Oral hygiene in critically ill patients at a tertiary hospital in São Paulo, Brazil: a best practice implementation project.

OBJECTIVES: This project aimed to promote evidence-based practices relat. ed to the oral health of critically ill patients in an intensive care unit in Brazil. INTRODUCTION: The oral hygiene of patients on mechanical ventilation is an essential component of nursing care quality, and well-defined guidelines ensure appropriate care. Mechanical ventilation is associated with the risk of ventilator-associated pneumonia, which can increase mortality, length of stay, time on mechanical ventilation, and hospital costs. METHODS: This project was guided by the JBI Evidence Implementation Framework, which consists of seven stages: (1) identification of the area of practice to be changed, (2) involvement of change agents, (3) context assessment and readiness for change, (4) review of practices against evidence-based audit criteria, (5) implementation of practice changes, (6) reassessment of practices using a follow-up audit and (7) consideration of the sustainability of changes in practice. RESULTS: Four audit criteria were developed to evaluate compliance with best practices. In the follow-up audit, Criteria 1, 2, and 3 obtained compliance of ≥ 80%. Thus, for Criterion 1, all the patients on mechanical ventilation for more than 24 hours were evaluated by the oral medicine team, resulting in 100% compliance. For Criterion 2 on appropriate oral hygiene measures, a compliance rate of 80% was achieved. For Criterion 3, 39 professionals (90.7%) participated in educational activities related to the oral health protocol for critically ill patients, obtaining 90.7% compliance. For Criterion 4 regarding patients being evaluated before receiving any oral health care, improvement was low (only 50%), revealing the need for further improvement. CONCLUSION: This best practice project improved the professional practice of nursing staff and increased compliance with best practices for the oral health of critically ill patients. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A175.

Mentoring in research: development of competencies for health professionals.

BACKGROUND: Mentoring programmes in health research are beneficial for both mentors and mentees and are essential for the development of the next generation of research leaders. This study describes the self-assessment of research skills in health professionals participating in a research mentoring programme and determines the correlation between the participants' self-assessment of research skills and professional characteristics. METHOD: This was a quasi-experimental, time-series study conducted in a Brazilian tertiary hospital. Thirty-five health professionals holding a master's or PhD degree were included. The participants answered a survey in which they self-assessed their research skills distributed into eight domains, with one group responding before training and another group responding after training. The level of significance was set at 5% (p < 0.05). RESULTS: Those who received training scored better in research skills related to two domains: critical analysis of the literature and identification of appropriate research methods (p = 0.0245). CONCLUSION: Trained professionals performed better in the domains of critical thinking and knowledge and management of steps in the research process.

Prepulse inhibition of the acoustic startle reflex impairment by 5-HT2A receptor activation in the inferior colliculus is prevented by GABAA receptor blockade in the pedunculopontine tegmental nucleus.

The relationship between serotonin dysfunction and schizophrenia commenced with the discovery of the effects of lysergic acid diethylamide (LSD) that has high affinity for 5-HT2A receptors. Activation of these receptors produces perceptual and behavioural changes such as illusions, visual hallucinations and locomotor hyperactivity. Using prepulse inhibition (PPI) of the acoustic startle, which is impaired in schizophrenia,we aimed to investigate:i) the existence of a direct and potentially inhibitory neural pathway between the inferior colliculus (IC) and the pedunculopontine tegmental nucleus (PPTg) involved in the mediation of PPI responses by a neural tract tracing procedure;ii) if the microinjection of the 5-HT2A receptors agonist DOI in IC would activate neurons in this structure and in the PPTg by a c-Fos protein immunohistochemistry study;iii) whether the deficits in PPI responses, observed after the administration of DOI in the IC, could be prevented by the concomitant microinjection of the GABAA receptor antagonist bicuculline in the PPTg.Male Wistar rats were used in this study. An IC-PPTg reciprocated neuronal pathway was identified by neurotracing. The number of c-Fos labelled cells was lower in the DOI group in IC and PPTg, suggesting that this decrease could be due to the high levels of GABA in both structures. The concomitant microinjections of bicuculline in PPTg and DOI in IC prevented the PPI deficit observed after the IC microinjection of DOI. Our findings suggest that IC 5-HT2A receptors may be at least partially involved in the regulation of inhibitory pathways mediating PPI response in IC and PPTg structures.

