Clinical validity of the nursing diagnosis risk for unstable blood glucose level in persons with type 2 diabetes mellitus: A case-control study.

OBJECTIVE: To assess clinical-causal validity evidence of the nursing diagnosis, risk for unstable blood glucose level (00179), in individuals with type 2 diabetes mellitus. METHODS: A case-control study was conducted in 5 primary healthcare units, involving 107 subjects with type 2 diabetes mellitus, 60 in the case group and 47 in the control group. Causality was determined by the association between sociodemographic and clinical factors, risk factors related to the nursing diagnosis, and the occurrence of unstable blood glucose level. An association was considered when the risk factor had a p-value of <0.05 and odds ratio >1. RESULTS: Risk factors, such as stress, inadequate physical activity, and low adherence to therapeutic regimen, were prevalent in the sample. Time since diagnosis between 1-5 and 6-10 years, multiracial ethnicity, and the risk factor of low adherence to therapeutic regimen increased the likelihood of the outcome. Completion of high school education was identified as a protective factor. CONCLUSIONS: The clinical validation of the nursing diagnosis, risk for unstable blood glucose level, has been successfully established, revealing a clear association between sociodemographic and clinical factors and the risk factors inherent to the nursing diagnosis. IMPLICATIONS FOR NURSING PRACTICE: The results contribute to advancing scientific knowledge related to nursing education, research, and practice and provide support for the evolution of nursing care processes for individuals with type 2 diabetes mellitus.

OBJETIVO: Avaliar a evidência de validade clínico­causal do diagnóstico de enfermagem, risco para nível instável de glicose no sangue (00179), em indivíduos com diabetes mellitus tipo 2. MÉTODO: Foi realizado um estudo caso­controle em cinco unidades básicas de saúde, envolvendo 107 indivíduos com diabetes mellitus tipo 2, 60 no grupo caso e 47 no grupo controle. A causalidade foi determinada pela associação entre fatores sociodemográficos e clínicos, fatores de risco relacionados ao diagnóstico de enfermagem e a ocorrência de nível instável de glicose no sangue. Uma associação foi considerada quando o fator de risco tinha um valor de p < 0.05 e odds ratio > 1. RESULTADOS: Fatores de risco como estresse, atividade física inadequada e baixa adesão ao regime terapêutico foram predominantes na amostra. O tempo desde o diagnóstico entre 1 e 5 anos e 6 a 10 anos, a etnia parda e o fator de risco baixa adesão ao regime terapêutico aumentaram a probabilidade do resultado. A conclusão do ensino médio foi identificada como um fator de proteção. CONCLUSÕES: A validação clínica do diagnóstico de enfermagem, risco para nível instável de glicose no sangue, foi estabelecida com sucesso, revelando uma clara associação entre fatores sociodemográficos e clínicos e os fatores de risco inerentes ao diagnóstico de enfermagem. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os resultados contribuem para o avanço do conhecimento científico relacionado à educação, à pesquisa e à prática de enfermagem e fornecem suporte para a evolução dos processos de cuidados de enfermagem para indivíduos com diabetes.

Evidence of content validity of the nursing diagnosis risk for unstable blood pressure.

PURPOSE: To analyze evidence of content validity of the nursing diagnosis (ND) Risk for Unstable Blood Pressure in incarcerated women.  METHOD: A methodological study assessing the content validity of an ND, was performed in Brazil, between June and September 2022, with 49 nurses as experts. The label, definition, and relevance of the 19 risk factors of the ND Risk for Unstable Blood Pressure were appraised. Based on the predictive diversity model, the content validity index (CVI) and respective 95% confidence intervals were calculated for each risk factor. A CVI ≥ 0.8 was considered adequate evidence of content validity. FINDINGS: The label and the definition of the diagnosis was reformulated. The relevance of 19 etiological factors showed a CVI ≥ 0.8. According to the recommendation of the panel of experts, one of the etiological factors was split in two and two label of etiological factors were changed. CONCLUSIONS: A new label (Risk for Imbalanced Blood Pressure), new definition, and 20 etiological factors (11 risk factors, five associated conditions, and four at-risk populations) of the ND Risk for Unstable Blood Pressure in incarcerated women were considered valid. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I accepted the proposal for this nursing diagnosis; hence this study contributed to updating the classification based on scientific evidence. This evidence will favor diagnostic reasoning and recognition of the diagnosis during clinical assessment, and support studies assessing the clinical validity of these elements in incarcerated women.

