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Introduction: This review aimed at investigating the impact of bundle components on the prevention of ventilator-associated pneumonia (VAP) in adults and the elderly. Methodology: The databases consulted were PubMed, EBSCO, and Scielo. The terms Bundle and Pneumonia were searched in combination. The original articles were selected in Spanish and English; published between January 2008 and December 2017. After eliminating the duplicate papers, an analysis of the titles and the abstracts was performed in order to select the assessed articles. A total of 18 articles were included in this review that were evaluated according to the following criteria: research reference, country of data collection, type of study, characteristics of the studied patients, analysis and intervention performed, bundle items investigated and their results, and research outcome. Results: Four bundle items were presented in all the investigated papers. 61% of those works were considered from seven to eight bundle items. Daily evaluation of sedation interruption and daily assessment for verifying extubation condition, head-of-bed elevation at 30 degrees, cuff pressure monitoring, coagulation prophylaxis, and oral hygiene were the most reported bundle items. One study described the increased mortality of patients under mechanical ventilation when omitted the bundle items of oral hygiene and stress ulcer prophylaxis. Head-of-bed elevation at 30 degrees was the item reported in 100% of the studied papers. Conclusions: Existing research demonstrated that VAP reduction occurred when bundle items were performed for adults and the elderly. Four works showed the relevance of team education as a central approach to the event reduction related to the ventilator.

Simulation-based learning gains space in health education curricula with the use of simulated patients, providing students with skills development in a protected teaching-learning environment. The contact with a simulated situation stimulatesclinical skills training before the contact with real patients. The objective is to identify how the experience of being a simulated patient influences the academic formation of healthcare students. The method was exploratorydescriptive, with a quantitative approach, developed through cross-sectional research with a Likert scale questionnaire, applied through an online survey. This study evidenced that health students who participated in clinical simulations as Simulated Patients perceived benefits for their development as future professionals. Interpreting a clinical case arising from reality makes this learning more meaningful compared to a class with a traditional teaching method on the same subject

This study aimed to investigate the impact of the mindfulness-based interventions program on the quality of life of patients with Multiple Sclerosis. A systematic review was carried out based on the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes). For an updated perspective on the topic, the selected articles were published from March 2014 to March 2019. Thus, 10 articles were included in the review and were thoroughly compared. A detailed assessment was carried out to measure the impact of the mindfulness protocol both on the general quality of life and on its specific domains. It can be observed that there is some homogeneity of the results regarding the benefits of the practice of mindfulness in the patients’ general quality of life. Moreover, there was greater evidence of the effects of meditative practice on the psychological domain when compared to the physical domain. Hence, the present study considers the mindfulness program a viable tool to address quality of life in patients with Multiple Sclerosis. The lack of Brazilian studies in the area is highlighted. Also, further studies to evaluate the practice of mindfulness continuously, such as cohort studies, are necessary to elucidate the long-term effects of the protocol.

Counselling and genetic testing (CGT) after neonatal screening may increase depression and anxiety (DA) levels during cancer surveillance. This study assessed the DA scores in mothers of newborns from Paraná state, Southern Brazil, carrying the

AIM This study evaluated medication poisoning in paediatric patients through a systematic review and a retrospective documentary analysis in a Brazilian toxicological centre. METHODS The data were systematically collected on PubMed, Scopus and SciELO databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included epidemiologic and prevalence studies that were published in English or Portuguese from 2013 to 2017 and covered paediatric patients. The retrospective incidence study was carried out in a Brazilian toxicological centre and was a documentary analysis of paediatric medication poisoning cases from 2005 to 2015. RESULTS The systematic review comprised 13 papers covering 895 206 poisoning cases from six different countries. The main agents of intoxication were analgesics and antihistamines. The eight papers that explored the reasons for the poisonings showed that 93% of those 762 863 cases were accidental. The Brazilian toxicological centre recorded 443 paediatric patients poisoned by medication such as benzodiazepines, analgesics and antibiotics and found that 63.2% were accidental. However, it agreed with the global findings in many other aspects. CONCLUSION The systematic review showed a sustained number of paediatric medication toxicity cases worldwide and the key findings were broadly reflected by the retrospective study carried out in the Brazilian toxicological centre.