Validation of guidelines for the care of patients undergoing continuous renal replacement therapy.

BACKGROUND: Continuous renal replacement therapy is one of the most frequently used treatments for acute kidney injury (AKI) in intensive care units (ICUs). It requires professionals with specialized knowledge, specific facilities, and care guidelines to ensure appropriate clinical practice. AIM: To validate the care guidelines for patients undergoing continuous renal replacement therapy. METHOD: This is a methodological study regarding consensual validation of the directives of care. These directives followed the formulation of the research question, a literature review, elaboration of the directive, and validation of the agreement by a committee consisting of seven expert judges. RESULTS: The data were analysed based on the content validity index and described in four categories. Among 40 care-related items, 95% showed a degree of agreement above 80% for adequacy and 82.5% showed a degree of agreement above 75% for relevance. CONCLUSION: The care-related items identified in the literature showed a high percentage of agreement among the judges and reflected the treatment requirements of these patients. RELEVANCE TO CLINICAL PRACTICE: The guideline will be important to assist in the care process regarding patient safety and quality of care.

Instrumentos preditores de risco para lesão por pressão em pacientes críticos / Instrumentos predictores de riesgo de úlcera por presión en pacientes críticos / Risk predictor instruments for pressure injuries in critically ill patients

Resumo Objetivo Identificar, entre os instrumentos de predição de risco para lesão por pressão (LP) Waterlow, Cubbin & Jackson e EVARUCI , o mais específico e sensível para pacientes em Unidades de Terapia Intensiva (UTI). Métodos Estudo observacional, analítico e prospectivo, realizado em duas UTIs de São Paulo, Brasil, de agosto a novembro de 2019. Participaram 91 pacientes adultos que não apresentavam LP no momento da admissão na UTI e internados na UTI por mais de 24 horas. Os dados foram coletados de prontuários e por meio de avaliação clínica. A associação entre as variáveis clínicas, pessoais e a ocorrência de LP foi feita pelo Teste T-Student e Qui-quadrado e a sensibilidade e a especificidade dos instrumentos foram valiadas por meio da curva ROC. Resultados Houve predominância do sexo masculino (54,9%), média de idade de 66,2 ± 20,8 anos e de internação por razões clínicas (64,9%). O uso de drogas vasoativas, ventilação mecânica, contenção mecânica, sedação, dispositivos, a gravidade e procedência foram associados ao desenvolvimento de LP. A área sob a curva da Cubbin & Jackson, EVARUCI e Waterlow foram respectivamente 0,91, 0,96 e 0,76; e a EVARUCI demonstrou a maior acurácia (90,1%). Conclusão Os instrumentos Cubbin & Jackson e EVARUCI apresentaram alta sensibilidade e especificidade para avaliação de risco para LP em pacientes internados em UTIs, sendo que a EVARUCI mostrou melhor acurácia.

Resumen Objetivo Identificar, entre los instrumentos de predicción de riesgo de úlcera por presión (UP) Waterlow, Cubbin & Jackson y EVARUCI , cuál es el más específico y sensible para pacientes en Unidad de Cuidados Intensivos (UCI). Métodos Estudio observacional, analítico y prospectivo, realizado en dos UCI de São Paulo, Brasil, de agosto a noviembre de 2019. Participaron 91 pacientes adultos que no presentaban UP en el momento de la admisión a la UCI e internados en la UCI por más de 24 horas. Los datos fueron recopilados de las historias clínicas y por medio de evaluación clínica. La asociación entre las variables clínicas, personales y los casos de UP fue realizada por el test-T Student y ji cuadrado, y la sensibilidad y especificidad de los instrumentos fueron validadas mediante la curva ROC. Resultados Hubo predominancia de sexo masculino (54,9 %), promedio de edad de 66,2 ± 20,8 años y de internación por razones clínicas (64,9 %). El uso de drogas vasoactivas, ventilación mecánica, contención mecánica, sedación, dispositivos, la gravedad y procedencia se asociaron a la aparición de UP. El área bajo la curva de Cubbin & Jackson fue 0,91, de EVARUCI fue 0,96 y de Waterlow fue 0,76. El EVARUCI demostró la mayor precisión (90,1 %). Conclusión Los instrumentos Cubbin & Jackson y EVARUCI presentaron alta sensibilidad y especificidad para la evaluación de riesgo de UP en pacientes internados en UCI, de los cuales el EVARUCI demostró una mejor precisión.

