Nursing Interventions for Patients With Neurogenic Bowel Dysfunction Arising From Complete Spinal Cord Injury: A Scoping Review.

PURPOSE: We mapped key concepts and identified 4 fundamental nursing interventions for patients with neurogenic bowel dysfunction due to complete spinal cord injury (SCI). METHODS: A scoping review was conducted according to the recommendations of the Joanna Briggs Institute. SEARCH STRATEGY: Searches were performed in PubMed, LILACS, CINAHL, COCHRANE, and SCOPUS electronic databases. We use searched the gray literature using the Google Scholar search engine. We formulated a question to guide the search, based on the participants, concept, and context format: "What are the key manual nursing interventions performed in patients with neurogenic bowel dysfunction resulting from complete spinal cord injury?" We included nursing intervention strategies that may be performed by health professionals, patients, or caregivers. Two reviewers independently participated in the selection; disagreements were resolved by a third reviewer and 5 experts. FINDINGS: Thirteen studies conducted between 1998 and 2019 were selected; 5 were randomized clinical trials. Four main interventions were identified for conservative management of neurogenic bowel dysfunction in patients with complete SCI. They were digital-anal stimulation, manual extraction of feces, abdominal massage, and strategies used to stimulate the gastrocolic reflex. CONCLUSIONS: Research suggests that each of these interventions, administered alone or in combination, supports bowel evacuation in patients with a complete SCI. Each of these interventions may be performed by a nurse, and taught to the patient and/or lay caregiver. IMPLICATIONS FOR PRACTICE: An individualized bowel management program for patients with neurogenic bowel dysfunction due to SCI is necessary to ensure regular bowel evacuation, preserve fecal continence, and support dignity and health-related quality of life. The conservative interventions identified in this scoping review should be incorporated in protocols or guidelines for management of neurogenic bowel dysfunction in this vulnerable population.

Subjetividades e desafios de pessoas convivendo com estomia intestinal / Subjectivities and challenges of people living with an intestinal ostomy / Subjetividades y retos de las personas que viven con ostomía intestinal

Objetivo:Identificar vivências da pessoa com estomia intestinal relacionadas ao seu convívio social. Métodos:Estudo descritivo, de natureza qualitativa, realizado com dez pessoas com estomia intestinal. A coleta de dados foi realizada no Serviço de Estomaterapia de um hospital escola do Distrito Federal, por meio de entrevistas semiestruturadas relativas à vivência familiar e social antes e após a estomia. Resultados: Participaram seis homens e quatro mulheres, com idade média de 49 anos, a maioria com colostomia definitiva. Da análise surgiram duas categorias: "Como é viver com estomia e seus desafios"; e "Estratégias desenvolvidas diante das mudanças". Na primeira categoria destacam-se: autocuidado, falta de banheiro adequado, atividade laboral, hábitos alimentares, ruptura da imagem corporal e situações constrangedoras. Na segunda categoria buscam: apoiar na religiosidade, manter sentimentos positivos e preservar o equilíbrio emocional. Conclusão: A estomia interfere no convívio familiar e social. Ficou evidente que a pessoa com estomia desenvolve estratégias para enfrentar as mudanças. Acredita-se que o isolamento social decorre, em parte, pela falta de informação junto à sociedade, falta de material de qualidade que ofereça conforto e segurança e, por último, falta de banheiros, públicos e privados, adaptados

Objective:Identify experiences of the person with intestinal ostomy related to their social life. Methods: Descriptive study, qualitative in nature, carried out with ten people with intestinal ostomy. Data collection was performed at the Stomatherapy Service of a teaching hospital in the Federal District, through semi-structured interviews relating to family and social experience before and after the ostomy. Results: Six men and four women participated, with a mean age of 49 years, most with a permanent colostomy. From the analysis, two categories emerged: "What is it like to live with an ostomy and its challenges"; and "Strategies developed in the face of changes". In the first category, the following stand out: self-care, lack of adequate bathroom, work activity, eating habits, disruption of body image and embarrassing situations. In the second category, they seek to support religiosity, maintain positive feelings and preserve emotional balance. Conclusion: The ostomy interferes with family and social life. It was evident that the person with ostomy develops strategies to face changes. It is believed that social isolation stems, in part, from the lack of information from society, the lack of quality material that offers comfort and safety, and, finally, the lack of adapted public and private bathrooms.

