Polydimethylsiloxane Surface Modification of Microfluidic Devices for Blood Plasma Separation.

Over the last decade, researchers have developed a variety of new analytical and clinical diagnostic devices. These devices are predominantly based on microfluidic technologies, where biological samples can be processed and manipulated for the collection and detection of important biomolecules. Polydimethylsiloxane (PDMS) is the most commonly used material in the fabrication of these microfluidic devices. However, it has a hydrophobic nature (contact angle with water of 110°), leading to poor wetting behavior and issues related to the mixing of fluids, difficulties in obtaining uniform coatings, and reduced efficiency in processes such as plasma separation and molecule detection (protein adsorption). This work aimed to consider the fabrication aspects of PDMS microfluidic devices for biological applications, such as surface modification methods. Therefore, we studied and characterized two methods for obtaining hydrophilic PDMS surfaces: surface modification by bulk mixture and the surface immersion method. To modify the PDMS surface properties, three different surfactants were used in both methods (Pluronic® F127, polyethylene glycol (PEG), and polyethylene oxide (PEO)) at different percentages. Water contact angle (WCA) measurements were performed to evaluate the surface wettability. Additionally, capillary flow studies were performed with microchannel molds, which were produced using stereolithography combined with PDMS double casting and replica molding procedures. A PDMS microfluidic device for blood plasma separation was also fabricated by soft lithography with PDMS modified by PEO surfactant at 2.5% (v/v), which proved to be the best method for making the PDMS hydrophilic, as the WCA was lower than 50° for several days without compromising the PDMS's optical properties. Thus, this study indicates that PDMS surface modification shows great potential for enhancing blood plasma separation efficiency in microfluidic devices, as it facilitates fluid flow, reduces cell aggregations and the trapping of air bubbles, and achieves higher levels of sample purity.

How is Integration Defined and Measured, and what Factors Drive Success in Brazil? An Integrative Review.

Introduction: Integration in health and care can improve quality and outcomes, but it is challenged by expansion of medical knowledge, social pressures on patient needs, and demands to deliver critical information. In Latin American and in other lower and middle-income countries integrated care remains in development. This paper examined the available literature on integrated care to understand how Latin American countries identify and measure integration, and what factors influence success. Methods: This integrative literature review included systematic searches in Global Health, PubMed, SciELO and BVSPsi databases for articles on integrated care in Spanish, Portuguese, and English in the period from January of 1999 to December 2020. The articles were screened for selection and assessed independently by five reviewers that used the inclusion criteria of papers about integration in health care systems. The sample excluded articles that did not deal with the integration of health care, which addressed issues related to public health campaigns, programs to control endemics and epidemics, reports on the experience of implementing health services, health promotion guidelines, food safety, oral health, and books evaluation. Results: 24 articles were included: qualitative (75%), quantitative (12,5%), and mixed-method research (4%) published between 2000 and 2017. All studies were undertaken in Brazil, and two of them were also conducted in Latin American countries. In 15 articles there was an interchangeable use between concepts of integration of services and integrated care, while nine studies did not define integration. Barriers to integration included absence of shared understanding of knowledge among members of interprofessional teams, lack of clarity on professional roles, missing consensus on a definition and measurement of integrated care, power struggles between professionals, poor institutional support, insufficient team preparation and training and unequal valuation of professions by society. Conclusion: Several types of integration and factors contributing to the success of implementation of integrated care in various contexts in Brazil were identified. The concept of integration reflected the varied local and regional realities including different health settings and levels of health and care, suggesting a need for further clarifications on its objective and components especially in LMIC contexts.

The effect of interprofessional simulation practice on collaborative learning: A randomized controlled trial.

This study examined the effect of simulation on readiness for collaborative practice and learning using a randomized-controlled trial design that used the same education protocol with interprofessional and uniprofessional groups. The sample consisted of 43 students from four different majors. The students were assessed with the Readiness for Interprofessional Learning Scale, and a care plan measurement instrument. The interprofessional group showed a small increase (0.1 ± 0.43; p = .02) in readiness for teamwork and collaboration; the uniprofessional group showed a smaller increase for teamwork and collaboration (0.04 ± 0.31; p = .04) and for patient-centred care (0.0 ± 0.35; p = .01). The enriching work of interprofessional learning was evident within the care plan activity, suggesting that interprofessional simulation is an effective learning method for interprofessional education.

