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Carolina Mariano Pompeo,1 Marcos Antonio Ferreira Júnior,1 Andreia Insabralde de Queiroz Cardoso,1 Mercy da Costa Souza,2 Oleci Pereira Frota,1 Felipe Machado Mota,1 Maria Lúcia Ivo2 1Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil; 2Graduate Program in Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, BrazilCorrespondence: Carolina Mariano PompeoIntegrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil, Tel +55 67 99984-7048, Email carolmpompeo@gmail.comPurpose: To analyze the clinical-epidemiological characteristics and mortality in patients with sickle-cell anemia (SCA).Patients and Methods: A cohort study with retrospective data, conducted in two reference hospitals for SCA treatment from January 1980 to December 2018, recorded in two reference services. With a 5% significance level, the Chi-Square and Student’s t-tests were employed in the inferential statistical analysis.Results: A total of 128 patients with SCA were studied. Diagnosis up to the fifth day of life was made in 10 patients. There were 19 deaths, of which 12 (63.2%) were female, and the average age at death was 27.05 (± 14.78) years. The leading causes of death were septic shock and cardiogenic shock. The use of invasive medical devices was considered a risk factor for death (RR=2.63; 95% CI=1.16– 5.96; p=0.018), and monitoring time up to 20 years presented a 31% reduction in the risk of dying (RR=0.31; 95% CI=0.12– 0.82; p=0.011) when compared to the monitoring of more than 20 years.Conclusion: These findings are to be considered in the treatment of patients with SCA, mainly regarding early diagnosis and access to the treatment immediately afterward, since they are fundamental in improving survival and reducing severe complications.Keywords: hematologic diseases, early diagnosis, neonatal screening, survival, epidemiology

Objective: To analyze public management actions regarding organ, cell, and tissue transplant procedures and their financial investments in Brazil., Method: Mixed (time and place) ecological study, carried out based on data from the Hospital Information System of the Brazilian Public Health System (SUS) Information Technology Department and the National Transplant System, from 2001 to 2023. Temporal trend analyses, descriptive and inferential statistics were performed., Results: Organ, cell, and tissue transplants are concentrated in the Southeast region of the country, with increased costs there. The Northeast and South regions of Brazil have the longest waiting list, with an increasing trend (R2 = 0.96), associated with a decreasing trend in the number of transplants (R2 = 0.97)., Conclusion: The difference in the total number of transplants and procedures performed among the Brazilian regions represents the need for organization and investments with strategies aimed at training professionals and raising awareness among the population.

Introduction: The cornea is an avascular and transparent layer of connective tissue crucial to retinal image quality. Diseases can impair its quality, affecting vision. Keratoplasty is the only therapy capable of restoring vision quality in severe corneal involvement. Despite the established practice of transplantation, access to corneal tissue is limited in many places, and the quality of retrieved corneas is not always adequate, resulting in disqualification. Not all factors affecting tissue quality are fully understood due to the multifactorial nature of processes and variations in procedures globally., Objective: The objective is to map the global literature to establish the factors associated with the clinical and sociodemographic conditions of donors, and the conditions inherent in the processing of corneas that can influence the quality of this tissue for transplantation purposes., Methods and Analysis: A scoping review will be developed based on the methodological framework of the Joanna Briggs Institute. The scientific report will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension checklist for Scoping Reviews. Searches will be conducted in 30 indexed and 12 grey literature databases, without time or location restrictions. The selection of studies will be carried out in three distinct phases: screening, eligibility and inclusion. After defining the sample, data from the selected studies will be systematically extracted into an electronic spreadsheet. The results will be presented descriptively through tables and graphs of absolute and relative frequency. In addition, the PRISMA Scoping Review flow chart will be presented to present the process of searching, including and excluding articles and documents., Ethics and Dissemination: This scoping review study does not require prior ethical approval as it uses publicly available and already published studies. The research protocol is registered in the Open Science Framework (osf.io/bw6r7). The findings will be submitted for publication in peer-reviewed scientific journals and presented at ophthalmology and/or transplantation conferences through oral presentations or posters., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Critically ill patients are more vulnerable to medical adhesive-related skin injuries (MARSI), whose prevention is a constant challenge and one of the main quality indicators of nursing care. MARSI associated with indwelling urinary catheter (IUC) fixation is a relevant adverse event, mainly because of the constant involuntary traction and high skin vulnerability of the fixation site. Silicone adhesive tape has appreciable qualities for fragile skin among the range of adhesives, leading to the inference that it reduces the risk of MARSI., Aim: To compare silicone adhesive tape for IUC fixation with acrylate tape regarding its safety and efficacy., Study Design: This was a randomized controlled trial blinded to the patients and evaluator. Data were collected from an intensive care unit (ICU) of a tertiary university hospital in Brazil. Patients with IUC and no MARSI at the fixation site were considered eligible. The omega (Ω) fixation technique was used for IUC fixation. A total of 132 participants were enrolled and divided into two research groups: 66 patients in the intervention group (silicone tape) and 66 in the control group (acrylate tape). Outcomes were the incidence of MARSI, patient outcome in the ICU and hospital and partial, total and overall spontaneous detachment of the tapes., Results: The overall incidence of MARSI was 28%, with 21% in the silicone group and 35% in the acrylate group, with no statistically significant difference (p = .121), including the severity of the lesions (p = .902). However, partial (p = .003) and overall (p < .001) detachment of the tapes were more frequent in the silicone group., Conclusions: Silicone tape is no safer than acrylate tape for IUC fixation and is less adhesively effective., Relevance to Clinical Practice: There is no evidence to support the extensive use of silicone tape in this context., (© 2023 British Association of Critical Care Nurses.)

