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The purpose of this study is to compare clinical assessment of congestion performed by a nurse to that performed by cardiologist and correlate them with NT-ProBNP levels. The nurses' role in heart failure has been strongly focused in therapeutic, educational and self-care interventions. The diagnostic performance of nurses in heart failure outpatients is not well explored. N-terminal pro-B-type natriuretic peptide is a cardiac marker that reflects elevated filling pressures. Cross-sectional contemporaneous study. Heart failure outpatients underwent a systematic clinical assessment of clinical congestion score performed by cardiologist and nurse during the same visit. Assessments were performed independently and N-terminal pro-B-type natriuretic peptide levels obtained. The nurses' ability to classify patients in hemodynamic profile was compared to the cardiologist's. Eighty-nine assessments were performed in 63 patients with heart failure. The correlation of clinical congestion scores obtained by nurse with those obtained by cardiologist was r = 0·86; p < 0·001. The correlation of clinical congestion scores from nurse and cardiologist with levels of N-terminal pro-B-type natriuretic peptide were as follows: r = 0·45; p < 0·0001 and r = 0·51, respectively, p < 0·0001. Patients with clinical congestion score ≥3 had levels of NT-ProBNP significantly higher than those with clinical congestion score <3, in the assessment performed by the cardiologist (1866 SD 1151 vs. 757 SD 988 pg/ml; p < 0·0001) and by the nurse (1720 SD 1228 vs. 821 SD 914 pg/ml; p < 0·0001). The nurse and cardiologist had similar capacity in classifying patients in congested quadrants ( p = 0·027) or in dry quadrants ( p = 0·03), according to the levels of N-terminal pro-B-type natriuretic peptide. Area under the receiver-operating characteristic curve of the nurse and cardiologist to detect congestion was, respectively, 0·77 and 0·72. Our data suggests that nurses trained in heart failure may have a similar performance to that of the cardiologist for the clinical detection of congestion and assessment of the hemodynamic profile in patients with chronic heart failure. Considering that consistent clinical assessment can identify congested or hypovolemic patients with reasonable reliability, as well as patients with low or normal cardiac output, our results may help confirm nurses' capability in performing reliable clinical assessment in heart failure patients. While nurses' led heart failure programmes are usually focused on the management of patients, nurses' ability to perform accurate assessment would expand nurses' role in these programmes. As many institutions now focus on home visits by heart failure nurses, accurate assessment would benefit patients and improve their clinical outcomes. [ABSTRACT FROM AUTHOR]

Clinically validate (using Fehring's model) characteristics of the nursing diagnosis (ND) of decreased cardiac output (DCO) in 29 patients with decompensated heart failure. Cross-sectional study conducted in a Brazilian university hospital. According to the reliability rate (R) between the experts, the major characteristics (R ≥ 0.80) were fatigue, dyspnea, edema, orthopnea, paroxysmal nocturnal dyspnea, and elevated central venous pressure, and the secondary characteristics were weight gain, hepatomegaly, jugular vein distension, palpitations, crackles, oliguria, coughing, clammy skin, and skin color changes. Characteristics with R > 0.50 and ≤1 were valid in the ND of DCO. Implications for the nursing practice: Clinical validation studies are necessary to determine the adequacy of this diagnosis and its determining characteristics with Taxonomy II. Validar clinicamente, segundo o modelo proposto por Fehring, as características definidoras do diagnostico de enfermagem (DE) débito cardíaco diminuído (DCD) em 29 pacientes com insuficiência cardíaca congestiva descompensada. Estudo transversal conduzido em um hospital universitário no sul do Brazil. De acordo com a taxa de fidedignidade de Fehring (R) obtidas entre as peritas, as características definidoras consideradas maiores (R ≥ 0.80) foram fadiga, dispnéia, edema, ortopnéia, dispnéia paroxística noturna e pressão venosa central aumentada; e características secundárias foram ganho de peso, hepatomegalia, distensão da veia jugular, palpitações, crepitações, oliguria, tosse, pele fria e pegajosa e mudanças na cor da pele. Características com R > 0.50 e ≤1 foram validadas para o diagnóstico débito cardíaco diminuído (DCD). Estudos de validação clínica são necessários para evidenciar a adequação deste diagnóstico e suas características definidoras a Taxonomia II. [ABSTRACT FROM AUTHOR]

This study verified the daily TISS-28 score in the postoperative period of cardiac surgery at a cardiology intensive care unit. This cohort study included 55 postoperative cardiac surgery patients, who were sent to the intensive care unit to recover. Data were collected from patients records with daily application of the TISS-28. The obtained data revealed that the average age of the population was 61.47 years +/- 12.12 years, 78.2% were male, 51.43% underwent valve repair surgery and 48.57% myocardial revascularization surgery. The severity index in the immediate postoperative period was 41.33 +/- 5.01. The follow-up of patients using the TISS-28 evidenced a significant decrease in the index values up to the patients discharge, averaging at 13.19 +/- 2.59. The results indicate that immediate postoperative cardiac surgery patients are in severe conditions, hemodynamically unstable and classified in class III according to the TISS-28, though scores gradually decrease over time. [ABSTRACT FROM AUTHOR]

