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BACKGROUND: Surgical wound infection is the most frequent type of care health associated infection. Lack of knowledge about the prevention of surgical wound infection in patients undergoing left ventricular assist device implantation could significantly undermine the potential benefits of surgical intervention. OBJECTIVES: This study aimed to map the recommendations for adult patients undergoing left ventricular assist device implantation. DESIGN: This is a scoping review, being registered in the Open Science Framework under DOI https://doi.org/10.17605/OSF.IO/Q76B3 (https://osf.io/q76b3/). METHOD: Left ventricular assist device coordinators and nurse specialists in dermatology and stomatherapy conducted a scoping review in Scopus, The Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), limited to the period between 2015 and 2022. The results of this scoping review will be discussed and presented in separate articles. This paper will synthesize research evidence on the perioperative topic. RESULTS: The initial searches resulted in 771 studies. Sixty nine met the eligibility criteria and were included in the scoping review. Eight articles addressing the perioperative topic that answered the question of this article were included. CONCLUSION: Although this scoping review included heterogeneous, and scarce studies with left ventricular assist device patients. As such, there are many promising future research directions for this topic. IMPLICATIONS FOR CLINICAL PRACTICE: Infection surveillance should be an integral part of left ventricular assist device implantation programs in health care institutions. Velvet completely buried in subcutaneous tissues reduces transmission system infection. Triple tunnel method reduces transmission system infection risk.
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Coração Auxiliar , Infecção da Ferida Cirúrgica , Adulto , Humanos , Infecção da Ferida Cirúrgica/prevenção & controle , Coração Auxiliar/efeitos adversos , Revisões Sistemáticas como AssuntoRESUMO
OBJECTIVE: to analyze pressure injury (PI) incidence and risk factors in patients with COVID-19 admitted to an Intensive Care Unit and characterize the identified PIs. METHOD: a retrospective cohort study, consisting of 668 patients, carried out between March 2020 and February 2021. Clinical/demographic and PI variables were collected from medical records and electronic database. Data were analyzed using descriptive and inferential statistics. Logistic regression was performed to analyze risk factors for PI. RESULTS: PI incidence was 30.2% (n=202), with the majority located in the sacral region (52.9%) and in stage 1 (39%). Risk factors were age (p<0.001), Diabetes Mellitus (p=0.005), length of stay (p<0.001), immunosuppression (p=0.034), nutritional risk (p=0.015) and mechanical ventilation (p<0.001). CONCLUSION: PI incidence in critically ill patients with COVID-19 was high.
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COVID-19 , Úlcera por Pressão , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/etiologia , Estudos Retrospectivos , Estado Terminal/epidemiologia , Incidência , Fatores de Risco , Unidades de Terapia IntensivaRESUMO
Objetivo: analizar los efectos de las tecnologías educativas en la prevención y tratamiento de la úlcera diabética. Método: revisión sistemática realizada en siete bases de datos, un índice bibliográfico, una biblioteca electrónica y literatura gris. La muestra estuvo compuesta por 11 ensayos clínicos controlados aleatorizados. La síntesis de los resultados fue descriptiva y mediante metaanálisis. Resultados: las tecnologías educativas predominantes fueron la capacitación y la orientación verbal, se destacaron las tecnologías blandas-duras. En comparación con la atención habitual, las tecnologías educativas demostraron ser un factor protector para prevenir la incidencia de úlcera diabética (RR=0,40; IC 95%=0,18-0,90; p=0,03) y la evaluación de certeza de evidencia fue baja. Las tecnologías educativas también demostraron ser un factor protector para prevenir la incidencia de amputación en miembros inferiores (RR=0,53; IC 95%=0,31-0,90; p=0,02) y la certeza de evidencia fue muy baja. Conclusión: tecnologías educativas blandas-duras, como orientación verbal estructurada, juegos educativos, clase expositiva, capacitación teórico-práctica, video educativo, folder, rotafolio educativo y dibujos lúdicos, y tecnologías duras, como calzado terapéutico, plantillas, termómetro infrarrojo digital, kits para el cuidado de los pies, aplicación de telemedicina y teléfono móvil, resultaron efectivas para la prevención y el tratamiento de la úlcera diabética, sin embargo, es necesario que se realicen estudios más robustos.
Objective: to analyze the effects of educational technologies in the prevention and treatment of diabetic ulcers. Method: a systematic review conducted in seven databases, a bibliographic index, an electronic library and the Gray Literature. The sample consisted of 11 randomized controlled clinical trials. The synthesis of the results was descriptive and through meta-analysis. Results: the predominant educational technologies were training sessions and verbal guidelines, with soft-hard technologies standing out. When compared to usual care, the educational technologies presented a protective factor to prevent the incidence of diabetic ulcers (RR=0.40; 95% CI=0.18-0.90; p=0.03) and the certainty of the evidence assessment was low. The educational technologies also had a protective factor to prevent the incidence of lower limb amputations (RR=0.53; 95% CI=0.31-0.90; p=0.02) and certainty of the evidence was very low. Conclusion: soft-hard educational technologies such as structured verbal guidelines, educational games, lectures, theoretical-practical training sessions, educational videos, folders, serial albums and playful drawings, and hard technologies such as therapeutic footwear, insoles, infrared digital thermometer, foot care kits, Telemedicine app and mobile phone use, were effective for the prevention and treatment of diabetic ulcers, although more robust studies are required.