Prevalência e fatores associados à síndrome metabólica em idosos atendidos na atenção primária em saúde / Prevalence and factors associated with metabolic syndrome in elderly attended in primary health care / Prevalencia y factores asociados al síndrome metabólico en el cuidado del anciano en la atención primaria de salud

Objetivo: avaliar a prevalência de síndrome metabólica e sua associação com variáveis sociodemográficas, clínicas, antropométricas e estilo de vida em idosos atendidos na atenção primária. Método: estudo transversal realizado com 344 idosos em uma Unidade Básica de Saúde do Distrito Federal. Realizaram-se análises do perfil lipídico, glicemia de jejum e hemoglobina glicada. Foram avaliados dados sociodemográficos, hábitos de vida, pressão arterial, antropometria e percentual de gordura. Realizou-se regressão de Poisson para cálculo da razão de prevalência bruta e ajustada. Resultados: a prevalência de síndrome metabólica foi de 62,2%. A hipertensão arterial (RPajustada=1,31; IC95%=1,02-1,67), cintura aumentada (RPajustada=1,46; IC95%=1,21-1,76), hipertrigliceridemia (RPajustada=1,98; IC95%=1,67-2,34) e HDL diminuído (RPajustada=1,19; IC95%=1,03-1,37) foram significativamente associados à síndrome metabólica. Conclusão: a elevada prevalência de síndrome metabólica e sua associação com fatores modificáveis apontam para a necessidade de identificar e controlar precocemente os fatores de risco em idosos

Objective: to evaluate the prevalence of metabolic syndrome and association with sociodemographic, clinical, anthropometric and lifestyle variables in elderly people attended in primary care. Method: cross-sectional study carried out with 344 elderly in a Basic Health Unit in the Federal District. Analyzes of lipid profile, fasting glucose and glycated hemoglobin were performed. Sociodemographic data, lifestyle habits, blood pressure, anthropometry and fat percentage were evaluated. Poisson regression was performed to calculate the crude and adjusted prevalence ratio. Results: the prevalence of metabolic syndrome was 62.2%. The arterial hypertension (PRadjusted =1.31; 95%CI=1.02-1.67), increased waistline (PRadjusted=1.46; 95%CI=1.21-1.76), hypertriglyceridemia (PRadjusted=1.98; 95%CI=1.67-2.34) and decreased HDL (PRadjusted=1.19; 95%CI=1.03-1.37) were significantly associated with metabolic syndrome. Conclusion: the high prevalence of metabolic syndrome and association with modifiable factors point to the need to early identify and control risk factors in the elderly

Objetivo: evaluar la prevalencia del síndrome metabólico y su asociación con variables sociodemográficas, clínicas, antropométricas y de estilo de vida en ancianos atendidos en atención primaria. Método: estudio transversal realizado con 344 ancianos en una Unidad Básica de Salud del Distrito Federal. Se realizaron análisis del perfil lipídico, glucosa en ayunas y hemoglobina glucosilada. Se evaluaron datos sociodemográficos, hábitos de vida, presión arterial, antropometría y porcentaje de grasa. Se realizó regresión de Poisson para calcular la razón de prevalencia cruda y ajustada. Resultados: la prevalencia de síndrome metabólico fue del 62,2%. Hipertensión arterial (RPajustada=1,31; IC95%=1,02-1,67), aumento de cintura (RPajustada=1,46; IC95%=1,21-1,76), hipertrigliceridemia (RPajustada=1,98; IC95%=1,67-2,34) y la disminución de HDL (RPajustada= 1,19; IC del 95 % = 1,03-1,37) se asoció significativamente con el síndrome metabólico. Conclusión: la alta prevalencia del síndrome metabólico y su asociación con factores modificables apuntan a la necesidad de identificar y controlar precozmente los factores de riesgo en los ancianos

Geometry effect in multi-step crossflow microfluidic devices for red blood cells separation and deformability assessment.

The efficient separation of blood components using microfluidic systems can help to improve the detection and diagnosis of several diseases, such as malaria and diabetes. Therefore, a novel multi-step microfluidic device, based on passive crossflow filters was developed. Three different designs were proposed, fabricated and tested in order to evaluate the most suitable geometry to perform, simultaneously, blood cells separation and cell deformability measurements. All the proposed geometries include a main channel and three sequential separation steps, all comprised of symmetrical crossflow filters, with multiple rows of pillars, to reduce the amount of red blood cells (RBCs) flowing to the outlets of the microfluidic device (MD). Sets of hyperbolic constrictions located at the outlets allow the assessment of cells deformability. Based on the proposed geometries, the three correspondent MD were evaluated and compared, by measuring the RBCs velocities, the cell-free layer (CFL) effect through the microchannels and by quantifying the amount of RBCs at the outlets. The results suggest that the proposed MD 3 configuration was the most effective one for the desired application, due to the formation of a wider CFL. As a result, a minor amount of RBCs flow through the hyperbolic contraction at the third separation level of the device. Nevertheless, for all the proposed geometries, the existence of three separation levels shows that it is possible to achieve a highly efficient cell separation. If needed, such microdevices have the potential for further improvements by increasing the number of separation levels, aiming the total separation of blood cells from plasma.