Introduction: Organ transplantation is one of the most successful advances in modern medicine. However, a legal system is necessary for its practice to be free from ethical flaws and to respect donors, recipients, and family members., Objective: To map the global legislation regulating the donation, capture and distribution processes of organs and tissues from deceased donors for transplants., Method: A scoping review according to the Joanna Briggs Institute was conducted in the following databases: Medline, CINAHL, Virtual Health Library, SCOPUS, Web of Science, Science Direct, and EMBASE, as well as gray literature, and reported according to the PRISMA extension for scoping reviews., Results: We identified 3302 records, of which 77 were analyzed which enabled mapping the type of consent adopted and the existence of current legislation for harvesting organs and tissues after circulatory and brain death., Conclusion: Opt-out consent predominates in Europe, and there is harvesting after brain and circulatory death. Opt-out predominates in the Americas, while Opt-in and harvesting of organs and tissues after brain death predominate in Asia and Oceania. The procurement of organs and tissues from deceased donors is practically non-existent in Africa., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Objective: To assess the evidence regarding the effectiveness of interventions aimed at strengthening self-efficacy beliefs in college students., Methods: Integrative Review conducted on the Lilacs, PubMed, CinahL, Cochrane Collaboration Databases, Scopus, and PsycInfo databases. The methodological quality of the studies was assessed using tools proposed by the Joanna Briggs Institute, and the results were analyzed descriptively., Results: Out of the 10 selected studies, six demonstrated that interventions aimed at strengthening self-efficacy were effective (Levels of Evidence II and III), and four revealed contrary results (Levels of Evidence I and II). Programs aimed at enhancing self-efficacy should include content on positive mental health, psychoeducation strategies, cover a period of eight to twelve weeks, and consider the completion of homework assignments., Conclusion: The synthesis of evidence pointed to pathways for building an effective self-efficacy strengthening program to be implemented in universities.

Objective: to analyze the concept associated with diagnostic proposition Ocular dryness in adult patients hospitalized in an Intensive Care Unit, identifying its attributes, antecedents and consequences., Methods: a methodological study carried out through concept analysis, operationalized by scoping review., Results: the analysis of 180 studies allowed the identification of two attributes, 32 antecedents and 12 consequences. The attributes were tear film deficiency and ocular signs and/or symptoms. The prevalent antecedents were incomplete eyelid closure (lagophthalmos) and blinking mechanism decrease. Major consequences included conjunctival hyperemia and decreased tear volume., Conclusions: this study allowed constructing nursing diagnosis Ocular dryness, part of domain 11, class 2, with 12 defining characteristics, 12 related factors, seven populations at risk and 13 associated conditions. This problem-focused proposal may provide targeted care by promoting early detection and implementing interventions that reduce the risk of ocular damage.