Objetivo: analisar os efeitos das tecnologias educativas na prevenção e tratamento da úlcera diabética. Método: revisão sistemática conduzida em sete bases de dados, um índice bibliográfico, uma biblioteca eletrônica e na literatura cinzenta. A amostra foi constituída de 11 ensaios clínicos controlados randomizados. A síntese dos resultados foi descritiva e por meio de metanálise. Resultados: as tecnologias educativas predominantes foram os treinamentos e as orientações verbais, destacando-se as tecnologias leve-duras. Na comparação com o cuidado usual, as tecnologias educativas apresentaram fator de proteção para prevenção da incidência de úlcera diabética (RR=0,40; IC 95%=0,18-0,90; p=0,03) e a avaliação de certeza da evidência foi baixa. As tecnologias educativas também tiveram fator de proteção para prevenção da incidência de amputação em membros inferiores (RR=0,53; IC 95%=0,31-0,90; p=0,02) e a certeza da evidência foi muito baixa. Conclusão: as tecnologias educativas leve-duras, como orientações verbais estruturadas, jogos educativos, aula expositiva, treinamentos teórico-práticos, vídeo educativo, folder, álbum seriado e desenhos lúdicos, e as tecnologias duras, a exemplo do calçado terapêutico, palmilhas, termômetro digital de infravermelho, kits de cuidados com os pés, aplicativo de telemedicina e telefone móvel, foram efetivas para prevenção e tratamento da úlcera diabética, porém, estudos mais robustos são necessários.
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Humanos , Pé Diabético/terapia , Tecnologia Educacional , Filme e Vídeo Educativo , Complicações do Diabetes , Diabetes Mellitus/terapiaRESUMO
OBJECTIVE: to analyze the effects of educational technologies in the prevention and treatment of diabetic ulcers. METHOD: a systematic review conducted in seven databases, a bibliographic index, an electronic library and the Gray Literature. The sample consisted of 11 randomized controlled clinical trials. The synthesis of the results was descriptive and through meta-analysis. RESULTS: the predominant educational technologies were training sessions and verbal guidelines, with soft-hard technologies standing out. When compared to usual care, the educational technologies presented a protective factor to prevent the incidence of diabetic ulcers (RR=0.40; 95% CI=0.18-0.90; p=0.03) and the certainty of the evidence assessment was low. The educational technologies also had a protective factor to prevent the incidence of lower limb amputations (RR=0.53; 95% CI=0.31-0.90; p=0.02) and certainty of the evidence was very low. CONCLUSION: soft-hard educational technologies such as structured verbal guidelines, educational games, lectures, theoretical-practical training sessions, educational videos, folders, serial albums and playful drawings, and hard technologies such as therapeutic footwear, insoles, infrared digital thermometer, foot care kits, Telemedicine app and mobile phone use, were effective for the prevention and treatment of diabetic ulcers, although more robust studies are required.
Assuntos
Diabetes Mellitus , Dermatopatias , Humanos , Úlcera , Tecnologia Educacional , Escolaridade , TecnologiaRESUMO
ABSTRACT Objective: to analyze pressure injury (PI) incidence and risk factors in patients with COVID-19 admitted to an Intensive Care Unit and characterize the identified PIs. Method: a retrospective cohort study, consisting of 668 patients, carried out between March 2020 and February 2021. Clinical/demographic and PI variables were collected from medical records and electronic database. Data were analyzed using descriptive and inferential statistics. Logistic regression was performed to analyze risk factors for PI. Results: PI incidence was 30.2% (n=202), with the majority located in the sacral region (52.9%) and in stage 1 (39%). Risk factors were age (p<0.001), Diabetes Mellitus (p=0.005), length of stay (p<0.001), immunosuppression (p=0.034), nutritional risk (p=0.015) and mechanical ventilation (p<0.001). Conclusion: PI incidence in critically ill patients with COVID-19 was high.
RESUMEN Objetivo: analizar la incidencia y factores de riesgo de lesiones por presión (LP) en pacientes con COVID-19 ingresados en Unidad de Cuidados Intensivos y caracterizar las LP identificadas. Método: estudio de cohorte retrospectivo, compuesto por 668 pacientes, realizado entre marzo de 2020 y febrero de 2021. Las variables clínico/demográficas y de LP se recogieron de historias clínicas y bases de datos electrónicas. Los datos fueron analizados mediante estadística descriptiva e inferencial. Se realizó una regresión logística para analizar los factores de riesgo de LP. Resultados: la incidencia de LP fue del 30,2% (n=202), localizándose la mayoría en la región sacra (52,9%) y en estadio 1 (39%). Los factores de riesgo fueron edad (p<0,001), Diabetes Mellitus (p=0,005), tiempo de estancia hospitalaria (p<0,001), inmunosupresión (p=0,034), riesgo nutricional (p=0,015) y ventilación mecánica (p<0,001). Conclusión: la incidencia de LP en pacientes críticos con COVID-19 fue alta.
