Crambe (Crambe abyssinica) is a non-edible annual herb, which was first cultivated to extract oil for industry, and now has great potential for biodiesel production. The objective of this ...investigation was to evaluate the genetic stability of micropropagated plants of the C. abyssinica Hochst cultivar 'FMS brilhante' using polymerase chain reaction techniques based on inter-simple sequence repeat (ISSR) molecular markers. The aim was to develop a protocol for the in vitro regeneration of these plants with low genetic variation as compared to the donor plant. For micropropagation, shoot tips from in vitro germinated seedlings were used as explants and were initially cultivated for 90 days on MS medium with 5.0 μM 6-benzylaminopurine (BAP), which at 90 days, led to the highest number of shoots per explant (NSE) (12.20 shoots) being detected. After 120 days, the interaction between BAP concentration and naphthalene acetic acid (NAA) was tested, and the highest NSE was observed following exposure to 0.0/0.5 μM BAP/NAA (11.40 shoots) and 1.0/0.0 μM BAP/NAA (11.00 shoots). The highest proportion of rooting phase were observed following exposure to 0.5 μM NAA (30%). The 13 ISSR primers used to analyze genetic stability produced 91 amplification products, of which only eight bands were polymorphic and 83 were monomorphic for all 10 regenerated crambe plants, compared to the donor plant explant. These results indicate that crambe shoot tips are a highly reliable explant that can be used to micropropagate genetically true-to-type plants or to maintain genetic stability, as verified using ISSR markers.
Abstract Purpose The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. Materials and methods We ...performed a systematic search to identify publications (from January 1980 to September 2014) that evaluated the pharmacologic interventions to treat or prevent delirium in intensive care unit (ICU) patients. Results From 2646 citations, 15 studies on prevention (6729 patients) and 7 studies on treatment (1784 patients) were selected and analyzed. Among studies that evaluated surgical patients, the pharmacologic interventions were associated with a reduction in delirium prevalence, ICU length of stay, and duration of mechanical ventilation, but with high heterogeneity (respectively, I2 = 81%, P = .0013; I2 = 97%, P < .001; and I2 = 97%). Considering treatment studies, only 1 demonstrated a significant decrease in ICU length of stay using dexmedetomidine compared to haloperidol (Relative Risk, 0.62 1.29-0.06; I2 = 97%), and only 1 found a shorter time to resolution of delirium using quetiapine (1.0 confidence interval, 0.5-3.0 vs 4.5 confidence interval, 2.0-7.0 days; P = .001). Conclusion The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.
Purpose
Detailed information on organization and process of care in intensive care units (ICU) in emerging countries is scarce. Here, we investigated the impact of organizational factors on the ...outcomes and resource use in a large sample of Brazilian ICUs.
Methods
Retrospective cohort study of 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We retrieved patients’ data from an ICU quality registry and surveyed ICUs regarding structure, organization, staffing patterns, and process of care. We used multilevel logistic regression analysis to identify factors associated with hospital mortality. Efficient resource use was assessed by estimating standardized resource use and mortality rates adjusted for the SAPS 3 score.
Results
ICUs were mostly medical-surgical (79 %) and located at private hospitals (86 %). Median nurse to bed ratio was 0.20 (IQR, 0.15–0.28) and board-certified intensivists were present 24/7 in 16 (21 %) of ICUs. Multidisciplinary rounds occurred in 67 (86 %) and daily checklists were used in 36 (46 %) ICUs. Most frequent protocols focused on sepsis management and prevention of healthcare-associated infections. Hospital mortality was 14.4 %. In multivariable analysis, the number of protocols was the only organizational characteristic associated with mortality odds ratio = 0.944 (95 % CI 0.904–0.987). The effects of protocols were consistent across subgroups including surgical and medical patients as well as the SAPS 3 tertiles. We also observed a significant trend toward efficient resource use as the number of protocols increased.
Conclusions
In emerging countries such as Brazil, organizational factors, including the implementation of protocols, are potential targets to improve patient outcomes and resource use in ICUs.
