-
Revista Da Escola de Enfermagem Da U S P 2024To understand the experience of nurses working in pediatric units in the face of innovations and changes in the process of caring for children and families during the...
OBJECTIVE
To understand the experience of nurses working in pediatric units in the face of innovations and changes in the process of caring for children and families during the COVID-19 pandemic. Also, the objective is to understand the typical experience of nurses in this care.
METHOD
Qualitative research, which involved the participation of 16 nurses from pediatric units of a public teaching hospital. The data were analyzed according to the theoretical-methodological framework of Alfred Schütz's social phenomenology.
RESULTS
The participants' reports generated the categories: the challenge of experiencing changes amid fear, the team's adaptation to innovations and changes caused by the COVID-19 pandemic and the expectation for care and the work process.
CONCLUSION
The understanding of the nurses' experience highlighted changes, team adaptations and expectations for the care of children and families, which, although permeated by learning, were experienced by ethical dilemmas and moral suffering for these professionals.
Topics: COVID-19; Humans; Child; Pediatric Nursing; Qualitative Research; Female; Adult; Male; Pandemics; Family; Nursing Staff, Hospital
PubMed: 38949511
DOI: 10.1590/1980-220X-reeusp-2023-0355en -
Implementation of the São Paulo Nursing Courses Consortium for the Progress Test: experience report.Revista Da Escola de Enfermagem Da U S P 2024To report the experience of implementing the São Paulo Nursing Courses Consortium for the Progress Test.
OBJECTIVE
To report the experience of implementing the São Paulo Nursing Courses Consortium for the Progress Test.
METHOD
This is an experience report of the consortium's work in Progress Test preparation and application for Public Schools of Nursing in São Paulo in 2019, 2021 and 2022, with a descriptive analysis of the work process and the results obtained.
RESULTS
The consortium's activities are structured into the following stages: planning; theme review; distributing and requesting questions; professor training; question elaboration; question reception; question selection; question validation; student registration; test application; analysis and dissemination of results. A total of 57.3% of enrolled students participated. There was a predominance of questions of medium difficulty and a gradual progression in the level of discrimination of the questions, with, in 2022, 82.5% being considered adequate.
FINAL CONSIDERATIONS
The consortium has allowed the test to be applied interinstitutionally, with greater scope, accuracy, and quality of questions. Through this experience, it is expected to encourage progress testing in undergraduate nursing courses in other contexts.
Topics: Brazil; Humans; Students, Nursing; Educational Measurement; Education, Nursing, Baccalaureate; Education, Nursing; Schools, Nursing
PubMed: 38949510
DOI: 10.1590/1980-220X-REEUSP-2023-0347en -
Molecular Imaging and Radionuclide... Jun 2024To evaluate the relationships between volumetric Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) parameters,...
OBJECTIVES
To evaluate the relationships between volumetric Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) parameters, Gleason score (GS), prostate-specific antigen (PSA) levels, histopathological data, and metastatic status in newly diagnosed prostate cancer (PCa) patients and to assess the predictive factors for progression despite treatment.
METHODS
A total of 78 newly diagnosed patients with PCa who had Ga-PSMA PET/CT scans were included. Clinical parameters, histopathological data, and metastatic status were documented, and volumetric parameters of primary prostate lesions were measured. All obtained data were compared statistically.
RESULTS
Primary prostate tumor maximum standardized uptake value (SUV) and GS were significantly related to serum PSA levels (p<0.05). PSA levels and SUV values were significantly higher in patients with lymph node metastases than in those without. GS was found to be significantly increased in metastatic patients. PSMA-derived tumor volume (PSMA-TV) and total lesion PSMA of the primary lesion had a significant relationship with PSA value, GS, and regional lymph node metastases. Receiver operating characteristic analysis, conducted in patients with metastatic and localized disease, identified the cutoff value for SUV as 10.85. According to the results of the logistic regression analysis, PSMA-TV was found to be a predictive factor for progression despite treatment.
CONCLUSION
Ga-PSMA PET/CT remains an invaluable imaging modality that should be considered first in PCa staging because of its superior compatibility with clinical and histopathologic data. The importance of this method goes beyond diagnostic accuracy; it also extends into the predictive domain, where the PSMA-TV value of primary prostate lesions is a potential predictor of treatment efficacy. This information is valuable for personalizing patient treatment, improving prognostic accuracy, and predicting clinical outcomes.