As metodologias ativas de ensino e aprendizagem têm ganhado destaque no cenário do ensino superior nos últimos anos. Elas estão baseadas na premissa de que o estudante é o centro do processo educativo, e, para seu sucesso, há a necessidade do preparo técnico do docente. Muitos docentes do Curso de Fisioterapia, assim como de outras áreas da saúde, não receberam a capacitação necessária para trabalhar com essas metodologias ao longo dos seus anos de estudo na graduação ou mesmo em cursos de pós-graduação. Nesse aspecto, é grande a responsabilidade das Instituições de Ensino Superior em preparar esses docentes para atender à nova demanda do mercado educacional. Esta pesquisa teve como objetivo conhecer a percepção de docentes de um Curso de Fisioterapia do interior do Paraná em relação ao uso de metodologias ativas de ensino e aprendizagem. Caracteriza-se por um estudo de natureza qualitativa e de cunho exploratório e descritivo. A técnica escolhida para abordagem dos docentes foi o grupo focal, cujos encontros permitiram com que seis professores pudessem descrever a sua relação profissional com o uso das metodologias ativas de ensino. Os discursos foram categorizados pelo software MAXQDA, e seu conteúdo, analisado pelo referencial teórico de Bardin. Os resultados apontaram que os docentes se sentem inseguros quanto ao uso das metodologias ativas de ensino, justificado, em parte, pela falta de acesso a informações sobre o assunto e pela pouca oportunidade de praticar as diferentes técnicas em ambiente protegido fora do contexto da sala de aula.

A forma de ensino na saude mudou em todo o mundo, com a implementacao da simulacao realistica, que adquiriu um papel importante na educacao, porque e uma forma ativa de aprendizado. O estudo objetivou pesquisar publicacoes brasileiras sobre a utilizacao dessa metodologia de ensino-aprendizagem nas escolas de saude, analisando os cursos e areas que mais utilizam a tecnica, limitacoes, desafios e beneficios alcancados. Trata-se de uma revisao integrativa da literatura. Totalizaram-se 25 publicacoes, selecionadas nas bases de dados BVS e SciELO utilizando os descritores “simulacao realistica” e “ensino baseado em simulacao”. Constatou-se que a simulacao e metodologia indispensavel no ensino em saude, porque promove o protagonismo do estudante no processo ensino-aprendizagem. Concluiu-se que a simulacao pode ser utilizada no desenvolvimento de competencias essenciais do profissional de saude. No entanto, existem limitacoes na sua implementacao. Tambem sao escassos os estudos alem das graduacoes de medicina e enfermagem e na atencao primaria.

Counselling and genetic testing (CGT) after neonatal screening may increase depression and anxiety (DA) levels during cancer surveillance. This study assessed the DA scores in mothers of newborns from Paraná state, Southern Brazil, carrying the TP53 p.R337H variant. To understand and adjust DA conditions during term of pregnancy, we initially detected sociodemographic covariates [marital status (MS), number of children (NC), and/or education level (EL): MS-NC-EL] on an independent group of pregnant women (not subjected to genetic testing). The Hospital Anxiety and Depression Scale (HADS) was used to assess risk factors in pregnant (cross-sectional analysis) and unrelated mothers (at 2-month intervals, longitudinal study) of TP53 p.R337H-tested newborns (three sessions of HADS analysis) using Wilcoxon (Mann–Whitney) and Kruskal–Wallis nonparametric tests. Lower anxiety levels were observed in mothers of noncarriers (without MS-NC-EL = 6.91 ± 1.19; with MS-NC-EL = 6.82 ± 0.93) than in mothers of p.R337H carriers in the first session (without MS-NC-EL = 6.82 = 8.49 ± 0.6025, with MS-NC-EL = 6.82 = 9.21 ± 0.66). The anxiety levels significantly decreased 4 months after CGT (third session) in mothers of p.R337H carriers. We did not find a significant change in depression scores. Mothers with mental health instability requiring medications need periodical psychological support during and after CGT.

Goji berry (Lycium barbarum) is largely consumed in Asia as a supplement and functional food, being rapidly introduced worldwide. Its phytochemical constituents include polysaccharides, phenolics, flavonoids, lipids and carotenoids. The myriad of compounds also includes polyamines (spermidine), conjugated with caffeic and dihydrocaffeic acids, that are O-glycosylated. In the present investigation, an extensive chromatographic and spectrometric approach has been employed to characterize these molecules, allowing identification of novel isomers of glucosyl-caffeoylspermidine, including novel tetraglucosides. Besides of these novel structures, we described a novel class of glycosides present in L. barbarum, that contains the spermine as polyamine core, rather than spermidine. As in the caffeoylspermidines, in these novel caffeoylspermines, the glycosylation patterns yield several isomers, which makes their analysis a particularly challenging. The degrees of glycosylation, ranging from 1 to 4 glucose units, could not be explained the number of novel isomers, considering only monosaccharides attached to the caffeoyl moieties, as previously reported. Nevertheless, mass spectrometry and methylation analyses revealed that the glucosyl moieties can produce oligosaccharides chains, augmenting the number of isomers. Thus, considering the presence of novel glycan chains and novel polyamine core linked to caffeic and/or dihydrocaffeic acids, we found and characterized approximately one hundred different structures.

