A segurança do paciente e a avaliação do risco de quedas / Patient safety and fall-risk assessment / Seguridad del paciente y evaluación de riesgo de caída

Objetivo: Avaliar os pacientes hospitalizados quanto ao risco de quedas. Métodos: Estudo transversal, realizado por meio da aplicação da escala de Morse e registros de prontuários. Realizou-se estatísticas descritivas e Teste Qui-quadrado de Pearson, adotando-se o nível de 5%. Resultados: Dos 244 participantes, 139 (57%) eram do sexo masculino, 86 (47,5%) idosos, 116 (47,5%) com companheiro, 112 (45,9%) pardos e 173 (70,9%) com baixa escolaridade. O risco de quedas foi associado ao histórico de quedas (p=0,000), diagnóstico secundário (p<0,001), deambulação (p=0,002), marcha (p<0,001) e estado mental (p<0,000). A maioria dos entrevistados 194 (79,5%) estão sob um risco moderado a alto de sofrer quedas da própria altura 37 (15,2%), ocorridas no quarto ou na enfermaria 38 (15,6%). Conclusão: Observou-se um risco moderado a alto para quedas nos pacientes hospitalizados, o que aponta para a necessidade de implementação de políticas de segurança do paciente para garantir a qualidade da assistência. (AU)

Objective: Assess hospitalized patients for the risk of falls. Methods: Cross-sectional study, carried out through the application of the Morse scale and medical records. Descriptive statistics and Pearson's Chi-square test were performed, adopting the 5% level. Results: Of the 244 participants, 139 (57%) were male, 86 (47.5%) elderly, 116 (47.5%) with a partner, 112 (45.9%) brown and 173 (70.9%) with low education level. The risk of falls was associated with a history of falls (p = 0.000), secondary diagnosis (p <0.001), walking (p = 0.002), gait (p <0.001) and mental status (p <0.000). Most respondents 194 (79.5%) are at moderate to high risk of suffering falls from their own height 37 (15.2%), in their bedroom or in the ward 38 (15.6%). Conclusion: There was a moderate to high risk for falls in hospitalized patients, which points to the need of implementing patient safety policies in order to guarantee quality of care. (AU)

Objetivo: Evaluar a los pacientes hospitalizados por el riesgo de caídas. Métodos: Estudio transversal, realizado a través de la aplicación de la escala Morse y registros médicos. Se realizaron estadísticas descriptivas y la prueba de Chi-cuadrado de Pearson, adoptando el nivel del 5%. Resultados: De los 244 participantes, 139 (57%) eran hombres, 86 (47.5%) ancianos, 116 (47.5%) con una pareja, 112 (45.9%) marrones y 173 (70.9%) con baja educacion. El riesgo de caídas se asoció con antecedentes de caídas (p = 0.000), diagnóstico secundario (p <0.001), caminar (p = 0.002), marcha (p <0.001) y estado mental (p <0.000). La mayoría de los encuestados 194 (79.5%) tienen un riesgo moderado a alto de sufrir caídas desde su propia altura 37 (15.2%), ocurriendo en el dormitorio o en la sala 38 (15.6%). Conclusión: Hubo un riesgo moderado a alto de caídas en pacientes hospitalizados, lo que apunta a la necesidad de implementar políticas de seguridad del paciente para garantizar la calidad de la atención. (AU)

Evaluation of the Combination of CO2 Laser and Bifunctional Bonding Agents for Composite Resin Repairs After 1 Year of Aging.

Objective: to evaluate the bond strength of repairs to composite resin restorations treated with CO2 laser and bifunctional monomers after 1 year of aging. Background: Adequate bond strength between a composite restoration and resin repair agent can be achieved through mechanical and/or chemical treatment. However, the longevity of such repairs is unknown. Methods: Resin blocks (volume: 125 mm3) were created. Failure surfaces were either not treated or were treated before the repair with a universal adhesive, a silane bonding agent and/or CO2 laser. The blocks were distributed into six groups (n = 6 per group): resin+resin group (RRG), universal adhesive+resin group (ARG), silane+universal adhesive group (SAG), laser+silane+universal adhesive group (LSAG), laser+universal adhesive group (LAG), and laser+silane group (LSG). After treatment, repairs were made with another resin composite. "Sticks" (1.0 mm2 in area and 1.0 cm in length) were cut from the specimens in each group and immersed in distilled water at 37°C. Microtensile bond strength was evaluated after 1 year of aging. Bond strength values were compared using the Kruskal-Wallis test and Dunn's test. Results: Bond strength was significantly higher in the LSAG compared with the RRG, adhesive system, LSG, whereas statistically similar results were found for the SAG, LSAG, and LAG. Bond strength was lowest in the RRG. The LSAG and LAG presented predominantly cohesive fractures. Conclusions: The bond strength of composite resin repairs was satisfactory over time. Treatment with CO2 laser contributed to the maintenance of bond strength during the 1-year storage period and bifunctional monomers present in the universal adhesive on the irradiated repair surface were of fundamental importance to the maintenance of bond strength values, as demonstrated by microtensile bond test and fracture pattern analysis.