Triage Strategies for COVID-19 Cases: A Scope Review.

In the midst of the pandemic caused by the new coronavirus (SARS-CoV-2), researchers and governmental and non-governmental institutions are mobilizing to implement strategies to face cases of COVID-19. Aim: This study aimed to map the triage strategies for cases of COVID-19, with the purpose of identifying sources in the literature that make it possible to explore the understanding of the strategies in different contexts. A scope review was conducted with searches in the CINAHL Database, PubMed, LILACS and hand-search, considering studies carried out with users of health services and documents published by governmental and non-governmental institutions, between the years 2019 and 2020, resulting in 40 articles for full reading. To explore the key concept, thematic analysis was carried out at two levels: (1) triage strategies, (2) forms and experiences of triage. Five triage strategies were mapped: health services triage; digital triage by remote use of technologies; community triage; home visit triage and airport and port triage. The forms and experiences of mapped triages involved risk classification, diagnosis and definition of conducts or combined. The use of strategies with remote technological resources stands out, as well as the adaptation of existing scales with simple algorithms as a tendency.

Organ-on-a-Chip Platforms for Drug Screening and Delivery in Tumor Cells: A Systematic Review.

The development of cancer models that rectify the simplicity of monolayer or static cell cultures physiologic microenvironment and, at the same time, replicate the human system more accurately than animal models has been a challenge in biomedical research. Organ-on-a-chip (OoC) devices are a solution that has been explored over the last decade. The combination of microfluidics and cell culture allows the design of a dynamic microenvironment suitable for the evaluation of treatments' efficacy and effects, closer to the response observed in patients. This systematic review sums the studies from the last decade, where OoC with cancer cell cultures were used for drug screening assays. The studies were selected from three databases and analyzed following the research guidelines for systematic reviews proposed by PRISMA. In the selected studies, several types of cancer cells were evaluated, and the majority of treatments tested were standard chemotherapeutic drugs. Some studies reported higher drug resistance of the cultures on the OoC devices than on 2D cultures, which indicates the better resemblance to in vivo conditions of the former. Several studies also included the replication of the microvasculature or the combination of different cell cultures. The presence of vasculature can influence positively or negatively the drug efficacy since it contributes to a greater diffusion of the drug and also oxygen and nutrients. Co-cultures with liver cells contributed to the evaluation of the systemic toxicity of some drugs metabolites. Nevertheless, few studies used patient cells for the drug screening assays.

Fourier Transform Infrared (FTIR) Spectroscopy to Analyse Human Blood over the Last 20 Years: A Review towards Lab-on-a-Chip Devices.

Since microorganisms are evolving rapidly, there is a growing need for a new, fast, and precise technique to analyse blood samples and distinguish healthy from pathological samples. Fourier Transform Infrared (FTIR) spectroscopy can provide information related to the biochemical composition and how it changes when a pathological state arises. FTIR spectroscopy has undergone rapid development over the last decades with a promise of easier, faster, and more impartial diagnoses within the biomedical field. However, thus far only a limited number of studies have addressed the use of FTIR spectroscopy in this field. This paper describes the main concepts related to FTIR and presents the latest research focusing on FTIR spectroscopy technology and its integration in lab-on-a-chip devices and their applications in the biological field. This review presents the potential use of FTIR to distinguish between healthy and pathological samples, with examples of early cancer detection, human immunodeficiency virus (HIV) detection, and routine blood analysis, among others. Finally, the study also reflects on the features of FTIR technology that can be applied in a lab-on-a-chip format and further developed for small healthcare devices that can be used for point-of-care monitoring purposes. To the best of the authors' knowledge, no other published study has reviewed these topics. Therefore, this analysis and its results will fill this research gap.

Risco de glicemia instável em pessoas idosas com diabetes mellitus tipo 2 / Riesgo de glucemia inestable en ancianos con diabetes mellitus tipo 2 / Risk of unstable glycemia in elderly people with type 2 diabetes mellitus

Objetivo: avaliar os fatores de risco do diagnóstico de enfermagem Risco de glicemia instável em pessoas idosas com diabetes mellitus tipo 2. Método: estudo transversal realizado com 152 pessoas idosas atendidas na atenção primária de agosto a outubro de 2021. Na consulta de enfermagem, avaliaram-se dados clínicos, perda de sensibilidade protetora plantar e checklist com fatores de risco do Risco de glicemia instável da NANDA. Empregaram-se análise descritiva e testes de associação. Resultados: 46,7% apresentaram HbA1c ≥ 7,0 e maior prevalência dos fatores de risco: Conhecimento insuficiente sobre o controle da doença (p<0,001); Conhecimento insuficiente sobre os fatores modificáveis (p<0,001); Controle insuficiente do diabetes (p<0,001); Falta de adesão ao plano de controle do diabetes (p=0,002); e Monitorização inadequada da glicemia (p<0,001). Conclusão: os fatores de risco foram relacionados ao conhecimento insuficiente e à falta de manejo com a doença, ressaltando a importância do enfermeiro no planejamento de cuidados adequado.