Abstract Objective To identify, among the Waterlow, Cubbin & Jackson and EVARUCI risk prediction instruments for pressure injuries (PI), the most specific and sensitive for patients in Intensive Care Units (ICU)). Methods This is an observational, analytical and prospective study, carried out in two ICUs in São Paulo, Brazil, from August to November 2019. Participants were 91 adult patients who did not have PI at the time of admission to the ICU and who had been hospitalized in the ICU for more than 24 hours. Data were collected from medical records and through clinical assessment. The association between clinical and personal variables and PI occurrence was performed using Student's t test and chi-square test, and the instruments' sensitivity and specificity were assessed using the ROC curve. Results There was a predominance of males (54.9%), mean age of 66.2 ± 20.8 years and hospitalization for clinical reasons (64.9%). Vasoactive drug use, mechanical ventilation, mechanical restraint, sedation, devices, severity and origin were associated with PI development. The area under the curve for Cubbin & Jackson, EVARUCI and Waterlow were, respectively, 0.91, 0.96 and 0.76, and EVARUCI demonstrated the highest accuracy (90.1%). Conclusion The Cubbin & Jackson and EVARUCI instruments showed high sensitivity and specificity for PI risk assessment in patients admitted to ICUs, and EVARUCI showed better accuracy.

Aplicação das metodologias ativas para ensino de enfermagem em meio à pandemia de COVID-19 / Application of active methodologies for nursing teaching in the midst of the COVID-19 pandemic

Objetivo:Relatar a aplicação das metodologias ativas para o ensino em enfermagem em meio à pandemia de COVID-19.Métodos:Trata-se de um relato de experiênciadas vivências na disciplina de Laboratório de Fundamentos de Enfermagem de uma Universidade Pública em Fortaleza-CE.Resultados:Utilizou-se multimétodos, como aulas e jogos online, estudosde caso, simulação realística, elaboração de portfólio e vídeos com os procedimentos de Enfermagem abordados na disciplina.As diversas estratégias foram necessárias para colaborar com a construção do conhecimento durante a pandemia, uma vez que se utilizou do modelo híbrido de ensino.Conclusão:Constata-se que os vários métodos tecnológicos,como sala virtual, o WhatsAppcomo ferramenta de comunicação rápida, a elaboração do portfólio e a utilização de vídeos e jogos online, os estudos de caso e a simulação realística,foram utilizados de forma complementar e integrada, tornando-se favoráveis para os alunos, pois eles fazem parte de uma geração que tem maior facilidade em utilizartecnologias e são receptivos a multimétodos de aprendizagem

Objective: To report the application of active methodologies for nursing teaching in the midst of the COVID-19 pandemic. Methods: This is an experience report of lived situations in the Nursing Fundamentals Laboratory discipline at a Public University in Fortaleza-CE.Results: Multi-methods were used, such as online classesand games, case studies, realistic simulation, portfolio development and videos with the Nursing procedures addressed in the course. The various strategies were necessary to collaborate with the construction of knowledge during the pandemic, since the hybrid teaching model was used. Conclusion: It appears that the various technological methods, such as the virtual room, WhatsApp as a quick communication tool, the elaboration of the portfolio and the use of videos and online games, case studies and realistic simulation, were used in a complementary and integrated way, becoming favorable for students, as they are part of a generation that is more comfortable using technologies and are receptive to multi-method learning

Enfermeiros e as práticas recomendadas no manejo de delirium: estudo transversal / Enfermeras y mejores prácticas en el manejo del delirio: estudio transversal / Nurses and the best practices in the management of delirium: cross-sectional study