Objetivo:Identificar las principales estrategias para la prevención de lesiones por presión faciales ocasionadas por el uso de posición prona. Métodos: Revisión integrativa de literatura, realizada durante el mes de marzo del 2021. Fueron investigados artículos en las bases de datos de MEDLINE, LILACS, BDENF e IBECS. Los artículos seleccionados fueron redactados en los idiomas inglés, portugués y español, entre el 2016 y el 2021. Fueron excluidos los duplicados y los que no incluían la temática abordada. Inicialmente, fueron identificados 29 artículos. Después de la aplicación de los criterios de inclusión y exclusión, resultaron 10 artículos para análisis. Resultados: De las complicaciones relacionadas al uso de la posición prona, 10 (100%) de los estudios abordan la lesión por presión como la principal complicación de esta maniobra terapéutica. Con respecto a las estrategias de prevención, los estudios analizados citan el cambio de decúbito asociada al uso de apoyo e hidrocoloides como principales métodos preventivos. Conclusión: Fueron identificadas las siguientes estrategias de prevención de lesión por presión facial por el uso de posición prona: cambio de decúbito en tiempos preestablecidos; uso de dispositivos que proporcionan alivio de puntos de presión, tales como los apoyos e hidrocoloides; y la utilización de materiales de bajo costo y fácil acceso, como esponjas quirúrgicas adaptadas, respetando las estructuras anatómicas de cada paciente

The effect of Gestational Diabetes Mellitus on the fetal compartment.

In indicated preterm births such a Gestational Diabetes Mellitus (GDM), little is known about the role of the amnion membranes. Investigating the role of amnion membrane inflammation in response GDM may suggest novel pathophysiologic mechanisms. We hypothesize that increased GDM inflammatory mediators may weaken the amnion membrane predisposing them to infection. Maternal and fetal serum and amnion membrane biopsies were collected from 20 GDM and 38 normoglycemic subjects (control) who underwent elective cesarean sections. Cytokines and adipokines were evaluated in serum and amnion culture supernatant samples. Amnion membrane biopsies from GDM and control subjects were studied: fresh frozen for RNA analysis for Toll-like receptor expression; cultured with LPS to test membrane permeability, and inflammation LPS + anti-TLR4 for testing mechanism. GDM was associated with higher fetal serum leptin (p = 0.004) and IL-10 (p = 0.04) compared to controls. Amnion membrane explants from GDM had higher levels of IL-6 (p = 0.019), and lower expression of Claudin-4 (p = 0.007) and increased permeability (p = 0.046) compared to controls. GDM membranes treated with LPS showed an increased expression of IL-10 (p = 0.013); IL-6 (p = 0.004) and TNF-α (p = 0.0005) but did not affect membrane permeability. LPS and anti-TLR4 antibody treatment reduced the production of TNF-α in controls (p = 0.03) and GDM (p = 0.007) compared to LPS alone. Fetal inflammatory response seems more balanced in GDM and does not impact membrane permeability function even with an infectious stimulus. Light fetal membrane inflammatory response may explain lack of preterm labor in GDM. Concluding, benign inflammation in the membranes may not be harmful for pregnancy maintenance.

Sustainable recycling of mooring ropes from decommissioned offshore platforms.

Decommissioning offshore Floating Production, Storage and Offloading (FPSO) platforms requires extensive technical knowledge, since it generates different post-consumer materials, including mooring lines. These ropes are made from polyester high tenacity yarn, based on polyethylene terephthalate (PET), and their high added value means they should not be discarded as scrap. This paper aims to present a review and technical opportunities, from an economic standpoint, of recycling the mooring lines recovered from decommissioned FPSOs. Studies conducted over the last two years have researched and developed different potential applications for the fibers. These studies include collaborative project initiatives involving technical and management professionals, universities and private enterprises, with a view to achieving a more sustainable destination for these fibers.

