regular; já a acomodação foi avaliada por 50,6% dos alunos como ruim e péssima. Quanto ao horário de funcionamento, 63,5% dos alunos avaliaram como bom ou ótimo. Os alunos avaliaram positivamente as enfermeiras especialistas em laboratório e as monitoras com 87,0% e 84,9% de bom ou ótimo, respectivamente. A maioria dos aspectos obteve conceito bom, exceto a infra-estrutura física. O aspecto melhor avaliado foi o recurso humano.

Direct detection of a BRAF mutation in total RNA from melanoma cells using cantilever arrays.

Malignant melanoma, the deadliest form of skin cancer, is characterized by a predominant mutation in the BRAF gene. Drugs that target tumours carrying this mutation have recently entered the clinic. Accordingly, patients are routinely screened for mutations in this gene to determine whether they can benefit from this type of treatment. The current gold standard for mutation screening uses real-time polymerase chain reaction and sequencing methods. Here we show that an assay based on microcantilever arrays can detect the mutation nanomechanically without amplification in total RNA samples isolated from melanoma cells. The assay is based on a BRAF-specific oligonucleotide probe. We detected mutant BRAF at a concentration of 500 pM in a 50-fold excess of the wild-type sequence. The method was able to distinguish melanoma cells carrying the mutation from wild-type cells using as little as 20 ng µl(-1) of RNA material, without prior PCR amplification and use of labels.

Total knee arthroplasty - a clinical and numerical study of the micromovements of the tibial implant

Introduction The importance of the micromovements in the mechanism of aseptic loosening is clinically difficult to evaluate. To complete the analysis of a series of total knee arthroplasties (TKA), we used a tridimensional numerical model to study the micromovements of the tibial implant.Material and Methods Fifty one patients (with 57 cemented Porous Coated Anatomic TKAs) were reviewed (mean follow-up 4.5 year). Radiolucency at the tibial bone-cement interface was sought on the AP radiographs and divided in 7 areas. The distribution of the radiolucency was then correlated with the axis of the lower limb as measured on the orthoradiograms.The tridimensional numerical model is based on the finite element method. It allowed the measurement of the cemented prosthetic tibial implant's displacements and the microvements generated at bone-ciment interface. A total load (2000 Newton) was applied at first vertically and asymetrically on the tibial plateau, thereby simulating an axial deviation of the lower limbs. The vector's posterior inclination then permitted the addition of a tangential component to the axial load. This type of effort is generated by complex biomechanical phenomena such as knee flexion.Results 81 per cent of the 57 knees had a radiolucent line of at least 1 mm, at one or more of the tibial cement-epiphysis jonctional areas. The distribution of these lucent lines showed that they came out more frequently at the periphery of the implant. The lucent lines appeared most often under the unloaded margin of the tibial plateau, when axial deviation of lower limbs was present.Numerical simulations showed that asymetrical loading on the tibial plateau induced a subsidence of the loaded margin (0-100 microns) and lifting off at the opposite border (0-70 microns). The postero-anterior tangential component induced an anterior displacement of the tibial implant (160-220 microns), and horizontal micromovements with non homogenous distribution at the bone-ciment interface (28-54 microns).Discussion Comparison of clinical and numerical results showed a relation between the development of radiolucent lines and the unloading of the tibial implant's margin. The deleterious effect of lower limbs' axial deviation is thereby proven. The irregular distribution of lucent lines under the tibial plateau was similar of the micromovements' repartition at the bone-cement interface when tangential forces were present. A causative relation between the two phenomenaes could not however be established.Numerical simulation is a truly useful method of study; it permits to calculate micromovements which are relative, non homogenous and of very low amplitude. However, comparative clinical studies remain as essential to ensure the credibility of results.

The effect of femoral component rotation on the five-year outcome of cemented mobile bearing total knee arthroplasty.