RESUMO Objetivo: analisar a incidência e os fatores de risco de lesão por pressão (LP) em pacientes com COVID-19 internados em Unidade de Terapia Intensiva e caracterizar as LP identificadas. Método: estudo de coorte retrospectivo, constituído por 668 pacientes, realizado entre março de 2020 e fevereiro de 2021. Variáveis clínicas/demográficas e das LP foram coletadas dos prontuários e banco de dados eletrônico. Os dados foram analisados por meio de estatística descritiva e inferencial. A regressão logística foi realizada para análise dos fatores de risco para LP. Resultados: a incidência de LP foi de 30,2% (n=202), sendo a maioria localizada na região sacral (52,9%) e em estágio 1 (39%). Os fatores de risco foram idade (p<0,001), Diabetes Mellitus (p=0,005), tempo de internação (p<0,001), imunossupressão (p=0,034), risco nutricional (p=0,015) e ventilação mecânica (p<0,001). Conclusão: a incidência de LP em pacientes críticos com COVID-19 foi alta.
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INTRODUCTION: Hospitalized cancer patients experience limitations in their daily activities resulting from the severity of their condition. Such changes alter patients' sensory perception and hinder their mobility, thus predisposing them to the development of PI. OBJECTIVE: The goal of this study was to analyze the prevalence of PI and associated factors in hospitalized cancer patients. MATERIALS AND METHODS: This observational, epidemiological, cross-sectional, descriptive study was carried out in the inpatient and ICU settings of an oncological hospital in São Paulo, Brazil. RESULTS: A total of 341 patients who met the inclusion criteria and agreed to participate in the study were interviewed and assessed. Data obtained in the interviews were analyzed for logistic regression analysis. Pressure injury prevalence was 10% (34 patients). The use of disposable diapers was significantly associated with the development of PI, with a 6.077 increased chance of PI in such patients in the ICU setting. In this epidemiologic study of 341 hospitalized cancer patients, the prevalence of PI was 10%. The use of disposable diapers was the only factor associated with the presence of PI after logistic regression analysis. CONCLUSION: Knowing the risk factors of this specific population was essential to implement actions and optimize indications of disposable diaper use. There is an absence of epidemiologic records due to limited publications available on the subject; creating a program to prevent PI development within the inpatient, assisted population.
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Neoplasias , Úlcera por Pressão , Adulto , Humanos , Brasil/epidemiologia , Estudos Transversais , Neoplasias/epidemiologia , Prevalência , Úlcera por Pressão/epidemiologiaRESUMO
OBJECTIVE: To assess the prevalence of skin lesions and evaluate the clinical and sociodemographic factors associated with their presence in hospitalised patients. METHOD: This descriptive, cross-sectional, correlational study was performed in inpatient units and intensive care units of a cancer hospital in São Paulo, Brazil, after approval by the Institutional Research Ethics Committee. Data from hospitalised adult patients with cancer were collected during physical examinations and from medical records. A Chi-squared test, univariate analysis, a logistic regression model with results expressed as odds ratio (OR) and 95% confidence intervals (CI), and Classification and Regression Tree (CART) analysis were used to evaluate the data. RESULTS: Of 341 patients, 80 had skin lesions, equating to an overall prevalence of 23.5%. The skin lesions included pressure injuries (10%), incontinence-associated dermatitis (6.7%), skin tears (6.5%), malignant wounds (3.8%) and complicated surgical wounds (3.2%). The factors associated with skin lesions in cancer patients were the use of disposable nappies (OR: 4.436) and age (59.1±15.1 years), according to the CART analysis, and the wearing of nappies (OR: 4.466, p<0.001), presence of ecchymosis (OR: 2.532, p<0.001) and infection (OR: 6.449, p=0.040), according to multiple regression analysis. CONCLUSION: This study contributed to knowledge about prevalence and associated factors of skin lesions in hospitalised patients with cancer, allowing the implementation of preventive measures.
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Neoplasias , Dermatopatias , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Prevalência , Dermatopatias/epidemiologiaRESUMO
OBJECTIVE: To estimate the prevalence of complicated surgical wounds and its related factors in hospitalized adults. METHOD: In this cross-sectional study, information from 251 patients hospitalized in seven public hospitals in Manaus, Brazil, and at risk of suffering surgical site complications after undergoing surgery was analyzed. Data were collected via interviews, physical examinations, and a medical record review from March to June 2015. Prevalence rate was estimated as the ratio between individuals with complications and patients at risk. To explore associated variables, individuals with and without complications were compared via 5% significant logistic regression and bivariate analyses. This study was approved by a research ethics committee. RESULTS: Overall, 15 patients (6%) showed complicated surgical wounds. General hospitalization (p < 0.003), presence of ecchymosis, (p < 0.001), and men (p = 0.047) increased patients' probability of developing complications in 13.9, 10.1, and 8.2 times, respectively. CONCLUSION: Assessing the prevalence of complicated surgical wounds and its associated factors in adults contributes to their epidemiological understanding, highlighting prevention targets and making data available for scientific comparisons.
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Ferida Cirúrgica , Adulto , Estudos Transversais , Hospitalização , Hospitais Públicos , Humanos , Masculino , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: To evaluate the effect of abdominal electrical stimulation (EE) on bowel movement frequency and feces consistency and expelled amount in people with constipation due to spinal cord injuries (SCI). METHOD: This is an experimental, crossover, randomized pilot study with two treatment groups: conventional intestinal rehabilitation and conventional rehabilitation associated with EE via 8- and 20-Hz Functional Electrical Stimulation (FES) of the abdominal muscles. Both groups were followed for two weeks with daily 30-minute EE sessions. Participants were hospitalized in a rehabilitation institute in the municipality of São Paulo. Data were analyzed using descriptive and inferential statistics. RESULTS: This study included 10 people with SCI, of which most were male (70%), with a mean age of 39 years (SD = 16.37). EE, associated with conventional treatment, was more effective in increasing defecation frequency (p = 0.029) and amount of feces expelled (p = 0.031). CONCLUSION: Abdominal EE, associated with conventional treatment, helped to increase defecation frequency and amount of feces expelled in people with constipation due to SCI. This pilot study will serve as the basis for a future clinical trial with greater sampling and statistical evidence.