Objetivos:descrever a concordância dos enfermeiros quanto à avaliação, diagnóstico e prevenção de delirium em uma Unidade de Terapia Intensiva e verificar a associação da concordância ao perfil sociodemográfico dos profissionais. Método:estudo transversal realizado nas Unidades de Terapia Intensiva geral e cardiológica de um hospital de alta complexidade, entre janeiro e fevereiro de 2018. Participaram 61 enfermeiros por meio de surveyeletrônica com dezessete questões, sendo excluídos os que estavam em férias ou licença médica durante a coleta de dados. Resultados:A mediana de afirmativas com alta concordância foi de 11 por profissional, com 64% da amostra obtendo baixa concordância. As afirmativas com melhor concordância incluíram fatores de risco, algoritmo de avaliação, atuação do enfermeiro e conhecimento sobre sinais da síndrome. Conclusão:Os enfermeiros apresentaram baixa concordância às diretrizes de melhores práticas no manejo do delirium e não foi encontrada associação entre a alta concordância e ascaracterísticas sociodemográficas

Objectives:to describe nurses' agreement to regarding the assessment, diagnosis and preventionof delirium in the Intensive Care Unit and to verify the association of agreement with the sociodemographic profile of professionals. Method:cross-sectional study carried out in the general and cardiac Intensive Care Units of a high-complexity hospital, between January and February 2018. Sixty one nurses participated in an electronic survey with seventeen questions, excluding those who were on vacation or sick leave during the data collection. Results:The median of statements with high agreement was 11 per professional, with 64% of the sample obtaining low agreement. The statements with the best agreement included risk factors, assessment algorithm, nurse's role and knowledge about signs of the syndrome. Conclusion:Nurses showed low agreement with the guidelines for best practices in the management of delirium and no association was found between high agreement and sociodemographic characteristics.

Objetivos:describir la concordancia de enfermeras sobre la evaluación, diagnóstico y prevencióndel delirio en la Unidad de Cuidados Intensivos y verificar la asociación de concordancia con el perfil sociodemográfico de los profesionales. Método:estudio transversal realizado en las Unidades de Cuidados Intensivos Generales y Cardíacos de un hospital de alta complejidad, entre enero y febrero de 2018. Participaron 61 enfermeras en una encuesta electrónica con diecisiete preguntas, excluyendo a las que se encontraban de vacaciones o baja laboral durante la recopilación de datos. Resultados:La mediana de enunciados con alta concordancia fue de 11 por profesional, con un 64% de la muestra obteniendo baja concordancia. Los enunciados con mejor concordancia incluyeron factores de riesgo, algoritmo de evaluación, rol de la enfermera y conocimiento sobre los signos del síndrome. Conclusión:las enfermeras mostraron bajo acuerdo con las guías de buenas prácticas en el manejo del delirio y no se encontró asociación entre alto acuerdo y características sociodemográficas

Assessment of the Hawthorne effect during central venous catheter manipulation.

OBJECTIVES: To describe the compliance to the practices of hand hygiene and hub disinfection before manipulation of the central venous catheter in two moments: before and after educational intervention. Adherence to hand hygiene was assessed with two methods: direct observation and video camera. METHODS: Before and after study conducted with the nursing team in an adult intensive care unit, in São Paulo, Brazil, including 180 observations using video cameras and direct observation. Hand hygiene compliance before catheter manipulation and compliance with the correct technique and the hub disinfection for five seconds were observed. RESULTS: When video cameras recording was observed, hand hygiene compliance increased from 46% to 66% and the use of the proper technique increased from 23% to 46% (p < 0.05). Regarding hub disinfection compliance, no difference was observed between the periods. Hand hygiene compliance in direct observation increased from 83% to 87% and in indirect observation, from 46% to 66% after the intervention. CONCLUSION: After the educational intervention, hand hygiene compliance before CVC manipulation and the use of the correct technique improved. When observed indirectly, the adherence to these practices was lower, reinforcing the Hawthorne effect.

Neurological Manifestations Associated With SARS-CoV-2 in Children: A Case Series.