PURPOSE. The purpose of this study was to identify the impact of institutional, professional, and personal factors on nurses and on their efforts to make nursing diagnoses. METHODS. A cross-sectional study was conducted in which all participants completed a questionnaire established to measure each individual group of factors. A score (0-100) was established to measure each group of factors. RESULTS. Twenty-one nurses responded that their busy shifts, the number of patients per nurse, and their involvement with administrative tasks were the three parameters most frequently identified as interfering with implementing nursing diagnosis. CONCLUSION. The recognition of these factors and improved institutional support may facilitate the implementation of nursing diagnoses. PRACTICE IMPLICATIONS. Electronic records may contribute to the implementation of the nursing process, particularly if the identified signs and symptoms are documented and then linked to nursing diagnoses and interventions. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate nursing professionals' theoretical knowledge of cardiopulmonary arrest (CPA) treatment before specific training, immediately after, and six months later. Methods: Cohort study, performed in a cardiology hospital in Porto Alegre, Rio Grande do Sul (November/2005 to May/2006), Brazil. Nurses, nursing technicians and assistants were included. A questionnaire was administered in the three periods, and 75% of correct answers was considered a satisfactory result. Results: Thirty-five nurses participated in the pre-test, and 34 in the immediate and 6-month tests. Among technicians and assistants, 232, 227, and 104 participated in the pre-test, immediate, and 6-months tests, respectively. Among nurses, 62.9% achieved an adequate percentage of correct answers in the pre-test, 94.1% in the immediate, and 64.7% in the 6-months test; for nursing technicians and assistants, these values were 36.2%, 79.3%, and 62.5%, respectively. Conclusion: Training in CPA improved the nursing professionals' knowledge immediately after its administration, with a reduction in the rate of correct answers after 6 months. [ABSTRACT FROM AUTHOR]

OBJECTIVES: to identify the prevalent nursing diagnoses (ND) in the hospitalized elder care; to compare the prevalent ND with the duration of hospital stay and with the prescribed cares for their respective diagnoses. METHOD: Transversal historical study carried through in Porto Alegre, RS, by analyzing patient records age e60 years old, interned in clinical unities of a university hospital. RESULTS: 1665 records were analyzed; the four prevalent NANDA nursing diagnoses - within 62 identified ones - were: Self-Care Deficit - Bathing/Hygiene, Imbalanced Nutrition - Less than Body Requirements, Risk for Infection and Ineffective Breathing Patterns, varying from 14 to 17 days of hospital stay. THE MAIN CARES WERE: aiding bed bath, communicating diet acceptance, implementing routines of care in venous puncture and checking respiratory pattern. CONCLUSION: four prevalent ND were identified with the appropriate prescribed care. However, other care could have been established as a priority. [ABSTRACT FROM AUTHOR]

Ovarian tissue cryopreservation has been widely investigated for preserving female fertility. In the present study, we aimed to compare the effects of three concentrations (1, 1.5, and 3 M) of dimethylsulfoxide (DMSO) on the vitrification of ovarian tissue. The ovarian cortex was divided into control and vitrified groups: (i) 1 M-DMSO, (ii) 1.5 M-DMSO, and (iii) 3 M-DMSO. Follicles from all fragments were analyzed for DMSO-induced deleterious effects, morphological and morphometric aspects, and concentration of reactive oxygen species. Additionally, the fragments were cultured to assess the integrity and return of follicular development post-vitrification. All DMSO concentrations resulted in a higher percentage of degenerated preantral follicles than before the cryopreservation process. After vitrification, the cryopreserved ovarian fragments showed similar percentages of intact follicles; however, the 3 M DMSO concentration differed from the control. Analyzing free radical production, we found that the 3 M DMSO concentration had higher levels of oxidative stress than the lower DMSO. After in vitro cultivation of the vitrified/warmed fragments, the 1 M DMSO concentration exhibited higher percentages of morphologically intact follicles than the other concentrations. Therefore, we suggest that bovine preantral follicles can be cryopreserved in situ with greater efficiency in 1 M DMSO.

Objective: This study investigated the auditory sensory-perceptual level of specific learning disorder (SLD) and explored relationships among neuropsychological assessments for SLD, auditory processing, and short and long latencies of auditory event-related potentials (ERPs)., Methods: Fifteen children (7-14 years old) comprised the control group; 34 children comprised the SLD group. Audiologic assessments included tone audiometry, acoustic immittance measurements, acoustic reflex, central auditory processing, brainstem evoked response audiometry, and long latency potentials (P3 and N2). Children's intelligence levels were assessed with 2 intelligence batteries, 1 verbal and 1 non-verbal, as well as with visuomotor skills., Results: Multiple regression showed a significant interaction effect of APE tests and P3/N2 over Wechsler Scale performance in freedom of distractibility indexes and multiple subtests. Errors in the Bender Visual Motor Gestalt Test were predicted by lower parental education, lower performance in APE tests: dichotic digits and pediatric/synthetic sentence identification-ipsilateral, and longer P3/N2 latencies, particularly regarding integration and rotation distortions., Conclusions: Children with altered auditory processing exhibit a specific cognitive profile, including lower verbal and spatial reasoning performance, that is sensitive to parental education level., Significance: Children with SLD should undergo a complete multimodal examination to identify their specific difficulties and needs.