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Constipação Intestinal , Traumatismos da Medula Espinal , Músculos Abdominais , Adulto , Brasil , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Estimulação Elétrica , Feminino , Humanos , Masculino , Projetos Piloto , Traumatismos da Medula Espinal/complicaçõesRESUMO
Objetivo: Analisar na literatura científica as evidências sobre lesão por pressão em pacientes adultos internados com COVID-19. Método:Revisão integrativa de artigos nas bases Medical Literature Analysis and Retrieval System Online, Literatura latino-americana e do caribe de informações em ciências da saúde, base de dados de Enfermagem, Biblioteca virtual em saúde e cumulative index to nursing and Allied Health Literature, nos idiomasportuguês, inglês e espanhol. Resultados:Identificou-se 76 artigos, 13 atenderam aos critérios de inclusão. Agrupou-se os artigos em lesão por pressão em posição prona, lesão por pressão relacionado a dispositivo médico e lesão por pressão em região glútea/sacral. As recomendações para lesão por pressão prona foram: avaliação frequente das principais áreas submetidas a pressão; manutenção da pele limpa e hidratada, descarga de pressão facial, mudanças de decúbito com rodiziamento dos membros e uso de coberturas protetivas. Os achados de lesão por pressão sacral e glútea evidenciam uma relação entre as alterações trombogênicas e a ocorrência de lesão por pressão, identificadas geralmente região sacral/glútea e demonstraram aspectos isquêmicos. ConsideraçõesFinais:Acredita-se que asrecomendações aqui delineadas possam contribuir para a melhora da assistência aos pacientes com COVID-19 em risco de desenvolvimento de lesão por pressão.
Objective: To analyze the evidence in the scientific literature about pressure injuries in adult patients hospitalized with COVID-19. Method:Integrative review of articles published in the Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean literature of information on health sciences, Nursing database, Virtual health library and cumulative index to nursing and Allied Health Literature, in Portuguese, English and Spanish. Results:76 articles were identified, of which 13 met the inclusion criteria. The articles were grouped into pressure injury in the prone position, pressure injury related to medical device and pressure injury in the gluteal/sacral region. The recommendations for prone pressure injuries were: frequent assessment of the main areas subjected to pressure; maintenance of clean and hydrated skin, facial pressure relief, decubitus changes with limb rotation and use of protective coverings. The findings of sacral and gluteal pressure injury show a relationship between thrombogenic alterations and the occurrence of pressure injury in these patients, usually identified in the sacral/gluteal region and showing ischemic aspects. FinalConsiderations:It is believed that the synthesis of evidence and recommendations outlined here can contribute to the improvement of care for patients with COVID-19 at risk of developing pressure injury.
Objetivo: Analizar la evidencia en la literatura científica sobre lesiones por presión en pacientes adultos hospitalizados con COVID-19. Método:Revisión integrativa de artículos en el Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean literature of information on health sciences, Nursing database, Virtual health library and cumulative index to nursing and Allied Health Literature, en portugués, inglés y español. Resultados: Se identificaron 76 artículos, 13 cumplieron los criterios de inclusión. Los artículos se agruparon en lesiones por presión en decúbito prono, lesiones por presión relacionadas con dispositivos médicos y lesiones por presión en la región glútea / sacra. Las recomendaciones para las lesiones por presión en decúbito prono fueron: evaluación frecuente de las principales áreas sometidas a presión; mantenimiento de la piel limpia e hidratada, alivio de la presión facial, cambios de decúbito con rotación de extremidades y uso de cubiertas protectoras. Los hallazgos de lesión por presión sacra y glútea muestran una relación entre las alteraciones trombogénicas y la ocurrencia de lesión por presión en estos pacientes, generalmente identificados en la región sacra / glútea y que muestran aspectos isquémicos. ConsideracionesFinales: Lasrecomendaciones descritas aquí pueden contribuir a mejorarla atención de los pacientes con COVID-19 en riesgo de desarrollar lesiones por presión.
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Humanos , Masculino , Feminino , Úlcera por Pressão , Dermatologia , COVID-19RESUMO
Objetivo:Analisar a prevalência pontual de dermatite associada à incontinência (DAI) e os fatores associados em pacientes adultos internados em unidades de terapia intensiva (UTIs). Método: Estudo transversal, observacional, retrospectivo, realizado com 105 pacientes em UTI de três hospitais universitários localizados no estado de São Paulo. As variáveis demográficas, clínicas e de DAI foram coletadas do banco de dados do projeto de pesquisa "Prevalência de lesão por pressão em Unidade de Terapia Intensiva", composto por informações extraídas dos prontuários e de exames físicos. Os dados foram analisados por meio de estatística descritiva e inferencial. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição proponente. Resultados: Dos 105 pacientes, 58 (55,2%) eram do sexo masculino, com média de idade de 55,76 anos (desvio padrão = 16,4), 105 (91,3%) estavam com cateter urinário e 89,4% usavam fraldas. Dez pacientes apresentaram DAI, com prevalência pontual de 9,5%. O fator associado à DAI foi a admissão por trauma (p = 0,02). Conclusão: Estudos sobre DAI são fundamentais para uma assistência de enfermagem de qualidade, bem estruturada e fundamentada, sobretudo no cuidado aos pacientes críticos.