Neurological manifestations of COVID-19 may affect both central and peripheral nervous systems. Unlike in adults, in whom majority of severe cases derive from respiratory complications, neurological involvement is one of the main causes of severe COVID-19 in children. This study aimed to detect viral respiratory pathogens, mainly SARS-CoV-2, in nasopharynx and cerebrospinal fluid samples utilizing qRT-PCR (TaqMan) in a pediatric population in Brazil. We evaluated four children with neurological symptoms and laboratory-confirmed SARS-CoV-2 infection: three presenting with meningoencephalitis and one presenting with Guillain-Barré syndrome. All four patients had mild respiratory symptoms. SARS-CoV-2 RNA was identified in two cerebrospinal fluid samples. SARS-CoV-2 involvement should be considered for differential diagnosis in pediatric cases presenting neurological alterations even if symptoms such as headache, anosmia, or dizziness are absent.

Survival of cancer patients under treatment with the palliative care team in a Brazilian hospital in São Paulo.

Introduction: The Karnofsky Performance Status Scale is a relevant functional evaluation instrument that can be used to determine which patients should be followed by multidisciplinary palliative care teams. Objective: To analyze the clinical outcomes of patients with performance status lower than 70%, according to the Karnofsky Scale, who received care from a palliative care team compared to those who did not receive care from a palliative care team. Methods: In this retrospective cohort, follow-up of cancer patients by the palliative care team for 10 days was considered the exposure factor, while the dependent variable was patient survival. Data were extracted from medical records and descriptive and survival curve analyses were conducted. Results: Among 581 participants in the sample, 42.5% had metastasis, and the most prevalent medical diagnosis was gastrointestinal cancer (29.1%). Fifty-one (8.7%) were followed by the palliative care team. The mortality rate during the 10 days in the sample was 10.8%, and the rate was higher (15.7%) among patients followed by the palliative care team. Conclusion: Patients with a performance status below 70% who were followed by the palliative care team had poorer clinical conditions and a shorter survival than those who were not followed up by the team.

Survie des patients en oncologie traités par l'équipe de soins palliatifs d'un hôpital de São Paulo, au Brésil.

Introduction: L'échelle de l'indice fonctionnel de Karnofsky (Karnofsky Performance Status Scale) est un instrument d'évaluation pertinent et fonctionnel qui sert à déterminer quelles personnes devraient être suivies par des équipes multidisciplinaires de soins palliatifs. Objectif: Analyser les résultats cliniques de patients, suivis par une équipe de soins palliatifs, dont l'indice fonctionnel de Karnofsky est inférieur à 70 %, et les comparer aux résultats de personnes n'ayant pas bénéficié de ce type de soins. Méthodologie: Dans la présente étude de cohorte rétrospective, le suivi pendant 10 jours des patients par l'équipe de soins palliatifs constituait le facteur d'exposition et la survie, la variable dépendante. Des données ont été extraites des dossiers médicaux afin de réaliser des statistiques descriptives et des analyses des courbes de survie. Résultats: Parmi les 581 participants de l'échantillon, 42,5 % avaient des métastases. Le cancer gastro-intestinal était le diagnostic plus prévalent (29,1 %). Du groupe, 51 participants (8,7 %) étaient suivis par l'équipe de soins palliatifs. Le taux de mortalité pendant les 10 jours de suivi s'élevait à 10,8 %; il était plus élevé encore (15,7 %) chez les patients suivis par l'équipe de soins palliatifs. Conclusion: Les patients ayant un indice fonctionnel inférieur à 70 % qui étaient suivis par l'équipe de soins palliatifs présentaient un piètre état clinique et une période de survie plus réduite comparativement aux autres patients.

Probióticos y enfermedad periodontal. Revisión de la literatura / Probiotics and periodontal disease. Review of the literature

RESUMEN: La enfermedad periodontal se clasifica en dos grandes grupos principales: gingivitis y periodontitis, desencadenadas por una alteración de la microbiota oral, que causa un aumento de microorganismos patógenos con respecto a los beneficiosos. Estos, en interacción con el hospedero y con los factores de riesgo del paciente, definirán una presentación clínica específica. Una de las estrategias que se propone como alternativa frente al uso de antibióticos y como coadyuvante del raspado y alisado radicular (RAR) para tratar las periodontitis, es la administración de probióticos. Los probióticos son denominados como microorganismos vivos que al ser administrados en cantidades adecuadas son capaces de ejercer una acción benéfica sobre la salud del hospedador. Por tanto, el objetivo de este trabajo fue describir el beneficio de los probióticos en la prevención y tratamiento de las principales enfermedades periodontales. Para ello, se realizó una búsqueda desde Enero del 2010 a Mayo del 2020 en Pubmed, Web of Science, SciELO, Science Direct y el Portal Timbó. Obteniéndose como resultado que los probióticos son capaces de reducir los parámetros clínicos y microbiológicos de dichas enfermedades y que pueden ser un valioso complemento en su prevención y tratamiento.