Background: The skin in contact with the adhesives used to secure catheters is vulnerable to medical adhesive-related skin injury (MARSI). The incidence of these injuries and the risks associated with their development have not been accurately estimated previously in critically ill patients., Aim: The aim of this study was to investigate the incidence and risk factors for MARSI in catheters of critically ill patients., Methods: A prospective cohort study was conducted in adult intensive care units of two Brazilian university hospitals. A total of 150 patients (439 catheters) were included. The skin exposed to the catheter fixation adhesives (central venous, nasogastric, nasoenteral, and indwelling urinary) was examined daily by four trained researchers. The patients' sociodemographic and clinical data were collected from their electronic medical records. The association between independent variables and MARSI was investigated by bivariate statistics, followed by a multiple logistic regression., Results: The MARSI incidence was 42% (86.5 MARSIs per 1000 patient-days). Advanced age, prolonged hospital stay, dry skin, repetitive adhesive removal, low Braden Scale score, and hypoalbuminemia were associated with MARSI (p < .05). According to the multivariate logistic regression, dry skin increased the chance of MARSI by 5.2 times (odds ratio: 5.2; 95% confidence interval: 2.4-11.1), while the Braden Scale score was a protective factor, showing 30% less chance of MARSI for each added score (odds ratio: 0.7; 95% confidence interval: 0.6-0.9). A higher incidence of MARSI was observed in nasoenteral catheters and in those fixed with adhesive using natural rubber. The MARSI types were predominantly mechanical (70.3%): skin stripping (41.3%), skin tear (26.1%), and tension injury or blister (2.9%)., Conclusions: MARSI is a common event in adult intensive care units, and most risk factors are modifiable. Preventive actions are potentially capable of reducing incidence, optimising financial resources, and improving clinical results., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Introduction: The number of transplants in the world is growing, although there is a demand that exceeds supply. It is worth mentioning that the costs for obtaining organs are considered high. However, few studies have been developed on analyzing the costs of obtaining organs and tissues for transplants in order to support the decision-making of managers and health professionals., Objective: To summarize the studies related to the cost of obtaining organs for transplants from a deceased donor., Method: A systematic literature review was conducted in the following databases: PubMed, Cochrane Library CINAHAL, Virtual Health Library (BVS), SCOPUS, Web of Science and EMBASE, using the following descriptors: Costs and cost analysis; Donor Selection; Tissue and Organ Procurement; Tissue and Organ Harvesting; and Tissue Donors, in studies published until April 2021. The risk of bias assessment was performed using the Joanna Briggs Institute's Checklist for Economic Assessments. It was not possible to perform a meta-analysis due to the heterogeneity of the studies., Results: A total of 1731 studies were identified, of which 11 were analyzed. The cost of kidneys in US dollars (USD) ranged between USD $1672 and USD $25,058. Obtaining a liver ranged from USD $586 to USD $44,478. Heart procurement ranged from USD $633 to USD $24,264. The combined heart-lung transplant ranged from USD $860 to USD $23,203. Obtaining the pancreas ranged from USD $413 to USD $29,708., Conclusions: Cost of obtaining organs for transplants from a deceased donor is substantial and varies widely across different studies. The overall cost of failures to obtain organs is currently unknown. Understanding organ procurement expenses can help clarify areas in which organ and tissue procurement can improve in cost and efficiency., Competing Interests: Declaration of Competing Interest None of the authors have any conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: To analyze the temporal trend of mortality from sickle cell anemia in Brazil, by region, in the period 1997-2017., Methods: epidemiological study, with an ecological design, with a temporal trend, carried out with data from the Mortality Information System. For descriptive analysis, absolute and relative frequencies were used. In the correlation analysis, the ANOVA test was used, followed by Tukey's post-test. The temporal trend was obtained using the cubic polynomial regression test., Results: 6,813 deaths from sickle cell anemia were registered. Brown individuals (50.87%) were more frequent, with a predominance of males (50.4%), aged between 25 and 34 years and a higher incidence of deaths in the Midwest (0.25/100 thousand inhabitants). The time curve showed an increasing trend of deaths in the country between 1997 and 2015 (R2 = 0.98)., Conclusions: sickle cell anemia showed increasing mortality in the 21 years analyzed and alerts health professionals and managers.

Objective: To analyze the time trend, spatial distribution, and the cases of human immunodeficiency virus/acquired immunodeficiency syndrome cases with social determinants of health., Methods: Ecological and analytical study, carried out based on the cases of human immunodeficiency virus/acquired immunodeficiency syndrome notified in a state in the Brazilian Midwest, from 2009 to 2018. The study used descriptive analysis, polynomial regression, and geospatial analysis., Results: In 10 years, there were 9,157 notifications, growing each year. There was a growing trend for both sexes (p<0.001, r2=0.94). The City Human Development Index was related to the higher number of cases (city of notification, p=0.01; and city where the person lives, p=0.02). The highest concentration was in cities that house health macro-regions., Conclusion: Social determinants have a relationship with the time trend and the spatial distribution of cases and can direct strategies for prevention and care.