Hepatitis C virus (HCV) is the major cause of hepatocellular carcinoma (HCC). The risk to develop HCC increases with the severity of liver inflammation and hepatic fibrosis. It is believed that a balance between the releases of pro- and anti-inflammatory cytokines will determine the clinical course of HCV and the risk to develop HCC. The inteleukin-10 (IL-10) and the tumor necrosis factor alpha (TNF-α) play key roles in the Th1 and Th2 balance during the inflammatory response against HCV. The aim of the present study was to investigate the association between polymorphisms in TNF-α -308 G>A (rs1800629), IL-10 -1082 G>A (rs1800896) and -819/-592 (rs1800871/rs1800872) with HCC risk in individuals with HCV. The present study evaluated 388 chronic HCV patients. Polymorphisms were determined by real-time PCR. Diplotypes associated with low IL-10 production and the TNF-α GG genotype were significantly associated with HCC occurrence after multivariate logistic regression analysis (P = 0.027 and P = 0.029, respectively). Additionally, the IL-10 -819 (-592) TT (AA) genotype was significantly associated with multiple nodules and HCC severity according to BCLC staging (P = 0.044 and P = 0.025, respectively). Patients carrying low production haplotypes of IL-10 and the TNF-α GG genotype have higher risk to develop HCC. J. Med. Virol. 88:1587-1595, 2016. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objective: Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents., Methods: Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale., Results: In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries., Conclusion: Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide., Practice Implications: Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Importance: The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (ADHF) are unclear., Objective: To compare the effects of a fluid-restricted (maximum fluid intake, 800 mL/d) and sodium-restricted (maximum dietary intake, 800 mg/d) diet (intervention group [IG]) vs a diet with no such restrictions (control group [CG]) on weight loss and clinical stability during a 3-day period in patients hospitalized with ADHF., Design: Randomized, parallel-group clinical trial with blinded outcome assessments., Setting: Emergency room, wards, and intensive care unit., Participants: Adult inpatients with ADHF, systolic dysfunction, and a length of stay of 36 hours or less., Intervention: Fluid restriction (maximum fluid intake, 800 mL/d) and additional sodium restriction (maximum dietary intake, 800 mg/d) were carried out until the seventh hospital day or, in patients whose length of stay was less than 7 days, until discharge. The CG received a standard hospital diet, with liberal fluid and sodium intake., Main Outcomes and Measures: Weight loss and clinical stability at 3-day assessment, daily perception of thirst, and readmissions within 30 days., Results: Seventy-five patients were enrolled (IG, 38; CG, 37). Most were male; ischemic heart disease was the predominant cause of heart failure (17 patients [23%]), and the mean (SD) left ventricular ejection fraction was 26% (8.7%). The groups were homogeneous in terms of baseline characteristics. Weight loss was similar in both groups (between-group difference in variation of 0.25 kg [95% CI, -1.95 to 2.45]; P = .82) as well as change in clinical congestion score (between-group difference in variation of 0.59 points [95% CI, -2.21 to 1.03]; P = .47) at 3 days. Thirst was significantly worse in the IG (5.1 [2.9]) than the CG (3.44 [2.0]) at the end of the study period (between-group difference, 1.66 points; time × group interaction; P = .01). There were no significant between-group differences in the readmission rate at 30 days (IG, 11 patients [29%]; CG, 7 patients [19%]; P = .41)., Conclusions and Relevance: Aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at 3 days and is associated with a significant increase in perceived thirst. We conclude that sodium and water restriction in patients admitted for ADHF are unnecessary., Trial Registration: clinicaltrials.gov Identifier: NCT01133236.

Aim: To validate, clinically, the defining characteristics for the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to heart catheterization and to validate acute pain, haematoma, bleeding, redness, and heat as additional characteristics., Background: In clinical practice, an applicable nursing diagnosis for patients subjected to diagnostic heart catheterization has not been well-defined., Design: Cross-sectional., Methods: This clinical validation study using Fehring's model was performed at a Brazilian general hospital between November 2009-November 2010. This study included 250 patients who received elective femoral artery catheterization. Each patient was identified as having two characteristics of Impaired Tissue Integrity and three characteristics of Impaired Skin Integrity, according to NANDA-I nursing diagnoses. Due to certain postprocedure events, five additional characteristics were added to be validated in this setting. In addition to Fehring's reliability rating, the kappa coefficient was used to evaluate inter-rater agreement during the clinical evaluation., Results: The defining characteristic of damaged tissue was validated for Impaired Tissue Integrity and the defining characteristics of the invasion of body structures and the disruption of the skin surface were validated for Impaired Skin Integrity. Although the five characteristics that were added to the investigated diagnoses were not validated because of their low rate of occurrence in this setting, the measurements of acute pain, haematoma, bleeding, redness, and heat each had excellent inter-rater agreement., Conclusion: The validation of characteristics from both of these diagnoses suggested that these criteria could be utilized for clinical practice in a diagnostic setting. Moreover, additional characteristics should also be observed to better guide nursing intervention., (© 2012 Blackwell Publishing Ltd.)

A clinical intervention study was developed in a hospital specialized in cardiology in Porto Alegre, RS, Brazil, with the objective of evaluating the implementation of the pain scale in post-operative cardiac surgery patients. It was developed in four steps: pre-test on pain, training lecture for nursing staff, and, reapplication of the pre-test at 30 and 60 days. The test consisted of ten questions weighing one point each. Scores > or =7 were determined to represent satisfactory knowledge in using the pain scale. The sample consisted of 57 nursing professionals. The scores ranged from 6.12 +/- 1.65 in the pre-test to 7.73 +/- 1.05 and 8.18 +/- 0.99 after 30 and 60 days, respectively (p<0.005). Pain intensity was correlated to medication standardized by protocol. The training improved the knowledge of the team and the type of analgesia administered in relation to pain intensity.