Objective:To analyze the point prevalence of incontinence-associated dermatitis (IAD) and associated factors in adult patients admitted to Intensive Care Units (ICUs). Method: A cross-sectional, observational, retrospective study carried out with 105 patients in the ICU of three university hospitals located in the state of São Paulo. The demographic and clinical variables and IAD come from the database of the research project "Prevalence of pressure injuries in the Intensive Care Unit," composed of information from medical records and physical examination. Data were analyzed using descriptive and inferential statistics. The study was approved by the Research Ethics Committee of the proposing institution. Results: Of the 105 patients, 58 (55.24%) were male, with a mean age of 55.76 years (SD = 16.39), 105 (91.3%) had a urinary catheter and 89.4% wore diapers. Ten patients had IAD, with a point prevalence of 9.52%. The factor associated with IAD was admission due to trauma (p = 0.02). Conclusion: Studies on IAD are essential for quality, well-structured and grounded nursing care, especially in the care of critically ill patients.
Objetivo:Analizar la prevalencia puntual de Dermatitis Asociada a Incontinencia (DAI) y factores asociados en pacientes adultos ingresados en Unidades de Cuidados Intensivos (UCI). Método: estudio transversal, observacional, retrospectivo, realizado con 105 pacientes en la UTI de tres hospitales universitarios ubicados en São Paulo. Las variables demográficas, clínicas y DAI provienen de la base de datos del proyecto de investigación "Prevalencia de lesiones por presión en la Unidad de Cuidados Intensivos", compuesta por información de historias clínicas y exámenes físicos. Los datos se analizaron mediante estadística descriptiva e inferencial. El estudio fue aprobado por el Comité de Ética en Investigación de la institución proponente. Resultados: de los 105 pacientes, 58 (55,24%) eran del sexo masculino, con una edad media de 55,76 años (DE = 16,39), 105 (91,3%) tenían sonda vesical y 89,4% usaban pañales. Diez pacientes tenían DAI, con una prevalencia puntual del 9,52%. El factor asociado a la DAI fue el ingreso por traumatismo (p = 0,02). Conclusión: los estudios sobre la DAI son esenciales para una atención de enfermería de calidad, bien estructurada y fundamentada, especialmente en el cuidado de pacientes críticos.
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Incontinência Urinária , Prevalência , Dermatite , Incontinência Fecal , Estomaterapia , Unidades de Terapia IntensivaRESUMO
The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.
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ABSTRACT Objective: To estimate the prevalence of complicated surgical wounds and its related factors in hospitalized adults. Method: In this cross-sectional study, information from 251 patients hospitalized in seven public hospitals in Manaus, Brazil, and at risk of suffering surgical site complications after undergoing surgery was analyzed. Data were collected via interviews, physical examinations, and a medical record review from March to June 2015. Prevalence rate was estimated as the ratio between individuals with complications and patients at risk. To explore associated variables, individuals with and without complications were compared via 5% significant logistic regression and bivariate analyses. This study was approved by a research ethics committee. Results: Overall, 15 patients (6%) showed complicated surgical wounds. General hospitalization (p < 0.003), presence of ecchymosis, (p < 0.001), and men (p = 0.047) increased patients' probability of developing complications in 13.9, 10.1, and 8.2 times, respectively. Conclusion: Assessing the prevalence of complicated surgical wounds and its associated factors in adults contributes to their epidemiological understanding, highlighting prevention targets and making data available for scientific comparisons.
RESUMEN Objetivo: Estimar la prevalencia de herida quirúrgica complicada y sus factores asociados en adultos hospitalizados. Método: Estudio transversal, aprobado por el comité de ética. Se analizaron los datos de 251 pacientes, sometidos a cirugía y con riesgo de complicación del sitio quirúrgico, hospitalizados en siete hospitales públicos de Manaos (Brasil); la recolección de datos se dio por entrevistas, examen físico y revisión de historias clínicas, en el periodo de marzo a junio de 2015. La tasa de prevalencia se calculó como la razón entre los individuos con complicaciones y los pacientes de riesgo. Para explorar las variables asociadas, se compararon individuos con y sin complicaciones mediante análisis bivariado y regresión logística, con un nivel de significancia del 5%. Resultados: Fue identificada herida operatoria complicada en quince pacientes (6%). La presencia de equimosis (p < 0,001), ajustada por sexo masculino (p = 0,047) y la hospitalización en clínica general (p < 0,003) aumentaron en 10,1; 8,2 y 13,9 veces, respectivamente, la probabilidad de desarrollar complicaciones. Conclusión: La identificación de la prevalencia de herida quirúrgica complicada en adultos y sus factores asociados contribuye a su comprensión epidemiológica, destacando focos potenciales de prevención y proporcionando datos para la comparación científica.