Abstract Purpose The purpose of this study is to evaluate the prevalence and the prognostic impact of antiphospholipid antibodies (aPL) in critically ill cancer patients. Methods This is a ...prospective cohort study in adult patients admitted to the intensive care unit for more than 48 hours at a cancer center. Clinical and laboratory data including coagulation parameters were obtained. Cox proportional hazard models were used to identify predictors of 6-month mortality. Results Ninety-five (solid tumor, 79%; hematologic malignancies, 21%) patients were included, and aPL were identified in 74% of them. Median Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment scores were 51 (37-65) and 5 (2-8) points, respectively. The most frequent aPL were lupus anticoagulant (61%) and anti- β 2 glicoprotein I (32%). Vascular complications occurred in 18% of patients and were comparable between aPL + and aPL − patients. Sepsis and need for renal replacement therapy were more frequent in aPL + patients. Hospital and 6-month mortality rates were 44% and 56%, respectively. Higher Sequential Organ Failure Assessment scores (each point) (hazard ratios HR = 2.83 95% confidence interval, 1.59-5.00), medical admissions (HR = 2.66 1.34-5.27), and d -dimer more than 500 ng/dL (HR = 1.89 (1.04-3.44) were independently associated with mortality. After adjusting for these covariates, aPL status was not associated with outcomes (HR = 1.22 0.60-2.47). Conclusions Lupus anticoagulants were frequent in critically ill cancer patients. However, they were not associated with medium-term survival in these patients.
•Obtaining thermodynamically consistent adsorption isotherms using PCP-SAFT DFT.•Predicting excess isotherms with a minimum number of representative pores.•The adsorbed region of the DFT density ...profiles is discriminated from the free fluid.•The DFT was directly coupled with the algorithm for obtaining the PSD.
Gravimetric measurements are often used to generate excess adsorption isotherms. However, adsorbed density and volume should be known to transform excess isotherms into absolute ones by considering buoyance effects. Depending on the strategy used, the results may present artifacts, especially at high pressures. A Density Functional Theory (DFT) augmented with the PCP-SAFT equation of state is applied to describe the experimental data of excess and absolute adsorption isotherms of CH4 and CO2 fluids on activated carbon slit pores. The representative pore size distribution (PSD) adequately predicted the excess adsorption isotherms at different temperatures. The absolute adsorption isotherms obtained using our approach are compared with the classic approaches as the triple point density of the liquid and the Ozawa expression (and extrapolated to the high-pressure regions). The classical methodologies underestimate the amount adsorbed while the proposed methodology provides thermodynamically consistent results even when condensation of CO2 occurs in the bulk phase.
To investigate the impact of organizational characteristics and processes of care on hospital mortality and resource use in patients with cancer admitted to intensive care units (ICUs).
We performed ...a retrospective cohort study of 9,946 patients with cancer (solid, n = 8,956; hematologic, n = 990) admitted to 70 ICUs (51 located in general hospitals and 19 in cancer centers) during 2013. We retrieved patients' clinical and outcome data from an electronic ICU quality registry. We surveyed ICUs regarding structure, organization, staffing patterns, and processes of care. We used mixed multivariable logistic regression analysis to identify characteristics associated with hospital mortality and efficient resource use in the ICU.
Median number of patients with cancer per center was 110 (interquartile range, 58 to 154), corresponding to 17.9% of all ICU admissions. ICU and hospital mortality rates were 15.9% and 25.4%, respectively. After adjusting for relevant patient characteristics, presence of clinical pharmacists in the ICU (odds ratio OR, 0.67; 95% CI, 0.49 to 0.90), number of protocols (OR, 0.92; 95% CI, 0.87 to 0.98), and daily meetings between oncologists and intensivists for care planning (OR, 0.69; 95% CI, 0.52 to 0.91) were associated with lower mortality. Implementation of protocols (OR, 1.52; 95% CI, 1.11 to 2.07) and meetings between oncologists and intensivists (OR, 4.70; 95% CI, 1.15 to 19.22) were also independently associated with more efficient resource use. Neither admission to ICUs in cancer centers compared with general hospitals nor annual case volume had an impact on mortality or resource use.
Organizational aspects, namely the implementation of protocols and presence of clinical pharmacists in the ICU, and close collaboration between oncologists and ICU teams are targets to improve mortality and resource use in critically ill patients with cancer.
