ABSTRACT BACKGROUND: Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES: To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING: Cohort study conducted at a national reference center for lung transplantation. METHODS: Medical charts were reviewed regarding patients’ demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS: Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. CONCLUSIONS: LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.

Objetivo: To know the factors that influence the improvement of obstetric nurse care in the delivery process. Methods: Qualitative, descriptive exploratory study conducted at a maternity school located in the city of Salvador, Bahia, Brazil with 20 obstetric nurses from the Obstetric Center. Data collection took place through interviews, guided by a semi-structured form between the months of June and September 2017. The data were subjected to the Categorical Thematic Content Analysis proposed by Franco. Results: Six categories emerged, which presented factors that collaborate and hinder the care of the obstetric nurse in the delivery process. These address the power and gender relations between health professionals; recognition of the obstetric nurse; physical space and bed occupation; interaction between woman / companion, among others. Final considerations: The factors indicated by obstetric nurses reveal the need for improvements in working conditions by managers and changes in the conduct / behavior of professionals.

Objetivo: Conocer los factores que influyen en la mejora de la atención de la enfermera obstetra en el proceso de parto. Métodos: Estudio exploratorio cualitativo y descriptivo realizado en una escuela de maternidad ubicada en la ciudad de Salvador, Bahía, Brasil, con 20 enfermeras obstetras del Centro de Obstetricia. La recopilación de datos se realizó a través de entrevistas, guiadas por una forma semiestructurada entre los meses de junio y septiembre de 2017. Los datos se presentaron al análisis de contenido temático categórico propuesto por Franco. Resultados: Surgieron seis categorías, que presentaban factores que colaboran y dificultan el cuidado de la enfermera obstétrica en el proceso de parto. Estos abordan el poder y las relaciones de género entre los profesionales de la salud; reconocimiento de la enfermera obstétrica; espacio físico y ocupación de la cama; interacción entre mujer / acompañante, entre otros. Consideraciones finales: Los factores indicados por las enfermeras obstétricas revelan la necesidad de mejoras en las condiciones laborales por parte de los gerentes y los cambios en la conducta / comportamiento de los profesionales.

Objetivo: Conhecer os fatores que influenciam a melhoria do cuidado da enfermeira obstetra no processo de parto. Métodos: Estudo qualitativo, descritivo exploratório realizado em uma maternidade escola localizada no município de Salvador, Bahia, Brasil com 20 enfermeiras obstetras do Centro Obstétrico. A coleta de dados ocorreu por meio de entrevistas, guiadas por formulário semiestruturado entre os meses de junho e setembro de 2017. Os dados foram submetidos à Análise de Conteúdo Temático-Categorial proposta por Franco. Resultados: Emergiram seis categorias, as quais apresentaram fatores que colaboram e dificultam o cuidado da enfermeira obstetra no processo de parto. Estes abordam as relações de poder e gênero entre profissionais de saúde; reconhecimento da enfermeira obstetra; espaço físico e ocupação de leitos; interação entre mulher/acompanhante, dentre outros. Considerações finais: Os fatores sinalizados pelas enfermeiras obstetras revelam a necessidade de melhorias nas condições de trabalho por gestores e mudanças de condutas/comportamentos de profissionais.

RESUMO Objetivo: Conhecer os fatores que influenciam a melhoria do cuidado da enfermeira obstetra no processo de parto. Métodos: Estudo qualitativo, descritivo exploratório realizado em uma maternidade escola localizada no município de Salvador, Bahia, Brasil com 20 enfermeiras obstetras do Centro Obstétrico. A coleta de dados ocorreu por meio de entrevistas, guiadas por formulário semiestruturado entre os meses de junho e setembro de 2017. Os dados foram submetidos à Análise de Conteúdo Temático-Categorial proposta por Franco. Resultados: Emergiram seis categorias, as quais apresentaram fatores que colaboram e dificultam o cuidado da enfermeira obstetra no processo de parto. Estes abordam as relações de poder e gênero entre profissionais de saúde; reconhecimento da enfermeira obstetra; espaço físico e ocupação de leitos; interação entre mulher/acompanhante, dentre outros. Considerações finais: Os fatores sinalizados pelas enfermeiras obstetras revelam a necessidade de melhorias nas condições de trabalho por gestores e mudanças de condutas/comportamentos de profissionais.

ABSTRACT Objective: To identify the factors that influence the improvement of obstetric nurse care in the delivery process. Methods: Descriptive exploratory study with a qualitative approach conducted at a teaching maternity hospital located in the city of Salvador, Bahia, Brazil with 20 obstetric nurses from the Obstetric Center. Data was collected through semi-structured interviews between June and September 2017 and was then subjected to the Thematic-Categorical Content Analysis proposed by Franco. Results: Six categories emerged from the analysis, which presented factors that favor the improvement of obstetric care in the delivery process and factors unfavorable to this care. These factors address power and gender relations among health professionals; recognition of obstetric nurses; physical space and bed occupation; interaction between woman/ companion, among others. Final considerations: The factors indicated by obstetric nurses reveal the need for improvements in the working conditions by managers and changes of behavior and codes of conduct of health professionals.