Effectiveness of educational interventions to develop patient safety knowledge, skills, behaviours and attitudes in undergraduate nursing students: a systematic review protocol.

INTRODUCTION: Patient safety is a healthcare discipline that aims to prevent and reduce patient harm, risks and errors during the provision of healthcare. Given the size of the nursing workforce in the healthcare system the inclusion of patient safety in the undergraduate nursing curriculum is necessary to enhance a safe culture in the daily work of their future careers. To this end, it is essential to apply effective teaching strategies to develop patient safety competencies. This review will aim to evaluate the effectiveness of educational interventions in developing patient safety knowledge, skills, behaviours and attitudes in undergraduate nursing students within the existing topic areas of the WHO Multi-professional Patient Safety Curriculum Guide. METHODS AND ANALYSIS: The databases Medline, CINAHL, Scopus, Education Research Complete, The Cochrane Central Register of Controlled Trials, LILACS, Medes and Grey literature such as ClinicalTrials.gov, Google Scholar, DART-Europe, ProQuest Dissertations, CAPES thesis and dissertations, The Virginia Henderson Global e-Repository, Mednar and Thesis Canada will be searched from July 2011 to January 2022. Two independent reviewers will conduct the search, extract the data and assess the risk of bias for the included studies, using standardised critical appraisal instruments from the Joanna Briggs Institute. The quality of the evidence will be assessed using the Grading of Recommendations, Assessment Development and Evaluation methodology. Studies will be pooled in the meta-analysis. Alternatively, the findings will be presented in narrative form, including tables and figures, to aid in data presentation. ETHICS AND DISSEMINATION: This study raises no ethical issues. The findings will be disseminated through presentations at professional conferences and publications in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42021254965.

Effect of Er:YAG Laser and Association of Protocols on the Demineralized Enamel Microhardness.

Objective: The aim of this study was to analyze the microhardness of demineralized enamel following different treatments (fluoride varnish, Er:YAG laser, and Er:YAG laser associated with fluoride varnish). Methods: Forty-eight enamel blocks (4 × 4 × 7 mm) were divided into six groups (n = 8): (S) Sound; (DE) Demineralized; (DED) DE + Duraphat® 5% (fluoride varnish); (DEL20) DE + Er:YAG laser (20 mJ pulse mode; 0.20 W; 10 Hz; 60 sec; 1.18 J/cm2; 11.83 W/cm2); (DEL50) DE + Er:YAG laser (50 mJ pulse mode; 0.50 W; 10 Hz; 60 sec; 2.95 J/cm2; 29.58 W/cm2); (DEL20D) DE + Er:YAG laser (20 mJ) + Duraphat 5%. The irradiation was performed at 1 mm distance from the surface using a tip (AS7066X, L-14 mm, D-1.3 mm in diameter) in water/air spray refrigeration (level 6). The enamel blocks were submitted to pH cycling (4 h into DES solution +20 h into RE solution for 8 days and the solutions were changed every day). Knoop microhardness was measured (50 g/15 sec, six readings per sample) and data were analyzed by Kruskal-Wallis test at 5% significance. Results: After treatments, DF group showed higher microhardness values than all the groups. Also, DEL20D group showed similar results with H group according to the microhardness analysis (p < 0.05). Conclusions: It could be concluded that Duraphat 5% treatment showed better results when compared with all tested groups, however, the association of Er:YAG Laser 20 with Duraphat 5% also showed promising results.

National Patient Safety Program in Brazil: Incidents Reported Between 2014 and 2017.

OBJECTIVE: The aim of the study was to analyze the patient safety incidents reported to the Brazilian National Health Surveillance System from March 2014 to March 2017. METHOD: A documentary study that used the records of the incidents published in the Reports of Adverse Events (AE) in Brazil. The following variables were selected: number of incidents by type, type of health service, hospital unit, and degree of harm. To find whether there was a significant difference across the Brazilian regions by notifications related to general incidents, AE, and deaths, the analysis of variance and the Tukey tests were used. RESULTS: A total of 109,082 incidents were reported, of which 75,088 were AE, with 649 deaths. In relation to the types of incidents reported, there was a higher frequency in the categories other (30.04%) and failures during health care (26.72%). A total of 93.90% of the incidents occurred in hospitals, with 54,950 cases registered in hospitalization units and 30,141 cases in intensive care units. Statistically significant differences across the Brazilian regions were observed in the number of incidents (P = 0.004), AE (P = 0.004), and deaths (P = 0.024). CONCLUSIONS: A significant underreporting of incidents was found in Brazil, demonstrating only the tip of a giant iceberg. More than half of the incidents were reported as AE and were registered in hospitals, reiterating the importance of establishing public health policies at national, state, and municipal levels, with adequate supervision of the health service regarding the implementation of the Patient Safety Nuclei and the preparation of new protocols based on the most prevalent incidents.

