Sleep, Fatigue, and Inflammatory Biomarkers in Older Adults with Chronic Venous Leg Ulcers Receiving Intensive Outpatient Wound Care.

Objective: Chronic venous ulcers are a relatively common and distressing condition that disproportionately affects older individuals. Along with multiple concomitant issues such as wound drainage, pain, and mobility impairments, individuals with chronic venous leg ulcers (CVLUs) commonly report sleep disturbances and fatigue; however, limited research has examined these symptoms in relation to inflammatory biomarkers in this population over the intensive wound care treatment trajectory. This study aimed at describing the symptoms of sleep and fatigue in older adults with CVLUs receiving intensive wound treatment with weekly debridement and exploring the relationships between these symptoms and tumor necrosis factor-alpha (TNF-α), c-reactive protein (CRP), and interleukin (IL)-6. Approach: Demographics, clinical characteristics, Pittsburgh Sleep Quality Index (PSQI) scores, Brief Fatigue Inventory (BFI), TNF-α, CRP, and IL-6 levels were collected from 84 older adults with CVLUs at three time points (baseline, week 4, and week 8). Data analysis included descriptive statistics and Bayesian estimation of associations. Results: Findings showed a consistent pattern of poor sleep quality and mild fatigue among these individuals. Lower IL-6 levels at week 4 and higher CRP levels at week 8 were linked to poor sleep quality. Higher CRP levels were linked to greater fatigue at baseline and week 8. Sleep and fatigue were correlated at all time points. Innovation and Conclusion: This study highlights the importance of clinicians evaluating sleep and fatigue in those with CVLUs. Further research is needed to validate circulating inflammatory biomarkers to enhance our understanding of sleep and fatigue's role in wound healing.

Associação entre variáveis clínicas e demográficas de pacientes internados em unidade de terapia intensiva oncológica e a carga de trabalho de enfermagem / Asociación entre variables clínicas y demográficas de pacientes en unidad de terapia intensiva oncológica y la carga de trabajo de enfermería / Association between Clinical and Demographic Variables in Patients in an Oncology Intensive Care Unit and the Nursing Workload

Introdução: O uso do Nursing Activity Score permite correlacionar a carga de trabalho de enfermagem com os índices de avaliação prognóstica na unidade de terapia intensiva e auxiliar no desenvolvimento do processo de trabalho dos enfermeiros por meio do dimensionamento adequado da equipe. Objetivo: Analisar a associação entre variáveis clínicas e demográficas de pacientes com carga de trabalho de enfermagem em uma Unidade de Terapia Intensiva Oncológica. Métodos: Coorte prospectiva, realizada no Instituto Nacional de Câncer José Alencar Gomes da Silva, no período de setembro a dezembro de 2016. A coleta de dados inclui a mensuração da carga de trabalho por meio do Escore de Atividades de Enfermagem. Foi realizada análise estatística descritiva dos dados. Em seguida, a associação das variáveis qualitativas com o NAS foi testada pelo teste de Kruskal-Wallis e as variáveis quantitativas foram analisadas por análise de regressão múltipla. Para o tratamento dos dados, foram consideradas significância p = 0,05 e 95 porcento de confiança. Resultado: A carga total de trabalho encontrada (79,04 porcento) corresponde a 18 horas e 57 minutos de assistência a cada paciente em 24 horas. A média da condição de saída do paciente é dividida em sobreviventes e não sobreviventes, com uma pontuação de 74,19 porcento (DP = 11,54) e 126,64 porcento (DP = 17,62), respectivamente. Conclusão: Apenas as variáveis status de desempenho de Karnofsky e condição de saída foram significativamente associadas à carga de trabalho(AU)