ABSTRACT: Periodontal disease is classified into two main groups: gingivitis and periodontitis, triggered by an alteration of the oral microbiota, which causes an increase in pathogenic microorganisms with respect to the beneficial ones. In interaction with the host and with the risk factors of the patient. They will define a specific clinical presentation. One of the strategies proposed as an alternative to the use of antibiotics and as an adjunct to scraping and root planning (RAR) to treat periodontitis, is the administration of probiotics. Probiotics are living microorganisms that, when administered in adequate amounts, are capable of exerting a beneficial action on the health of the host. Therefore, the objective of this work was to describe the benefit of probiotics in the prevention and treatment of the main periodontal diseases. For this, a search was carried out between 2010 and 2020 in PubMed, Web of Science, SciELO, Science Direct and the Timbó Portal. The results obtained showed that probiotics are capable of reducing the clinical and microbiological parameters of these diseases and that they can be a valuable complement in their prevention and treatment.

Clozapine prevented social interaction deficits and reduced c-Fos immunoreactivity expression in several brain areas of rats exposed to acute restraint stress.

In the present study, we evaluate the effect of acute restraint stress (15 min) of male Wistar rats on social interaction measurements and c-Fos immunoreactivity (c-Fos-ir) expression, a marker of neuronal activity, in areas involved with the modulation of acute physical restraint in rats, i.e., the paraventricular nucleus of the hypothalamus (PVN), median raphe nucleus (MnR), medial prefrontal cortex (mPFC), cingulate prefrontal cortex (cPFC), nucleus accumbens (NaC), hippocampus (CA3), lateral septum (LS) and medial amygdala (MeA). We considered the hypothesis that restraint stress exposure could promote social withdrawal induced by the activation of the hypothalamic-pituitary-adrenocortical (HPA) axis, and increase c-Fos expression in these limbic forebrain areas investigated. In addition, we investigated whether pretreatment with the atypical antipsychotic clozapine (5 mg/kg; I.P.) could attenuate or block the effects of restraint on these responses. We found that restraint stress induced social withdrawal, and increased c-Fos-ir in these areas, demonstrating that a single 15 min session of physical restraint of rats effectively activated the HPA axis, representing an effective tool for the investigation of neuronal activity in brain regions sensitive to stress. Conversely, pretreatment with clozapine, prevented social withdrawal and reduced c-Fos expression. We suggest that treatment with clozapine exerted a preventive effect in the social interaction deficit, at least in part, by blocking the effect of restraint stress in brain regions that are known to regulate the HPA-axis, including the cerebral cortex, hippocampus, hypothalamus, septum and amygdala. Further experiments will be done to confirm this hypothesis.

Effects of Educational Interventions on Maternal Self-efficacy and Childhood Diarrhea: A Randomized Clinical Trial.

OBJECTIVE: Diarrhea still causes high morbidity and mortality in children under five, requiring constant interventions. Thus, the study aims to evaluate the effects of educational technologies on maternal self-efficacy to prevent childhood diarrhea. METHODS: Randomized clinical trial carried out in Fortaleza, Ceará, Brazil, with four randomized groups of mothers of children under 5 years of age, as follows: control group (n = 61), group A (booklet, n = 60), group B (video, n = 60), and group AB (booklet and video, n = 60). From June to October 2015, data collection was carried out in three moments (the first in person and the others by telephone monitoring). RESULTS: All groups improved their self-efficacy after the intervention, with higher scores in the group AB (booklet and video). A statistically significant association was found between the occurrence of diarrhea and maternal self-efficacy in groups A (booklet) (p = 0.023) and AB (booklet and video) (p = 0.042) at the second moment of data collection. From the second moment to the third moment, the risk of diarrhea decreased in group A, from 12.8 to 1.3, and in group AB, from 8.5 to 1.1. CONCLUSION: The technologies used, isolated or combined, were effective in improving maternal self-efficacy and decreasing the occurrence of childhood diarrhea; therefore, they can be used by nurses as health education tools.