Iniciativas nacionais para segurança do paciente no cenário brasileiro e português: percepção dos profissionais envolvidos em sua concepção e implementação / National initiatives regarding patients safety in Brazil and Portugal: the perception of the professionals responsible for the concept and implementation of it

Introdução: Iniciativas de âmbito nacional para a segurança do paciente envolvem os diversos níveis de atenção saúde e são fundamentais para equalizar as estratégias e estimular a cultura de segurança em todo o sistema de saúde. Objetivo: Compreender a percepção dos profissionais envolvidos na concepção e na implementação de iniciativas nacionais para segurança do paciente nos contextos do sistema de saúde brasileiro e português. Caminho Metodológico: Trata-se de uma pesquisa qualitativa, exploratório-descritiva, na modalidade estudo de caso, desenvolvida nas instâncias ligadas à segurança do paciente em níveis central, intermediário e local hospital universitário público de grande porte, constituintes do sistema de saúde brasileiro e português. Participaram 17 profissionais envolvidos na construção ou implementação das iniciativas nacionais de segurança do paciente. A coleta de dados foi iniciada após a aprovação do Comitê de Ética em Pesquisa. Os dados foram coletados pelo pesquisador no período entre agosto de 2018 e junho de 2019, por meio de entrevistas semiestruturadas. Os dados foram transformados em narrativas e, posteriormente, foi realizada a análise temática, de acordo com Minayo. O referencial teórico Abordagem de Ciclo de Políticas foi adotado para subsidiar a análise interpretativa dos achados. Resultados: Emergiram das narrativas cinco categorias temáticas relativas às iniciativas, a saber: Panorama das diretrizes referentes à segurança do paciente pré-implementação, Alicerces para a construção, Vertentes adotadas para a efetivação, Fatores intervenientes no processo de implementação e Desafios para o aperfeiçoamento. A Abordagem Ciclo de Políticas permitiu compreender os contextos da influência, da produção de texto e da prática e sua contínua articulação no processo de interpretação e recontextualização das iniciativas. A aplicação da Matriz SWOT, nos contextos investigados, possibilitou a identificação de aspectos facilitadores, como: influência de órgãos internacionais, processos de acreditação, instâncias locais para operacionalizar as ações, educação permanente e apoio do corpo diretivo. Como dificultadores, foram evidenciados o subfinanciamento, ocasionando déficit de recursos humanos, material e infraestrutura; a resistência para integração com outros órgãos e a dificuldade em manter o tema na agenda política. Dentre as peculiaridades, a estrutura organizativa específica sobre a temática, em Portugal, contribuiu para o desdobramento das ações. No Brasil, o formato de programa tornou a iniciativa abrangente e flexível e a instituição de um comitê para implementação promoveu articulação de várias partes interessadas. Considerações Finais: Tendo em vista a percepção dos profissionais sobre a iniciativas nacionais, foram observados avanços e os desafios para qualificação do cuidado. O estudo indicou caminhos para uma autoavaliação e um benchmarking estrutural entre as inciativas, contribuindo com ações que podem ser compartilhadas para o aperfeiçoamento das iniciativas de âmbito nacional para a segurança do paciente.

Introduction: Nationwide initiatives to ensure patients health involve several levels and are essential to equalize their strategies and foster a safety culture in the health system as a whole. Goal: To understand the perception of the professionals relevant to the conception and implementation of National initiatives regarding patients safety in Brazil and Portugal. Methodology: A qualitative research and exploration regarding the subject of patients safety set and used by Ministry of health, State and hospitals in big public college hospitals that are part of the Brazilian and Portuguese Health system. Seventeen professionals participated of these studies. The data collection was started after the approval of the Ethic research Committee. The researcher collected the data between August 2018 and June 2019 through semi-structured interviews. We made the into narratives and later submitted to theme studies according to Minayo. The theoretical framework Policy Cycle Approach was used in the data comprehension and analysis. Results: Five thematic narratives arose: Overview of the guidelines concerning Patients safety in the pre-implementation stage, Foundations for its creation, Aspects used in the implementation, Factors that interfere in the implementation process, and Challenges for improving it. The Policy Cycle Approach allowed us to understand the scope of text production, text comprehension, and contextualizing of the initiatives used. The use of the SWOT analysis (Strengths, Weakness, Opportunities and Threats) allowed us to identify factors that facilitate it such as international organizations, certification processes, local entities to perform the required actions, to keep a program of ongoing training, and managing support. As factors that make things difficult, the following were revealed underfinancing, this causes a lack of human resources, lack of supplies and lack of suitable infrastructure; the struggle to integrate with other public entities; and the difficulty to keep the topic in the politics agenda. About the singularities of each country, Portugals specific structure regarding it helped performing the actions. In Brazil, the program structure created a broad and flexible initiative and the implementation of a committee that linked all professionals involved. Final thoughts: Bearing in mind the professionals perceptions on the local initiatives, the advances and the challenges of training care workers. This study showed the way for a self-assessment and a structural benchmarking among the initiatives to contribute to the creation of actions that can be shared in order to improve the initiatives in a national range to ensure patients safety.