PURPOSE: Performing total knee replacement, accurate alignment and neutral rotation of the femoral component are widely believed to be crucial for the ultimate success. Contrary to absolute bone referenced alignment, using a ligament balancing technique does not automatically rotate the femoral component parallel to the transepicondylar axis. In this context we established the hypothesis that rotational alignment of the femoral component parallel to the transepicondylar axis (0° ± 3°) results in better outcome than alignment outside of this range. METHODS: We analysed 204 primary cemented mobile bearing total knee replacements five years postoperatively. Femoral component rotation was measured on axial radiographs using the condylar twist angle (CTA). Knee society score, range of motion as well as subjective rating documented outcome. RESULTS: In 96 knees the femoral component rotation was within the range 0 ± 3° (neutral rotation group), and in 108 knees the five-year postoperative rotational alignment of the femoral component was outside of this range (outlier group). Postoperative CTA showed a mean of 2.8° (±3.4°) internal rotation (IR) with a range between 6° external rotation (ER) and 15° IR (CI 95). No difference with regard to subjective and objective outcome could be detected. CONCLUSION: The present work shows that there is a large given natural variability in optimal rotational orientation, in this study between 6° ER and 15° IR, with numerous co-factors determining correct positioning of the femoral component. Further studies substantiating pre- and postoperative determinants are required to complete the understanding of resulting biomechanics in primary TKA.

An intramedullary alignment guide lodging within the femoral canal during total knee arthroplasty: a case report.

The usual complications of total knee arthroplasty include thrombo-embolism, infection, and loosening. We report an unusual and potentially serious complication of an intramedullary guide lodging within the femoral canal during the procedure. Considering the risk of fracture and additional exposure, the guide was not removed and was cut in situ. The rest of the operation was completed successfully and the patient made an uneventfully recovery.

Custo econômico do tratamento das úlceras por pressão: uma abordagem teórica

O presente artigo consiste numa abordagem teórica sobre a problemática dos custos económicos das úlceras por pressão. Parte-se do conhecimento do problema, numa perspetiva conceptual, para, de seguida, apresentar resultados de estudos de prevalência, a partir dos quais foram delineados estudos de impacto económico. O objectivo deste artigo é o de reflectir sobre os custos económicos associados às úlceras por pressão, quer numa perspetiva global, considerando a repercussão financeira, quer numa vertente personalista, atendendo aos custos intangíveis. Relativamente ao impacto económico das úlceras por pressão, foi efectuada uma estimativa ao nível da Região Autónoma dos Açores do custo total do tratamento por ambiente de cuidados. Nos cuidados domiciliários o custo com o tratamento de todas as categorias é calculado em 7.086.415 euros; nos cuidados hospitalares, em 1.723.509 euros, e nos cuidados prestados em lares de idosos, em 1.002.562 euros. Nos Açores, a estimativa do custo total do tratamento das úlceras por pressão, considerando todas as suas categorias, ronda os 9.812.486 euros. Quanto ao impacto emocional associado, este tem elevados custos para pessoa e para os familiares, nomeadamente pelo sofrimento gerado. De facto, as úlceras por pressão acarretam elevados custos económicos associados ao tratamento, bem como custos intangíveis pelo sofrimento vivenciado por pessoas e cuidadores.

Body surface area and body weight predict total liver volume in Western adults.

Computed tomography (CT) is used increasingly to measure liver volume in patients undergoing evaluation for transplantation or resection. This study is designed to determine a formula predicting total liver volume (TLV) based on body surface area (BSA) or body weight in Western adults. TLV was measured in 292 patients from four Western centers. Liver volumes were calculated from helical computed tomographic scans obtained for conditions unrelated to the hepatobiliary system. BSA was calculated based on height and weight. Each center used a different established method of three-dimensional volume reconstruction. Using regression analysis, measurements were compared, and formulas correlating BSA or body weight to TLV were established. A linear regression formula to estimate TLV based on BSA was obtained: TLV = -794.41 + 1,267.28 x BSA (square meters; r(2) = 0.46; P <.0001). A formula based on patient weight also was derived: TLV = 191.80 + 18.51 x weight (kilograms; r(2) = 0.49; P <.0001). The newly derived TLV formula based on BSA was compared with previously reported formulas. The application of a formula obtained from healthy Japanese individuals underestimated TLV. Two formulas derived from autopsy data for Western populations were similar to the newly derived BSA formula, with a slight overestimation of TLV. In conclusion, hepatic three-dimensional volume reconstruction based on helical CT predicts TLV based on BSA or body weight. The new formulas derived from this correlation should contribute to the estimation of TLV before liver transplantation or major hepatic resection.