Objective: to assess the risk factors of the nursing diagnosis Risk of unstable glycemia in elderly people with type 2 diabetes mellitus. Method: cross-sectional study carried out with 152 elderly people assisted in primary care from August to October 2021. In the nursing consultation, clinical data, loss of plantar protective sensitivity and a checklist with risk factors of unstable NANDA glycemia risk were evaluated. Descriptive analysis and association tests were used. Results: 46.7% had HbA1c ≥ 7.0 and higher prevalence of risk factors: Insufficient knowledge about disease control (p<0.001); Insufficient knowledge about modifiable factors (p<0.001); Insufficient control of diabetes (p<0.001); Lack of adherence to the diabetes control plan (p=0.002); and Inadequate blood glucose monitoring (p<0.001). Conclusion: risk factors were related to insufficient knowledge and lack of management with the disease, emphasizing the importance of nurses in the planning of appropriate care.

Objetivo: evaluar los factores de riesgo del diagnóstico de enfermería Riesgo de glucemia inestable en ancianos con diabetes mellitus tipo 2. Método: estudio transversal realizado con 152 ancianos atendidos en la atención primaria de agosto a octubre de 2021. En la enfermería consulta, se evaluaron datos clínicos, pérdida de sensibilidad protectora plantar y se utilizó la lista de verificación con factores de riesgo de NANDA Riesgo para glucemia inestable. Se utilizaron análisis descriptivos y pruebas de asociación. Resultados: 46,7% tenían HbA1c ≥ 7,0 y mayor prevalencia de factores de riesgo: Insuficiente conocimiento sobre control de la enfermedad (p<0,001); Conocimiento insuficiente sobre factores modificables (p<0,001); control insuficiente de la diabetes (p<0,001); Falta de adherencia al plan de control de la diabetes (p=0,002); y Monitoreo inadecuado de glucemia en sangre (p<0.001). Conclusión: los factores de riesgo se relacionaron con el conocimiento insuficiente y la falta de administración de la enfermedad, destacando la importancia de los enfermeros en la planificación de la atención adecuada.

[Application of conceptual mapping in the regulation of access to public health services in the Federal District, Brazil]. / Aplicação do mapeamento conceitual na regulação do acesso aos serviços públicos de saúde, Distrito Federal, Brasil.

Health regulation in the pursuit of equity is the goal of management and requires evaluation methods that improve work processes. The scope of this article is to analyze the application of conceptual mapping in the regulation of access to public health services. It is an exploratory and descriptive study, using a mixed approach, carried out at the Health Regulatory Complex of the Federal District. The data were collected between August and October 2019 and analyzed with the assistance of IRaMuTeQ and Concept Systems® software. There is a convergence of the 25 statements generated by the 71 participants, grouped into 4 clusters, on regulation towards the principle of equity. The healthcare priority level was presented as the focus of regulation and management, the driving force behind the integration of processes. Conceptual mapping is a tool that can support regulation planning and evaluation, as it makes it possible to identify priority points to be worked on by management in improving the regulatory processes identified in this study. These include the training of professionals, the transparency of information and the level of priority healthcare, for effective, equitable, rational and timely access for users of the health system.

A regulação em saúde na busca da equidade subsidia a gestão e necessita de métodos avaliativos que incrementem os processos de trabalho. O objetivo deste artigo é analisar a aplicação do mapeamento conceitual na regulação do acesso aos serviços públicos de saúde. Estudo exploratório e descritivo, sob abordagem mista, realizado no Complexo Regulador em Saúde do Distrito Federal. Os dados foram coletados entre agosto e outubro de 2019 e analisados com o auxílio dos softwares IRaMuTeQ e Concept Systems®. Há uma convergência de 25 declarações geradas pelos 71 participantes, agrupadas em 04 Clusters sobre a regulação rumo ao princípio da equidade. O nível de prioridade assistencial apresentou-se como o foco da regulação e a gestão, a força motriz para a integração dos processos. O mapeamento conceitual é uma ferramenta que pode apoiar o planejamento e avaliação da regulação, pois possibilita identificar pontos prioritários a serem trabalhados pela gestão na melhoria dos processos regulatórios evidenciados neste estudo como a capacitação dos profissionais, a transparência da informação e o nível de prioridade assistencial para um acesso efetivo, equânime, racional e oportuno aos usuários do sistema de saúde.