Associação terapêutica conservadora para o tratamento das manchas de fluorose dental / Conservative treatment therapy for dental fluorosis staining

O excesso de ingestão de flúor durante o desenvolvimento do órgão dental pode resultar em alterações estruturais tanto em esmalte quanto em dentina. No esmalte, observa-se um aumento de porosidades causadas pela interação do flúor com os prismas em desenvolvimento, tanto na superfície quanto em profundidade. Clinicamente essas alterações são visíveis como manchas com aspecto que vai do branco opaco ao amarelo amarronzado. A presença de manchas no esmalte dental leva ao comprometimento estético do sorriso tão valorizado atualmente. Para a homogeinização de cor, nos casos mais brandos, recomenda-se a realização do tratamento clareador com agentes oxidantes de baixa concentração (clareamento caseiro). Em casos mais severos a associação do clareamento caseiro com o procedimento de microabrasão é indicada para remoção das manchas de fluorose. Na microabrasão, o uso simultâneo da abrasão e da erosão ácida é capaz de remover as manchas decorrentes de alterações superficiais em esmalte. Portanto, utilizando tratamentos conservadores é possível devolver a autoestima do paciente de forma bastante satisfatória.

The excess fluoride intake during dental organ development may result structural changes in enamel and dentin. Increase porosity was observed by fluorine interaction with enamel prisms development, both on surface and in depth. Clinically these changes are visible as spots with aspect that goes from opaque white to brownish yellow. The enamel spots leads to unpleasant smile. In mild cases, for color homogenization, it is recommended bleaching treatment with low concentration oxidizing agents (home bleaching). In more severe cases, the home bleaching and microabrasion procedure association are indicated for fluorosis stains removal. In microabrasion, the association of abrasion and acid erosion remove stains from changes on enamel surface. Thus conservative treatments can successfully restore patient's self- esteem.

In-Office Bleaching During Orthodontic Treatment.

OBJECTIVE: To demonstrate that it is possible to pursue teeth whitening treatment protocols during orthodontic treatment with no esthetic loss. CLINICAL CONSIDERATIONS: Many patients undergoing orthodontic treatment desire to have a straight and well aligned dentition, but also whiter teeth. For many years, it was believed that carrying out a whitening treatment with positioned orthodontic brackets in place would result in localized spots on the enamel labial surfaces of teeth. However, a deeper understanding of the bleaching process suggests that the oxidation caused by products, which results from hydrogen peroxide decomposition, are able to diffuse peripherally into the tooth structure and reach even that under the cemented brackets. Two in-office-bleaching treatments were performed in patients using orthodontic fixed braces in two or three 40-minute sessions using a 35% hydrogen peroxide. CONCLUSION: In-office bleaching is possible and effective, even with orthodontic brackets in position. The teeth were successfully bleached despite the presence of brackets. All biological criteria have been fulfilled satisfying patients' expectations of aligned and whitened teeth in less time than if treatments had been performed separately, with satisfactory results and no esthetic loss. CLINICAL SIGNIFICANCE: The whitening of teeth is possible during orthodontic treatment with fixed braces without any esthetic loss. The in-office bleaching treatment with brackets in position also may act as a motivation factor, preventing patient withdrawal or treatment interruption. Therefore, at the end of the orthodontic treatment, the patient is able to display an aligned, functional and whitened smile. (J Esthet Restor Dent 29:83-92, 2017).

A qualidade da assistência de enfermagem em uma unidade de emergência: a percepção do usuário / The quality of nursing care at an emergency unit: the patient's perception / Calidad de atención de enfermería en unidad de emergencias: percepción del paciente

Estudo exploratório-descritivo, realizado em um hospital público e de ensino, cujo objetivo foi analisar a qualidade da assistência de enfermagem em uma unidade de emergência a partir da percepção dos usuários. A população foi constituída por 260 participantes e os dados foram coletados entre agosto e outubro de 2008 por meio de um questionário empregando-se a escala Likert. Verificamos que 52,7% dos participantes pertenciam ao sexo masculino, com média de idade de 46,9 anos e a maior parte possuía ensino fundamental (54,6%). O instrumento de coleta de dados teve Alpha de Cronbach igual a 0,88. Na comparação das dimensões de estrutura, processo e resultado, a que obteve maior escore foi a de resultado 36,20 e a que teve menor, a de estrutura com 33,20. O estudo permitiu analisar a assistência de enfermagem na referida unidade de emergência e, logo, contribuirá para a reformulação dos aspectos avaliados nas três dimensões investigadas.