Background: Reducing the blood-culture contamination rate is a constant challenge for health services. This study aimed to analyze whether blood-culture (BC) collection using sterile gloves reduces the contamination rate when compared to the non-sterile gloves, and to compare baseline and intervention periods., Methods: A randomized clinical trial, performed in an intensive care unit in Brazil and paired in two groups: sterile (BCs obtained with modified sterile technique: only sterile gloves; no fenestrated drape or dedicated sterile collection kit) and clean (clean technique: usual care with non-sterile gloves). Two paired blood samples were obtained from each patient by trained and calibrated nurses. BCs were processed by conventional microbiological methods and the results were issued by blinded microbiologists., Results: There was no difference (P = 1.00) in the contamination rate of BC between the sterile (1%) and clean (1%) groups. However, there was a significant difference (P = 0.05; relative risk: 0.17; 95% confidence interval: 0.04-0.70) in the contamination rate between baseline (6.1%; 20/330) and intervention (1%; 2/200)., Conclusions: This study suggests that the aseptic care provided in obtaining samples is more important than the sterile technique itself, and highlights the value of standardizing the practices, qualification and calibration of phlebotomists., (Copyright © 2021. Published by Elsevier Inc.)

Objective: to analyze the factors associated with the failure of Hematopoietic Stem Cell Transplantation (HSCT) in patients undergoing Hematopoietic Stem Cell Retransplantation (HSCR)., Method: this study implemented a quantitative approach and was a case-control type which addressed patients undergoing HSCR. To do so, a paired sample of two controls was used for each case (2:1). The case group consisted of the medical records of all patients who underwent HSCR (28) and the control group (56) of those who underwent only one transplant. Three variables guided the pairing: gender, diagnosis and type of transplant., Results: a total of 24 (85.71%) patients in the case group were re-transplanted due to disease relapse and four (14.29%) due to graft failure. There was a statistical difference in the analysis between patients who did not use ursodeoxycholic acid, opioid analgesics and immunosuppressants. The need for HSCR among those who used these medications inappropriately was 16.12, 12.79 and 4.5 times more likely, respectively, than those who used them correctly., Conclusion: there was a difference regarding the reasons which led to the retransplantation and the analyzed subjects, and this study concluded that the predictive reason for retransplantation in the studied sample was disease relapse.

Objective: to summarize the extrication techniques of entrapped car crash victims with potential spinal injury., Method: a literature review study, of scoping review type, using the MEDLINE/PubMed, CINAHL, Scopus, Science Direct, Web of Science, Cochrane Library and gray literature data sources, without time frame, with studies that addressed extricating techniques extrication of entrapped car crash victims., Results: a total of 33 studies were included that enabled identifying and summarizing the different types of extrication and respective devices for extrication of entrapped car crash victims, indicated according to injury assessment and the victim's clinical condition. All pointed to the need for techniques to maintain neutral alignment and prevent spine twists., Conclusion: this study indicated that injury assessment with an emphasis on the victim's clinical condition provides a coherent decision-making regarding the technique and device to be used. However, carrying out other comparative studies between existing techniques may help in the decision-making process more assertively.

Introduction: The quality of the corneal tissue can be influenced by several factors inherent to the recipient, donor, and to the donation and transplantation process. The donated corneal tissue can be classified by its quality as excellent, good, regular, bad, or unacceptable for transplantation, evaluating it in a slit lamp., Objective: To analyze the relationship between the clinical and sociodemographic variables of the donors and the donation process and the classification of the quality of the corneal tissue collected for transplantation., Methods: This is an epidemiologic study, retrospective cohort type, which addressed the process of cornea donation by the Human Eye Tissue Bank in a reference service in Northeast Brazil. The sample consisted of corneas processed by the Human Eye Tissue Bank of Rio Grande do Norte (n = 419). For descriptive and inferential analysis, the study used the Statistical Package for the Social Sciences (SPSS) software, version 25.0, and considered a significance level of 0.05. Logistic regression analysis was used for the adjustment of the final model., Results: It was verified that the epidemiological profile showed a prevalence of individuals with a mean age of 42.54 years old, male (73.99%), and living in the metropolitan region of the state capital (75.66%). When analyzing the relationship between the clinical and sociodemographic variables of the donors, it was identified that those aged 45 years old or less had better quality corneas (excellent and good), while the chronological variables were predictive factors for corneas of regular and bad qualities., Conclusion: The identification of the factors inherent to the donation process and predictors of corneal tissue quality contribute to minimizing the risk of transplantation and to a better ocular prognosis., Competing Interests: The authors have declared that no competing interests exist.

