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OBJETIVO: Determinar las estrategias utilizadas para dar continuidad a los cuidados paliativos en pandemia. MÉTODO: Se realizó una revisión bibliográfica sistematizada en seis bases de datos: PubMed, Scopus, Sciencedirect, EBSCO, WOS y BVS desde marzo a junio 2022. Se utilizaron descriptores normalizados MESH "Terminal care", "Nursing care" y "COVID-19" y sinónimos que fueron combinados con el operador booleano "AND". Se incluyen todos los artículos en inglés, español y portugués publicados durante la pandemia por COVID-19 (2019-2022), seleccionándolos luego según criterios de elegibilidad. RESULTADOS: Se seleccionaron 13 artículos, siendo 12 en inglés y 1 en español, en su mayoría de Europa. Las estrategias encontradas se clasificaron en 5 categorías principales: Reorganización de los servicios, planificación anticipada, apoyo a los profesionales, apoyo al paciente y familia; y uso de la tecnología de la información. CONCLUSIÓN: La pandemia por COVID-19 trajo consecuencias para todo el sistema de salud. Una de las afectadas fue el área de cuidados paliativos, donde se debió trabajar sólo con los recursos disponibles. De esta situación surgieron estrategias positivas para continuar dando una buena calidad de vida al paciente en sus últimos momentos, siendo el uso de la tecnología el más utilizado, sin dejar de lado el papel protagónico de la enfermera.
OBJECTIVE: To determine the strategies used to perpetuate palliative care during the COVID-19 pandemic. METHOD: A bibliographic inspection was conducted in six databases: PubMed, Scopus, Sciencedirect, EBSCO, WOS and BVS, from March to June 2022. Standardized descriptors from MESH were used, such as "Terminal care", "Nursing care", and "COVID-19", along with synonyms that were intertwined with the Boolean operator "AND". All articles in English, Spanish and Portuguese published during the COVID-19 pandemic (2019-2022) were included, selecting them afterwards according to eligibility criteria. RESULTS: 13 articles were selected, 12 of which were in English and 1 was in Spanish, mostly being from Europe. The strategies found were classified in 5 main categories: Reorganization of the services, anticipated planification, support to professionals, patients and family, and the usage of information technology. CONCLUSION: The COVID-19 pandemic brought consequences for the entire health system. Palliative care was one of the affected areas, where professionals had to work only with the resources available. From this situation positive strategies emerged to continue giving a good quality of life to the patient in his/her last moments, being the use of technology the most implemented, without leaving the nurse principal role aside.
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Fatty acids (FAs) are essential components of the central nervous system (CNS), where they exert multiple roles in health and disease. Among the FAs, docosahexaenoic acid (DHA) has been widely recognized as a key molecule for neuronal function and cell signaling. Despite its relevance, the molecular pathways underlying the beneficial effects of DHA on the cells of the CNS are still unclear. Here, we summarize and discuss the molecular mechanisms underlying the actions of DHA in neural cells with a special focus on processes of survival, morphological development, and synaptic maturation. In addition, we examine the evidence supporting a potential therapeutic role of DHA against CNS tumor diseases and tumorigenesis. The current results suggest that DHA exerts its actions on neural cells mainly through the modulation of signaling cascades involving the activation of diverse types of receptors. In addition, we found evidence connecting brain DHA and ω-3 PUFA levels with CNS diseases, such as depression, autism spectrum disorders, obesity, and neurodegenerative diseases. In the context of cancer, the existing data have shown that DHA exerts positive actions as a coadjuvant in antitumoral therapy. Although many questions in the field remain only partially resolved, we hope that future research may soon define specific pathways and receptor systems involved in the beneficial effects of DHA in cells of the CNS, opening new avenues for innovative therapeutic strategies for CNS diseases.