The objective of this exploratory-descriptive study was to analyze the nursing care at an emergency unit based on the patients' perception. The study was performed at a public teaching hospital. The study population consisted of 260 subjects, and data collection was performed between August and October of 2008 by means of a questionnaire using a Likert scale. We found that 52.7% of the participants were male, with an average age or 46.9 years, and most had a complete primary education (54.6%). The data collection instrument had a Cronbach's Alpha of 0.88. By comparing structure, process and outcome, the dimension with the highest score was outcome, with 36.20, while structure was the lowest, with 33.20. in conclusion, the study permitted to analyze the nursing care at the referred emergency unit, and, thus, will contribute with the reformulation of the aspects validated in the three studied dimensions.

Estudio exploratorio-descriptivo, objetivando analizar la calidad de atención de enfermería en unidad de emergencias en la percepción de los pacientes. Investigación realizada en hospital público de enseñanza. La población se constituyó con 260 participantes, datos recolectados de agosto a octubre de 2008, mediante un cuestionario empleando la escala de Likert. Verificamos que 51,7% de los participantes eran de sexo masculino, media etaria de 46,9 años, la mayoría poseía enseñanza primaria (54,6%). El instrumento de recolección de datos tuvo Alpha de Cronbach igual a 0,88. En la comparación de dimensiones de estructura, proceso y resultado; la que obtuvo mayor puntaje fue la de resultado, con 36,20; y el menor fue el de estructura, con 33,20. El estudio permitió así analizar la atención de enfermería en la referida unidad de emergencias y contribuirá a la reformulación de los aspectos evaluados en las tres dimensiones estudiadas.

Miíase na cavidade bucal em paciente geriátrico: relato de caso / Myiasis in the oral cavity in the geriatric patient: case report

Pacientes geriátricos que apresentam comprometimento sistêmico severo muitas vezes necessitam de cuidados especiais. A limitação da atividade motora pode estar relacionada com as diversas condições médicas que acometem esses pacientes. O acidente vascular cerebral pode causar sequelas graves como, por exemplo, o comprometimento da motricidade do indivíduo. Neste relato, apresentamos um caso clínico de um paciente geriátrico com importante comprometimento da atividade motora, decorrente de um acidente vascular cerebral, acometido por miíase oral, devido à falta de cuidados específicos.

Geriatric patients who have severe systemic involvement often require special care. The limitation of motor activity may be related to several medical conditions that affect thesepatients. Stroke can be cause serious sequelae, such as motor impairment of the individual. Here we report a case of a geriatric patient with a significant impairment of motor activity, resulting from a stroke, affected by oral myiasis due to lack of specific care.

Effect of pre-heated dual-cured resin cements on the bond strength of indirect restorations to dentin.

This study evaluated the effects of resin luting agents (LA) polymerized using increased temperature on the in vitro microtensile bond strength (mTBS) of indirect restorations to dentin. The occlusal dentin surfaces of 40 human third molars were exposed and flattened. The teeth were assigned to 8 groups (n = 5) according to the LA temperature (25°C o r 50°C), curing mode (dual- or self-curing mode), and product (Excite DSC/Variolink II [VII] and XP Bond/Calibra [Cal]). The bonding agents were applied to the dentin surfaces according to manufacturers' instructions. For preheated groups, the LAs were heated to 50°C, subsequently mixed on a heated stirrer surface, and applied to the previously heated pre-polymerized resin discs (2 mm thickness, TPH-Spectrum). The discs were bonded to the dentin surfaces, and the LAs were either exposed to a curing light according to manufacturers' instructions or allowed to self-cure. Specimens were stored in relative humidity at 37°C for 7 days. Specimens were mesio-distally and bucco-lingually sectioned to obtain multiple bonded beams with a 1-mm² cross-sectional area for mTBS testing. Data (MPa) were analyzed by 2-way ANOVA and Tukey's post hoc test (a = 5%) for each product. Specimen failure patterns were analyzed using a scanning electron microscope. VII groups showed higher mTBS at 50°C than at 25°C regardless of curing mode (p = 0.05). Cal groups showed similar mTBS at 25°C and 50°C in all activation modes. The use of some dual-polymerizing LAs at 50°C may improve the mTBS of indirect restorations to dentin.

Effect of pre-heated dual-cured resin cements on the bond strength of indirect restorations to dentin

This study evaluated the effects of resin luting agents (LA) polymerized using increased temperature on the in vitro microtensile bond strength (mTBS) of indirect restorations to dentin. The occlusal dentin surfaces of 40 human third molars were exposed and flattened. The teeth were assigned to 8 groups (n = 5) according to the LA temperature (25°C o r 50°C), curing mode (dual- or self-curing mode), and product (Excite DSC/Variolink II [VII] and XP Bond/Calibra [Cal]). The bonding agents were applied to the dentin surfaces according to manufacturers' instructions. For preheated groups, the LAs were heated to 50°C, subsequently mixed on a heated stirrer surface, and applied to the previously heated pre-polymerized resin discs (2 mm thickness, TPH-Spectrum). The discs were bonded to the dentin surfaces, and the LAs were either exposed to a curing light according to manufacturers' instructions or allowed to self-cure. Specimens were stored in relative humidity at 37°C for 7 days. Specimens were mesio-distally and bucco-lingually sectioned to obtain multiple bonded beams with a 1-mm² cross-sectional area for mTBS testing. Data (MPa) were analyzed by 2-way ANOVA and Tukey's post hoc test (a = 5%) for each product. Specimen failure patterns were analyzed using a scanning electron microscope. VII groups showed higher mTBS at 50°C than at 25°C regardless of curing mode (p = 0.05). Cal groups showed similar mTBS at 25°C and 50°C in all activation modes. The use of some dual-polymerizing LAs at 50°C may improve the mTBS of indirect restorations to dentin.