OBJETIVO: Analisar evidências de validade de conteúdo do diagnóstico de enfermagem (DE) Risco de Pressão Arterial Instável em mulheres encarceradas. MÉTODO: Estudo metodológico de validade de conteúdo de um DE, realizado no Brasil, entre junho e setembro de 2022, tendo 49 enfermeiros como experts. Foram avaliados o título, a definição e a relevância dos 19 fatores de risco do DE Risco de Pressão Arterial Instável. Com base no modelo de diversidade preditiva, foram calculados o Índice de Validade de Conteúdo (IVC) e respectivos intervalos de confiança de 95% para cada fator de risco. IVC ≥ 0,8 foi considerado evidência adequada de validade de conteúdo. RESULTADOS: A relevância de 19 fatores etiológicos mostrou IVC ≥ 0,8. De acordo com a recomendação do painel de experts, um dos fatores etiológicos foi dividido em dois e dois rótulos de fatores etiológicos foram alterados. O título e a definição do diagnóstico foram reformulados. CONCLUSÃO: Foram considerados válidos um novo título (Risco de pressão arterial desequilibrada), nova definição e 20 fatores etiológicos (11 fatores de risco, cinco condições associadas e quatro populações de risco) do DE Risco de Pressão Arterial Instável em mulheres encarceradas. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A NANDA-I aceitou a proposta deste diagnóstico de enfermagem; portanto, este estudo contribuiu para a atualização da classificação baseada em evidências científicas. Essas evidências favorecerão o raciocínio diagnóstico e o reconhecimento do diagnóstico durante a avaliação clínica, além de subsidiar estudos que avaliem a validade clínica desses elementos em mulheres encarceradas.

Predictive factors for bleeding-related re-exploration after cardiac surgery: A prospective cohort study.

BACKGROUND: Bleeding-related re-exploration is a life-threatening complication after cardiac surgery. Nurses must be aware of important risk factors for this complication so that their assessment, monitoring and evaluation activities can be prioritized, focused and anticipated. AIMS: To identify the predictive factors for bleeding-related re-exploration after cardiac surgery and to describe the sources of postoperative bleeding. METHODS: This is a prospective cohort study at a tertiary cardiac school-hospital in São Paulo/SP, Brazil. Adult patients (n=323) submitted to surgical correction of acquired cardiac diseases were included. Potential risk factors for bleeding-related re-exploration within the 24 hours following admission to the intensive care unit were investigated in the patients' charts. A univariate analysis and a multiple analysis through logistic regression were conducted to identify the outcome predictors. The area under the receiver-operating characteristic curve was calculated as a measure of accuracy considering the cut-off points with the highest sensitivity and specificity. RESULTS: The univariate factors significantly associated with bleeding-related re-exploration were a lower preoperative platelet count, a lower number of bypasses in coronary artery bypass surgery and postoperatively, a lower body temperature, infusion of lower intravenous volume, a higher positive end-expiratory pressure during mechanical ventilation and transfusion of blood products. The independent predictors of bleeding-related re-exploration included postoperative red blood cell transfusion, and transfusion of fresh frozen plasma, platelet or cryoprecipitate units. These predictors had a sensitivity of 87.5%, a specificity of 99.28% and an accuracy of 97.93%. CONCLUSIONS: Blood product transfusion postoperatively is an independent predictor of bleeding-related re-exploration. Surgical errors prevailed as sources of bleeding.

Lung tumor development in the presence of sphingosine 1-phosphate agonist FTY720.