Assuntos
Doenças do Sistema Nervoso Central , Ácidos Graxos Ômega-3 , Encéfalo/metabolismo , Sistema Nervoso Central/metabolismo , Doenças do Sistema Nervoso Central/tratamento farmacológico , Doenças do Sistema Nervoso Central/metabolismo , Ácidos Docosa-Hexaenoicos/metabolismo , Ácidos Docosa-Hexaenoicos/farmacologia , Ácidos Graxos/metabolismo , Ácidos Graxos Ômega-3/metabolismo , HumanosRESUMO
Despite current achievements and innovations in cancer treatment, conventional chemotherapy has several limitations, such as unsatisfactory long-term survival, cancer drug resistance and toxicity against non-tumoral cells. In the search for safer therapeutic alternatives, docosahexaenoic acid (DHA) has shown promising effects inhibiting tumor growth without significant side effects in several types of cancer, but in gastric cancer (GC) its effects have not been completely described. In this study, we characterized the effects of DHA in GC using in vivo and in vitro models. Among all of the evaluated Ω-3 and Ω-6 fatty acids, DHA showed the highest antiproliferative potency and selectivity against the GC-derived cell line AGS. 10-100 µM DHA decreased AGS cell viability in a concentration-dependent manner but had no effect on non-tumoral GES-1 cells. To evaluate if the effects of DHA were due to apoptosis induction, cells were stained with Annexin V-PI, observing that 75 and 100 µM DHA increased apoptosis in AGS, but not in GES-1 cells. Additionally, levels of several proapoptotic and antiapoptotic regulators were assessed by qPCR, western blot and activity assays, showing similar results. In order to evaluate DHA efficacy in vivo, xenografts in an immunodeficient mouse model (BALB/cNOD-SCID) were used. In these experiments, DHA treatment for six weeks consistently reduced subcutaneous tumor size, ascitic fluid volume and liver metastasis. In summary, we found that DHA has a selective antiproliferative effect on GC, being this effect driven by apoptosis induction. Our investigation provides promising features for DHA as potential therapeutic agent in GC.
Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos/farmacologia , Apoptose/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Ácidos Docosa-Hexaenoicos/farmacologia , Neoplasias Gástricas/tratamento farmacológico , Adenocarcinoma/genética , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Animais , Proteínas Reguladoras de Apoptose/genética , Proteínas Reguladoras de Apoptose/metabolismo , Linhagem Celular Tumoral , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos NOD , Camundongos SCID , Transdução de Sinais , Neoplasias Gástricas/genética , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia , Carga Tumoral/efeitos dos fármacos , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
ABSTRACT Objetive this article narrates the process of institutionalisation of history as a worthy subject for nursing in Chile. Method this is a discussion paper that reflects on the characteristics, resources and potential of the network as well as the future agenda to achieve its consolidation. Results there is an increasing interest in learning history in Chile. Although recent and somewhat disconnected from larger contemporary debates, this initiative can fruitfully contribute to the nursing curriculum in the country. Likewise, the growing interest in social and cultural history becomes apparent, seeking to understand different social realities that inform nursing. Conclusion the Chilean Network of Nursing History has come to put history forward as a transformative approach for the nursing community. Its short-term contribution to identity-building and professional empowerment can further enlighten the understanding of broader societal processes such as the differentiation of women's work in the public sphere. It is important to strengthen its institutionalization in academe and connect research topics with local, national and global histories as well as history collaborations elsewhere, so as to develop agendas, epistemic communities and methods. Nonetheless, this process is marking a turning point in nursing discourses and scholarship in the country.