Aplicação do mapeamento conceitual na regulação do acesso aos serviços públicos de saúde, Distrito Federal, Brasil / Application of conceptual mapping in the regulation of access to public health services in the Federal District, Brazil

Resumo A regulação em saúde na busca da equidade subsidia a gestão e necessita de métodos avaliativos que incrementem os processos de trabalho. O objetivo deste artigo é analisar a aplicação do mapeamento conceitual na regulação do acesso aos serviços públicos de saúde. Estudo exploratório e descritivo, sob abordagem mista, realizado no Complexo Regulador em Saúde do Distrito Federal. Os dados foram coletados entre agosto e outubro de 2019 e analisados com o auxílio dos softwares IRaMuTeQ e Concept Systems®. Há uma convergência de 25 declarações geradas pelos 71 participantes, agrupadas em 04 Clusters sobre a regulação rumo ao princípio da equidade. O nível de prioridade assistencial apresentou-se como o foco da regulação e a gestão, a força motriz para a integração dos processos. O mapeamento conceitual é uma ferramenta que pode apoiar o planejamento e avaliação da regulação, pois possibilita identificar pontos prioritários a serem trabalhados pela gestão na melhoria dos processos regulatórios evidenciados neste estudo como a capacitação dos profissionais, a transparência da informação e o nível de prioridade assistencial para um acesso efetivo, equânime, racional e oportuno aos usuários do sistema de saúde.

Abstract Health regulation in the pursuit of equity is the goal of management and requires evaluation methods that improve work processes. The scope of this article is to analyze the application of conceptual mapping in the regulation of access to public health services. It is an exploratory and descriptive study, using a mixed approach, carried out at the Health Regulatory Complex of the Federal District. The data were collected between August and October 2019 and analyzed with the assistance of IRaMuTeQ and Concept Systems® software. There is a convergence of the 25 statements generated by the 71 participants, grouped into 4 clusters, on regulation towards the principle of equity. The healthcare priority level was presented as the focus of regulation and management, the driving force behind the integration of processes. Conceptual mapping is a tool that can support regulation planning and evaluation, as it makes it possible to identify priority points to be worked on by management in improving the regulatory processes identified in this study. These include the training of professionals, the transparency of information and the level of priority healthcare, for effective, equitable, rational and timely access for users of the health system.

Propuesta teórica para tratar los aspectos conductuales de la incontinencia urinaria.

Theoretical model for treating behavioural aspects of urinary incontinence SINOPSIS This reflective article presents a theoretical model of behavioural evaluation and intervention for women with urinary incontinence. Nola Pender's health promotion model (HPM) was used as a reference to develop this proposal. Behavioural measures were identified to build the model: constipation control, bladder training, urination position, reduction of irritating drinks, water intake, and pelvic floor muscle training. Next, specific actions were defined to investigate and intervene on certain behavioural aspects: previous related behaviour, personal factors, benefits, and obstacles regarding the proposed action, perceived self-efficacy, feelings related to the expected behaviour and the proposed action, interpersonal and situational influences, commitment to the action plan, competitive demands, and health promotion behaviour. The model proposed by the authors could help nurses to guide the conversation between them and the patient to modify certain behavioural aspects, to develop an achievable plan and, thus, enhance the achievement of the goals established for the treatment of urinary incontinence.

Sinopsis Este artículo de reflexión presenta un modelo teórico de evaluación e intervención conductual para mujeres con incontinencia urinaria (IU). El Modelo de Promoción de Salud de Nola Pender, enfermera estadounidense, fue usado como referencia para desarrollar la propuesta. Se identificaron medidas conductuales para construir el modelo: control del estreñimiento, entrenamiento vesical, posición para orinar, reducción de bebidas irritantes, ingesta de agua, y entrenamiento muscular del suelo pélvico. Luego, se definieron acciones determinadas para investigar e intervenir sobre ciertos aspectos conductuales: comportamiento previo relacionado, factores personales, beneficios y obstáculos percibidos acerca de la acción propuesta, autoeficacia percibida, sentimientos relacionados con el comportamiento esperado y la acción propuesta, influencias interpersonales y situacionales, compromiso con el plan de acción, exigencias competitivas, y comportamiento de la promoción de la salud. El modelo propuesto por los autores podría ayudar a enfermeros y enfermeras a orientar la conversación entre ellos y el paciente para modificar determinados aspectos conductuales, con el fin de elaborar un plan alcanzable y, así, potenciar el logro de las metas establecidas para el tratamiento de la IU.

Manual and Automatic Image Analysis Segmentation Methods for Blood Flow Studies in Microchannels.