Liquidambar styraciflua L., ALTINGIACEAE, popularly known as sweet gum or alligator tree, is an aromatic tree with a natural distribution in North America and acclimated in Brazil. In traditional medicine, L. styraciflua L is used for the treatment of stomach disorders, wounds, and coughs. The present study was designed to investigate the biological potential and chemical profile of extracts obtained from aerial parts of L. styraciflua L. The chemical profile was established using liquid chromatography-mass spectrometry analysis and the extracts were tested for total phenolics, flavonoids, and tannins using spectrophotometric assays. The anti-inflammatory activity of L. styraciflua L was tested using an inhibition of hyaluronidase enzyme assay, and cytotoxic activities were tested by the 3-(4,5-dimethylthiazol-2 yl)-2, 5-diphenyl tetrazolium bromide (MTT) assay. The synergy between the plant extracts with ciprofloxacin and tetracycline was studied by the checkerboard assay method against eight bacterial strains.The phytochemical investigation showed that the leaves and stem are rich in phenolics compounds (1419.34-1614.02 mg GAE/g, 875.21-1557.57 mg GAE/g, respectively), mainly flavonoids and hydrolyzable tannins. The samples of the stem exhibited the best anti-inflammatory activity. The butanol fraction of the stem was better than the commercial propolis extract. The hydroalcoholic extract of the stem and the propolis did not exhibit significant differences (p 0.05) at any of the concentrations tested. A synergistic interaction was observed against the Gram-positive bacterial Enterococcus faecalis (hydroalcoholic extract of leaves and tetracycline) and Staphylococcus aureus (hydroalcoholic extract of stem and tetracycline). The IC50 values obtained for the extracts indicate the absence of toxicity and moderate cytotoxic for the hydroalcoholic extract of the stem. On the basis of our findings, L. styaciflua may be considered as a potential therapeutic source with high anti-inflammatory activity and synergistic interactions with antibiotics against bacteria.

The search for new bioactive molecules is a driving force for research pharmaceutical industries, especially those molecules obtained from fermentation. The molecules possessing angiogenic and anti-inflammatory attributes have attracted attention and are the focus of this study. Angiogenic activity from kefir polysaccharide extract, via chorioallantoic membrane assay, exhibited a pro-angiogenic effect compared with vascular endothelial factor (pro-angiogenic) and hydrocortisone (anti-angiogenic) activity as standards with an EC50 of 192ng/mL. In terms of anti-inflammatory activity determined via hyaluronidase enzyme assay, kefir polysaccharide extract inhibited the enzyme with a minimal activity of 2.08mg/mL and a maximum activity of 2.57mg/mL. For pharmaceutical purposes, kefir polysaccharide extract is considered to be safe because it does not inhibit VERO cells in cytotoxicity assays.

O projeto Ensino, Saúde e Desenvolvimento: rede de saberes e práticas foi uma proposição conjunta inicialmente de professores e pesquisadores da Faculdades Pequeno Príncipe, da Universidade Estadual de Londrina, da Universidade Federal de Santa Catarina e posteriormente da Universidade Estadual de Maringá e da Universidade Federal de Alagoas. O objetivo deste relato é uma autoavaliação, buscando analisar os resultados alcançados com um olhar crítico na busca de alternativas que levassem a maiores avanços. A avaliação foi dividida em tópicos: Contexto e problemática; A construção do projeto: seus a(u)tores e históricos envolvidos; Ousadia número 1: ensino, saúde e desenvolvimento; Ousadia número 2: rede de saberes e práticas; O desenvolvimento do projeto: avanços e recuos; Lições aprendidas; e Perspectivas. Os autores reconhecem a pertinência da iniciativa do Ministério da Saúde e da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes) e se posicionam para a continuidade do Programa Pró-Ensino na Saúde. El proyecto “Enseñanza, Salud y Desarrollo: red de saberes y prácticas” fue inicialmente una propuesta conjunta de profesores e investigadores de las Facultades Pequeno Príncipe, Universidad Estadual de Londrina y Universidad Federal de Santa Catarina y posteriormente de la Universidad Estadual de Maringá y de la Universidad Federal de Alagoas. El objetivo de este relato es una autoevaluación buscando analizar los resultados alcanzados con una mirada crítica en la búsqueda de alternativas que llevaran a mayores avances. La evaluación se dividió en tópicos: Contexto y problemática; La construcción del proyecto: sus autores y actores e historiales envueltos; Osadía Número 1: Enseñanza, salud y desarrollo; Osadía Número 2: Red de saberes y prácticas; El desarrollo del proyecto: avances y retrocesos; Lecciones aprendidas; Perspectivas. Los autores reconocen la pertinencia de la iniciativa del Ministerio de la Salud y de CAPES y se posicionan en favor de la continuidad del Programa “Pro-Enseñanza en la salud”. The project "Teaching, Health and Development: Network of Knowledge and Practices" was a joint proposal of teachers and researchers from Faculdades Pequeno Príncipe, Universidade Estadual de Londrina and Universidade Federal de Santa Catarina and, subsequently, from Universidade Estadual de Maringá and Universidade Federal de Alagoas. The objective of this report is a self-evaluation to analyze the results achieved with a critical eye in search of alternatives that could lead to greater advances. The evaluation was divided into topics: Context and problem; The construction of the Project: Its stakeholders and history; Boldness Number 1: Teaching, health and development; Boldness Number 2: Network of knowledge and practices; The development of the project: Advances and retreats; Lessons Learned; Perspectives. The authors acknowledge the relevance of the initiative of the Ministry of Health and CAPES and stand up for the continuity of the Program Pró-Ensino na Saúde.