RESUMO Objetivo este artigo narra o processo de institucionalização da história como disciplina digna da Enfermagem no Chile. Método trata-se de um documento de discussão que reflete sobre as características, recursos e potencialidades da rede, bem como, a agenda futura para alcançar a sua consolidação. Resultados há um interesse crescente em aprender história da Enfermagem no Chile. Embora recente e um tanto desconectada dos debates contemporâneos mais amplos, essa iniciativa pode contribuir de forma proveitosa para o currículo de Enfermagem no país. Da mesma forma, torna-se evidente o crescente interesse pela história social e cultural, buscando compreender as diferentes realidades que envolvem a profissão. Conclusão a Rede Chilena de História da Enfermagem propõe a história como uma abordagem transformadora para a comunidade de Enfermagem. A sua contribuição a curto prazo à construção de identidade e capacitação profissional pode esclarecer ainda mais a compreensão de processos sociais mais amplos, como a diferenciação do trabalho das mulheres na esfera pública. É importante fortalecer a sua institucionalização na academia e conectar tópicos de pesquisa com histórias locais, nacionais e globais, bem como, colaborações de história em outros lugares, de modo a desenvolver agendas, comunidades epistêmicas e métodos. No entanto, esse processo tem representado um ponto de inflexão nos discursos e saberes da Enfermagem no país.
RESUMEN Objetivo este artículo narra el proceso de institucionalización de la historia como materia digna de la enfermería en Chile. Método se trata de un documento de discusión que reflexiona sobre las características, recursos y potencialidades de la red, así como la agenda futura para lograr su consolidación. Resultados existe un creciente interés por aprender historia en Chile. Aunque reciente y algo desconectada de debates contemporáneos más amplios, esta iniciativa puede contribuir de manera fructífera al currículo de enfermería en el país. Asimismo, se manifiesta el creciente interés por la historia social y cultural, buscando comprender las diferentes realidades sociales que informan a la enfermería. Conclusión la Red Chilena de Historia de la Enfermería viene a plantear la historia como un enfoque transformador para la comunidad de enfermería. Su contribución a corto plazo a la construcción de identidad y el empoderamiento profesional puede iluminar aún más la comprensión de procesos sociales más amplios, como la diferenciación del trabajo de la mujer en la esfera pública. Es importante fortalecer su institucionalización en la academia y conectar temas de investigación con historias locales, nacionales y globales, así como colaboraciones históricas en otros lugares, para desarrollar agendas, comunidades epistémicas y métodos. Sin embargo, este proceso está marcando un punto de inflexión en los discursos y la erudición de enfermería en el país.
Assuntos
Humanos , Pesquisa em Enfermagem , Educação em Enfermagem , História , História da EnfermagemRESUMO
BACKGROUND: We investigated the efficacy of hyperbaric oxygen (HBO), low-intensity laser (LIL), and platelet-rich plasma (PRP) in the management of medication-related osteonecrosis of the jaws (MRONJ). METHODS: A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two examiners independently assessed eligibility and risk of bias and extracted data. RESULTS: There was improvement in 75.6% of the 41 patients submitted to HBO, with positive effects on pain relief and decreased size and number of lesions at a faster rate, with better effects when the drug was discontinued. For LIL, 158 (64.2%) of the 246 patients/sites improved the symptoms and 98 (39.8%) healed completely. Fourteen (17.3%) of the 81 patients treated with PRP significantly improved the symptoms and 65 (80.2%) completely healed. CONCLUSIONS: These therapies served as safe and effective adjuvant modalities for MRONJ treatment. The lack of randomized clinical trials evidences the need for more high-quality investigations on the subject.
Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia , Oxigenoterapia Hiperbárica/métodos , Terapia a Laser/métodos , Plasma Rico em Plaquetas , Idoso , Idoso de 80 Anos ou mais , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Conservadores da Densidade Óssea/efeitos adversos , Terapia Combinada , Denosumab/efeitos adversos , Difosfonatos/efeitos adversos , Feminino , Humanos , Doenças Maxilomandibulares/induzido quimicamente , Doenças Maxilomandibulares/terapia , Masculino , Pessoa de Meia-Idade , Osteonecrose/induzido quimicamente , Osteonecrose/terapia , Manejo da Dor , Pamidronato/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
El propósito de este estudio fue comprender cómo es la experiencia de las enfermeras en cuanto a vivenciar la limitación del esfuerzo terapéutico (LET) en unidades de paciente crítico de un hospital público de la región de Valparaíso. Se opta por un estudio de tipo cualitativo, de trayectoria fenomenológica, se realizó entrevista en profundidad a 3 enfermeras, con la pregunta orientadora ¿Qué experiencia tiene usted como enfermera de Unidad de Cuidados Intensivos (UCI) con respecto a la LET? Los discursos fueron interpretados bajo el referencial de Fenómeno Situado de Joel Martins. En los relatos se evidencia el uso de las palabras "manejo proporcional" como sinónimo, el rol de enfermería es confuso en la toma de decisión respecto a la LET pero se releva al momento del cuidado al final de la vida. Se concluye que las enfermeras son quienes deben asumir un rol más protagónico en el cuidado de la persona en esta situación, participando activamente en la toma de decisiones del binomio familia-paciente. Se recomienda la creación de protocolos para la LET, detallando la definición de la LET junto con el rol de enfermería y del equipo de salud, con el objetivo de no prolongar la vida innecesariamente, no aumentar la esperanza familiar y asegurar el cuidado al final de la vida.
The purpose of this study was to understand the experience of nurses in terms of experiencing limitation of therapeutic effort (LET) in critical patient units of a public hospital in Valparaíso. We opted for a qualitative study, a phenomenological trajectory, an in-depthinterview with 3 nurses, with the guiding question. What experience do you have as an Intensive Care Unit (ICU) nurse regarding LET? The speeches were interpreted under the referential of Located Phenomenon of Joel Martins. In the stories the use of the words "proportional management" is evidenced as synonymous, the nursing role is confusing in the decision making regarding the LET but it is relieved at the moment of care at the end of life. It is concluded that nurses are the ones who must assume a more protagonic role in the care of the person in this situation, participating actively in the decision making of the family-patient binomial. It is recommended the creation of protocols for the LET, detailing the definition of the LET along with the role of nursing and the health team, with the aim of not prolonging life unnecessarily, not increasing family hope and ensuring care at the end of life.
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Humanos , Feminino , Terapêutica/efeitos adversos , Direito a Morrer , Doente Terminal , Unidades de Terapia Intensiva , Enfermeiras e Enfermeiros , Bioética , Entrevista , Hospitais PúblicosRESUMO
Resumen Enmarcado en la Reforma Salud de Chile, la educación para la salud se ha transformado en una meta clave para fortalecer conductas que apoyen y complementen la prevención, recuperación y rehabilitación de la salud en la persona. Lo que implica una reflexión sobre cómo se desarrolla el proceso educativo en la atención cerrada. El objetivo propuesto es conocer el significado que le otorgan los profesionales de enfermería a la educación en salud, y cómo logran vivenciarlo en su ejercicio profesional. Estudio cualitativo, de orientación fenomenológica, que incluyó ocho enfermeras que desarrollan su ejercicio profesional en una Unidad de Mediana Complejidad Médica de un hospital alta complejidad. Se utilizó la entrevista fenomenológica, y los discursos se analizaron según los momentos de trayectoria metodológica. Se develan percepciones de los profesionales de enfermería, que pueden guiar a un cambio en el ejercicio profesional, permitiendo a las enfermeras brindar una educación en salud: holística y personalizada.
Abstract Enshrined in Chile's Health Reform, health education has become a key goal in strengthening behaviours that support and complement prevention, recuperation and rehabilitation. This implies a reflection on how the process of education can develop within an inpatient facility. Our proposed objective is to study the degree of importance that nurses ascribe to health education, and how they manage to incorporate health education into their professional practice. This is a qualitative research with a phenomenological orientation, which will include eight nurses who are developing their professional practice in a Medium Complexity Level Unit within a High Complexity Level Hospital. We will use phenomenological interviews, which we will analyse according to the moments of the methodological trajectory. The nurses' professional perceptions will be revealed and will be able to guide a change in professional practice, which will in turn enable the nurses to offer personalized and holistic health education.