Objective: To verify the effect of an educative nursing intervention composed of home visits and phone calls on patients' knowledge about the disease, self-care and adhesion to the treatment., Methods: Randomized clinical trial with patients with recent hospitalization caused by decompensated heart failure. There were two groups: the intervention group, which has received four home visits and four phone calls to reinforce the guidelines during six months of follow up; and the control group, which has received conventional follow up with no visits or phone calls., Results: Two hundred patients were randomized (101 in the intervention group and 99 in the control group). After six months, a significant improvement was observed in self-care and knowledge about the disease in the intervention group (P=0.001 and P<0.001), respectively; the adhesion to the treatment, measured and compared between the groups, was significantly higher in the intervention group (P=0.001)., Conclusion: the strategy of home visits to patients who were recently hospitalized with decompensated heart failure was effective in improving the outcomes assessed and its implementation deserves to be considered in Brazil aiming at avoiding unplanned hospitalizations. NCT-01213862.

This was a consensus study with six cardiology nurses with the objective of selecting nursing diagnoses, outcomes and interventions described by NANDA International (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), for home care of patients with heart failure (HF). Eight nursing diagnoses (NDs) were pre-selected and a consensus was achieved in three stages, during which interventions/activities and outcomes/indicators of each NDs were validated and those considered valid obtained 70% to 100% consensus. From the eight pre-selected NDs, two were excluded due to the lack of consensus on appropriate interventions for the clinical home care scenario. Eleven interventions were selected from a total of 96 pre-selected ones and seven outcomes were validated out of 71. The practice of consensus among expert nurses provides assistance to the qualifications of the care process and deepens the knowledge about the use of tazonomies in nursing clinical practice.

Background: Dietary vitamin K intake has been considered a major factor that influences stability of oral anticoagulation (OA) with coumarins. Few studies have evaluated the relationship between amounts of dietary vitamin K intake and stability of anticoagulation., Objective: To assess whether high dietary vitamin K intake is associated to stability of International Normalized Ratio (INR) of the prothrombin time., Methods: We performed a sub-analysis of a randomized clinical trial involving outpatients from the anticoagulation clinic of a university hospital. INR and vitamin K intake were prospectively collected at baseline, 15, 30, 60 and 90 days after randomization. Patients were considered with a stable anticoagulation when their INR coefficient of variation was less than 10%. Dietary vitamin K intake was assessed by a food frequency questionnair and a score of intake was derived., Results: We studied 132 patients on chronic OA (57 ± 13 years; 55% males); 23 patients (17%) were achieved stable anticoagulation. Stable and unstable patients had no significant differences in baseline characteristics. The dietary vitamin K score over the entire follow-up for stable patients was significantly lower than that for unstable patients (p = 0.012)., Discussion: Our findings suggest that INR stability could be achieved with relatively low amounts of dietary vitamin K.

Purpose:   To conduct a Fehring model-based clinical validation of the defining characteristics of the nursing diagnosis of impaired physical mobility in a sample of 250 patients., Method:   Cross-sectional study., Findings:   Three of the 11 NANDA-International defining characteristics assessed in this study were validated: limited range of motion, limited ability to perform gross motor skills, and difficulty turning. Although discomfort was not validated due to the rarity of occurrence, there was excellent interrater agreement as to its relevance (kappa coefficient)., Conclusions:   In this setting, three characteristics were validated., Implications for Nursing Practice:   Validation studies are important for advancing evidence-based practice., (© 2012, The Authors. International Journal of Nursing Knowledge © 2012, NANDA International.)

Purpose:   To describe the cross-cultural adaptation of the Quality of Diagnoses, Interventions and Outcomes instrument into Brazilian Portuguese., Method:   This process entailed translation, synthesis, back-translation, expert committee review, and pretesting., Findings:   Six items were altered in the Brazilian version, and the scoring system was changed from a five-point to a three-point Likert-type scale. Pretesting was conducted on a sample of 40 randomly selected nursing records. Overall reliability as measured by Cronbach's alpha was 0.96., Conclusions:   Adaptation resulted in a preliminary version of the instrument., Implications for Nursing Practice:   Assessment of the psychometric properties of the instrument in a larger sample of nursing records is required, and such a study is underway., (© 2012, The Authors. International Journal of Nursing Knowledge © 2012, NANDA International.)

Objective: To adapt and validate a Brazilian Portuguese version of the European Heart Failure Self-Care Behavior Scale., Methods: The cross-cultural adaptation (translation, synthesis, back-translation, expert committee review, and pretesting) and validation (assessment of face validity, content validity, and internal consistency reliability) were carried out in accordance with the literature. The European Heart Failure Self-Care Behavior Scale assesses key components of self-care: recognition of the signs and symptoms of decompensated heart failure (HF) and decision-making when these signs and symptoms arise. It comprises 12 items (range 12-60, where lower scores indicate better self-care)., Results: The sample comprised 124 HF patients with a mean age of 62.3 ± 12 years. The Cronbach's Alpha internal consistency was 0.70 and the intraclass correlation coefficient for reproducibility was 0.87., Conclusion: Face and content validity, internal consistency and reproducibility have lended validity and reliability for the use of the instrument in Brazil.

Purpose: Acute pain occurs in over 50% of hospitalized children. The accuracy of this diagnosis has been underexplored in the literature, as has the role of training to implement pain assessment. This study analyzed the accuracy of acute pain diagnoses after the implementation of a systematic evaluation of pain (study intervention)., Method: The sample was divided into: pre- and postintervention. The Nursing Diagnosis Accuracy Scale, which scores accuracy as null, low, moderate, or high, was used., Results: In the postimplementation, acute pain was diagnosed more often. However, accuracy only improved in the moderate category., Conclusion: Diagnosis of acute pain increased in the postimplementation period, but accuracy did not., Implications: The development of strategies for improvement of diagnostic accuracy is warranted., (© 2012, The Authors International Journal of Nursing Knowledge © 2012, NANDA International.)