In blood flow studies, image analysis plays an extremely important role to examine raw data obtained by high-speed video microscopy systems. This work shows different ways to process the images which contain various blood phenomena happening in microfluidic devices and in microcirculation. For this purpose, the current methods used for tracking red blood cells (RBCs) flowing through a glass capillary and techniques to measure the cell-free layer thickness in different kinds of microchannels will be presented. Most of the past blood flow experimental data have been collected and analyzed by means of manual methods, that can be extremely reliable, but they are highly time-consuming, user-intensive, repetitive, and the results can be subjective to user-induced errors. For this reason, it is crucial to develop image analysis methods able to obtain the data automatically. Concerning automatic image analysis methods for individual RBCs tracking and to measure the well known microfluidic phenomena cell-free layer, two developed methods are presented and discussed in order to demonstrate their feasibility to obtain accurate data acquisition in such studies. Additionally, a comparison analysis between manual and automatic methods was performed.

Establishment of Colorectal Cancer Organoids in Microfluidic-Based System.

Colorectal cancer is the second leading cause of cancer death worldwide. Significant advances in the molecular mechanisms underlying colorectal cancer have been made; however, the clinical approval of new drugs faces many challenges. Drug discovery is a lengthy process causing a rapid increase in global health care costs. Patient-derived tumour organoids are considered preclinical models with the potential for preclinical drug screening, prediction of patient outcomes, and guiding optimized therapy strategies at an individual level. Combining microfluidic technology with 3D tumour organoid models to recapitulate tumour organization and in vivo functions led to the development of an appropriate preclinical tumour model, organoid-on-a-chip, paving the way for personalized cancer medicine. Herein, a low-cost microfluidic device suitable for culturing and expanding organoids, OrganoidChip, was developed. Patient-derived colorectal cancer organoids were cultured within OrganoidChip, and their viability and proliferative activity increased significantly. No significant differences were verified in the organoids' response to 5-fluorouracil (5-FU) treatment on-chip and on-plate. However, the culture within the OrganoidChip led to a significant increase in colorectal cancer organoid-forming efficiency and overall size compared with conventional culture on a 24-well plate. Interestingly, early-stage and late-stage organoids were predominantly observed on-plate and within the OrganoidChip, respectively. The OrganoidChip thus has the potential to generate in vivo-like organotypic structures for disease modelling and drug screening applications.

An interprofessional international research collaboration: exploration of key opportunities and challenges.

Interprofessional research has made substantive progress in Brazil over the past decade, in line with globalization and the worldwide expansion of university international relationships. This sustained growth of interprofessional research in many other countries around the world has been increasingly reported in the literature. Interprofessional international research involves interactions and exchanges between researchers from different countries with different professional and disciplinary backgrounds who collaborate to undertake scholarly work. The benefits of interprofessional international research are many and varied. In this paper, we explore the opportunities and challenges related to interprofessional international research collaboration while reflecting on our personal experiences of a study focused on interprofessional collaboration in primary care which spanned two countries - Brazil and UK. A key element in our international research has been regular discussion, negotiation, and agreement. Collectively, these elements have helped to ensure that our international empirical work can be sustained.

Equipamentos de proteção individual utilizados por profissionais da saúde na pandemia da covid-19: revisão de escopo / Equipo de protección personal utilizado por profesionales de la salud en la pandemia covid-19: revisión del alcance / Personal protective equipment used by health professionals in the covid-19 pandemic: scope review

RESUMO Objetivo: mapear a utilização de equipamento de proteção individual (EPI) pelos profissionais da saúde no enfrentamento da COVID-19. Método: revisão de escopo pelo protocolo proposto pelo Instituto Joanna Briggs. A busca foi realizada em junho de 2020 utilizando as bases de dados PubMed, Cinahl, Lilacs. Critérios de inclusão: artigos na íntegra que seguiam o objetivo da pesquisa, em inglês, espanhol e português, artigos de revisão, metassíntese, metanálise, quantitativos, qualitativos e mistos. Critérios de exclusão: editoriais, correspondências e artigos sem reportação à COVID-19. As informações extraídas foram comparadas entre si, descrevendo evidências disponíveis que respondiam à questão norteadora. Resultados: foram identificados quatro artigos na Lilacs, 101 na Pubmed, 35 na Cinahl, sendo 19 incluídos na síntese, no idioma inglês. O acesso aos equipamentos foi escasso, incompleto ou de má qualidade. O uso inadequado e a reutilização aumentam o risco de contaminação, podendo diminuir com treinamento. O uso prolongado causou reações adversas. Discussão: como práticas de redução, reutilização e substituição foram criados protocolos nacionais e internacionais com orientações de reuso da máscara respiratória N95 ou equivalente, por período acima do previsto pelo fabricante. A seleção adequada do EPI deve ser compatível com a situação clínica do paciente. As principais limitações da pesquisa foram as poucas publicações de estudos e as constantes mudanças no cenário da pandemia. Conclusão: o mapeamento da utilização de EPI revelou que o foco deve estar na qualidade, na forma de utilização e no controle prévio do diagnóstico para planejamento do uso racional dos equipamentos.