PubMed: 38949389
DOI: 10.4274/mirt.galenos.2024.56933 -
International Maritime Health 2024In confined waters, ships run a high risk of groundings, contact, sinkings and near misses. In such waters the maritime traffic is dense, the waterway is narrow, the...
BACKGROUND
In confined waters, ships run a high risk of groundings, contact, sinkings and near misses. In such waters the maritime traffic is dense, the waterway is narrow, the depth is limited, and tides and currents are constantly changing.
MATERIALS AND METHODS
From 2009-2019, 75 accidents were investigated in the estuary of the Seine. Weather conditions and perceived fatigue were studied. From May to June 2020, 114 seafarers, 34 pilots and 80 captains, responded to a questionnaire focusing on the use of Pilot Portable Units (PPU) and Electronic Chart Display Information Systems (ECDIS).
RESULTS
The 75 accidents corresponded to an average of 6.8 ± 3.2 accidents per year. Groundings were the most frequent accidents (35%, n = 26) followed by contact accidents with the quayside (25%, n = 19), between ships or tugs while manoeuvring (8%, n = 6) or while sailing (1%, n = 1). There was no loss of vessels nor fatalities of crew members. In poor weather conditions, there were 76% more accidents than in normal conditions (4.4 ± 2.5 accidents/10,000 movements versus 2.5 ± 1.9 accidents/10,000 movements, p < 0.03). Almost all the accidents (96%) were related to human errors of judgment (81%), or negligence (53%), or both (39). Perceived fatigue was probably in cause in 6 accidents. Only 3 accidents were related to mechanical causes. Through the questionnaires, 69% of the pilots complained of difficulties in mastering the devices and software. They felt distracted by alarms which affected their attention while navigating. They requested training on a simulator. Concerning ship captains, 83% felt comfortable with ECDIS devices yet only 20% were able to configure the ECDIS correctly.
CONCLUSIONS
In the Seine estuary, 75 accidents occurred within the 11 year-study. Risk factors were poor weather conditions and human error. PPU and ECDIS were considered as useful tools in the prevention of accidents. However, pilots and captains requested more thorough training in their use.
Topics: Humans; Ships; Accidents, Occupational; France; Adult; Surveys and Questionnaires; Weather; Male; Estuaries; Pilots; Naval Medicine; Fatigue; Female; Middle Aged
PubMed: 38949220
DOI: 10.5603/imh.99407 -
International Maritime Health 2024Saturation diving is a standard method of intervention for commercial diving during offshore operations. Current saturation procedures achieve a high level of safety...
BACKGROUND
Saturation diving is a standard method of intervention for commercial diving during offshore operations. Current saturation procedures achieve a high level of safety with regards to decompression sickness but still put the divers under multiple stressors: 1) Environmental stress (long confinement, heat/cold, dense gases, high oxygen levels), 2) Work stress (muscular fatigue, psychological pressure, breathing equipment, etc.), 3) venous gas emboli associated with decompression, 4) Inflammation related to oxidative stress and microparticles. We present the results of a saturation divers monitoring campaign performed in the North Sea Danish sector, on the Tyra field, during 2022. The study was supported by TotalEnergies, the field operator, and performed by Boskalis Subsea Services, the diving contractor, onboard the diving support vessel Boka Atlantis. The objective was twofold: document the level of diving stress during saturation operations in the Danish sector, and compare the performances of two saturation procedures, the Boskalis and the NORSOK procedures.
MATERIALS AND METHODS
Fourteen divers volunteered for the study. The monitoring package include weight and temperature measurements, psychomotor tests (objective evaluation) and questionnaires (subjective evaluation), Doppler bubble detection and bioimpedance. The results were presented in a radar diagram that provides a general view of the situation.
RESULTS
The data were analysed along 3 dimensions: work and environmental, desaturation bubbles, oxidative stress and inflammation. The results showed little or no variations from the reference values. No bubbles were detected after excursion dives and the final decompression, except for two divers with a grade 1 after arriving at surface. No statistical difference could be found between the Boskalis and the NORSOK saturation procedures.