Objetivo: mapear las expresiones y medidas para combatir el edadismo contra las personas mayores en los servicios de salud. Método: revisión de alcance de estudios primarios en inglés, español y ...portugués, sin delimitación temporal, recopilados de 14 bases de datos. Dos revisores independientes realizaron de forma ciega la selección de títulos, resúmenes y texto completo, el corpus estuvo compuesto por 41 artículos. La extracción de datos se realizó por pares. Los datos se presentaron en resúmenes narrativos y cuadros. Resultados: las expresiones de edadismo se manifiestan a nivel interpersonal, mediante imágenes y actitudes que deprecian, infravaloran la vida y deslegitiman las necesidades de las personas mayores, y a nivel institucional, por medio de barreras para acceder a los servicios de salud, que provocan falta de atención y descuido. Las medidas para combatirlo consisten en intervenciones educativas y ampliación de los canales de comunicación entre las personas mayores, los profesionales de la salud y gestores. Conclusión: los resultados pueden hacer que los profesionales de la salud estén atentos a la (falta de) atención debido al sesgo etario y sensibilizarlos para que enfrenten el edadismo mediante la adquisición del conocimiento científico. Hay lagunas de conocimiento tanto en el análisis del fenómeno en el contexto del Sistema Único de Salud como sobre las expresiones implícitas de edadismo.
Objective: to map the expressions of ageism directed to older adults in health services and the respective coping measures. Method: a scoping review of primary studies in English, Spanish and Portuguese, without time delimitation and collected from 14 databases. Selection of the titles, abstracts and full text was in charge of two independent and blinded reviewers, totaling a corpus comprised by 41 articles. Data extraction was performed by pairs. The data were presented in narrative summaries and charts. Results: the ageism expressions are understood at the interpersonal level through images and attitudes that depreciate, devalue life and delegitimize older adults’ needs, as well as at the institutional level, which confers barriers to accessing health services, generating non-assistance and neglect. The coping measures consist of educational interventions and expansion of communication channels between aged people, health professionals and managers. Conclusion: the results may make health professionals vigilant for care/neglect guided by age bias and sensitive for coping with ageism by obtaining diverse scientific knowledge. The analysis of the phenomenon in the Unified Health System context constitutes a knowledge gap, as well as the implicit ageism expressions.
Objetivo: mapear as expressões e medidas de enfrentamento do ageísmo direcionado às pessoas idosas em serviços de saúde. Método: revisão de escopo de estudos primários em inglês, espanhol e português, sem delimitação temporal, coletados em 14 bases de dados. A seleção dos títulos, resumos e texto completo foi realizada por dois revisores independentes e às cegas, totalizando corpus de 41 artigos. A extração dos dados foi realizada por pares. Os dados foram apresentados em resumos narrativos e quadros. Resultados: expressões de ageísmo estão compreendidas no nível interpessoal, por meio de imagens e atitudes que depreciam, desvalorizam a vida e deslegitimam as necessidades das pessoas idosas, e o nível institucional, que confere barreiras ao acesso dos serviços de saúde, gerando desassistência e descuidado. As medidas de enfrentamento consistem em intervenções educativas e ampliação dos canais de comunicação entre pessoas idosas, profissionais da saúde e gestores. Conclusão: os resultados poderão tornar os profissionais da saúde vigilantes para o (des)cuidado guiado pelo viés de idade e sensíveis para o enfrentamento do ageísmo pela obtenção de conhecimentos científicos. A análise do fenômeno no contexto do Sistema Único da Saúde constitui lacuna do conhecimento, bem como as expressões implícitas do ageísmo.
Resumen Objetivo: analizar la educación superior en el área de la salud en Brasil en función de los resultados del desempeño de los estudiantes en el Examen Nacional de Rendimiento de los Estudiantes ...de 2019. Método: estudio transversal, retrospectivo con enfoque cuantitativo con datos online referentes a 192.715 estudiantes de 3.712 carreras de salud, recolectados en 2020. El desempeño de los estudiantes se expresó en conceptos, ordenados en una escala de uno a cinco. Se elaboraron box-plots y se estimaron y las prevalencias de los conceptos y se evaluaron las diferencias según las características administrativas, de gestión y de las ciudades sede de las carreras a través de pruebas estadísticas (α=5%). Resultados: se observó un nivel satisfactorio de educación superior en salud (70,0% con concepto ≥3). Las carreas de Medicina obtuvieron las mejores calificaciones, las de Fonoaudiología y Enfermería las peores. Se asoció la educación pública, presencial y universitaria con una educación de mayor calidad. Los niveles más bajos se encontraron en los estados de la región Norte, en los pueblos pequeños y fuera de las áreas metropolitanas, y en las carreras de gestión privada. Conclusión: se verificó que había heterogeneidad en la calidad de la educación superior en las carreras de salud, lo que indica que hay una asociación entre las características de las instituciones educativas y la infraestructura de las ciudades donde se dictan las carreras, y señala que la calidad de la educación en salud en Brasil enfrenta desafíos.