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Área de Atuação Profissional , Educação em Saúde , Enfermagem , Educação em Enfermagem/organização & administração , Chile , Reforma dos Serviços de Saúde , ExistencialismoRESUMO
El objetivo de este trabajo fue determinar la disminución del dolor y la mejora de la función en los procesos artrósicos de la ATM mediante el empleo de hialuronato de sodio o corticoides. Realización de una revisión sistemática conforme a la metodología PICO del Centro de Medicina Basada en la Evidencia de Oxford. Se formula una pregunta dirigida al objetivo fijado y se elabora una estrategia de búsqueda, empleando términos MeSH y palabras clave específicas derivados de la pregunta en la base de datos de MEDLINE de enero de 1985 hasta abril del 2016. Se consultan un total de 43 artículos, incluyendo finalmente 7 estudios clínicos controlados y aleatorizados que cumplían los criterios de inclusión y se realiza una evaluación crítica del nivel de evidencia. Se estudiaron trabajos que comparasen la eficacia del hialuronato de sodio con los corticoides en la inyección articular de las patologías artrósicas de la ATM. No se encontraron diferencias significativas en la realización de la inyección con hialuronato de sodio y corticoides. Es necesario realizar estudios con una muestra y un tiempo de seguimiento mayor. A largo plazo podría ser más eficaz el hialuronato de sodio debido a los posibles efectos adversos de los corticoides, sin embargo, no se han demostrado cambios óseos con ninguno de los tratamientos.
The aim of this study was to determine decreasing pain and improving function in TMJ osteoarthritic processes using sodium hyaluronate or corticosteroids. A systematic review was carried out based on the PICO methodology of the Centre for Evidence-Based Medicine in Oxford. A question is addressed to the fixed aim and a search strategy is developed using specific MeSH terms and key words which come from the question in the PubMed database from January 1985 to April 2016. A total of 43 articles are consulted, finally including 7 randomized controlled trials which met the inclusion criteria and a critical assessment of the level of evidence is performed. Works that compare the efficacy of sodium hyaluronate to corticosteroids in the osteoarthritic pathologies articular injection were studied. No significant differences were found when injecting the sodium hyaluronate and the corticosteroids. It is necessary to do studies with a broader sample and a longer follow-up. In the long term sodium hyaluronate could be more effective because of possible corticosteroids adverse effects; however, no bone change has been shown with either treatment.
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Humanos , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular , Síndrome da Disfunção da Articulação Temporomandibular/terapia , Osteoartrite , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/uso terapêuticoRESUMO
El objetivo de este estudio establecer si el método de evaluación de la dimensión vertical mediante cefalometría y el convencional con rodillos de articulación, consiguen resultados sin diferencias estadísticamente significativas. Realización de una revisión sistemática conforme a la metodología PICO del Centro de Medicina Basada en la Evidencia de Oxford. Se formula una pregunta dirigida al objetivo fijado y se elabora una estrategia de búsqueda empleando MeSH key words específicos derivados de la pregunta en la base de datos PubMed hasta 2015 y libros de rehabilitación oral. Se consultan un total de 833 artículos por título, siendo 26 revisados a texto completo. Se analizan trabajos sobre distintos métodos de determinación de la dimensión vertical, haciendo especial hincapié en los basados en métodos cefalométricos. Finalmente 9 artículos cumplen los criterios de inclusión y se realiza una evaluación crítica del nivel de evidencia. No se ha encontrado suficiente evidencia científica que demuestre la repetibilidad de ambos métodos. Es necesario realizar estudios controlados y aleatorizados que comparen ambos métodos para determinar si son repetibles y reproducibles y obtienen resultados sin diferencias estadísticamente significativas.