Antifibrinolítico em cirurgia cardíaca: como e quando usar? / Anfibrinolytic in cardiac surgery: how and when to use?

O sangramento pós-operatório continua sendo uma das principais complicações em cirurgia cardíaca. A etiologia desse sangramento é multifatorial, com hiperfibrinólise e disfunção plaquetária desempenhando papel fundamental Tendo em vista essas causas, as drogas antifibrinolíticas têm sido preconizadas. Desde a retirada da aprotinina do mercado, o ácido epsilon-aminocaproico e o ácido tranexâmico passaram a ser os únicos representantes disponíveis dessa classe de drogas. Essas medicações diminuem a perda de sangue e agem na resposta inflamatória associada ao procedimento cirúrgico. A eficácia variável dessas drogas ocorre devido aos vários esquemas terapêuticos e níveis séricos existentes. Recentemente têm surgido alguns questionamentos na literatura a respeito das complicações, doses, vias de administração e melhor momento para administração desses agentes...

The postoperative bleeding remains a major complication in cardiac surgery. The etiology of this bleeding is multifactorial, with hyperfibrinolysis and platelet dysfunction playing a key role. Given these causes antifibrinolytic drugs have been recommended Since the with drawal of aprotinin in the market, epsilon-aminocaproic acid and tranexamic acid became the sole representatives of this class of drugs available. These medications reduce blood loss and act on the inflammatory response associated with surgery. The variable efficacy of these drugs is due to multiple drug regimens and serum available. Recently some questions have arisen in the literature regarding the comptications, doses, routes of administration and timing for administration of these agents...

Cirurgia plástica periodontal para otimização de resultados estéticos na região anterior / Periodontal plastic surgery for optimal esthetic results in the anterior maxilla

O diagnóstico multidisciplinar envolvendo procedimentos restauradores, cirúrgicos e laboratoriais são essenciais para o sucesso de uma reabilitação estética. Este caso clínico descreve um protocolo multidisciplinar utilizado para a reabilitação de dentes anteriores superiores por meio de cirurgia plástica periodontal e restaurações cerâmicas adesivas. Após adequação inicial, foram realizados gengivoplastia para remoção de excesso e melhora do contorno gengival, e a confecção de preparos conservadores para laminados e coroas totais cerâmicas. Após a finaliza- ção deste caso, pôde-se concluir que um diagnóstico bem estabelecido associado a uma abordagem multidisciplinar são procedimentos fundamentais para obtenção de resultados estéticos previsíveis em áreas comprometidas esteticamente.

The multidisciplinary diagnosis considering clinical surgical and laboratorial procedures are essential for a successful aesthetic dental treatment. This clinical report describes a protocol to obtain optimal results in the anterior maxilla by conservative preparations on anterior teeth for adhesively retained porcelain restorations with periodontal plastic surgery. After the ini- tial preparation of patient and diagnostic additive wax-up confection, a periodontal aesthetic crown-Iengthening gengivoplasty followed by osteotomy to remove the excess of gingival was performed. Conservative preparations for ceramic laminate veneers and full-coverage crowns were used for the aesthetic rehabilitation of the patient. An accurate diagnostic and interdiscipli- nary approach is necessary for obtaining improved, conservative and predictable aesthetic results in esthetically compromised areas, such as the anterior maxillary dentition.

Qualidade e avaliação em saúde: publicações em periódicos de enfermagem nas últimas duas décadas / Health care quality and evaluation: papers in nursing journals over the past two decades

O objetivo desta investigação foi identificar e analisar a produção científica em periódicos nacionais de enfermagem, classificados pela Coordenação de Aperfeiçoamento de Pessoal de Ensino Superior como Qualis B e C Internacional, acerca da qualidade e avaliação em saúde, nos últimos 20 anos. Identificaram-se nas bases de dados MEDLINE, LILACS e PERIENF, 68 publicações. As revistas selecionadas abordavam os assuntos em questão com os seguintes descritores: garantia da qualidade dos cuidados de saúde, avaliação de serviços de saúde, qualidade da assistência à saúde e qualidade dos cuidados de saúde. A Revista Brasileira de Enfermagem apresentou predominância nas publicações, 26,0 e 68,0 dos artigos publicados eram originais derivados de dissertações ou teses. Quanto ao método, 58,0 empregaram o quantitativo e, no qüinqüênio 2003-2007, ocorreu o maior número de produções - 44,1. Concluiu-se que as publicações vêm crescendo ao longo dos anos no que se refere à qualidade e avaliação.