As mudanças nos paradigmas da comunicação implicam em avanços na área da educação, sob esta ótica que comunicação é educação, a evolução em uma das áreas possibilita uma modificação em outra. Nas últimas décadas os avanços tecnológicos tem instigado o profis-sional de saúde em relação a formas rápidas e confiáveis para se formar e atualizar. O presente trabalho irá abordar as estratégias de utilização do suporte midiáticos na educação a distância de profissionais da área da saúde. O problema de pesquisa que orientou a escrita desse texto: Qual a contribuição dos recursos midiáticos da EAD na formação profissional na área da saúde? O texto está estruturado da seguinte forma: Mídias e tecnologias na EAD em uma perspectiva comunicacional; Panorama Geral da EAD: comprovando sua relevância; A EAD e a formação superior na área da saúde; Recursos midiáticos da EAD na formação dos profissionais da saúde. Para o desenvolvimento da pesquisa foi realizada uma revisão bibliográfica e uma pesquisa documental sobre o tema. Com o avanço e a popularização dos recursos midiáticos e o fortalecimento da EAD é possível identificar oportunidades emergentes e inovadoras para a educação em saúde. Como resultados alcançados apontam-se as evidências com relação à relevância cada vez maior de utilização de TICs na educação em saúde, sobretudo para a formação continuada de profissionais e como apoio à aprendizagem presencial em cursos de graduação.

Objetivo: O presente artigo procura avaliar o perfil da terapia medicamentosa utilizada via sonda enteral em um hospital pediatrico com o intuito de detectar possiveis inadequacoes terapeuticas. Com isso, acaba abordando o manuseio das sondas e a maneira correta de as utilizar, alem de propor cenarios preveniveis de possiveis inadequacoes terapeuticas. Metodo: Foi realizado um estudo descritivo do perfil da farmacoterapia utilizada via sonda enteral, exploratorio nos meses de Maio e Junho de 2015, por uma populacao de carater pediatrico. Resultados: Foi constatado que dos pacientes a media de medicamentos administrados via sonda era 5,89 ± 4,30, em que a maioria e utilizada off-label . Sendo do total de medicamentos prescritos, os de forma liquida apresentaram maiores discrepâncias entre a via prescrita e a via administrada. Alem disso, 46,83% dos casos o flushing era efetuado apenas apos a administracao dos farmacos. Conclusao: Conclui-se que um acompanhamento farmacoterapeutico diario detalhado e vital para garantir uma terapia farmacologica eficaz e segura em pediatria.