The objective of this work was to establish if the method of evaluation of the vertical dimension by cephalometry and the common one with joint rollers, obtains results without statistically significant differences. We carried out a systematic review based on the PICO methodology of the Center for Evidence-Based Medicine for Oxford. A question aimed at the objective was made, and a search strategy was developed using specific MeSH key words derived from the question in the Pubmed database up to 2015 and oral rehabilitation books. A total of 833 items were consulted by tittle, and for 26 of these full text was reviewed. Works on different methods for determining the vertical dimension were studied, with special emphasis on those based on cephalometric methods. Finally 9 articles fulfilled the criteria for inclusion and a critical assessment of the evidence level was performed. We did not find sufficient scientific evidence to demonstrate the repeatability of these methods. It is necessary to realize randomized controlled trials comparing both methods to determine if they were statistically repeatable and reproducible.
Assuntos
Humanos , Dimensão Vertical , Cefalometria/métodos , Articulações/anatomia & histologia , Reabilitação Bucal/métodos , Reprodutibilidade dos TestesRESUMO
Objetivo: comprender la evolución de la identidad profesional de la enfermería en Valparaíso, Chile, en el periodo de 1933 hasta el 2010. Materiales y métodos: se trabajó con un diseño cualitativo complementado con análisis documental, apoyado por el software de análisis cualitativo Atlas TI. Se realizaron 17 entrevistas en profundidad a enfermeras que ejercieron la profesión en distintas épocas de la enfermería en Valparaíso, distribuidas en tres periodos que abarcan desde 1933 al 2010. Resultados: los datos muestran que la identidad de la enfermería ha ido variando desde un rol caracterizado por una vocación desinteresada de lo económico e interesada en la ayuda al otro de manera incondicional, a una nueva etapa en que perdura una vocación en el servicio aunque, esta vez, desde un servicio más profesionalizado y complejo. Conclusiones: esta investigación permite identificar que, al igual que las sociedades modernas, la enfermería está caracterizada por un creciente individualismo y complejización de sus procesos, por la exacerbación de la responsabilidad personal y los múltiples quehaceres de estos/as estimulados por el desarrollo científico y académico de la profesión.
Objective: The study is designed to arrive at an understanding of how the professional identity of nursing in Valparaiso, Chile evolved during the period from 1933 to 2010. Materials and Methods: A qualitative design was used, supplemented with documentary analysis supported by Atlas TI qualitative analysis software. Seventeen (17) in-depth interviews were conducted with nurses who were active professionally during different eras of nursing in Valparaiso, which were divided into three periods spanning from 1933 to 2010. Results: The data show the identity of nursing has evolved from a role characterized by a selfless vocation in economic terms, coupled with an interest in unconditionally helping others, to a new phase that continues to involve a vocation to serve, but now from the standpoint of more professional and complex service. Conclusions: The results show that nursing, like modern societies, is characterized by growing individualism and the complexity of its processes, an intensification of personal responsibility and the multiple tasks of nurses stimulated by scientific and academic development of the profession.
Objetivo: compreender a evolução da identidade profissional da enfermagem em Valparaíso (Chile) no período de 1933 a 2010. Materiais e métodos: trabalhou-se com um desenho qualitativo complementado com análise documental, apoiado pelo software de análise qualitativa Atlas TI. Realizaram-se 17 entrevistas em profundidade com enfermeiras que exerceram a profissão em diferentes épocas da enfermagem em Valparaíso, distribuídas em três períodos que abrangem de 1933 a 2010. Resultados: os dados mostram que a identidade da enfermagem tem variado desde um papel caracterizado por uma vocação desinteressada do econômico e interessada na ajuda ao próximo de maneira incondicional até uma nova etapa em que perdura uma vocação no serviço que, nesse caso, é mais profissionalizado e complexo. Conclusões: esta pesquisa permite identificar que, assim como as sociedades modernas, a enfermagem está caracterizada por um crescente individualismo e complexização de seus processos, pela exacerbação da responsabilidade pessoal e dos múltiplos fazeres desses/as estimulados/as pelo desenvolvimento científico e acadêmico da profissão.