O Papel das Demonstrações Financeiras na Corporate Governance: O caso da Cabo Verde Telecom

O fenómeno da Corporate Governance tem vindo a ocupar um lugar importante na literatura moderna dada a sua importância no mercado global e competitivo em que vivemos. A partir do final dos anos 80, esta matéria ganhou um grande relevo devido ao aumento da participação activa dos investidores institucionais e pequenos investidores individuais nos mercados de capitais e sua crescente exigência por uma gestão mais rigorosa, transparente e que defende os interesses dos accionistas ou shareholders. Os grandes escândalos financeiros, envolvendo diversas empresas nos EUA e na Europa, que causaram prejuízos incomensuráveis ao mercado, despertaram a atenção do mundo para a relevância das boas práticas de Corporate Governance. O maior destaque para este tema aconteceu em 2002, após a ocorrência os escândalos com as multinacionais Enron, WorldCom, Parmalat, entre outros. Naturalmente, para os países em desenvolvimento, a qualidade da Corporate Governance local é de fundamental importância para o crescimento económico duradouro. Essa visão global e transversal da Corporate Governance veio acentuar a procura de soluções para o alinhamento dos interesses entre gestores e accionistas. A solução para os conflitos de agência e a melhoria dos mecanismos de gestão estão no cerne do debate sobre o tema. Este estudo faz uma análise das teorias da Corporate Governance, a sua evolução e importância e o papel das demonstrações financeiras como um dos elementos que suportam a boa Corporate Governance, aplicada na gestão de uma empresa cabo-verdiana – A CVTelecom. Pretende-se, assim, identificar os benefícios advindos da aplicação das boas práticas de Corporate Governace para a gestão da empresa e para a sociedade como um todo. A escolha da CVTelecom, operadora de telecomunicações, prende-se com dois aspectos fundamentais: i) ser a empresa privada que exerce maior impacto sobre a economia cabo-verdiana, empregando cerca de 1,3% do total dos trabalhadores do sector privado no País; ii) o crescimento da economia cabo-verdiana estar suportado, mais do que nunca, nas TIC, constituindo, por essa razão, num dos principais desafios do País. Concluiu-se que a CVTelecom, embora esteja localizada num país onde ainda não existe uma entidade com a responsabilidade de fazer a avaliação da gestão das empresas no quadro das normas que enformam a Corporate Governance, encontra-se bem encaminhada ao nível da implementação de normas e procedimentos que favoreçam uma boa Corporate Governance.

Paralysis of ventilated newborn babies does not influence resistance of the total respiratory system.

Paralysis with pancuronium bromide is used in newborn infants to facilitate ventilatory support during respiratory failure. Changes in lung mechanics have been attributed to paralysis. The aim of this study was to examine whether or not paralysis per se has an influence on the passive respiratory mechanics, resistance (Rrs) and compliance (Crs) of the respiratory system in newborn infants. In 30 infants with acute respiratory failure, Rrs was measured during paralysis with pancuronium bromide and after stopping pancuronium bromide (group A). Rrs was also measured in an additional 10 ventilated infants in a reversed fashion (group B): Rrs was measured first in nonparalysed infants and then they were paralysed, mainly for diagnostic procedures, and the Rrs measurement repeated. As Rrs is highly dependent on lung volume, several parameters, that depend directly on lung volume were recorded: inspiratory oxygen fraction (FI,O2), arterial oxygen tension/alveolar oxygen tension (a/A) ratio and volume above functional residual capacity (FRC). In group A, the Rrs was not different during (0.236+/-0.09 cmH2O x s x mL(-1)) and after (0.237+/-0.07 cmH2O x s x mL(-1)) paralysis. Also, in group B, Rrs did not change (0.207+/-0.046 versus 0.221+/-0.046 cm x s x mL(-1) without versus with pancuronium bromide). FI,O2, a/A ratio and volume above FRC remained constant during paralysis. These data demonstrate that paralysis does not influence the resistance of the total respiratory system in ventilated term and preterm infants when measured at comparable lung volumes.