Objective: To analyse the coping strategies of family members of patients admitted to intensive care units., Design: A cross-sectional study developed with 70 relatives of patients admitted to the intensive care unit., Setting: An adult intensive care unit at a university hospital in Brazil., Main Outcome Measures: Coping strategies were identified by the Folkman and Lazarus Inventory of Coping Strategies and statistically compared to the sociodemographic data of family members and patients' clinical data., Results: Coping strategies focused on emotion were the most used, especially those attributed to the escape-avoidance factor. There was a significant association (p < 0.05) between women and the use of adaptive strategies focused on the problem; less education and lower income with maladaptive strategies focused on emotion; second-degree relatives and the positive reassessment factor; participants involved in religious activities and the social support factor. Regarding the clinical variables, patients admitted to the intensive care unit for more than seven days showed an association (p < 0.05) with the social support factor., Conclusion: Family members used adaptive coping strategies more focused on emotion. Additionally, the lower the educational and economic levels, the greater the use of maladaptive strategies focused on emotion., (Copyright © 2020. Published by Elsevier Ltd.)

Objective: to analyze the characteristics, related factors, and consequences of physical violence and verbal abuse against nurses working with risk stratification., Methods: a cross-sectional, descriptive and quantitative study carried out with 80 nurses who work with risk stratification in emergency services. Data were collected using an adapted instrument and analyzed using (uni)bivariate inferential statistics., Results: companions were the main perpetrators of verbal abuse (86.1%); and patients inflicted physical violence (100%). Professionals with up to five years of experience are 74% less likely to suffer physical violence (p=0.029). Women suffer 5.83 times more verbal abuse than men (p=0.026). Sadness (15.8%) and fear of the aggressor (15.3%) were the main consequences of verbal abuse; and fear of the aggressor (22.2%) and stress (22.2%) were results of physical violence., Conclusion: violence is influenced by institutional, professional and client aspects. Therefore, coping with it requires multidimensional strategies.

Objective: To discuss the methods employed to evaluate the effectiveness of clinical surface cleaning and disinfection (C&D)., Method: This is a theoretical reflection based on scientific studies and the experience of the authors. Knowledge and current gaps, the need for further studies, and practical application of the methods were approached., Results: There are four main methods used to evaluate the effectiveness of clinical surface C&D: visual inspection, fluorescent markers, microbiological cultures, and adenosine triphosphate (ATP) bioluminescence. The first two are used to evaluate the process and to predict adherence to protocols by the staff, and the last two are employed to evaluate the results, therefore being the most relevant to assess the risk of infection., Final Considerations: The ideal method was not found, because all of them showed limitations. There is a need for strategies to optimize the precision of these methods.

Objective: To analyze the overall critical thinking and the development of each of the cognitive skills or attributes that compose it in students of the undergraduate program in nursing through the creation of concept maps in two Brazilian teaching institutions., Method: Before-and-after experimental study, randomized, performed in two universities of two Brazilian regions, with a sample of 21 subjects at the A school and 56 at the B school. Data were collected through sociodemographic questionnaire and the California Critical Thinking Skills Test. Intervention consisted in the creation of four concept maps., Results: Scores measured for overall critical thinking do not differed between the groups of both schools; however, positive aspects among them were found for skills of evaluation, induction, and inference., Conclusion: We perceived validity as a facilitating teaching strategy of the use of concept maps in several aspects.