RESUMO Objetivo: Estimar a prevalência de Ferida Operatória Complicada e seus fatores associados, em adultos hospitalizados. Método: Estudo transversal, aprovado por comitê de ética. Foram analisadas informações de 251 pacientes submetidos à cirurgia e com risco de complicação do sítio cirúrgico, internados em sete hospitais públicos em Manaus (Brasil); cujos dados foram coletados por meio de entrevista, exame físico e revisão de prontuários, no período de março a junho de 2015. A taxa de prevalência foi calculada como a razão entre os indivíduos com complicação e os pacientes em risco. Para exploração de variáveis associadas, foram comparados indivíduos com e sem complicação por meio de análises bivariadas e regressão logística, com significância de 5%. Resultados: 15 pacientes (6%) apresentaram ferida operatória complicada. A presença de equimose (p < 0,001), ajustada pelo sexo masculino (p = 0,047) e a internação na clínica geral (p < 0,003) aumentaram a probabilidade de desenvolver a complicação em 10,1; 8,2 e 13,9 vezes, respectivamente. Conclusão A identificação da prevalência da ferida operatória complicada em adultos e seus fatores associados contribuem para a sua compreensão epidemiológica, destacando alvos de prevenção e disponibilizando dados para comparação científica.
Assuntos
Complicações Pós-Operatórias , Enfermagem , Deiscência da Ferida Operatória , Infecção da Ferida Cirúrgica , Prevalência , EstomaterapiaRESUMO
ABSTRACT Objective: To evaluate the effect of abdominal electrical stimulation (EE) on bowel movement frequency and feces consistency and expelled amount in people with constipation due to spinal cord injuries (SCI). Method: This is an experimental, crossover, randomized pilot study with two treatment groups: conventional intestinal rehabilitation and conventional rehabilitation associated with EE via 8- and 20-Hz Functional Electrical Stimulation (FES) of the abdominal muscles. Both groups were followed for two weeks with daily 30-minute EE sessions. Participants were hospitalized in a rehabilitation institute in the municipality of São Paulo. Data were analyzed using descriptive and inferential statistics. Results: This study included 10 people with SCI, of which most were male (70%), with a mean age of 39 years (SD = 16.37). EE, associated with conventional treatment, was more effective in increasing defecation frequency (p = 0.029) and amount of feces expelled (p = 0.031). Conclusion: Abdominal EE, associated with conventional treatment, helped to increase defecation frequency and amount of feces expelled in people with constipation due to SCI. This pilot study will serve as the basis for a future clinical trial with greater sampling and statistical evidence.
RESUMEN Objetivo: Evaluar el efecto de la electroestimulación abdominal (EE) sobre la frecuencia de las evacuaciones, la consistencia y la cantidad de heces en personas con estreñimiento debido a una lesión de la médula espinal (LME). Método: Estudio piloto experimental de tipo crossover-aleatorizado en dos grupos de tratamiento: convencional rehabilitación intestinal y convencional asociado a EE con Functional Electrical Stimulation (FES) de 8 y 20 Hz aplicados a los músculos abdominales. Se realizó un seguimiento de ambos grupos durante dos semanas con 30 minutos de sesión diaria de EE. Los participantes estaban hospitalizados en un instituto de rehabilitación de la ciudad de São Paulo. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados: Diez personas con LME participaron en el estudio, la mayoría hombres (70%) con una edad media de 39 años (DE = 16,37). La EE asociada al tratamiento convencional demostró ser más eficaz en el aumento de la frecuencia de evacuación (p = 0,029) y la cantidad de heces (p = 0,031). Conclusión: La EE abdominal asociada al tratamiento convencional ayudó a aumentar la frecuencia de evacuación y la cantidad de heces en el contexto de estreñimiento en personas con LME. Este estudio piloto servirá de base para futuros ensayos clínicos con mayor muestreo y evidencia estadística.
RESUMO Objetivo: Avaliar o efeito da eletroestimulação (EE) abdominal sobre a frequência de evacuações, a consistência e a quantidade de fezes em pessoas com constipação decorrente da lesão medular (LM). Método: Estudo piloto experimental do tipo crossover-randomizado em dois grupos de tratamento: convencional de reabilitação intestinal e convencional associado à EE com Functional Electrical Stimulation (FES) de 8 e 20 Hz aplicados na musculatura abdominal. Ambos os grupos em seguimento por duas semanas, com 30 minutos de sessão diária de EE. Os participantes estavam internados em um instituto de reabilitação da cidade de São Paulo. Os dados foram analisados por meio de estatística descritiva e inferencial. Resultados: Participaram do estudo 10 pessoas com LM, a maioria do sexo masculino (70%), com média de idade de 39 anos (DP = 16,37). A EE, associada ao tratamento convencional, mostrou-se mais eficaz no aumento da frequência evacuatória (p = 0,029) e na quantidade de fezes (p = 0,031). Conclusão: A EE abdominal associada ao tratamento convencional auxiliou no aumento da frequência evacuatória e na quantidade de fezes no quadro de constipação em pessoas com LM. Este estudo piloto servirá como base para um futuro ensaio clínico com maior amostragem e comprovação estatística.