This study aims to perform the cross-cultural adaptation and to verify the content validity and stability of Nurses' Knowledge of Heart Failure Education Principles to evaluate what Brazilian nurses know of heart failure. The process of cross-cultural adaptation involved translation, synthesis, back-translation, committee's proofreading and pre-test. The following psychometric properties were assessed content validity (face), reliability through internal consistency (Cronbach's Alpha) and stability (Kappa coefficient). After the cross-cultural adaptation, the instrument was applied to 54 nurses (27 from a cardiology hospital and 27 from a general hospital). The Cronbach's Alpha was 0.7. The questions 4, 5, and 11 presented a Kappa coefficient less than or equal to 0.4, and further questions presented a Kappa coefficient superior or equal to 0.7. This questionnaire was validated and proved to be adequate to assess the knowledge of this group of professionals.

Background: Sodium restriction is a non-pharmacological measure often recommended to patients with heart failure (HF). However, adherence is low, being among the most common causes of HF decompensation. The Dietary Sodium Restriction Questionnaire (DSRQ) aims at identifying factors that affect adherence to dietary sodium restriction by patients with HF. In Brazil, there are no instruments to assess these factors., Objective: Perform the transcultural adaptation of DSRQ., Methods: Methodological study that involved the following steps: translation, synthesis, back-translation, review by an expert committee, pretest of the final version and analysis of interobserver agreement. In the pretest, items and their understanding were evaluated, as well as internal consistency by Cronbach's alpha. The instrument was simultaneously and independently administered by two researchers and the kappa test was used for agreement analysis., Results: Only one question underwent major semantic and/or cultural alteration. At the pretest, Cronbach's alpha for the total obtained was 0.77; for the Attitude, Subjective Norm and Behavioral Control scales were obtained, respectively: 0.66, 0.50 and 0.85. At the agreement step, the Kappa was calculated for 12 of the 16 questions, with values ranging from 0.62 to 1.00. In items for which the calculation was not possible, the incidence of equal responses ranged from 95% to 97.5%., Conclusion: Based on the transcultural adaptation of DSRQ, it was possible to propose a version of the questionnaire for further evaluation of psychometric properties.

Objectives: To estimate the prevalence of antibodies to hepatitis A virus (antiVHA-IgG) in children aged 7-14 years from public and private schools, and to identify demographic, socioeconomic and sanitation factors associated with the prevalence of antiVHA-IgG., Methods: Seroepidemiological study for the detection of IgG antiVHA. It was conducted from April 2002 to April 2004 with 462 elementary school students from São Luis, ranging from 7 to 14-years of age. Thirty schools randomly selected took part in the study, with a probability proportional to the number of students enrolled; 23 schools were public and 7 were private. Data was obtained through a structured questionnaire. In order to identify the variables independently associated with IgG antiVHA, the Poisson multiple regression analysis was performed, estimating the adjusted PRs and their 95% confidence intervals. The variables associated with the prevalence of hepatitis A with p < 0 were the only ones that remained in the final model. The level of significance of 0.05 (α = 0.05) was adopted., Results: The prevalence of antiVHA-IgG was 64%, 71.5% in public and 36.5% in private schools. After multivariate analysis, age 11 to 14 years, more than one person per bedroom, and less than two bathrooms per household were associated with a higher prevalence of antiVHA-IgG. Higher parental education was associated with lower prevalence of antiVHA-IgG., Conclusions: Hepatitis A is endemic among schoolchildren in São Luís. The prevalence rate was similar to those found in other regions of the country with similar socio-economic and health conditions. Factors historically associated with a higher prevalence of hepatitis A were also identified in this population.

Purpose: Clinically validate (Fehring's model) the characteristics of the nursing diagnosis acute pain in 65 hospitalized children., Methods: Cross-sectional study., Findings: This study resulted in 13 major characteristics (expressive behavior, change of mental state, verbal report of pain, observed evidence of pain, narrowed focus, position to avoid pain, guarding behavior, sleep disturbance, protective gestures, changes in heart rate, changes in muscle tone, changes in respiratory rate, and facial mask) and in 5 minor characteristics (changes in blood pressure, coded report, changes in breathing pattern, distraction behavior, and changes in appetite)., Conclusions: Characteristics with R > 0.50 and ≤ 1 were valid in the diagnosis acute pain., Implications for Nursing Practice: Clinical validation studies must be reproduced in different populations., (© 2011, The Authors International Journal of Nursing Terminologies and Classifications © 2011, NANDA International.)

The aim of this study is to identify the signs and symptoms of patients admitted for decompensated heart failure (HF) in order to infer the priority nursing diagnoses (ND). This is a cross-sectional study undertaken in a university hospital. The data were collected by nurses trained to deal with HF and registered in a file containing identification items, and demographic and clinical variables. We included 303 patients. Most patients were in emergency departments (95.7%) with functional class III (65.7%). The signs and symptoms identified at the time of admission were dyspnea (91.4%), paroxysmal nocturnal dyspnea (87.5%), fatigue (67.3%), edema (63.7%), orthopnea (55.4 %) and jugular vein distention (28.7%). From the signs and symptoms raised, that became the set of relevant clues and consistent as an indicator for ND, we conclude that Decreased Cardiac Output and Fluid Volume Excess diagnoses were the priorities for this population.