Syphilis is a disease that is found all over the world that causes damaging effects to the fetus through vertical transmission. This study aimed to analyze the processes that trigger the vertical transmission of syphilis through gestational and congenital syphilis notifications. It is a cross-sectional study. The sample totaled 129 notifications of syphilis in pregnant women and 132 notifications of congenital syphilis in the city of Natal, from 2011 to 2015. Data were obtained from the Information System for Disease Notification. The Chi-square, Student's and Fisher's tests were used to verify associations of interest. Diagnosis of maternal syphilis was predominant in the third trimester of pregnancy. Only 1.6% of the pregnant women were registered with an adequate treatment regimen, of these 16.3% had the concomitant treatment with their partners. Of the affected children, 78.8% were registered as asymptomatic. The factors that trigger vertical transmission are related to the late diagnosis of the pregnant woman and sexual partner(s) and the deficiencies in clinical/therapeutic management in relation to the phase of the disease. Strategies of professional training should be adopted to notify and expand the provision of information for epidemiological surveillance, aiming to strengthen care, reduce vertical transmission and enable the continuous analysis of this problem.

Objective: To evaluate the predictive clinical factors for ocular dryness and for the nursing diagnosis Risk for dry eye in the ocular surface of hospitalized adult patients in an intensive care unit., Method: A cross-sectional study was conducted between January and July 2016, with 206 patients (412 eyes). An inference about the presence of the diagnosis in the evaluated patients was performed by diagnostic nurses. The descriptive and inferential statistics subsidized the data analysis., Results: 47.6% of the patients presented Risk for dry eye, and 52.4% were already diagnosed with ocular dryness. Statistical differences between the ocular dryness diagnosis in the right eye with hyperemia, mucous secretion, eyelid edema and lagophthalmia were identified. In addition, statistical differences were observed between hyperemia and eyelid edema with Risk for dry eye in the left eye and with the nursing diagnosis Risk for dry eye., Conclusion: Hyperemia, mucous secretion, eyelid edema and lagophthalmia are the predictive clinical factors for the nursing diagnosis Risk for dry eye and also of ocular dryness in the intensive care unit environment which deserve special attention in the preventive evaluation.

Objective: to identify the main intraoperative complications of patients who underwent keratoplasty and relationship between these complications and clinical and surgical factors., Method: cross-sectional observational study. A census of the patients submitted to keratoplasty was carried out, which totaled 258 procedures., Results: twenty-two intraoperative complications were recorded, all in penetrating keratoplasty surgeries, of which 59.09% were performed in male patients with a mean age of 58.5 years. The main intraoperative complication was vitreous loss (36.36%). A statistically significant relationship was found between the variable "intraoperative complication" and the variables "previous surgery", "combined keratoplasty and cataract extraction" and "corneal host button greater than 8.0 mm"., Conclusion: identifying the main intraoperative complications of keratoplasty enables nurses to understand which factors may interfere with these procedures, point out possible predictors of complications, and seek control measures so that such complications do not occur.

Objective: To describe the process of hypermedia construction to support the teaching of the Systematization of the Nursing Care (SNC)., Method: Methodological research of educational technology development. The hypermedia construction stages were conducted from February 2015 to March 2016 and integrated theoretical studies, focus group with professors and educational technology development process in the light of the referential Theory of Significant Learning., Results: Hypermedia consists of interactive content and shows a splash screen with a concept map that guides a free way of learning about four structuring aspects in the SNC learning: concept, history and benefits; ethical-legal aspects; operationalization; and nursing process: steps and technical integration in nursing., Conclusions: It was concluded that it is essential that the educational technologies are built from a pedagogical rationale to support your incorporation into educational environments.

Objective: Clinically validate the Nursing Outcome Behavior of falls prevention in hospitalized patients., Method: This was a cross-sectional study developed at a public university hospital with a sample of 45 patients. The data collection was performed through the evaluation of four nurses, with a double used the instrument with the constitutive and operational definitions of the indicators and magnitudes of the Fall Prevention Behavior Result, while the other pair did not use such definitions., Results: When applying the non-parametric analysis of variance by the Friedman test, ten indicators showed statistical differences between the inferences made by the evaluators for each patient. In relation to the intraclass correlation coefficient, confidence interval and p value assigned to each indicator of the scale, most of the indicators were statistically significant., Conclusions: The instrument referring to the Fall Behavior Outcome Behavior was considered valid for the study population.

