Mammalian Target of Rapamycin Inhibitors Vs Calcineurin Inhibitors in Chronic Graft Rejection After Lung Transplantation: A Systematic Review and Meta-Analysis.

BACKGROUND: The number of lung transplantations has been rising constantly. However, use of this therapeutic resource is limited by several issues that are difficult to resolve, such as chronic graft rejection and complications secondary to immunosuppression. METHODS: This systematic review compared mammalian target of rapamycin (mTOR) inhibitor immunosuppression associated with low-dose calcineurin inhibitors with isolated calcineurin inhibitor immunosuppression on the new-onset chronic rejection development and mortality 12 months after lung transplantation. Three controlled randomized clinical trials (SHITRIT, NOCTET, and 4EVERLUNG) were selected from electronic databases. RESULTS: Meta-analysis of the data at 12 months postintervention showed that only 4EVERLUNG assessed chronic graft rejection, with a higher incidence in the control group; however, the difference was not statistically significant (P = .197). Significant data were related to an increase in the number of adverse events (P = .0064) and improved renal function (P < .0001) in the mTOR inhibitor-based scheme. The other outcomes indicated a trend toward greater risk of death and acute graft rejection with the use of mTORs. CONCLUSIONS: The researchers suggest considering the use of mTOR inhibitors, whose greatest benefit is felt by patients with renal dysfunction, in association with the use of calcineurin inhibitors, because of the imminent risk of death among patients with renal failure.

Validação de instrumento avaliativo para capacitação de enfermeiros em ressuscitação cardiopulmonar / Validation of evaluating instrument for training nurses in cardiopulmonary resuscitation / Validación de instrumento evaluador para la formación de enfermeras en reanimación cardiopulmonar

Objetivo: validar critérios de um instrumento para avaliação da capacitação de enfermeiros em ressuscitação cardiopulmonar. Método: estudo metodológico para validação de critério de um instrumento previamente validado quanto ao conteúdo. Realizou-se a aplicação de um instrumento pré e pós-teste de uma capacitação com 20 enfermeiros de um hospital do interior do Estado de São Paulo. Resultados: realizou-se a análise das respostas do pré e pós-teste sobre o entendimento dos participantes antes e após a realização de teoria atrelada a simulação sobre ressuscitação cardiopulmonar. Foram avaliadas as variáveis objetividade, simplicidade, clareza e pertinência, destacando-se que os participantes concordaram que os critérios citados foram atendidos. Conclusão: o instrumento investigado possui relação com os padrões definidos, sendo comprovadamente validado. Ao utilizar-se deste instrumento durante a avaliação de capacitações em ressuscitação cardiopulmonar, as equipes de trabalho, alunos e pacientes serão beneficiados, garantindo a padronização e melhor efetividade no atendimento a PCR

Objective: to validate criteria of an instrument for assessing the qualification of nurses in cardiopulmonary resuscitation. Method: methodological study for criterion validation of a previously validated instrument for content. The application of a pre and post test instrument of a training with 20 nurses from a hospital in the interior of the state of São Paulo was performed. Results: pre and post test answers were analyzed on the participants' understanding before and after the theory of the cardiopulmonary resuscitation simulation. The variables objectivity, simplicity, clarity and relevance were evaluated, highlighting that the participants agreed that the criteria mentioned were met. Conclusion: the instrument investigated is related to the defined standards and has been validated. By using this instrument during the assessment of training in cardiopulmonary resuscitation, workteams, students and patients will benefit through standardization and effectiveness of care

Objetivo: validar los criterios de un instrumento para evaluar la calificación de las enfermeras en reanimación cardiopulmonar. Método: estudio metodológico para la validación de criterios de un instrumento previamente validado para el contenido. Se realizó la aplicación de un instrumento de prueba previa y posterior a una capacitación con 20 enfermeras de un hospital en el interior del estado de São Paulo. Resultados: las respuestas previas y posteriores a la prueba se analizaron según la comprensión de los participantes antes y después de la teoría de la simulación de reanimación cardiopulmonar. Se evaluaron las variables objetividad, simplicidad, claridad y relevancia, destacando que los participantes estuvieron de acuerdo en que se cumplieron los criterios mencionados. Conclusión: el instrumento investigado está relacionado con los estándares definidos y ha sido validado. Al utilizar este instrumento durante la evaluación de la capacitación en reanimación cardiopulmonar, los equipos de trabajo, los estudiantes y los pacientes se beneficiarán mediante la estandarización y la eficacia de la atención

Checklist validation for care provided to patients in the immediate postoperative period of cardiac surgery.

AIMS AND OBJECTIVES: We created and validated a checklist for nursing care of patients in the immediate postoperative period of cardiac surgery. BACKGROUND: Cardiovascular diseases (CVD) account for about 30% of all deaths recorded in Brazil. There is an arsenal of clinical and surgical treatments for CVD, with a significant number of patients evolving to surgical treatment. Thus, health professionals working in the perioperative period of cardiovascular surgeries need to be updated, trained and qualified to provide adequate and safe care to patients. DESIGN: We developed a checklist that defined essential parameters for quality care, to ensure greater agility and patient safety. METHODS: This methodology validation study comprised two stages: checklist creation for care provided by nurses to patients in the IPO of cardiac surgery, and content validation using the Delphi method. Participants were selected through an advanced survey conducted on the Lattes Platform website of the National Council for Scientific and Technological Development. The STROBE checklist was used to guide the study. RESULTS: Three rounds of analysis by specialists resulted in average CVIs of: 95.8% for objectivity, 97.9% for simplicity, 91.0% for clarity, 93.1% for relevance and 96.5% for variety, suggesting high agreement among specialists. CONCLUSIONS: The checklist focused on nursing care of patients in the IPO of cardiac surgery and was validated with three topics, four categories, 16 items and 86 sub-items of care assignments to be applied in clinical practice. RELEVANCE TO CLINICAL PRACTICE: This is a validated instrument that guides nurses' actions by admitting postoperative cardiac surgery patients to the ICU based on evidence, which provides more scientific and professional support to health teams' performance, with the objective of strengthening roles and establishing routines; thus presenting a powerful tool for planning nursing actions, providing quality care to patients, and facilitating communication between teams, thereby minimising risks.