Assuntos
Traumatismos da Medula Espinal , Estimulação Elétrica , Reabilitação , Músculos Abdominais , Constipação Intestinal , EstomaterapiaRESUMO
Objetivo:relatar o caso de um paciente crítico com COVID-19 e mostrar os principais achados relacionados à lesão considerada Acute skin failure (ASF), bem como realizar seu diagnóstico diferencial com lesão por pressão (LP) evitável. Método: estudo observacional do tipo relato de caso, desenvolvido em um hospital de São Paulo, na unidade de terapia intensiva (UTI) exclusiva a pessoas diagnosticadas com COVID-19. Os dados foram coletados de um único paciente, entre os meses de março e setembro de 2020. Resultados: paciente com complicações da COVID-19 evoluiu com lesão de pele, inicialmente definida como LP e posteriormente reclassificada como ASF. Os seguintes achados corroboraram o diagnóstico: ventilação mecânica invasiva prolongada, insuficiências respiratória, renal e cardíaca e sepse de foco respiratório. Além disso, outros fatores agravantes, como o uso de droga vasoativa, instabilidade hemodinâmica com intolerância ao mínimo reposicionamento, jejum prolongado e coagulopatia intravascular disseminada associada à infecção pelo coronavírus. Conclusão: o relato mostra que existem dificuldades para o diagnóstico diferencial entre ASF e LP na prática clínica. Trata-se de conceito novo, sendo fundamental que o profissional de saúde reconheça os principais fatores associados ao aparecimento da ASF, muitos dos quais também estão relacionados ao desenvolvimento das LP, ressaltando a necessidade de análise individualizada dessas lesões, e garantia da implementação de intervenções adequadas para prevenção e tratamento.
Objective:report the case of a critical patient with COVID-19 and show the main findings related to the injury considered acute skin failure (ASF), as well as perform his differential diagnosis with preventable pressure injury (PI). Method: observational, longitudinal, case report type study, developed in a hospital in São Paulo, in the intensive care unit (ICU) exclusively for people diagnosed with COVID-19. Data were collected from a single patient between March and September 2020. Results: A patient with complications from COVID-19 developed a skin lesion, initially defined as PI and later reclassified as ASF. The following findings corroborated the diagnosis: prolonged invasive mechanical ventilation, respiratory, renal and cardiac insufficiency and sepsis of respiratory focus. In addition, other aggravating factors, such as the use of vasoactive drugs, hemodynamic instability with intolerance to minimal repositioning, prolonged fasting and disseminated intravascular coagulopathy associated with coronavirus infection. Conclusion: the report shows that there are difficulties for the differential diagnosis between ASF and PI in clinical practice. This is a new concept, and it is essential that health professionals recognize the main factors associated with the appearance of ASF, many of which are also related to the development of PI, highlighting the need for individualized analysis of these injuries, and ensuring the implementation of interventions for prevention and treatment
Objetivo:Informar los principales hallazgos en un paciente con COVID-19 ingresado en una unidad de cuidados intensivos (UCI), que desarrolló una lesión considerada Insuficiencia cutánea aguda (PPA), así como diferenciar la lesión por presión (LP) de la PPA. Método: estudio observacional, longitudinal y descriptivo, del tipo reporte de caso, desarrollado en un hospital de São Paulo, en la UCI exclusivamente para personas diagnosticadas con COVID-19, entre los meses de marzo a septiembre de 2020. La muestra estuvo conformada por un paciente. Resultados: Un paciente con complicaciones por COVID-19, evoluciona con una lesión cutánea, inicialmente definida como LP, sin embargo, reclasificada como ASK. Los hallazgos que corroboran el diagnóstico fueron: Ventilación mecánica invasiva prolongada, insuficiencia respiratoria, renal y cardíaca y sepsis del foco respiratorio. Además, factores agravantes como el uso de fármacos vasoactivos, inestabilidad hemodinámica con intolerancia al reposicionamiento mínimo, ayuno prolongado, história clínica con varias comorbilidades y coagulopatía intravascular diseminada inducida por infección por coronavirus. Conclusión: El informe muestra que existen dificultades para el diagnóstico diferencial entre PPA y PL en la práctica clínica. Es un concepto novedoso, y es fundamental que el profesional de la salud reconozca los principales factores asociados a la aparición de la PPA, muchos de los cuales también están relacionados con el desarrollo de LP, destacando la necesidad de un análisis individualizado de estas lesiones y asegurando la implementación de intervenciones adecuadas, para la prevención y el tratamiento
Assuntos
Infecções por Coronavirus , Úlcera por Pressão , Unidades de Terapia Intensiva , Cuidados de EnfermagemRESUMO
Objetivo:identificar e descrever os fatores de risco para desenvolvimento de lesão por pressão em pacientes oncológicos adultos e as intervenções preventivas interdisciplinares. Método: revisão integrativa da literatura. A coleta de dados foi realizada no período de março e abril de 2019 e dezembro de 2020, utilizando as bases de dados: BDENF; PubMed/Medline; Embase; Scopus; Cinahal e Web of Science. Resultados: a amostra foi composta por 16 artigos publicados no período de 2008 a 2019. Dentre os fatores de risco identificados destacam-se: situação nutricional, idade avançada, incontinência e imobilidade; as intervenções preventivas interdisciplinares identificadas foram: mudança de decúbito, avaliação e acompanhamento nutricional, cuidados com a pele e uso de superfícies de suporte. Conclusão: há necessidade de mais estudos para um olhar cuidadoso e assertivo para os pacientes oncológicos.
Objective:identify and describe the risk factors for the development of pressure injuries in adult cancer patients and interdisciplinary preventive interventions. Method: integrative literature review. Data collection was carried out between March and April 2019 and December 2020, using the databases: BDENF; PubMed/Medline; Embase; Scopus; Cinahal and Web of Science. Results: the sample consisted of 16 articles published from 2008 to 2019. Among the risk factors identified, the following stand out: nutritional status, advanced age, incontinence and immobility; the interdisciplinary preventive interventions identified were: decubitus change, nutritional assessment and monitoring, skin care and use of support surfaces. Conclusion: further studies are needed to take a careful and assertive look at cancer patients.