Purpose: To analyse the concept of Dry Eye Syndrome in patients admitted to Intensive Care Units (ICU)., Method: This is a concept analysis, according to Walker's and Avant's method, conducted using an integrative review, through search in the database. Science Direct, Scopus, Cinahl, Pubmed, Lilacs, Cochrane and Web of Science. The following keywords were used: "Keratoconjuntivite Sicca", "Risk Factors", "Dry eye Syndromes" and "Intensive Care Units". After selection, 85 articles have been kept., Results: Antecedents found: age, lagophthalmos, environmental factors, use of medications, systemic diseases, mechanical ventilation and eye surgeries. Attributes: Tear Break-up Time < 10 s, Schirmer's test I < 10 mm, Schirmer's test II < 5 mm and signs and symptoms. Consequents: eye damage and discomfort; unstable vision. The Model Case and the Contrary Case were used to illustrate it., Conclusion: The research provided clarification of the concept and consequent understanding of the Dry Eye Syndrome, which is preventable especially in ICU.

Introduction: The quality of corneal tissue is influenced by several factors inherent to the recipient, donor, donation process, and transplantation that may primarily or secondarily interfere in the survival of a corneal graft., Objective: The objective of this study was to identify the factors inherent to the donation process, specifically related to the harvesting and processing of tissue and to the donor, that may interfere with the quality of corneal tissue., Materials and Methods: This was a cross-sectional, descriptive, and analytical study carried out from January to April 2015 at the Onofre Lopes University Hospital, Natal/RN, Brazil. A survey of the keratoplasties performed between the years 2010 and 2014 was carried out, totaling 258 donated corneas., Results: The mean age of donors was 42.08 years, ranging from 2-80 years. As for quality, 64.45% of the corneas were classified as good, 23.05% as regular, 11.33% as poor, and 1.17% as excellent. The mean time between death and preservation was approximately 7 hours and 15 minutes, and the mean time elapsed until use was 10 days after immersion in preservation medium., Discussion and Conclusions: Factors inherent in the donation process that may interfere with the quality of the corneal graft correspond to factors of a chronological nature: donor age and time elapsed between death and preservation of the graft., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Hematopoietic stem cell transplantation (HSCT) consists of the intravenous infusion of healthy hematopoietic stem cells to restore the medullary and immunologic function of patients affected by a series of hematologic, oncologic, immunologic, malignant and nonmalignant inherited or acquired diseases, with the possibility of cure or increase of disease-free survival., Objective: To characterize the epidemiologic profile and the cases of death of patients who underwent HSCT., Methods: This is a cohort quantitative study, nested with a retrospective, descriptive, and analytical study of a hospital-based cohort that included the patients who underwent HSCT at a referral service in the state of Rio Grande do Norte, a region of northeastern Brazil., Results: There was a slight male prevalence (52.94%), the age of the patients ranged from 2 to 73 years old, 18.38% were brown, 47.06% were married, 15.07% were students, 78.31% had a diagnosis of multiple myeloma, 93.38% developed gastrointestinal toxicities, all patients received chemotherapeutic treatment, 54.78% had allogeneic HSCT, and the cause of the most recorded deaths was septic shock (48.19%)., Conclusions: This study showed relevant scientific evidence on the clinical and epidemiologic profile of patients who underwent HSCT. In general, sociodemographic data are similar to national and international research results., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: to describe the content validation process of a Virtual Learning Object to support the teaching of nursing care systematization to nursing professionals., Method: methodological study, with quantitative approach, developed according to the methodological reference of Pasquali's psychometry and conducted from March to July 2016, from two-stage Delphi procedure., Results: in the Delphi 1 stage, eight judges evaluated the Virtual Object; in Delphi 2 stage, seven judges evaluated it. The seven screens of the Virtual Object were analyzed as to the suitability of its contents. The Virtual Learning Object to support the teaching of nursing care systematization was considered valid in its content, with a Total Content Validity Coefficient of 0.96., Conclusion: it is expected that the Virtual Object can support the teaching of nursing care systematization in light of appropriate and effective pedagogical approaches.