Noise reduction in the ICU: a best practice implementation project.

INTRODUCTION: Sleep deprivation is a relevant problem among patients hospitalized in ICUs. Further, noise is the most critical disruptive factor according to patients. OBJECTIVE: To implement scientific evidence-based best practices for noise control in an adult ICU. METHODS: This was an evidence-based implementation project of best practices in noise control, conducted in a high-complexity hospital's adult ICU. The intervention consisted of three steps: baseline audit and identification of barriers, implementation of best practices, and a follow-up audit. RESULTS: No compliance with best practices was detected in the baseline audit. After the implementation phase, the unit reached compliance levels of 78-88% for most of these criteria only one criterion related to noise level did not match the expected compliance. CONCLUSION: Adherence to best practices regarding noise control was satisfactory, achieving more than 70% compliance in the six audit criteria. Only the noise level did not reach the threshold recommended by the WHO - a difficulty reported in other studies. RELEVANCE TO CLINICAL PRACTICE: Best practices related to noise control are essential for managing sleep deprivation in ICUs and include changes in the behaviour of involved professionals.

Assessment of the Hawthorne effect during central venous catheter manipulation / Avaliação do efeito Hawthorne durante a manipulação do cateter venoso central / Evaluación del efecto Hawthorne durante la manipulación del catéter venoso central

ABSTRACT Objectives: To describe the compliance to the practices of hand hygiene and hub disinfection before manipulation of the central venous catheter in two moments: before and after educational intervention. Adherence to hand hygiene was assessed with two methods: direct observation and video camera. Methods: Before and after study conducted with the nursing team in an adult intensive care unit, in São Paulo, Brazil, including 180 observations using video cameras and direct observation. Hand hygiene compliance before catheter manipulation and compliance with the correct technique and the hub disinfection for five seconds were observed. Results: When video cameras recording was observed, hand hygiene compliance increased from 46% to 66% and the use of the proper technique increased from 23% to 46% (p < 0.05). Regarding hub disinfection compliance, no difference was observed between the periods. Hand hygiene compliance in direct observation increased from 83% to 87% and in indirect observation, from 46% to 66% after the intervention. Conclusion: After the educational intervention, hand hygiene compliance before CVC manipulation and the use of the correct technique improved. When observed indirectly, the adherence to these practices was lower, reinforcing the Hawthorne effect.

RESUMO Objetivos: Descrever o cumprimento das práticas de higienização das mãos e desinfecção dos conectores antes da manipulação do cateter venoso central antes e após intervenção educativa. A adesão à higienização das mãos foi avaliada por observação direta e câmera de vídeo. Métodos: Estudo antes e depois realizado com a equipe de enfermagem em unidade de terapia intensiva para adultos, em São Paulo, Brasil, com 180 observações com câmeras de vídeo e observação direta. A adesão à higienização das mãos antes da manipulação do cateter e à técnica correta e desinfecção do conector por cinco segundos foram observadas. Resultados: Quando as câmeras de vídeo foram observadas, a adesão à higiene das mãos aumentou de 46% para 66% e o uso da técnica adequada aumentou de 23% para 46% (p < 0,05). Em relação à adesão à desinfecção do conector, não foi observada diferença entre os períodos. A adesão à higienização das mãos na observação direta aumentou de 83% para 87% e na indireta, de 46% para 66% após a intervenção. Conclusão Após a intervenção educativa, houve melhora na adesão à higienização das mãos antes da manipulação do cateter venoso central e no uso da técnica correta. Quando observada indiretamente, a adesão a essas práticas foi menor, reforçando o efeito Hawthorne.