RESUMEN Objetivo: mapear el uso de equipos de protección personal (EPP) por parte de los profesionales de la salud para hacer frente al COVID-19. Método: revisión del alcance mediante el protocolo propuesto por el Instituto Joanna Briggs. La búsqueda se realizó en junio de 2020 utilizando las bases de datos PubMed, Cinahl, Lilacs. Criterios de inclusión: artículos completos que siguieron el objetivo de la investigación, en inglés, español y portugués, artículos de revisión, meta-síntesis, metaanálisis, cuantitativo, cualitativo y mezclado. Criterios de exclusión: editoriales, correspondencia artículos sin reportar a COVID-19. La información extraída se comparó entre sí, describiendo la evidencia disponible que respondió a la pregunta guía. Resultados: se identificaron cuatro artículos en Lilacs, 101 en Pubmed, 35 en Cinahl, siendo 19 incluidos en la síntesis, en inglés. El acceso al equipo era escaso, incompleto o de mala calidad. El uso y la reutilización inadecuados aumentan el riesgo de contaminación, que puede reducirse con formación. El uso prolongado provocó reacciones adversas. Discusión: como prácticas de reducción, reutilización y sustitución, se crearon protocolos nacionales e internacionales con orientaciones para la reutilización de la máscara respiratoria N95 o equivalente, por un período mayor al esperado por el fabricante. La selección adecuada de EPI debe ser compatible con la situación clínica del paciente. Las principales limitaciones de la investigación fueron las pocas publicaciones de estudios y los constantes cambios en el escenario pandémico. Conclusión: el mapeo del uso de EPI reveló que el foco debe estar en la calidad, forma de uso y control previo del diagnóstico para planificar el uso racional de los equipos.

ABSTRACT Objective: to map the use of personal protective equipment (PPE) by health professionals in coping with COVID-19. Method: scope review by the protocol proposed by the Joanna Briggs Institute. The search was performed in June 2020 using PubMed, CINAHL, LILACS databases. Inclusion criteria: full articles that followed the research objective, in English, Spanish and Portuguese, review articles, meta-synthesis, meta-analysis, quantitative, qualitative, and mixed. Exclusion criteria: editorials, correspondence, and articles without reporting to COVID-19. The extracted information was compared to each other, describing available evidence that answered the guiding question. Results: four articles were identified in LILACS, 101 in Pubmed, 35 in CINAHL, being 19 included in the synthesis, in English. Access to equipment was scarce, incomplete or of poor quality. Improper use and reuse increases the risk of contamination, which can be reduced with training. Long-term use caused adverse reactions. Discussion: as reduction, reuse and replacement practices, national and international protocols were created with guidelines for the reuse of respiratory mask N95 or equivalent, for a period longer than that foreseen by the manufacturer. The proper selection of PPE must be compatible with the patient's clinical situation. The main limitations of the research were the few publications of studies and the constant changes in the pandemic scenario. Conclusion: the mapping of the use of PPE revealed that the focus should be on the quality, form of use and prior control of the diagnosis for planning the rational use of equipment.

Erros e incidentes de medicação na atenção primária: revisão integrativa / Errores e incidentes de medicación en la atención primaria: revisión integradora / Medication errors and incidents in primary care: integrative review

RESUMO Objetivo: Identificar, na literatura científica, publicações acerca dos erros de medicação e os incidentes relacionados, na atenção primária à saúde. Método: Realizou-se uma revisão integrativa da literatura nas bases de dados Medical Literature Analysis and Retrieval System on Line, Cumulative Index to Nursing and Allied Health Literature, Scientific Eletronic Library Online e Web of Science. Analisaram-se 17 artigos que atenderam aos critérios de inclusão. Para extração dos dados, fez-se a leitura, na íntegra, dos artigos selecionados. Resultados: dos 17 estudos analisados, sete (41,17%) foram indexados, tanto no PubMed, quanto no Medline; nove (52,94%) na Web of Science; um (5,9%) na base Scielo; e nenhum na Cinahl. Os estudos apontam fortes evidências na aplicação clínica, sendo que a maioria desses mostra que prescrições com medicamento incorreto, dose incorreta, interações medicamentosas e alergias medicamentosas foram as principais causas de erros com potencial para danos graves. Conclusão: Ainda é crescente o desenvolvimento de pesquisas que visem identificar estratégias e intervenções voltadas aos erros de medicação. Sabe-se que esses estudos fornecem subsídios para o aprimoramento das práticas, além de propiciar maior segurança no processo de medicação, a fim de reduzir os eventos adversos evitáveis.