Objetivo:Identificar y describir los factores de riesgo para el desarrollo de úlcera por presión en pacientes adultos con cáncer e intervenciones preventivas interdisciplinarias. Método: Revisión integrativa de la literatura. https://doi.org/10.30886/estima.v19.1005_PTESTIMABrazilian Journal of Enterostomal Therapy. La recolección de datos se realizó en el período de marzo y abril de 2019 y diciembre de 2020 utilizando las bases de datos: BDENF; PubMed/Medline; Embase; Scopus; Cinahal y Web of Science. Resultados: la muestra estuvo conformada por 16 artículos publicados en el período de 2008 a 2019. Entre los factores de riesgo identificados están el estado nutricional, la edad avanzada, la incontinencia y la inmovilidad; Las intervenciones preventivas interdisciplinarias identificadas fueron reposicionamiento, evaluación y seguimiento nutricional, cuidado de la piel y uso de superficies de apoyo. Conclusión: se necesitan más estudios para una mirada cuidadosa y asertiva de los pacientes oncológicos
Assuntos
Equipe de Assistência ao Paciente , Fatores de Risco , Úlcera por Pressão , OncologiaRESUMO
AIM: The purpose of this study was to identify and analyze the prevalence of diabetic foot ulcers (DFU) as well as associating factors in the city of Manaus, Amazonas State, Brazil. METHODS: This was an observational, epidemiological, cross-sectional study, point prevalence, with 229 adults' diabetic inpatients from seven hospitals. Written signed consent was obtained from all participants or their legal representative if they had a cognitive impairment. Sociodemographic and clinical data were collected through interviews and medical records. Each participant was examined by the research team to evaluate for foot deformity. RESULTS: Of the 229 patients diagnosed with DM, 60 presented DFU, resulting in a prevalence of 26.2 %. The logistic regression model that included all variables with a significance level of 5 % (p ≤ 0.05) shows: Patients with PAD were more likely to have DFU (OR = 2956; p = 0,01). The use of emollients (OR = 0.097; p < 0.001) and anticoagulants (OR = 0.149; p = 0.002) were related to reduced likelihood for developing DFU. CONCLUSION: This study contributes to a better understanding of DFU epidemiology in hospitalized patients, as well as the factors associated with them. The results are important for nursing in order to develop early prevention and intervention strategies.
Assuntos
Diabetes Mellitus , Pé Diabético , Adulto , Estudos Transversais , Pé Diabético/epidemiologia , Hospitais Públicos , Humanos , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: To identify and analyze the point prevalence of medical adhesive-related skin injury in patients hospitalized in cardiac Intensive Care Units and demographic and clinical factors associated to their occurrence. METHOD: Cross-sectional study conducted in Intensive Care Units of two public hospitals, reference centers for cardiology, located in São Paulo city, with 123 patients. Demographic and clinical data from patients' medical records were collected and lesions were identified through skin inspection. The data were analyzed through descriptive statistics and bivariate and multivariate analysis (Classification and Regression Tree). RESULTS: Medical adhesive-related skin injury was presented by 28 patients, which amounts to a 22.7% prevalence. Its main causative agent was transparent polyurethane film (46.9%) and the cervical region was the most affected area (25.1%). From the multivariate analysis, the associated factors were found to be the presence of serum urea higher than or equal to 48.5 mg/dL and platelets lower than 193,500 mm3 or platelets higher than or equal to 193,500 mm3 and systolic blood pressure higher than or equal to 122 mmHg. CONCLUSION: This study has contributed to knowledge related to the epidemiology of this type of injury, favoring preventive care planning.
Assuntos
Adesivos , Unidades de Terapia Intensiva , Cuidados Críticos , Estudos Transversais , Humanos , PrevalênciaRESUMO
Objective: The use of gamification can promote health-related behavior. This article is the first attempt to provide a historical overview of the use of games in patients undergoing hip arthroplasty. Materials and Methods: We conducted a scoping review to map and characterize the games used for the person undergoing hip arthroplasty. To perform this review, the respective descriptors were identified using search syntax appropriate to each of the databases: MEDLINE_ (Medical Literature Analysis and Retrieval System Online), CINAHL_ (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, in the Psychology and Behavioral Sciences Collection, SCOPUS, SciELO (Scientific Electronic Library Online), and PEDRo (Physiotherapy Evidence Database). Results: An initial 968 articles were identified, of which 7 articles were included. The domains of the games under analysis essentially focus on aspects of rehabilitation (n = 5), or related (n = 2), and mostly exergames (n = 6). However, the instruments, characteristics, and procedures used to evaluate the games in the included studies have little depth and large variability. Conclusion: Few games exist that support people who have undergone hip arthroplasty. Most of the games under review were exergames to support rehabilitation. Consequently, we recommend developing another type of game with a focus on monitoring, counseling, and/or social support for selfmanagement training in persons undergoing hip arthroplasty.
Assuntos
Artroplastia de Quadril/normas , Promoção da Saúde/métodos , Jogos de Vídeo/normas , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Humanos , Jogos de Vídeo/psicologia , Jogos de Vídeo/estatística & dados numéricosRESUMO
This study aimed to estimate the incidence of hospital-acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6-month follow-up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow-up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS-2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04-1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92-6.61); in patients admitted for non-surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12-3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03-1.06); high blood pressure (RR = 1.76; 95% CI 1.17-2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71-7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75-0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI-preventative actions.