Hypothermia post-cardiopulmonary resuscitation with low inputs: an experience report.

OBJECTIVE: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. METHOD: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. RESULTS: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. CONCLUSION: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.

Hypothermia post-cardiopulmonary resuscitation with low inputs: an experience report / Hipotermia post-ressuscitación cardiopulmonar con bajos insumos: relato de experiencia / Hipotermia pós ressuscitação cardiopulmonar com baixos insumos: relato de experiência

ABSTRACT Objective: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. Method: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. Results: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. Conclusion: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.

RESUMEN Objetivo: relatar la experiencia de la conducción de control dirigido de la temperatura de una paciente después de la resucitación cardiopulmonar, con insumos reducidos y básicos disponibles en la institución. Método: el informe de experiencia de control direccionado de la temperatura en paciente (edad 15 años), después de cuatro horas de resucitación cardiopulmonar en una Unidad de Terapia Intensiva de un hospital del interior del estado de São Paulo, en el año 2016, conforme protocolo sugerido por la American Heart Association en 2015. Se utilizaron aplicaciones de compresas embebidas en agua helada, bolsas plásticas con hielo triturado y control de la temperatura rectal. Resultados: en ocho horas, la temperatura alcanzó los 34 ºC. El enfriamiento corporal se mantuvo durante 24 horas, sin embargo, las bolsas con hielo triturado se utilizaron en las primeras 6 horas. Conclusión: la conducta de los enfermeros para obtener el enfriamiento corporal con insumos reducidos y básicos, se mostró efectiva durante la permanencia en la Unidad de Terapia Intensiva.

RESUMO Objetivo: relatar a experiência da condução de controle direcionado da temperatura de uma paciente pós ressuscitação cardiopulmonar, com insumos reduzidos e básicos disponíveis na instituição. Método: relato de experiência de controle direcionado da temperatura em paciente (idade 15 anos) após quatro horas de ressuscitação cardiopulmonar em uma unidade de terapia intensiva de um hospital do interior do Estado de São Paulo, no ano de 2016, conforme protocolo sugerido pela American Heart Association 2015. Utilizou-se aplicações de compressas embebidas em água gelada, sacos plásticos com gelo triturado e controle da temperatura retal. Resultados: em oito horas a temperatura atingiu 34ºC. O resfriamento corporal foi mantido por 24 horas, todavia os sacos com gelo triturado foram utilizados nas primeiras 6 horas. Conclusão: a conduta dos enfermeiros para obter o resfriamento corporal com insumos reduzidos e básicos, mostrou-se efetiva durante a permanência na unidade de terapia intensiva.

Validação de conteúdo de um instrumento para avaliação da capacitação em ressuscitação cardiopulmonar / Validation of content of an instrument for the evaluation of training in cardiopulmonary resuscitation / Validación de contenido de un instrumento para evaluación de la capacitación en resucitación cardiopulmonar

O objetivo deste estudo foi realizar a validação de conteúdo de um instrumento para avaliação da capacitação em ressuscitação cardiopulmonar para profissionais da saúde.Trata-se de uma validação de conteúdo e aparência de um instrumento de coleta de dados, constituído pelas etapas de ajuizamento e elaboração da versão final do instrumento. Participaram cinco avaliadores/juízes e a representatividade dos itens em relação ao conteúdo abordado foi mensurada por meio do índice de validade de conteúdo (IVC), calculado pelo número de avaliadores concordante com o item pelo número total de avaliadores. Foram realizadas as readequações do instrumento de coleta de dados em concordância com as contribuições advindas dos avaliadores e análise da literatura científica. O instrumento elaborado com base nas diretrizes internacionais de ressuscitação cardiopulmonar, em sua versão final, após o processo de validação de conteúdo e aparência, apresenta 18 itens voltados para a avaliação do impacto e da qualidade das capacitações de profissionais da saúde no atendimento à vítima em parada cardiorrespiratória.(AU)

The aim of this study was to validate the content of an instrument for the evaluation of training in cardiopulmonary resuscitation for health professionals. This is a validation of the content and appearance of a data collection instrument, consisting of the steps of assessment and preparation of the final version of the instrument. Five evaluators / judges participated and the representativeness of the items in relation to the content was measured using the Content Validity Index (CVI), calculated by the number of evaluators according to the item by the total number of evaluators. The adjustments of the instrument of data collection were carried out in agreement with the contributions coming from the evaluators and analysis of the scientific literature. The instrument, based on international guidelines for cardiopulmonary resuscitation, in its final version, after the content and appearance validation process, presents eighteen items aimed at assessing the impact and quality of training of health professionals in the care of the victims at standstill Cardiopulmonary resuscitation.