The aim of this study was to identify and analyze scientific papers about health care quality and evaluation published in the last 20 years in Brazilian nursing journals classified as Qualis international B or C by CAPES (Brazil’s postgraduate studies coordinating agency). Of the 68 such publications identified in the MEDLINE, LILACS and PERIENF databases, about 13 contained papers on the subject in question on the following themes: guaranteeing quality health care, evaluating health care services, and quality of health care (at various levels of generality and specificity). The Brazilian journal of nursing, REBEN, was the major source of papers (26), of which 68 were original articles derived from dissertations or theses. Of the papers, 58 used quantitative methods and the highest concentration (44.1) occurred in the period 2003 to 2007. It was concluded that output of papers on quality and evaluation has grown over the years.

El objetivo de esta investigación  fue identificar y analizar la producción científica en periódicos nacionales de enfermería, clasificados por la Coordinación de Perfeccionamiento del Personal de Enseñanza superior como Qualis B y C Internacional, y acerca de la calidad y evaluación en salud en los últimos 20 años. Fueron identificadas, en las bases de datos MEDLINE, LILACS y PERIENF, 68 publicaciones. Las revistas seleccionadas enfocaban los asuntos con las siguientes palabras clave: garantía de la calidad de los cuidados de salud, evaluación de los servicios de salud, calidad de la asistencia a la salud y de la calidad en los cuidados de salud. La Revista Brasileña de Enfermería presentó un dominio en las publicaciones, 26 y 68 de los artículos publicados eran originales provenientes de disertaciones o tesis. En relación al método, 58 utilizaron el cuantitativo y, en un periodo de 5 años, entre 2003 y 2007, ocurrió el número más grande de producciones - 44.1. Se concluyó que las publicaciones aumentan a lo largo de los años en lo que refiere a la calidad y evaluación.

Seletividade de inseticidas para ovos e ninfas de Orius insidiosus ( Say ) ( Hemiptera: Anthocoridae ) / Selectivity of inseticides to eggs and nymphs of Orius insidiosus ( Say ) ( Hemiptera: Anthocoridae )

O predador Orius insidiosus (Say) alimenta-se de tripes, afídeos, moscas-brancas, ácaros e pequenas lagartas, contribuindo para a regulação populacional dessas pragas em diferentes agroecossistemas. Este trabalho teve por objetivo avaliar a seletividade dos inseticidas abamectina, cartape, ciromazina, fempropatrina e imidaclopride, registrados para a cultura do crisântemo, para ovos e ninfas de 1°, 2° e 3° instares de O. insidiosus. Os produtos foram pulverizados em torre de Potter, sendo utilizadas as maiores doses recomendadas para o controle de pragas na cultura do crisântemo. Após a pulverização, os ovos e ninfas foram mantidos em condições controladas, com temperatura de 25 ± 1°C, UR de 70 ± 10 por cento e fotofase de 12h. Avaliaram-se a duração do período embrionário, a viabilidade dos ovos e a duração e sobrevivência de ninfas. Os ovos de O. insidiosus foram tolerantes a todos os inseticidas. Cartape e ciromazina foram seletivos às ninfas de 1°, 2° e 3° ínstares, enquanto que os demais produtos foram tóxicos. Fempropatrina provocou 100 por cento de mortalidade de O. insidiosus nos três ínstares avaliados. Os inseticidas cartape e ciromazina podem ser recomendados para uso em programas de manejo integrado de pragas na cultura do crisântemo.

Seletividade de inseticidas utilizados na cultura dos citros para ovos e larvas de Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) / Selectivity of insecticides used in citrus crops to eggs and larvae of Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae)

The objective of this work was to evaluate the selectivity of abamectin (0.0054 g a.i. L-1), deltamethrin (0.0125 g a.i. L-1), fenbutatin oxide (0.4 g a.i. L-1), lufenuron (0.0375 g a.i. L-1), tebufenozide (0.12 g a.i. L-1) and thiacloprid (0.036 g a.i. L-1) to eggs and larvae of Chrysoperla externa (Hagen). Commercial formulations of the insecticides were diluted in water and sprayed, using a Potter’s tower,at 1.5 ± 0.5 mg.cm-2, either on eggs or on glass plates, where first, second and third-instar larvae were placed to assess the contact action on them. Egg viability, survival of larvae, pupae and adults, and the effects of the compounds on the reproductive capacity of individuals were evaluated. The total toxic effect (E) of the insecticides was calculated according to the standard methodology established by IOBC. All tested insecticides were selective for eggs of C. externa. Lufenuron and deltamethrin were highly toxic to first, second and third-instar larvae of C. externa (E > 99% of mortality). Abamectin, fenbutatin oxide, tebufenozide and thiacloprid were moderately toxic to larvae of C. externa. First-instar larvae were the most sensitive to the compounds. All tested insecticides need to be tested undergreenhouse and field conditions, to further evaluate their suitability for IPM programs in citrus crops.