RESUMEN Objetivo: Describir el cumplimiento de las prácticas de higiene de manos y desinfección del hub antes de la manipulación del catéter venoso central en dos momentos: antes y después de la intervención educativa. La adherencia a la higiene de manos se evaluó con dos métodos: observación directa y cámara de video. Métodos: Estudio antes-después realizado con el equipo de enfermería en una unidad de cuidados intensivos de adultos, en São Paulo, Brasil, que incluye 180 observaciones utilizando cámaras de video y observación directa. Se observaron el cumplimiento de la higiene de manos antes de la manipulación del catéter y el cumplimiento de la técnica correcta y la desinfección del hub durante cinco segundos. Resultados: Cuando se observó la grabación de cámaras de video, el cumplimiento de la higiene de manos aumentó del 46% al 66% y el uso de la técnica adecuada aumentó del 23% al 46% (p<0,05). En cuanto al cumplimiento de la desinfección de hubs, no se observó diferencia entre los períodos. El cumplimiento de la higiene de manos en observación directa aumentó del 83% al 87% y en observación indirecta del 46% al 66% tras la intervención. Conclusión: Después de la intervención educativa mejoró el cumplimiento de la higiene de manos antes de la manipulación del CVC y el uso de la técnica correcta. Cuando se observó indirectamente, la adherencia a estas prácticas fue menor, reforzando el efecto Hawthorne.

Does Panoramic X-ray Induce Cytogenetic Damage to Oral Cells? A Systematic Review With Meta-analysis.

AIM: The aim of this review was to evaluate the scientific literature regarding the cytogenetic damage in oral exfoliated cells of adult patients submitted to panoramic X-ray. MATERIALS AND METHODS: An extensive search of the literature was conducted on PubMed, Scopus and Web of Science databases for all studies published until April 2021 using combinations of the following keywords: "panoramic X-ray," "DNA damage," "genetic damage", "genotoxicity", "mutagenicity", cytotoxicity", "buccal cells", "oral mucosa", "tongue", "gingiva", "micronucleus assay", according to the PRISMA guidelines. All clinical studies in English language were included in the study. A total of 10 studies were identified. RESULTS: As expected, the results regarding the cytogenetic damage induced by panoramic X-ray are conflicting. Some authors have demonstrated that panoramic X-ray induces mutagenesis in oral cells, whereas others did not. After reviewing the 10 studies, two were classified as strong, four were considered moderate, and four were considered weak, according to the quality assessment components of the Effective Public Health Practice Project (EPHPP). Meta-analysis data revealed a negative response related to mutagenicity in oral cells by panoramic X-ray. CONCLUSION: Taken together, this review failed to demonstrate the association between micronucleus frequency and panoramic X-ray.

Inhibition of Toll Like Signaling Pathway Is Associated With Genomic Instability in Rat Liver Exposed to Crack Cocaine.

BACKGROUND/AIM: The aim of the present study was to investigate the biological effects of subacute crack cocaine exposure in rat liver. MATERIAL AND METHODS: A total of 32 rats were distributed into four groups (n=8): Experimental group 1 (G1) and Experimental group 2 (G2): rats received 18 mg/kg of body weight (b.w) of crack cocaine for 5 days, once a day, group G2 remained 72 h without exposure after the experimental period (5 days)(abstinence); Experimental group 3 (G3): rats received 36 mg/kg of body weight (b.w) of crack cocaine for 5 days, once a day; Control Group (CTRL): rats received only the vehicle (DMSO) administered by the intraperitoneal (i.p) route for 5 days, once a day. RESULTS: All groups exposed to crack cocaine had an increase in the number of micronucleated hepatocytes and binucleated cells only in the highest tested dose (36 mg/kg). Karyolysis had an increase in the 18 mg/kg dose, in the abstinence group (G2), and 36 mg/kg group (G3); whereas pyknotic nuclei had an increase in the G2 group. The group exposed to 18 mg/kg of crack cocaine also showed high 8 OHdG expression. The p-NF-κB p65 protein decreased in the groups exposed to crack cocaine at doses of 18 and 36 mg/kg, as well as in the abstinence group. MyD88 was also found decreased in the group exposed to crack cocaine at 18 mg/kg. CONCLUSION: Crack cocaine inhibited toll like signaling pathway whilst being associated with genomic instability in rat liver cells.