Urethane is a chemical carcinogen which causes lung tumorigenesis in mice with similarities to human adenocarcinoma (AC). The sphingosine 1-phosphate agonist FTY720 administered to mice in doses above 5 mg/kg/day has been able to prevent hepatocellular carcinoma and bladder cancer. We used BALB/c mice in urethane-induced lung cancer model to investigate the effects of a lower dose of FTY720 (1 mg/kg/day). The benefits of FTY720 were associated with the time point of the compound administration. FTY720 30 Group presented lower incidence and smaller area of lung nodules, decreased PCNA and increased Caspase-3 expressions. The findings in FTY720 0 Group (nodule multiplicity and area, PCNA expression) were similar to Urethane Group suggesting that the administration of the compound at early time point did not affect lung tumor development. FTY720 90 Group presented the biggest nodule area which was associated with increased PCNA and decreased Caspase-3 expressions. FTY720 (30 days and 90 days) administration decreased CD4 + splenocytes and blood lymphocytes which caused opposite effects in lung tumor development - impairment and improvement respectively.In conclusion, FTY720 in low dose did not provide lung tumor inhibition in mice but its administration 30 days after the chemical carcinogen (Urethane) injection was associated with impaired tumor development.

Changes in lymphocyte phenotype and increased skin allograft survival after FTY720+FK506 therapy / Modificação do fenótipo linfocitário e aumento da sobrevida do enxerto de pele após a terapia com FTY720 + FK506

The development of new drugs to be associated with calcineurin inhibitors and promote additional immunosuppression with fewer side effects is the goal in transplantation. FTY720 is a new synthetic compound which presents immunomodulatory properties which are not fully understood. It has been reported that the main mechanism of action of FTY720 is to reduce the peripheral lymphocyte count by redirecting these cells toward secondary lymphoid organs. Skin allograft transplantation in a fully mismatched strain combination was used to investigate the potential of FTY720 alone or in combination with a calcineurin inhibitor - FK506 - in preventing rejection. The number and phenotype of immune system cells was also evaluated. FTY720 alone or in combination with FK506 provided significant skin allograft survival. FTY720+FK506 therapy was associated with decreases of total lymphocyte numbers in spleen and blood, and increases in apoptosis levels in splenocytes. In FTY720 isolated treatment, a significant decrease in the CD4 expression and significantly lower expressions of MHC II and ICAM-1 molecules were observed in spleen lymphocytes. Despite of allograft survival being the same in both FTY720 and FTY720+FK506 treated groups, the association of drugs was associated with the absence of macroscopic skin necrosis for a longer period than the other treatments (FTY720, FK506) and histology showed less cell infiltration. Our results suggest that a decrease of effector T cells due to elevated levels of apoptosis and impairment in the appearance of antigens were events associated with FTY720+FK506 administration.

O objetivo na área dos transplantes é o desenvolvimento de novas drogas que possam ser associadas a inibidores da calcineurina para evitar o processo de rejeição e causar menos efeitos colaterais. FTY720 é um novo composto sintético que apresenta propriedades imunomoduladoras não completamente elucidadas. Foi relatado que o principal mecanismo de ação do FTY720 é a redução do número de linfócitos periféricos através do redirecionamento dessas células para órgãos linfóides secundários. O alotransplante de pele entre linhagens de camundongos completamente incompatíveis quanto ao MHC foi usado para investigar o potencial de FTY720 isolado ou em combinação com um inibidor da calcineurina - FK506 - na prevenção da rejeição. Também foram avaliados o número e fenótipo das células do sistema imune. A administração de FTY720 como monoterapia ou FTY720+FK506 associou-se a uma diminuição do número total de linfócitos no baço e no sangue e aumento dos níveis de apoptose nos esplenócitos. No grupo tratado somente com FTY720, foi observada uma diminuição mais importante da expressão de CD4 e expressão significativamente menor de moléculas de MHC II e ICAM-1. Apesar de a sobrevida do aloenxerto ter sido igual para os grupos tratados com FTY720 ou FTY720 +FK506, a associação das drogas promoveu ausência de necrose macroscópica da pele por um período maior do que os outros tratamentos (FTY720, FK506) e os achados histológicos mostraram menor infiltrado celular. Nossos resultados sugerem que uma diminuição do número de células T efetoras devido a elevados níveis de apoptose e o prejuízo da apresentação de antígenos foram os eventos associados à administração de FTY720+FK506.