CONCLUSIONS
At a depth of 40-50 msw corresponding to the Danish sector, the two saturation procedures monitored induce no or little stress to the divers. The divers know how to manage their diet, equilibrate their hydration and pace their effort. Data available on divers' post saturation period show a recovery over the 24-48 hours following the end of the decompression. Further research should focus on diving deeper than 100 msw where a greater stress can be anticipated.
Topics: Humans; Diving; Decompression Sickness; North Sea; Adult; Male; Oxygen Saturation; Middle Aged; Stress, Physiological; Denmark; Monitoring, Physiologic
PubMed: 38949219
DOI: 10.5603/imh.99606 -
International Maritime Health 2024The World Health Organization (WHO) reported an estimated 249 million malaria cases globally in 2023, of which 94% were reported from Africa. Tanzania, a Sub-Saharan...
BACKGROUND
The World Health Organization (WHO) reported an estimated 249 million malaria cases globally in 2023, of which 94% were reported from Africa. Tanzania, a Sub-Saharan African country, has an exceptionally high malaria prevalence (3.6 million in 2023). The aim of the present study was to assess malaria prevalence rates in the Arusha Region, northern Tanzania. This region is famous for its national parks and wildlife reserves, and it is visited by thousands of tourists from all over the world each year. The assessment of malaria prevalence in the region is important in the context of the necessity to administer antimalarial chemoprophylaxis to international travellers.
MATERIAL AND METHODS
The study group consisted of 101 people, residents of the Karatu District in the Arusha Region, aged between 1 and 73 years, who volunteered to participate in the screening. Phase I of the study was conducted in July 2022 in the Karatu Lutheran Hospital in Karatu Town (located close to the Ngorongoro Conservation Area and the Serengeti National Park). During this phase a venous blood sample was collected from each patient. The samples were tested for malaria using a rapid diagnostic test (mRDT); the same samples were also used to measure haemoglobin concentration and next they were applied onto the Whatman FTA micro cards for further molecular diagnostics in Poland (phase II).
RESULTS
mRDT detected two (2.0%) infections caused by Plasmodium (the etiological factor of malaria), the molecular tests (RT-PCR) confirmed the two positive results by mRDT but also detected infections in six other samples (7.9% in total). The study found that six patients were infected with the Plasmodium falciparum species, while two other subjects had co-infections (P. falciparum + P. ovale, P. falciparum + P. vivax + P. malariae).
CONCLUSIONS
The study findings confirm the prevalence of malaria in areas located close to national parks in northern Tanzania and support the use of antimalarial chemoprophylaxis in international travellers visiting the area. The present study found co-infections caused by four different species of Plasmodium species which supports the prevalence of different parasitic species in Sub-Saharan Africa and is in line with CDC reports but contrary to WHO reports which estimate that 100% of malaria cases in Sub-Saharan Africa are caused by P. falciparum.
Topics: Humans; Tanzania; Prevalence; Adult; Middle Aged; Adolescent; Male; Female; Child; Aged; Young Adult; Child, Preschool; Malaria; Infant; Antimalarials
PubMed: 38949218
DOI: 10.5603/imh.100440 -
International Maritime Health 2024This study investigates seafarers' loneliness as a mediating variable between psychological well-being and resilience, and tests resilience as a mediating variable...
BACKGROUND
This study investigates seafarers' loneliness as a mediating variable between psychological well-being and resilience, and tests resilience as a mediating variable between psychological well-being and loneliness. It also examines the challenges faced by seafarers on different types of ships and evaluates the mediating roles of resilience and loneliness.
MATERIALS AND METHODS
The research uses descriptive data analysis, reliability analysis, correlation analysis, and mediation analysis with bootstrap-based regression models. An online survey was conducted with 471 active Turkish seafarers using a sociodemographic questionnaire and three standardized scales measuring psychological well-being (PW), loneliness at work (LAW), and psychological resilience (PR). Data were collected between 01/07/2023 and 01/09/2023.
RESULTS
The findings indicate that ship type is a significant factor in the mediating roles of loneliness at work and psychological resilience. There is a partial mediating role of loneliness at work and resilience in psychological well-being across different ship types. Specifically, loneliness at work partially mediates the relationship between psychological resilience and psychological well-being among seafarers on tanker or bulk carrier vessels, but not on container vessels.