[Conditions and motivations for the work of nurses and physicians in high complexity emergency services]. / Condições e motivações para o trabalho de enfermeiros e médicos em serviços de emergência de alta complexidade.

This study aimed to evaluate the motivations and conditions offered to the work of nurses and doctors in three high complexity emergency services of the city of Recife, Pernambuco. It is a descriptive transversal type study. It was interviewed 42 nurses and 84 doctors, of a total population of 97 nurses and 469 doctors. It was used a questionnaire prepared for this survey and the Scale of Values Related to Work. On the motivation assessment it was found that Professional Realization was the major motivational factor, and Prestige the less important factor.

[Teaching care in nursing graduation according to the perspective of complexity]. / O ensino do cuidar na Graduação em Enfermagem sob a perspectiva da complexidade.

This study highlights the teaching of care in Nursing Graduation according to the Complexity Theory, supported by Edgar Morin. This is a qualitative study using Thematic Content Analysis. Twelve individual semi-structured interviews were performed at a private university in the city of São Paulo, Brazil. Data collection was performed between 2004 and 2005, using a guiding question. Data analysis revealed categories, herein referred to as Complex Pedagogical Indicators, which assigned meanings to complex care. Results showed that the interviewees realized and expressed sensitive care in nursing, making relations and interrelations of the parts with the whole and the whole with the parts, thus approaching complex care.

Planejamento estratégico de uma unidade saúde da família: Região Leste de Goiânia / Strategic planning of a family health unit: East Region of Goiania

Relato de experiencia de académicos del curso de graduación en enfermería en una Unidad de Atención primaria en Salud Familiar (UAPSF) de la región Este de Goiana-Goiás, Brasil, realizada en 2009. Objetivó a construir de forma participativa el planeamiento estratégico de la unidad. Fuero realizadas dos oficinas durante el estagio que promoverán un ambiente favorable para la identificación y preguntas de los problemas de la unidad. Dados los problemas han sido elaborado objetivos, discusiones de acciones creativas y posibles, para hacer frente a ellos y de esto fue elaborado un plan de acción. Acciones derivadas del plan estratégico desarrolladas por los profesionales de UAPSF, tuvieron resultados inmediatos y significativos para el equipo de salud y comunidad de usuarios del Sistema Unico de Salud.

Sudden deafness as a presenting symptom of acoustic neuroma: case report.

UNLABELLED: Vestibular schwannoma, also known as acoustic neurinoma, is the most frequent tumor of the cerebellopontine angle, and represents 9% of all intracranial tumors. CASE REPORT: The authors report a case of sudden deafness with unilateral tinnitus. The patients responded to therapy with Prednisone and Pentoxifylline after the diagnosis of acoustic neurinoma by imaging exams. DISCUSSION: Sudden deafness can be described as an intense and abrupt sensorineural loss. Usually it is higher than 30 dB at three or more frequencies and develops in less than three days. CONCLUSION: Investigation of the etiology of sudden deafness is extremely important to establish the adequate strategy for the case.

[Nursing education in the light of the complexity paradigm]. / A educaçã em enfermagem à luz do paradigma da complexidade.

The objectives of this research were to recognize, interpret and discuss themes that arise out of the speeches of instructors of an undergraduate course of Nursing as guiding sources to a humanized teaching-learning experience in the light of Edgard Morin's Theory of Complexity. It is a qualitative, exploratory and analytic research. The study tried to verify principles of the paradigm of complexity through content analysis, theme modality, in the speeches of 11 instructors, obtained in 2004. The themes that were found were: teaching the instructor's responsibility; combining knowledge: connections and interrelations to face reality; teaching human complexity; stimulating creativity and curiosity; facing uncertainty: building life's continuous, dynamic knowledge; experiencing the teaching-learning process through transdisciplinarity; and teaching citizenship. This study shows that it is possible to have a university education based on the human condition, solidarity and knowledge interconnection.

[The importance of the Support Network for the stomized patient]. / A relevância da Rede de Apoio ao estomizado.