Objetivou-se neste trabalho avaliar a seletividade dos inseticidas abamectina (0,0054 g i.a. L-1), deltametrina (0,0125 g i.a. L-1), óxido de fenibutatina (0,4 g i.a. L-1), lufenurom (0,0375 g i.a. L-1), tebufenozide (0,12 g i.a. L-1) e tiaclopride (0,036 g i.a. L-1) para ovos e larvas de Chrysoperla externa (Hagen). Os inseticidas foram pulverizados, por meio de torre de Potter, garantindo a aplicação de 1,5± 0,5 mg/cm2, nos ovos ou em placas de vidro, sobre as quais foram colocadas larvas de primeiro, segundo e terceiro ínstares. Avaliaram-se a viabilidade dos ovos, a sobrevivência de larvas, pupas eadultos e o efeito dos inseticidas na capacidade reprodutiva dos indivíduos oriundos de ovos e de larvas tratadas. A toxicidade dos inseticidas foi calculada em função do seu efeito total (E), conforme metodologia padrão estabelecida pela “IOBC”. Todos os inseticidas foram seletivos para ovos de C. externa. Lufenurom e deltametrina foram altamente nocivos a larvas de primeiro, segundo e terceiro ínstares de C. externa (E > 99% de mortalidade). Abamectina, óxido de fenibutatina, tebufenozide e tiaclopride apresentaram toxicidade intermediária à fase larval de C. externa. O primeiro ínstar dessepredador foi o mais susceptível à ação dos produtos avaliados. Recomenda-se avaliar os efeitos dos inseticidas testados para larvas de C. externa em condições de casa de vegetação e campo para confirmação de sua toxicidade e possível utilização em programas de manejo integrado de pragas em citros.

Seletividade de seis inseticidas utilizados em citros a pupas e adultos de Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) / Selectivity of six insecticides used in citrus crops on pupae and adults of Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae)

The selectivity of the insecticides abamectin, lufenuron, fenbutatin oxide, tebufenozide, thiacloprid and deltamethrin used in citrus crops was evaluated for pupae and adults of Chrysoperla externa (Hagen). The experiments were conducted in the Entomology Department of the Universidade Federal de Lavras, MG, Brazil. The spraying was accomplished by means of Potter tower with volume ofapplication of 1.5 ± 0.5 mg/cm2. After spraying, the pupae were kept in test tubes in a climatic chamber and the adults in PVC cages in a room at 25 ± 2oC, 70 ± 10% RH and 12h photophase. A completely randomized experimental design was used, with six products and ten replicates, each one composed of three pupae or a pair of adults. The action of lufenuron on males or females of C. externa was also evaluated under acompletely randomized design with three treatments and ten replicates, each one composed of one pair. The insecticides were classified following the method established by the International Organization for Biological and Integrated Control of Noxious Animals and Plants (IOBC). All compounds were selective to the pupae (E < 30% of mortality). However, thiacloprid and deltamethrin were toxic to the adults (E > 99% of mortality), whereas fenbutatin oxide and tebufenozide were selective. Lufenuron reduced the survival rate of the egg when sprayed on the females. Thus, the results indicate that only fenbutatin oxide and tebufenozide could be used with C. externa in integrated pest management programs in citrus crops.

Avaliou-se a seletividade dos inseticidas abamectina, lufenurom, óxido de fenbutatina, tebufenozide, tiaclopride e deltametrina utilizados em citros para pupas e adultos de Chrysoperla externa (Hagen). Os experimentos foram conduzidos no Departamento de Entomologia da UFLA, Lavras, MG. As pulverizações foram realizadas por meio de torre de Potter utilizando-se 1,5 ± 0,5 mg/ cm2. Após a pulverização, as pupas foram colocadas em tubos de vidro e mantidas em câmara climática,e os adultos em gaiolas de PVC em sala climatizada (25 ± 2oC, 70 ± 10% UR e fotofase de 12h). O delineamento experimental foi inteiramente casualizado com seis inseticidas e dez repetições, sendo cada uma formada por três pupas ou um casal de adultos. Também foi avaliado o efeito do lufenurom na capacidade reprodutiva quando pulverizado sobre machos ou fêmeas desse predador. Os produtosforam enquadrados em classes de toxicidade seguindo metodologia estabelecida pela Organização Internacional para Controle Biológico e Integrado de Animais e Plantas Nocivos (IOBC). Todos os produtos foram seletivos para pupas (E < 30% de mortalidade). Tiaclopride e deltametrina foram tóxicos aos adultos (E > 99% de mortalidade), sendo que óxido de fenbutatina e tebufenozide mostraram-seseletivos. Quando pulverizado somente sobre fêmeas de C. externa, lufenurom reduziu significativamente a viabilidade de ovos. Os produtos óxido de fenbutatina e tebufenozide, em função da baixa toxicidade apresentada, podem ser recomendados no manejo integrado de pragas na cultura dos citros emassociação com C. externa.