CONCLUSIONS
The study concludes with suggestions to address the mental health challenges faced by seafarers, emphasizing the importance of ship type in the mediating roles of loneliness and resilience. Regarding the mediating role of loneliness at work, it has been determined that there is partial mediation between psychological resilience and psychological well-being among seafarers working on tanker or bulk carrier vessels. However, on container vessels, loneliness at work does not mediate the relationship between psychological well-being and psychological resilience. Based on these findings, the authors conclude by offering a range of helpful solutions to address this problem.
Topics: Humans; Loneliness; Resilience, Psychological; Adult; Male; Ships; Female; Middle Aged; Naval Medicine; Surveys and Questionnaires; Mental Health; Turkey; Young Adult; Psychological Well-Being
PubMed: 38949217
DOI: 10.5603/imh.98445 -
International Maritime Health 2024In a working environment that is predominantly male, very tough physically, with a difficult working environment, occupational exposures and working, verbal and physical... (Observational Study)
Observational Study
BACKGROUND
In a working environment that is predominantly male, very tough physically, with a difficult working environment, occupational exposures and working, verbal and physical aggression can be more frequent than in other sectors. Fishing, merchant shipping and yachting are all sectors where fitness to sail is reassessed every year by doctors in the Seafarers' Health Service. Seafarers are increasingly reporting insulting, violent or sexist behaviour. The main types of abuse seen on board can be verbal and/or physical aggression, humiliation, whether in private or in front of others. Sexual harassment of women is a very worrying subject.
MATERIALS AND METHODS
It was a retrospective observational study which is part of the professional monitoring of seafarers. The target population was adult seafarers coming for a fitness to sail visit. The group was recruited from seafarers aged over 18 who were being monitored by one of the seafarers' health services (or local centres). The inclusion period was 4 months between January and April 2023. All the information was collected using a self-questionnaire developed from the questionnaires of the Surveillance Médicale des Expositions des Salariés au Risques Professionnels (SUMER) for health status, job satisfaction and the European mini-module, verbal and physical aggression and psychological violence at work (based on the Leymann questionnaire), sexual violence and aggression based on the sexual harassment questionnaire and the PCLS-5 scale validated and translated into French to assess post-traumatic stress. The population studied was therefore 788 sailors.
RESULTS
The study population was predominantly male (82.3%). The average age was 41.4 years (standard deviation = 11.7). 46.7% of seafarers estimate being in very good health. During the past 12 months, overall, 24.5% of seafarers disclaimed having been victim in work-related context of a verbal aggression, with a significant difference according to the gender (21.1% for men and 41.0% for women). During the last 12 months, overall, 3.2% of seafarers have been victim in work-related context of a physical aggression (2.6% for men and 5.8% for women, NS), whereas 10.9% of seafarers reported hostile behaviour at present. Twenty per cent of seafarers reported sexual harassment in the last 12 months. During the entire working life of seafarers, 65.5% of women and 38.2% of men reported sexual harassment, and 38.8% of seafarers stated that they had experienced at least one traumatic event in the last 12 months.
DISCUSSION
A quarter of seafarers say they have been the victim of verbal or physical aggression at work in the last twelve months. These figures are high, and higher than those of the global survey on violence and harassment at work carried out by the International Labour Organization. One of the most alarming results of our study is the overexposure of women working in the maritime industry to the risk of physical, verbal or sexual assault of any kind. Indeed, in all the questions concerning the experience of verbal and physical aggression, the number of women victims is twice as high as that of their male colleagues, and this difference is statistically significant. As far as prevention is concerned, it seems that an effort is needed in terms of information, since only one seafarer in two knows the procedure to follow in the event of aggression within their shipyard. Communication between shipowners and seafarers needs to be stepped up to ensure that everyone is familiar with the procedures.
Topics: Humans; Adult; Sexual Harassment; Female; Male; France; Aggression; Retrospective Studies; Middle Aged; Naval Medicine; Surveys and Questionnaires; Workplace Violence; Ships
PubMed: 38949216
DOI: 10.5603/imh.99382 -
Cancer Medicine Jul 2024Distress during SARS-CoV-2 outbreak affected also cancer patients' well-being. Aim of this study was to investigate patient' reactions and behavior (flexible-adaptive...