Introducción: El uso del Puntaje de Actividades de Enfermería permite correlacionar la carga de trabajo de enfermería con los índices de evaluación pronóstica en la unidad de cuidados intensivos y ayuda en el desarrollo del proceso de trabajo de las enfermeras a través del dimensionamiento del personal apropiado. Objetivo: Analizar la asociación entre variables clínicas y demográficas de pacientes con carga de trabajo de enfermería en una Unidad de Cuidados Intensivos de Oncología. Métodos: Estudio de cohorte prospectiva, realizada en Instituto Nacional del Câncer José Alencar Gomes da Silva de septiembre a diciembre de 2016. La recolección de datos incluye la medición de la carga de trabajo a través del Puntaje de Actividades de Enfermería. Se realizó un análisis estadístico descriptivo de los datos. Después, se probó la asociación de variables cualitativas con NAS mediante la prueba de Kruskal-Wallis y se analizaron las variables cuantitativas mediante análisis de regresión múltiple. Para el tratamiento de los datos, se consideró una significancia p = 0,05 y un 95 por ciento de confianza. Resultado: La carga de trabajo total encontrada (79,04 por ciento) corresponde a 18 horas y 57 minutos de asistencia a cada paciente dentro de las 24 horas. La media para la condición de salida de los pacientes se divide en sobrevivientes y no sobrevivientes, con un puntaje de 74,19 por ciento (SD = 11,54) y 126,64 por ciento (SD = 17,62), respectivamente. Conclusión: Solo las variables de estado de rendimiento de Karnofsky y la condición de salida se asociaron significativamente con la carga de trabajo(AU)

Introduction: The use of the Nursing Activity Score (NAS) makes it possible to correlate the nursing workload with prognostic evaluation indices in the intensive care unit and helps in the development of the nurses' work process through the sizing of the appropriate personnel. Objective: To analyze the association between clinical and demographic variables about patients with a nursing workload in an oncology intensive care unit. Methods: Prospective cohort study carried out at José Alencar Gomes da Silva National Cancer Institute, from September to December 2016. The data collection includes the measurement of the workload through the Nursing Activities Score. A descriptive statistical analysis of the data was performed. Afterwards, the association between qualitative variables and the NAS was tested using the Kruskal-Wallis test and the quantitative variables were analyzed using multiple regression analysis. For data treatment, significance was considered (P = 0.05; confidence interval 95 percent). Result: The total workload found (79.04 percent) corresponds to 18 hours and 57 minutes of assistance to each patient within 24 hours. The mean for the discharge condition of the patients is divided into survivors and non-survivors, with a score of 74.19 percent (SD=11.54) and 126.64 percent (SD=17.62), respectively. Conclusion: Only Karnofsky performance state variables and discharge condition were significantly associated with workload(AU)

Medication Errors in the Context of Hematopoietic Stem Cell Transplantation: A Systematic Review.

BACKGROUND: There have been numerous efforts by health institutions and professionals to prevent and reduce medication errors. OBJECTIVES: The aim of this study was to identify in the literature the incidence, related factors, consequences, and prevention mechanisms of medication errors in the context of hematopoietic stem cell transplantation. METHODS: This is a systematic review carried out in the databases LILACS, PubMed, PMC, EMBASE, and CINAHL databases, from January 11 to 13, 2017. RESULTS: Eleven studies were included in this review and presented in 4 categories of analysis. (1) occurrence-most of the medication errors were related to administration and prescription; (2) related factors-multicausal, highlighting issues including polypharmacy, lack of double checking, and similarity between the medications' names; (3) consequences-the main ones were associated with adverse reactions, with prolonged hospitalization time as outcome; (4) preventive measures-related to safe practices in pharmacotherapy, such as double check and application of the 10 rights of medication administration. CONCLUSION: Medication administration is an activity of great responsibility for nursing; however, in order to achieve a decrease in medication errors, prevention strategies are necessary for the whole health team. IMPLICATIONS FOR PRACTICE: Practice improvements are needed including establishing institutional drug administration protocols and keeping them updated, using a computerized prescription system, and promoting patient safety with staff.