The psychosocial impacts caused by diagnosis and treatment of Coeliac Disease

Abstract OBJECTIVE To comprehend the psychosocial effects that Coeliac Disease diagnosis entails. METHOD Qualitative study, achieved through semi-structured interviews, analyzed in accordance to the Association of ideas map Technique. A total 12 recently-diagnosed patients from the Centro de diagnóstico, tratamento e apoio ao paciente com doença celíaca (Coeliac Disease Prevention, Support and Treatment Diagnose Centre) from the Hospital Universitário de Brasília (University Hospital of Brasilia) were enrolled for the study, between the years of 2013 and 2014. RESULTS The interviewed patients presented negative impacts in three categories: psychoaffective, family and social relationships, indicating issues with social readaptation once the treatment had started, as well as difficulty coping with a gluten free diet. CONCLUSION Coeliac Disease holds substantial impact on psychological functions, family and social relationships to diagnosed patients, requiring a clinical biopsychological assistance for better adherence to treatment and patients quality of life.

Plantas Endémicas Medicinais de cabo verde

A quantidade de plantas medicinais do Arquipélago de Cabo Verde, actualmente, é de 308 espécies, distribuídas em 82 famílias pertencentes a Pteridófitas (5), Gimnospérmicas (2) e Angiospérmicas (75). Constata-se, assim, uma evolução positiva dos números, três vezes mais ao citado por Carvalho (1988), pelo que se confirma uma necessidade urgente em dar continuidade às pesquisas, tanto no campo como no laboratório, para uma maior valorização da flora medicinal de Cabo Verde. Portanto, existe matéria-prima em quantidade (número de espécies) para melhorar a farmacologia do País, o que permite intensificar os estudos da flora medicinal, nos aspectos químicos, farmacológicos, e clínicos, para o enriquecimento da matéria médico-vegetal, bem como valorizar melhor os recursos locais não utilizáveis actualmente, incluindo as espécies que não devem ser, na sua forma espontânea, subtraídas à natureza, quer pela sua raridade, quer pelo seu carácter endémico. É urgente um estudo científico com a finalidade de justificar o seu uso em bases correctas, e generalizar o conhecimento de algumas espécies endémicas medicinais num total de vinte e quatro espécies, existentes em Cabo Verde. Nesse âmbito, o INIDA (ex-INIA), desde 1986, através do seu Departamento, Recursos Naturais Renováveis, hoje Departamento Ciências do Ambiente, vem recolhendo informações de campo através de inquéritos à população local e publicações de algumas informações referentes a ecologia, distribuição por ilha e o uso tradicional das plantas. Actualmente, estes estudos estão a ser aprofundados, de modo a confirmar alguns aspectos fitoquímicos dessas plantas, nomeadamente, para as endémicas losna (Artemisia gorgonum) aipo-de-rocha (Lavandula rotundifolia).

Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case-control studies.

Although cigarette smoking and alcohol consumption increase risk for head and neck cancers, there have been few attempts to model risks quantitatively and to formally evaluate cancer site-specific risks. The authors pooled data from 15 case-control studies and modeled the excess odds ratio (EOR) to assess risk by total exposure (pack-years and drink-years) and its modification by exposure rate (cigarettes/day and drinks/day). The smoking analysis included 1,761 laryngeal, 2,453 pharyngeal, and 1,990 oral cavity cancers, and the alcohol analysis included 2,551 laryngeal, 3,693 pharyngeal, and 3,116 oval cavity cancers, with over 8,000 controls. Above 15 cigarettes/day, the EOR/pack-year decreased with increasing cigarettes/day, suggesting that greater cigarettes/day for a shorter duration was less deleterious than fewer cigarettes/day for a longer duration. Estimates of EOR/pack-year were homogeneous across sites, while the effects of cigarettes/day varied, indicating that the greater laryngeal cancer risk derived from differential cigarettes/day effects and not pack-years. EOR/drink-year estimates increased through 10 drinks/day, suggesting that greater drinks/day for a shorter duration was more deleterious than fewer drinks/day for a longer duration. Above 10 drinks/day, data were limited. EOR/drink-year estimates varied by site, while drinks/day effects were homogeneous, indicating that the greater pharyngeal/oral cavity cancer risk with alcohol consumption derived from the differential effects of drink-years and not drinks/day.