To adapt a questionnaire that assesses knowledge about heart failure (HF) and self-care and to analyze its content validity and reproducibility for use in Brazil. The questionnaire was validated through translation, summary, back-translation, expert committee review, pretest and assessment of psychometric properties. The final version (14 questions) was applied at the university hospital to HF outpatients under multidisciplinary team care. Five questions showed total agreement; seven scored Kappa > 0.4; one Kappa = 0.4, and just one presented no agreement. A group of 153 patients within 1-4 years of outpatient follow-up was assessed (age 59±13, 61% male). In the knowledge assessment, right answers varied from 4 to 14 (average 9.9±2.1). Results indicate the validity of the questionnaire for use in Brazil.

Background: Nursing approaches to manage patients with heart failure (HF) showed benefits in reducing the morbidity and mortality. However, combining intra-hospital education with telephone contact after hospital discharge has been little explored., Objective: To compare two nursing intervention groups among patients hospitalized due to decompensated HF: the intervention group (IG) received educational nursing intervention during hospitalization followed by telephone monitoring after discharge and the control group (CG) received in-hospital intervention only. Outcomes were levels of HF and self-care knowledge, the frequency of visits to the emergency room, rehospitalizations and deaths in a three-month period., Methods: Randomized clinical trial. We studied adult HF patients with left ventricle ejection fraction (LVEF) < 45% who could be contacted by telephone after discharge. HF awareness was evaluated through a standardized questionnaire that also included questions regarding self-care knowledge, which was answered during the hospitalization period and three months later. For patients in the IG group contacts were made using phone calls and final interviews were conducted in both groups at end of the study., Results: Forty-eight patients were assigned to the IG and 63 to the CG. Mean age (63 ± 13 years) and L (around 29%) were similar in the two groups. Scores for HF and self-care knowledge were similar at baseline. Three months later, both groups showed significantly improved HF awareness and self-care knowledge scores (P < 0.001). Other outcomes were similar., Conclusion: An in-hospital educational nursing intervention benefitted all HF patients in understanding their disease, regardless of telephone contact after discharge.

Cross-sectional study developed to relate the international normalized ratio (INR), used as a parameter to monitor the levels of blood clotting, stability to adherence, age, level of education, socioeconomic level, interaction with other drugs, comorbidities, vitamin K intake, anticoagulation time and drug cost. 156 patients were included, mean age 57 ± 13 years, (53.8%) male, 61 (39.1%) had high adherence, 91 (58.3%) medium and 4 (2.6%) low adherence to treatment, 117 (75%) had INR stability up to 50% and 39 (25%) > 75%, patients with shorter time of anticoagulation presented higher stability, those who spent less on the drug remained more stable and had better adherence. It was concluded that more than 90% of patients had high and medium adherence and that the anticoagulation time and drug cost were the factors related to the anticoagulation stability.

The aim of this study was to investigate the ultrastructural characteristics of primordial follicles after culturing of sheep ovarian cortical slices in the presence of indol acetic acid (IAA), Epidermal Growth Factor (EGF), and FSH. To evaluate ultrastructure of primordial follicles cultured in MEM (control) or in MEM containing IAA, EGF, and FSH, fragments of cultured tissue were processes for transmission electron microscopy. Except in the control, primordial follicles cultured in supplemented media for 6 d were ultrastructurally normal. They had oocyte with intact nucleus and the cytoplasm contained heterogeneous-sized lipid droplets and numerous round or elongated mitochondria with intact parallel cristae were observed. Rough endoplasmic reticulum (RER) was rarely found. The granulosa cells cytoplasm contained a great number of mitochondria and abundant RER. In conclusion, the presence of IAA, EGF, and FSH helped to maintain ultrastructural integrity of sheep primordial follicles cultured in vitro.

This cross-sectional study aimed to describe the prescription of non-pharmacological management of patients with heart failure attending the emergency care of a hospital and the effectiveness of the practice. 256 patients aged 63 ± 13 years, 153 (60%) men, participated in the research. The most commonly prescribed non-pharmacological treatment was sodium restriction, 240 (95%), followed by weight control, 135 (53%). Fluid restriction and fluid balance were the least commonly prescribed treatments, 95 (37%) and 72 (28%), respectively. Only 38 (54%) of balances, 89 (67%) of weight controls and 69 (57%) of diuresis controls were performed. Concerning patients' previous knowledge of the treatments, 229 (90%) were advised to restrict salt intake, and 163 (64%) were advised to restrict fluid intake. Weight control was the least commonly known care, 117 (46%). Except for salt control, the other treatments were prescribed in slightly more than half of the samples, and were ineffective.

Historical cohort study that assessed the adherence rate of patients of randomized clinical trials (RCT) of pharmaceutical industry in cardiology to appointments and follow-up medical treatment. This study was conducted at the cardiology research unit in a public university hospital in Porto Alegre, Rio Grande do Sul, Brazil. High adherence was regarded as > or = 80%. Seven RCT (120 medical records) were revised. We discovered that 117 (97%) of patients had adherence to follow-up visits to > or = 80%; 83.3% of patients had rates of > or = 80% adherence to medication in the study; the median number of tablets ingested, among patients with good adherence was 175 (72-500), and among patients with lower adherence was 500 (500-962). These results indicate that patients in studies with longer follow up and greater number of oral medication present loss in adherence

This study aimed to classify patients according to their degree of dependence on nursing care (Perroca Classification System) and correlate this with the anesthetic risk (American Society of Anesthesiologists--ASA classification) in a post-anesthesia care unit. A cross-sectional study was conducted, which included 402 patients, mean age 51.57 (±16.73) years, of which 216 (54%) were female. The results indicate that patients had a degree of dependence between intermediate and semi-intensive with an ASA classification of between two and three. There was a significant relationship between degree of dependence and ASA classification. The results indicate that the post-anesthesia care unit admits patients with semi-intensive care requirements and with moderate anesthetic risk.