RESUMEN Objetivo: identificar, en la literatura científica, publicaciones acerca de los errores de medicación y los incidentes relacionados, en la atención primaria a la salud. Método: se realizó una revisión integradora de la literatura en las bases de datos Medical Literature Analysis and Retrieval System on Line, Cumulative Index to Nursing and Allied Health Literature, Scientific Eletronic Library Online y Web of Science. Se analizaron 17 artículos que atendieron a los criterios de inclusión. Para la recolección de los datos, fue hecha la lectura, en su totalidad, de los artículos seleccionados. Resultados: de los 17 estudios analizados, siete (41,17%) fueron indexados, tanto en el PubMed, como en el Medline; nueve (52,94%) en la Web of Science; uno (5,9%) en la base Scielo; y ninguno en la Cinahl. Los estudios señalan fuertes evidencias en la aplicación clínica, siendo que la mayoría de ellos muestra que prescripciones con medicamento incorrecto, dosis incorrecta, interacciones y alergias a los fármacos fueron las principales causas de errores con potencial para daños graves. Conclusión: aún es creciente el desarrollo de investigaciones con el objetivo de identificar estrategias e intervenciones dirigidas a los errores de medicación. Sabemos que estos estudios aportan herramientas para el perfeccionamiento de las prácticas, además de ofrecer mayor seguridad en el proceso de medicación, a fin de reducir los eventos adversos evitables.

ABSTRACT Objective: To identify, in the scientific literature, publications on medication errors and related incidents in primary health care. Method: An integrative literature review was conducted in the databases Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Scientific Electronic Library Online and Web of Science. Seventeen articles that met the inclusion criteria were analyzed. For data extraction, the selected articles were read in full. Results: Of the 17 studies analyzed, seven (41.17%) were indexed in both PubMed and Medline, nine (52.94%) in Web of Science, one (5.9%) in Scielo and none in Cinahl. The studies point to strong evidence in clinical application, most of these show that prescriptions with incorrect drugs, incorrect doses, drug interactions and drug allergies were the main causes of errors with potential for serious harms. Conclusion: The development of research aimed to identify strategies and interventions for medication errors is still growing. It is known that these studies provide subsidies for the improvement of practices, in addition to providing greater safety in the medication process, in order to reduce preventable adverse events.

Visualization and Measurements of Blood Cells Flowing in Microfluidic Systems and Blood Rheology: A Personalized Medicine Perspective.

Hemorheological alterations in the majority of metabolic diseases are always connected with blood rheology disturbances, such as the increase of blood and plasma viscosity, cell aggregation enhancement, and reduction of the red blood cells (RBCs) deformability. Thus, the visualizations and measurements of blood cells deformability flowing in microfluidic devices (point-of-care devices) can provide vital information to diagnose early symptoms of blood diseases and consequently to be used as a fast clinical tool for early detection of biomarkers. For instance, RBCs rigidity has been correlated with myocardial infarction, diabetes mellitus, hypertension, among other blood diseases. In order to better understand the blood cells behavior in microfluidic devices, rheological properties analysis is gaining interest by the biomedical committee, since it is strongly dependent on the interactions and mechanical cells proprieties. In addition, the development of blood analogue fluids capable of reproducing the rheological properties of blood and mimic the RBCs behavior at in vitro conditions is crucial for the design, performance and optimization of the microfluidic devices frequently used for personalized medicine. By combining the unique features of the hemorheology and microfluidic technology for single-cell analysis, valuable advances in personalized medicine for new treatments and diagnosis approach can be achieved.

Interprofessional simulation effects for healthcare students: A systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review of studies describing the effects of interprofessional education (IPE) on collaborative competence using simulated-based training of undergraduate healthcare students. DESIGN: A systematic review and meta-analysis based on PRISMA guidelines. DATA SOURCES: PubMed and Cumulative Index to Nursing and Allied Health Literature databases were searched to identify articles in all languages published up to 2018. The systematic review protocol was registered at PROSPERO under number 133330. REVIEW METHODS: In total, 419 articles were identified. The following articles were excluded: non-English articles, articles for which the full text was not available, articles that did not employ a validated tool, articles that did not use quasi-experimental methods and that did not assess healthcare student populations. Eleven studies were included, and 6 were submitted to meta-analysis using forest plots through RevMan 5.3. RESULTS: Interprofessional simulation analysis yielded results regarding participants, protocols, scenarios, validated tools, collaborative competencies and primary outcomes. The meta-analysis was organized based on assessment tool, and summary value, confidence interval, and Z test results for the random-effects model are presented. CONCLUSION: Quantitative analysis reveals a positive impact and the effectiveness of interprofessional simulation. However, more research should be conducted utilizing clinical trials with distinguished analyses for each collaborative competency factor to assess long-term effects on the outcome.