RESUMEN Objetivo: Conocer los factores que influyen en la mejora de la atención de la enfermera obstetra en el proceso de parto. Métodos: Estudio exploratorio cualitativo y descriptivo realizado en una escuela de maternidad ubicada en la ciudad de Salvador, Bahía, Brasil, con 20 enfermeras obstetras del Centro de Obstetricia. La recopilación de datos se realizó a través de entrevistas, guiadas por una forma semiestructurada entre los meses de junio y septiembre de 2017. Los datos se presentaron al análisis de contenido temático categórico propuesto por Franco. Resultados: Surgieron seis categorías, que presentaban factores que colaboran y dificultan el cuidado de la enfermera obstétrica en el proceso de parto. Estos abordan el poder y las relaciones de género entre los profesionales de la salud; reconocimiento de la enfermera obstétrica; espacio físico y ocupación de la cama; interacción entre mujer / acompañante, entre otros. Consideraciones finales: Los factores indicados por las enfermeras obstétricas revelan la necesidad de mejoras en las condiciones laborales por parte de los gerentes y los cambios en la conducta / comportamiento de los profesionales.

Marco contextual: El ingreso en cuidados intensivos puede causar efectos adversos que conducen a situaciones de incapacidad funcional, que persisten durante mucho tiempo. La rehabilitación temprana puede prevenir o poner límite a estas situaciones. Objetivos: Caracterizar el nivel funcional y las dependencias en el alta de cuidados intensivos y verificar el momento de inicio de las intervenciones de enfermería de rehabilitación. Metodología: Estudio descriptivo/exploratorio, método cuantitativo, en una muestra de 30 pacientes. Resultados: Puntuación media del Medical Research Council de 27 (primera evaluación) y 38 (alta). El valor medio de la Medida de Independencia Funcional en autocuidado, movilidad/transferencia fue 2. La primera intervención de enfermería de rehabilitación ocurrió, de media, en el 10º día, y la primera vez que se levanta después de 13 días. Conclusión: En el momento del alta se observaron niveles altos de dependencia funcional en el autocuidado básico, así como la movilidad/transferencia, por lo que fue necesario mejorar su caracterización para la continuidad de los cuidados de rehabilitación. La movilización de los pacientes en estado crítico debe tener lugar en una fase temprana.

Enquadramento: O internamento em cuidados intensivos pode provocar efeitos adversos que originam situações de incapacidade funcional, que persistem por tempo prolongado. A reabilitação precoce pode impedir ou limitar essas situações. Objetivos: Caracterizar o nível funcional e dependências na alta dos cuidados intensivos e verificar o momento de início das intervenções de enfermagem de reabilitação. Metodologia: Estudo descritivo/exploratório, método quantitativo, numa amostra de 30 doentes. Resultados: Valor médio do Medical Research Council de 27 (primeira avaliação) e de 38 (alta). O valor médio da Medida de Independência Funcional, nos autocuidados, mobilidade/transferências foi de 2. A primeira intervenção de enfermagem de reabilitação ocorreu, em média, ao 10º dia, e o primeiro levante após 13 dias. Conclusão: No momento da alta verificaram-se elevados níveis de dependência funcional no autocuidado básico e mobilidade/transferências, sendo necessário melhorar a sua caraterização para a continuidade de cuidados de reabilitação. A mobilização dos doentes críticos deve acontecer precocemente.

Background: Stays in the intensive care unit can cause adverse effects that lead to situations of functional disability, which persist for a long time. Early rehabilitation can prevent or limit such situations. Objectives: To characterize the functional level and dependencies at discharge from intensive care. To assay the timing for initiating rehabilitation nursing interventions. Methodology: Descriptive/exploratory study, quantitative method, in a sample of 30 patients. Results: Average of Medical Research Council value was 27 (first evaluation) and 38 (at discharge). The mean value of the Functional Independence Measure, in the area of self-care, mobility / transfers was 2. The first intervention of rehabilitation nursing occurred, on average, on the 10th day and the patient got out of bed after 13 days. Conclusion: At discharge, there were high levels of functional dependence at the level of basic self-care and mobility/transfers, and their characterization should be improved for the continuity of rehabilitation care. Early mobilization of critical patients is necessary.

Ozone is an important disinfecting agent, however its influence on enamel adhesion has not yet been clarified. Objective: Evaluate the influence of ozone pretreatment on the shear strength of an etch-and-rinse and a self-etch system to enamel and analyze the respective failure modes. Material and Methods: Sixty sound bovine incisors were used. Specimens were randomly assigned to four experimental groups (n=15): Group G1 (Excite® with ozone) and group G3 (AdheSE® with ozone) were prepared with ozone gas from the HealOzone unit (Kavo®) for 20 s prior to adhesion, and groups G2 (Excite®) and G4 (AdheSE®) were used as control. Teeth were bisected and polished to simulate a smear layer just before the application of the adhesive systems. The adhesives were applied according to the manufacturer's instructions to a standardized 3 mm diameter surface, and a composite (Synergy D6, Coltene Whaledent) cylinder with 2 mm increments was build. Specimens were stored in 100% humidity for 24 h at 37°C and then subjected to a thermal cycling regimen of 500 cycles. Shear bond tests were performed with a Watanabe device in a universal testing machine at 5 mm/min. The failure mode was analyzed under scanning electron microscope. Means and standard deviation of shear bond strength (SBS) were calculated and difference between the groups was analyzed using ANOVA, Kolmogorov-Smirnov, Levene and Bonferroni. Chi-squared statistical tests were used to evaluate the failure modes. Results: Mean bond strength values and failure modes were as follows: G1- 26.85±6.18 MPa (33.3% of adhesive cohesive failure); G2 - 27.95±5.58 MPa (53.8% of adhesive failures between enamel and adhesive); G3 - 15.0±3.84 MPa (77.8% of adhesive failures between enamel and adhesive) and G4 - 13.1±3.68 MPa (36.4% of adhesive failures between enamel and adhesive). Conclusions: Shear bond strength values of both adhesives tested on enamel were not influenced by the previous application of ozone gas.