Adherence to chronic Oral Anticoagulant Therapy (OAT) is directly related to patients' understanding of the therapy. This study verified the knowledge of patients with mechanical valve prostheses concerning OAT. This is a contemporary cross-sectional study, the sample is composed of patients with mechanical valve prostheses (MVP) in outpatient follow-up. A 10-question instrument was used; answers were 'know' (1 point), 'know partially' (half point), or 'do not know' (zero). Patients were grouped according to the result obtained: ≤ 4 points was considered insufficient knowledge; > 4 ≤ 8 equated to moderate knowledge; and > 8 was considered appropriate knowledge. Of the 110 patients, 61.8% presented moderate knowledge, 40.9% were not able to name at least one factor that may alter the INR (International Normalized Ratio) and 37.3% were not able to report their INR target range. The majority of patients presented moderate knowledge concerning the treatment. Strategies to improve knowledge on the topic should be implemented to minimize risks.

Non-compliance in heart failure (HF) patients is one of the factors leading to hospital readmissions. Under this perspective, a study was carried out in a university hospital in Rio Grande do Sul, Brazil to describe the compliance with pharmacological and non-pharmacological treatments of patients admitted with decompensated HF, relating the compliance to the number of hospital admissions and readmissions during a years period. The pharmacological compliance was measured through Morisky scale and the non-pharmacological compliance was measured through a previously validated questionnaire. The sample was composed of 252 patients, median age 63 +/- 13, 151 (60%) male. For the pharmacological compliance, 118 (47%) patients demonstrated high compliance, and 45 (18%) adhered to non-pharmacological treatment. There was no relation found between treatment compliance (pharmacological or non-pharmacological) and readmissions. Patients who had been treated for HF, had knowledge about non-pharmacological care and were able to identify congestion symptoms demonstrated high compliance.

This study verified the daily TISS-28 score in the postoperative period of cardiac surgery at a cardiology intensive care unit. This cohort study included 55 postoperative cardiac surgery patients, who were sent to the intensive care unit to recover. Data were collected from patients records with daily application of the TISS-28. The obtained data revealed that the average age of the population was 61.47 years+/-12.12 years, 78.2% were male, 51.43% underwent valve repair surgery and 48.57% myocardial revascularization surgery. The severity index in the immediate postoperative period was 41.33+/-5.01. The follow-up of patients using the TISS-28 evidenced a significant decrease in the index values up to the patients discharge, averaging at 13.19+/-2.59. The results indicate that immediate postoperative cardiac surgery patients are in severe conditions, hemodynamically unstable and classified in class III according to the TISS-28, though scores gradually decrease over time.

Transversal study aiming to evaluate the predominance of risk factor (RF) regarding to coronary artery disease (CAD) in patients submitted to cardiac procedures in hemodynamic unit. The study encloses 302 patients of 62 +/- 11-years-old, 270 (89%) predominantly white and 172 (57%) male. The most prevalent RF was 227 (75%) sedentism, followed by 220 (73%) arterial hypertension, 150 (50,5%) dyslipidemia, 87 (29%) obesity, 81 (27%) diabetes mellitus, 77 (25,5%) smoking, 67 (22%) alcohol and 15 (5%) diet poor of fruits and vegetables. The correlation was not relevant between the quantity of RF and its variables: scholarship, income, age, marital status, professional activity and gender in addition to the quantity of procedures submitted, comparing those with five or more RF for CAD; however there is a positive connection that reinforces the importance of strategies towards to reduce or remove modifiable RF.

Objectives: To describe complications associated to the use of intra-aortic balloon pumps (IABP), and their relationship with dwelling time, presence of risk factors/comorbidities, and nursing records., Methods: Retrospective cohort study, in which medical records were analyzed through the completion of specifically designed forms., Results: In total, 104 patients were included, with mean age 65+/-11 years, 52% men; 26 (25%) of them presented vascular complications, more frequently ischemia (25%); peripheral vascular disease was the risk factor/comorbidity more frequently related to complications (56.3%; p=0.003). Nursing records showed that the use of catheter was recorded in 30 cases (29%), and the patient's clinical situation after its removal in 28 cases (27%)., Conclusion: This study showed that the frequency of complications related to IABP is high. Considering risk factor/comorbidity factors, peripheral vascular disease was significantly associated to complications. Nursing records were sub-optimal.

Objectives: To describe the steps of the nursing process as prescribed in the literature and to investigate the process as actually applied in the daily routine of a general hospital., Methods: Cross-sectional retrospective study (May/June 2005), performed in a hospital in Porto Alegre, RS. Medical records of adult patients admitted to a surgical, clinical or intensive care unit were reviewed to identify the nursing process steps accomplished during the first 48 h after admission. The form for data collection was structured according to other reports., Results: 302 medical records were evaluated. Nursing records and physical examination were included in over 90% of them. Nursing diagnosis was not found in any of the records. Among the steps performed, prescription was the least frequent. Evolution of the case was described in over 95% of the records., Conclusions: All nursing steps recommended in the literature, except for diagnosis, are performed in the research institution.