The essential oil of plants has potential biological activity and has attracted considerable interest in the pharmaceutical industry. The objective of the present study was to evaluate the chemical composition and the biological potential of L. styraciflua leaf essential oil. The essential oil composition was analyzed using gas chromatography and mass spectrometry. The main compounds were α-pinene (43.7%), β-pinene (10.7%), d-limonene (35.3%), and terpinen-4-ol (10.3%). The essential oil exhibited good anti-inflammatory activity in a concentration-dependent manner, evaluated using a hyaluronidase enzyme inhibition assay. Results showed also that there is a good synergistic effect with the combination of essencial oil and tetracycline by the checkboard method against most of test microorganisms. The best synergic effect was obtained against B. subtillis, with a fractional inhibitory concentration index of 0.06. A low cytotoxic profile in Vero cells was observed for the essential oil, with a positive selective index value against almost all bacterial strains, indicating potential selective activity. All essential oil concentrations were found to cause 100% mortality in house dust mites after 24 h of a direct contact assay, which was significantly higher than the synthetic acaricide, showing that the essential oil has a higher acaricidal activity. The chemical composition L. styraciflua leaf EO were identified and defined the main components as α-pinene (43.7%), d-limonene (35.3%), β-pinene (10.7%), and terpinen-4-ol (10.3%) e showed biological activity as good anti-inflammatory activity and synergistic interactions with tetracycline and ciprofloxacin against pathogenic bacteria.

Orientadora : Maria Eugęnia Duarte Noseda Co-orientador : Miguel Daniel Noseda Tese (doutorado) - Universidade Federal do Paraná, Setor de Cięncias Biológicas, Programa de Pós-Graduaçăo em Bioquímica. Defesa: Curitiba, 2005 Inclui bibliografia e anexo

O monitoramento terapêutico da concentração de vancomicina é uma forma de melhorar a segurança e a eficiência no tratamento com este antibiótico. A cromatografia líquida de alta eficiência (CLAE) é considerada padrão ouro para a quantificação desta droga. No entanto a análise exige que sejam realizados vários procedimentos de purificação e análise da amostra, o que reduz sua aplicabilidade ao uso clínico. Atualmente, não há consenso quanto aos níveis séricos adequados ao tratamento do neonato ou de como as doses devem ser ajustadas. Este trabalho propõe um protocolo de monitorização terapêutica da vancomicina e desenvolve e valida um método simplificado, de baixo custo e menor volume de amostra necessário para quantificação da concentração sérica da vancomicina através de CLAE com detecção por arranjo de diodos. As amostras foram extraídas por precipitação de proteínas com ácido trifluoroacético (ATF), o sobrenadante foi injetado diretamente no sistema cromatográfico. A fase móvel consistiu de ATF à concentração de 0,014% (pH 2.800) em água ultrapura e acetonitrila (92:8, v/v), sob fluxo de 2 mL/min por eluição em método isocrático e temperatura de 40 oC. As respostas foram monitoradas no comprimento de onda de 230,9 nm. A validação foi conduzida de acordo com a resolução da RDC n.o 27, de 17 de maio de 2012 da ANVISA. O analito e o padrão interno (7-hidroxicumarina) foram eluídos em torno de 5.1 min e 10.3 min respectivamente. A linearidade do método foi determinada entre 2 e 70 mg/L com correlação linear de superior a 0.999. O método mostrou-se adequado a aplicação proposta, com vantagens volume de amostra exigido, o processo de extração simplificado e resultados satisfatórios com relação às precisão, exatidão, estabilidade e seletividade. O método de análise testado em 17 amostras reais de 10 pacientes com resultados satisfatórios. O protocolo de monitorização terapêutica foi adequadamente desenvolvido. Therapeutic monitoring of vancomycin concentration can improve the safety and efficiency of the treatment with this antibiotic. High-performance liquid chromatography (HPLC) is considered gold standard for quantification for this drug. However the analysis requires multiple procedures for purification and analysis of the sample, which reduces their applicability for clinical use. There`s currently no consensus on vancomycin serum target levels and dose adjustment among newborns. This paper proposes a vancomycin therapeutic monitoring protocol and develops and validates a low cost, simplified method, with smaller sample volume requirement for serum concentration of vancomycin determination by using HPLC with diode array. Samples were extracted by protein precipitation with trifluoroacetic acid (TFA), supernatant was injected directly into the chromatographic system. Mobile phase consisted of TFA 0.014% (pH 2.800) in ultrapure water and acetonitrile (92:8, v /v) under flow rate of 2 mL / min eluting in isocratic method in 40oC. Response were monitored at a wavelength of 230.9 nm. Validation was conducted in accordance with the resolution of the RDC No. 27 of May 17, 2012 ANVISA. Vancomycin and internal standard (7-hydroxycoumarin) were eluted at approximately 5.1 min. and 10.3 min respectively. Linearity was assessed between 2 and 70 mg /L with linear correlation greater than 0.999. The method proved to be suitable for the proposed application, with the advantages of less sample volume required, simplified extraction and achieved satisfactory results of precision, accuracy, stability and selectivity. This method was tested in 17 real samples from 10 patients with satisfactory results. The drug monitoring protocol was successfully developed.