The purpose of the study was to learn about the social support stomized patients turn to, as well as their benefits in facing the changes a new way of life incur in. The methodological reference was oral history of topic lives. Ten half-structured interviews have been conducted with subjects with definitive intestinal ostomy It was used the technique of content analysis, which provided us with three important supporting networks: religious and spiritual beliefs, family and the Ostomy Association. Those networks worked as pillars that minimized the suffering of stomized patients. Health care professionals must value those supporting networks so as to enhance the lives of stomized patients.

Quality of life and self-esteem after breast asymmetry surgery.

BACKGROUND: Surgical correction of breast asymmetry involves not only an acceptable aesthetic result but also physical, social, and psychological consequences on the patient's quality of life. OBJECTIVE: The authors evaluated the impact of breast asymmetry surgical treatment on self-esteem and health-related quality of life in a group of 35 patients. METHODS: Patients completed the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), a generic health evaluation tool that covers quality of life across 8 dimensions, and the Rosenberg Self-Esteem Scale, a specific tool for evaluating self-esteem. Both were applied before and at 3 and 6 months after surgery. Friedman two-way analysis of variance and the Tukey test were used to compare the differences between the scores and the different time periods. RESULTS: There was a progressive improvement in all dimensions of the SF-36 that was statistically significant for 4 dimensions and self-esteem. Statistically significant differences were found for "emotional role" and "self-esteem" at 3 months after surgery and for "pain," "vitality," and "mental health" at 6 months after surgery. CONCLUSIONS: The results suggest that breast asymmetry surgical treatment provides an improvement in health-related quality of life and self-esteem.

A possible role of sphingolipids in the aluminium resistance of yeast and maize.

The plasma membrane is most likely the major target for sensing of aluminium (Al), leading to inhibition of plant root-growth. As a result of high external Al, alterations in plasma membrane composition may be expected in order to maintain its properties. As sphingolipids are characteristic components of this membrane, their involvement in membrane adjustment to increased Al concentrations was investigated. Heterologous expression of a stereounselective long-chain base (LCB) (8E/Z)-desaturase from Arabidopsis thaliana, Brassica napus and Helianthus annuus in Saccharomyces cerevisiae improved the Al resistance of the transgenic yeast cells. This encouraged us to investigate whether Al affects the LCB composition, and whether genetic engineering of the LCB profile modifies the Al resistance of the Al-sensitive plant species maize (Zea mays, L.). Constitutive expression of the LCB (8E/Z)-desaturase from Arabidopsis thaliana in maize roots led to an 8- to 10-fold increase in (8E)-4-hydroxysphing-8-enine in total roots. Less marked but similar changes were observed in 3 mm root apices. Al treatment of the Al-sensitive maize cv Lixis resulted in a significant increase in the proportion of (8Z)-LCB and in the content of total LCBs in root tips, which was not observed in the Al-resistant cv ATP-Y. When root tips of transgenic plants were exposed to Al, only minor changes of both (8Z)- and (8E)-unsaturated LCBs as well as of the total LCB were observed. Al treatment of the wild type parental line H99 decreased the (8Z)-unsaturated LCBs and the total LCB content. Based on Al-induced callose production, a marker for Al sensitivity, the parental line H99 was as Al-resistant as cv ATP-Y, whereas the transgenic line became as sensitive as cv Lixis. Taken together, these data suggest that, in particular, the loss of the ability to down-regulate the proportion of (8Z)-unsaturated LCBs may be related to increased Al sensitivity.

[A paradigmatic glance on nursing care -- a walk to complex care]. / Um olhar paradigmático sobre a Assistência de Enfermagem--um caminhar para o cuidado complexo.

The text addresses the Cartesian paradigms (modern) and the complexity paradigm (post-modern of Edgar Morin) aiming to deepen reflection on the theme and understanding to improve nursing. To this end, the authors discuss the model of care of methodical nursing in the Cartesian paradigm defining it as producer of an authoritarian, fragmented and linear care. They point the need to rethink that model because it restricts the autonomy of the people/patient moving in the direction of complex care that provides for customers/actors' participation in their health care planning.