Introduction: The evaluation of endothelial function has been performed in the arterial bed, but recently evaluation within the venous system has also been explored. Endothelial function studies employ different drugs that act as endothelium-dependent vasodilatory response inductors., Objectives: The aim of this study is to compare the endothelium-dependent venous vasodilator response mediated by either acetylcholine or bradykinin in healthy volunteers., Methods and Results: Changes in vein diameter after phenylephrine-induced venoconstriction were measured to compare venodilation induced by acetylcholine or bradykinin (linear variable differential transformer dorsal hand vein technique). We studied 23 healthy volunteers; 31% were male, and the subject had a mean age of 33 +/- 8 years and a mean body mass index of 23 +/- 2 kg/m(2). The maximum endothelium-dependent venodilation was similar for both drugs (p = 0.13), as well as the mean responses for each dose of both drugs (r = 0.96). The maximum responses to acetylcholine and bradykinin also had good agreement., Conclusion: There were no differences between acetylcholine and bradykinin as venodilators in this endothelial venous function investigation.

This cross-sectional study aimed at evaluating the knowledge of nurses on cardiopulmonary resuscitation (CPR) as a function of the time elapsed since training was concluded. The study was performed in a general hospital in Porto Alegre, Rio Grande do Sul, during July and August, 2005. Nurses were assigned to groups 1 (33 nurses, in units equipped with a heart monitor and a cardiac defibrillator) and 2 (23 nurses, in units without this equipment). Nurses in group 1 showed better knowledge on the recognition of electrocardiographic recordings, and 91% of them recognized the ventricular fibrillation algorithm. Among nurses in group 2, 85% had knowledge on issues relative to basic care. The results showed that training in CPR generates positive results. Continued and systematic education strategies are essential to ensure better performance of the nursing team.

Background: Endothelial function has been extensively evaluated at the arterial bed in several cardiovascular scenarios. Venous endothelial dysfunction, however, has not been thoroughly explored particularly in heart failure (HF)., Aims: To characterize venous endothelial function in severe HF., Methods and Results: Venous endothelial function was evaluated by the dorsal hand vein technique using a tripod holding a linear variable differential transformer. Dorsal hand veins were pre-constricted with phenylephrine and dose-response curves were constructed after acetylcholine and sodium nitroprusside administration. Maximum vasodilator response to acetylcholine, a marker of endothelium-dependent venodilation, was significantly lower (47+/-53% versus 102+/-54%, respectively, p=0.0004) in HF (n=27) patients compared to healthy controls (n=20). No difference in the endothelium-independent venodilator response was observed (p=0.87). Maximum vasodilator response to acetylcholine was also significantly lower on admission compared to the response immediately before hospital discharge in patients with acute decompensated HF (p<0.01). Improvement in venous endothelial function paralleled weight loss (mean difference of -3.8 kg, p<0.01) and improvement in the 6-minute walk test (mean difference of 107 m, p<0.01). There was no significant change in angiotensin-converting enzyme inhibitor or beta-blocker use during hospital stay., Conclusions: HF patients experience marked endothelium-dependent venous dysfunction with partial recovery during in-hospital management.

This study was carried out to assess patients' knowledge on anticoagulant therapy in an outpatient clinic. A questionnaire with ten questions with closed answers was applied. Correct answers to about 80% of the questions were considered satisfactory. Out of the 120 evaluated patients, 77 (64.1%) showed satisfactory knowledge, with an average of 7.8 +/- 1.7 correct answers. As to the International Normalized Ratio (INR), 69.4% of the sample was beyond therapeutic range, and 42.5% had hemorrhages in the last 6 months. Factors such as education level, income, hemorrhagic event, anticoagulation time, and gender did not show statistically significant difference. There is an obvious need for a systematic follow-up by health care professionals, using educational measures, to detect the difficulties faced by patients, maintaining an optimal INR.

With the objective of estimating the time elapsed between the beginning of the signs and symptoms of a heart attack until the arrival at the cardiology emergency service (Delta T) and the factors that influence in this process, 112 patients were studied, with an infarction diagnosis with supraunleveling ST segment. The delta T was on average of 3h59+/-2h55min; 99(88%) of those patients sought out an emergency service within 1h after the beginning of the event. Unmarried patients presented a delta T smaller in relation to the others (P=0,006), as well as those that recognized the symptoms as a heart event; thoracic pain with burning symptoms, were described by 25 (24%) of patients, and the first attitude taken, in view those symptoms, was self-medication 37(33%). The recognition of the signs and symptoms of Acute Myocardium Infarction, is a decisive factor for the seeking of a specialized service.

Objective: To identify factors that delay the onset of thrombolysis in patients with acute myocardial infarction (AMI)., Methods: A cohort study was carried out with 146 patients, each diagnosed with AMI and subjected to thrombolytic therapy. The data was extracted from medical records between January 2002 and December 2004., Results: The average age of the studied population was 57.5 +/- 9 years, 64.4% were male. The average time between the onset of pain and arrival at the hospital was 254.7 +/- 126.6 minutes, 28.1% used an ambulance for the trip to the hospital, the door-to-electrocardiogram time averaged 19.4 +/- 7.3 minutes and the door-to-needle time was 51.1 +/- 14.9 minutes. There was no significant difference between the time of arrival to the hospital and the method of transportation used (P= 0.81), and those seen by cardiologists and during the nightshift had a reduction in the door-to-needle time, respectively (P=0.014) and (P=0.034)., Conclusions: Study results show that the delay in the search for medical service, and the long time taken from door-to-electrocardiogram and to reach the AMI diagnosis were the factors involved in the delay of thrombolytic treatment.