Resumo Objetivo: analisar o ensino superior da área da saúde no Brasil segundo os resultados do desempenho dos estudantes no Exame Nacional de Desempenho dos Estudantes de 2019. Método: estudo transversal, retrospectivo, de abordagem quantitativa com dados on-line referentes a 192.715 estudantes de 3.712 cursos da saúde, coletados em 2020. O desempenho dos estudantes foi expresso em conceitos, ordenados em escala de um a cinco. Foram elaborados box-plot e estimadas prevalências dos conceitos e avaliadas diferenças segundo as características administrativas, de gestão e das cidades sede dos cursos por meio de teste estatísticos (α=5%). Resultados: observou-se nível satisfatório do ensino superior de saúde (70,0% com conceito ≥3). Cursos de medicina foram os mais satisfatoriamente avaliados, fonoaudiologia e enfermagem os piores. O ensino público, presencial e em universidades estiveram associados à maior qualidade do ensino. Níveis mais baixos foram verificados nos estados da região Norte, nas cidades pequenas e fora de áreas metropolitanas e naqueles sob gestão privada. Conclusão: verificou-se heterogeneidade na qualidade do ensino superior entre os cursos de saúde, indicando sua associação com características das instituições de ensino e à infraestrutura das cidades sedes dos cursos, apontando desafios para a qualidade da formação em saúde no Brasil.
Abstract Objective: to analyze higher education in the health area in Brazil according to the results of the students’ performance in the 2019 National Student Performance Examination. Method: a cross-sectional and retrospective study with a quantitative approach and online data referring to 192,715 students from 3,712 health courses, collected in 2020. The students’ performance was expressed in concepts, ordered on a scale of one to five. Box-plots were prepared, prevalence values of the concepts were estimated, and the differences were evaluated through statistical tests (α=5%) according to the administrative and management characteristics, as well as those of the cities where the courses were offered. Results: there was a satisfactory level of higher education in health (70.0% with a score ≥3). The Medicine courses were the most satisfactorily evaluated while Speech Therapy and Nursing obtained the worst scores. Public, face-to-face and university education were associated with better teaching quality. Lower levels were found in the North region states, in small towns, outside metropolitan areas and in those under private management. Conclusion: heterogeneity in the quality of higher education across the health courses was verified, indicating its association with the characteristics of the teaching institutions and with the infrastructure of the cities where the courses are offered, pointing out challenges to the quality of health education in Brazil.
Objetivo: validar la Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Debidas al Posicionamiento Quirúrgico en la estratificación del riesgo de desarrollo de lesiones en pacientes ...perioperatorios de un hospital de rehabilitación. Método: investigación analítica, longitudinal y cuantitativa. Se utilizó la escala y un instrumento en las tres etapas perioperatorias en 106 pacientes. El análisis de datos se realizó con estadística descriptiva e inferencial. Resultados: la mayor parte de los pacientes presentó alto riesgo de desarrollo de lesiones perioperatorias, tanto en el puntaje de la escala con tiempo estimado como en el puntaje de tiempo real, con promedio 19,97 (+3,02) y 19,96 (+3,12), respectivamente. La mayor parte de los participantes no presentaron lesiones de piel (87,8%) ni dolor (92,5%). El análisis inferencial permite afirmar que los puntajes de la escala están asociados con el surgimiento de lesiones provenientes del posicionamiento, por lo tanto, se infiere que los pacientes con bajo riesgo probablemente no presenten lesiones y que, aquellos de alto riesgo, serán más proclives a desarrollar lesiones. Conclusión: la validación de la escala se evidencia por la asociación de los puntajes con el surgimiento de lesiones, por tanto, es una herramienta válida y útil, y podrá guiar la práctica clínica del enfermero perioperatorio del hospital de rehabilitación en lo atinente a la reducción de riesgos de lesiones provenientes de la posición quirúrgica.
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