Objective: Identifying the strategies used to promote critical thinking (CT) during undergraduate education in nursing courses., Design: Systematic review., Source of Data: Five electronic databases were searched without language, publication time or geographic filters., Method: A systematic review of the literature. Including experimental studies that considered at least one teaching strategy to promote critical thinking of undergraduate students in Nursing courses. The search for studies occurred in three phases: title and summary review, complete text and implementation of a clinical form of selection according to predetermined criteria. All included studies were assessed for quality through a classification tool for experimental studies., Results: Six studies were selected. The results were grouped into three key themes: an evaluation of the quality of the selected studies, characterization of the studies and the strategies used to promote critical thinking. All selected studies were in English, with significant conceptual similarity of Critical Thinking and dominance in choosing the approached theme during strategies in clinical nursing education with an emphasis on the nursing process., Conclusions: The most widely used teaching intervention was Problem-Based Learning. Nursing education mediated by strategies that stimulate CT is considered a positive difference in undergraduate curriculums., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Magnetic resonance (MR) neurography has been used to evaluate entire nerves and nerve bundles by providing better contrast between the nerves and the surrounding tissues. The purpose of the study was to validate diffusion-weighted MR (DW-MR) neurography in visualizing the lumbar plexus during preoperative planning of lateral transpsoas surgery., Methods: Ninety-four (188 lumbar plexuses) spine patients underwent a DW-MR examination of the lumbar plexus in relation to the L3-4 and L4-5 disc spaces and superior third of the L5 vertebral body. Images were reconstructed in the axial plane using high-resolution Maximum Intensity projection (MIP) overlay templates at the disc space and L3-4 and L4-5 interspaces. 10 and 22 mm MIP templates were chosen to mimic the working zone of standard lateral access retractors. The positions of the L4 nerve root and femoral nerve were analyzed relative to the L4-5 disc in axial and sagittal planes. Third-party radiologists and a senior spine surgeon performed the evaluations, with inter- and intraobserver testing performed., Results: In all subjects, the plexus was successfully mapped. At L3-4, in all but one case, the components of the plexus (except the genitofemoral nerve) were located in the most posterior quadrant (zone IV). The L3 and L4 roots coalesced into the femoral nerve below the L4-5 disc space in all subjects. Side-to-side variation was noted, with the plexus occurring in zone IV in 86.2 % right and only 78.7 % of left sides. At the superior third of L5, the plexus was found in zone III in 27.7 % of right and 36.2 % of left sides; and in zone II in 4.3 % right and 2.1 % left sides. Significant inter- and intraobserver agreement was found., Conclusions: By providing the surgeon with a preoperative roadmap of the lumbar plexus, DW-MR may improve the safety profile of lateral access procedures.

Objective: To identify factors that can influence nursing mothers to interrupt exclusive breastfeeding during the first six months of life of the infant., Method: Descriptive, exploratory, qualitative research. Information was collected through semi-structured interviews with 14 nursing mothers who had received prenatal care in the Family Basic Health Units in the city of Campina Grande - PB, from April to May 2013. The data were subjected to the content analysis technique proposed by Bardin., Results: The nursing mothers had little knowledge of the mother-child bond, reduced family spending on child nutrition and the risk of bleeding after delivery. Their beliefs included insufficient milk production, the child´s rejection of the breast, and the possibility of various mammary postpartum complications., Conclusions: It is necessary to expand the guidance and support of breastfeeding for nursing mothers in the early postpartum period.

Objective: to estimate survival, mortality and cause of death among users or not of hydroxyurea with sickle cell disease., Method: cohort study with retrospective data collection, from 1980 to 2010 of patients receiving inpatient treatment in two Brazilian public hospitals. The survival probability was determined using the Kaplan-Meier estimator, survival calculations (SPSS version 10.0), comparison between survival curves, using the log rank method. The level of significance was p=0.05., Results: of 63 patients, 87% had sickle cell anemia, with 39 using hydroxyurea, with a mean time of use of the drug of 20.0±10.0 years and a mean dose of 17.37±5.4 to 20.94±7.2 mg/kg/day, raising the fetal hemoglobin. In the comparison between those using hydroxyurea and those not, the survival curve was greater among the users (p=0.014). A total of 10 deaths occurred, with a mean age of 28.1 years old, and with Acute Respiratory Failure as the main cause., Conclusion: the survival curve is greater among the users of hydroxyurea. The results indicate the importance of the nurse incorporating therapeutic advances of hydroxyurea in her care actions.

Due to the increasing number of schools of professional training at the technical level in nursing, the teaching sector became a large of employment for the professionals graduating from the superior nursing courses, did not receive pedagogic formation in their initial formation. This study focused on a group of nurses, teachers from a school at the technical level, analyzing their initial training in order to practice teaching. It is a qualitative based study of a descriptive-explicative nature, with data collected by questionnaire and the information studied by analysis of the content. What can be concluded is the responsibility for the teaching qualification should not only be attributed to the initial formation, since practical experience allied to constant learning in work are reinforcers for this action.