The emotional states and associated behavioral responses (flexible-adaptive behaviors vs. inflexible-maladaptive behaviors) of cancer patients during the SARS-CoV-2 outbreak: A multi-center cross-sectional study in Italy.
OBJECTIVE
Distress during SARS-CoV-2 outbreak affected also cancer patients' well-being. Aim of this study was to investigate patient' reactions and behavior (flexible-adaptive vs. inflexible-maladaptive) during the SARS-CoV-2 outbreak.
METHODS
A cross-sectional survey was designed with a self-report questionnaire, "the ImpACT questionnaire," developed for the study. Regression analysis was performed on data.
RESULTS
Four hundred and forty five cancer patients from 17 Italian regions participated in the study. 79.8% of participants were female (mean age of 58 years). 92.6% of participants reported feeling vulnerable to COVID-19 contagion; 75.6% reported helpless, 62.7% sad, 60.4% anxious, and 52.0% anger. Avoidance of thinking about coronavirus is the principal maladaptive behavior that emerged. Participants who reported feeling anxious were more likely to have fear of staff being infected with COVID-19 (OR = 3.01; 95% CI = 1.49-6.30) and to have disrupted sleep due to worry (OR = 2.42; 95% CI = 1.23-4.83). Younger participants reported more anxiety (OR = 0.97; 95% CI = 0.94-1.00); men reported feeling calm more than women (OR = 2.60; 95% CI = 1.27-5.43).
CONCLUSIONS
Majority of cancer patients reported serious concerns regarding SARS-CoV-2 infection; reliable information and psychological support must be offers to respond to these needs.
Topics: Humans; COVID-19; Female; Male; Cross-Sectional Studies; Middle Aged; Italy; Neoplasms; SARS-CoV-2; Aged; Anxiety; Adaptation, Psychological; Emotions; Surveys and Questionnaires; Adult; Fear
PubMed: 38949180
DOI: 10.1002/cam4.7442 -
Cancer Medicine Jul 2024The current guidelines for managing screen-detected pulmonary nodules offer rule-based recommendations for immediate diagnostic work-up or follow-up at intervals of 3,...
BACKGROUND
The current guidelines for managing screen-detected pulmonary nodules offer rule-based recommendations for immediate diagnostic work-up or follow-up at intervals of 3, 6, or 12 months. Customized visit plans are lacking.
PURPOSE
To develop individualized screening schedules using reinforcement learning (RL) and evaluate the effectiveness of RL-based policy models.
METHODS
Using a nested case-control design, we retrospectively identified 308 patients with cancer who had positive screening results in at least two screening rounds in the National Lung Screening Trial. We established a control group that included cancer-free patients with nodules, matched (1:1) according to the year of cancer diagnosis. By generating 10,164 sequence decision episodes, we trained RL-based policy models, incorporating nodule diameter alone, combined with nodule appearance (attenuation and margin) and/or patient information (age, sex, smoking status, pack-years, and family history). We calculated rates of misdiagnosis, missed diagnosis, and delayed diagnosis, and compared the performance of RL-based policy models with rule-based follow-up protocols (National Comprehensive Cancer Network guideline; China Guideline for the Screening and Early Detection of Lung Cancer).
RESULTS
We identified significant interactions between certain variables (e.g., nodule shape and patient smoking pack-years, beyond those considered in guideline protocols) and the selection of follow-up testing intervals, thereby impacting the quality of the decision sequence. In validation, one RL-based policy model achieved rates of 12.3% for misdiagnosis, 9.7% for missed diagnosis, and 11.7% for delayed diagnosis. Compared with the two rule-based protocols, the three best-performing RL-based policy models consistently demonstrated optimal performance for specific patient subgroups based on disease characteristics (benign or malignant), nodule phenotypes (size, shape, and attenuation), and individual attributes.
CONCLUSIONS
This study highlights the potential of using an RL-based approach that is both clinically interpretable and performance-robust to develop personalized lung cancer screening schedules. Our findings present opportunities for enhancing the current cancer screening system.
Topics: Humans; Lung Neoplasms; Male; Female; Early Detection of Cancer; Middle Aged; Case-Control Studies; Aged; Retrospective Studies; Tomography, X-Ray Computed; Reinforcement, Psychology; Precision Medicine
PubMed: 38949177
DOI: 10.1002/cam4.7436