Phlebotomines (Diptera, Psychodidae) in caves of the Serra da Bodoquena, Mato Grosso do Sul State, Brazil

The present paper deals with the phlebotomine species captured during the period from January 1998 to June 2000 in 12 caves located in the Serra da Bodoquena, situated in the south central region of Mato Grosso do Sul State, Brazil. Three of the caves are situated further north (in Bodoquena county), seven in the central area (Bonito county) and two in the south (Jardim county). These last two caves and three of those in Bonito are located at the west side of the ridge. Eighteen species of phlebotomines were captured within the caves: Brumptomyia avellari (Costa Lima, 1932), Brumptomyia brumpti (Larrousse, 1920), Brumptomyia cunhai (Mangabeira, 1942), Brumptomyia galindoi (Fairchild & Hertig, 1947), Evandromyia corumbaensis (Galati, Nunes, Oshiro & Rego, 1989), Lutzomyia almerioi Galati & Nunes, 1999, Lutzomyia longipalpis (Lutz & Neiva, 1912), Martinsmyia oliveirai (Martins, Falcão & Silva, 1970), Micropygomyia acanthopharynx (Martins, Falcão & Silva, 1962), Micropygomyia peresi (Mangabeira, 1942), Micropygomyia quinquefer (Dyar, 1929), Nyssomyia whitmani (Antunes & Coutinho, 1939), Psathyromyia campograndensis (Oliveira, Andrade-Filho, Falcão & Brazil, 2001), Psathyromyia punctigeniculata (Floch & Abonnenc, 1944), Psathyromyia shannoni (Dyar, 1929), Pintomyia kuscheli (Le Pont, Martinez, Torrez-Espejo & Dujardin, 1998), Sciopemyia sordellii (Shannon & Del Ponte, 1927) and Sciopemyia sp. A total of 29,599 phlebotomine sandflies was obtained. Lutzomyia almerioi was absolutely predominant (91.5%) over the other species on both sides of the Bodoquena ridge, with the exception of the southern caves in which it was absent. It presents summer predominance, with nocturnal and diurnal activities. The species breeds in the caves and was captured during daytime both in the dark area and in the mouth of the caves. Martinsmyia oliveirai, the second most frequent sandfly, also presents a summer peak and only predominated over the other species in one cave, in which there were human residues.0

Surgical approach for total hip arthroplasty: direct lateral or posterior?

OBJECTIVE: To determine the risks of prosthesis dislocation, postoperative Trendelenburg gait, and sciatic nerve palsy after a posterior approach compared to a direct lateral approach for adult patients undergoing total hip arthroplasty (THA) for primary osteoarthritis (OA). METHODS: Medline, Embase, CINHAL, and Cochrane databases were searched until August 2003. All published trials comparing posterior and direct lateral surgical approaches to THA in adults with a diagnosis of primary hip osteoarthritis were collected. Retrieved articles were assessed independently for their methodological quality. RESULTS: Four prospective cohort studies involving 241 participants met the inclusion criteria. Regarding dislocation rate, no significant difference between posterior and direct lateral surgical approach was found (relative risk 0.35). The presence of postoperative Trendelenburg gait was not significantly different between surgical approaches. The risk of nerve palsy or injury was significantly higher with the direct lateral approach (relative risk 0.16). However, there were no significant differences when comparing this risk nerve by nerve, in particular for the sciatic nerve. Of the other outcomes considered, only the average range of internal rotation in extension of the hip was significantly higher (weighted mean difference 16 degrees ) in the posterior approach group (mean 35 degrees, SD 13 degrees ) compared to the direct lateral approach (mean 19 degrees, SD 13 degrees ). CONCLUSION: The quality and quantity of information extracted from the trials performed to date are insufficient to make a firm conclusion on the optimum choice of surgical approach for adult patients undergoing primary THA for OA.