The Effectiveness of Advanced Practice Nurses with Respect to Complex Chronic Wounds in the Management of Venous Ulcers.

This study aims to evaluate the effectiveness of advanced practice nurses with respect to complex chronic wounds (APN-CCWs) in the care of patients with venous ulcers. A multicentric, quasi-experimental pre-post study was conducted without a control group in the sanitary management areas where the APN-CCW program is being piloted. The intervention consisted of a mass training of clinical nurses from the participating districts on the proper management of injuries and the use of compression therapy. The data were collected through a specifically constructed questionnaire with questions regarding descriptive variables of injuries and their treatment. A total of 643 professionals responded (response rate of 89.1%), attending to a total population of 707,814 inhabitants. An increase in multilayer bandage use by 15.67%, an increase in elastic bandage use by 13.24%, and a significant decrease in the referral of patients to consultation with hospital specialists was achieved, from 21.08% to 12.34%. The number of patients referred to the APNs was 13.25%, which implied a resolution rate of 94.08% of their injuries. In conclusion, the coordination by the APN-CCWs in patients with venous ulcers was effective in improving the continuity of care, in the optimization of resources, and in their care role.

Uso de adhesivos tisulares para el cierre de heridas en la práctica médica / Use of tissue adhesives for the wound closure in medical practice

Introducción: los adhesivos tisulares generan una película impermeable que una vez aplicados sobre la herida quirúrgica mantienen los bordes juntos hasta que se produce la cicatrización, lo que ayuda a disminuir el riesgo de infección de las heridas tratadas. Su empleo en la medicina permite simplificar procedimientos quirúrgicos complejos y brinda mayor comodidad al paciente. Objetivo: identificar los ámbitos de la práctica médica donde el cierre quirúrgico de heridas con el uso de adhesivos tisulares ofrece mejores resultados. Métodos: estudio descriptivo con un diseño de análisis de decisión, se confeccionó un árbol de decisión que comparó dos posibles alternativas: uso de adhesivos tisulares en adultos y en pediatría. La información se obtuvo de la literatura mediante la revisión de bases de datos médicas en el periodo de enero/2002 a diciembre/2012. Se identificaron 25 estudios (15,4 por ciento) que fueron válidos para estimar las probabilidades de complicaciones y éxito en el cierre de heridas. Resultados: el uso de adhesivos titulares en adultos mostró los mejores resultados con una alta probabilidad de éxito (0,99) para el cierre de heridas en piel y mucosas y especialmente en la cirugía de cabeza y cuello. En pediatría la probabilidad de éxito fue de 0,96 y su mejor uso se decidió en la cirugía de tórax y abdomen. Conclusiones: el uso de adhesivos titulares en adultos y niños ofrece una alta perspectiva de éxito para el cierre de heridas en piel y mucosas, si bien su uso en adultos es su mejor opción(AU)

Introduction: tissue adhesives generate, based on its characteristics, a water-proof film that once spread over the surgical wound, can keep wound edges together until cicatrization, all of which helps to decrease the infection risk. The use of tissue adhesives in medicine allows making complex surgical procedures simpler in addition to making the patient feel more comfortable. Objective: to identify the areas of medical practice where the surgical wound closure with adhesives exhibits better results. Methods: descriptive study with analysis decision design; a decision tree was created to compare two possible alternatives: use of tissue adhesives in adults and in pediatrics. Information was taken from literature through revision of medical database in the period of January 2002 to December 2012. Twenty five studies (15.4 percent), which were valid for estimating the odds of complications and successes of each wound closure option. Results: the use of tissue adhesives in adults showed the best results with high probabilities of being successful (0.99) in closing skin and mucosa wounds, mainly in the head and the neck. The probabilities for success in pediatrics were 0.96 and it is better used in thorax and abdomen surgery. Conclusions: use of tissue adhesives in adults and children provide high success probabilities for the closure of wounds in the skin and in the mucosa, although their use in adult people is the best choice(AU)

Conhecimento e prática de enfermeiros sobre cuidados aos pacientes com feridas / Conocimiento y práctica de enfermeros acerca del cuidado de los pacientes con heridas / Knowledge and practice of nurses about care for patients with wounds

Objective: identifying the knowledge, practice and nurses information sources about the care of patients with wounds. Method: a cross-sectional, descriptive and exploratory study performed in a university hospital in July 2010. The data were collected through an adapted questionnaire. The study included 35 nurses assigned to different sectors of work. The data was submitted to descriptive and analytical statistical treatment. Results: considering the overall results, the nurses had an average of 69.4% of hits (sd = 13.5%). The nurses that have cited utilizing sometimes some sources of information had a higher percentage of hits. Conclusion: it was concluded that nurses had insufficient knowledge in some areas on the subject. There is need to update professionals' knowledge on advances of the current evidences that base wound care, in order to guide, with the context studied, the planning of strategies to implement the best evidences available.

Objetivo: identificar o conhecimento, prática e fontes de informações de enfermeiros sobre o cuidado de pacientes com feridas. Método: estudo transversal, descritivo-exploratório, realizado em um hospital universitário em julho de 2010. Os dados foram coletados por meio de um questionário adaptado. Participaram deste estudo 35 enfermeiros distribuídos em diferentes setores de trabalho. Os dados sofreram tratamento estatístico descritivo e analítico. Resultados: considerando os resultados globais, os enfermeiros obtiveram, em média, 69,4% de acertos (dp= 13,5%). Os enfermeiros que citaram utilizar às vezes algumas fontes de informações tiveram maior porcentagem de acertos. Conclusão: conclui-se que os enfermeiros apresentaram conhecimento insuficiente em algumas áreas referentes ao tema. Destaca-se a necessidade da atualização dos profissionais quanto aos avanços das evidências atuais que embasam o cuidado de feridas, a fim de nortear, no contexto estudado, o planejamento de estratégias para a implementação das melhores evidências disponíveis.

Objetivo: identificar el conocimiento, la práctica y las fuentes de información de los enfermeros, sobre el cuidado con las heridas. Método: estudio transversal, descriptivo y exploratorio realizado en un hospital universitario en julio de 2010. Los datos fueron recolectados a través de un cuestionario adaptado. Participaron en el estudio 35 enfermeros asignados a diferentes sectores de trabajo. Los datos se sometieron a tratamiento estadístico descriptivo y analítico. Resultados: teniendo en cuenta los resultados globales, los enfermeros obtuvieron, en promedio, el 69,4% de respuestas correctas (de = 13,5%). Los enfermeros que informaron el uso, a veces algunas fuentes de información tuvieron el mayor porcentaje de respuestas correctas. Conclusión: se concluye que los enfermeros tenían un conocimiento insuficiente en algunas áreas acerca del tema. Se destaca la necesidad de actualizar a los profesionales sobre los avances de las evidencias actuales que sustentan el cuidado de las heridas, con el fin de orientar, en el contexto estudiado, la planificación de estrategias para la implementación de las mejores evidencias disponibles.

Avaliação do blog interativo sobre reparo de feridas e os cuidados de enfermagem / Evaluación de blog interactivo sobre reparación de heridas y cuidados de enfermería / Evaluation of the interactive blog on wound repair and nursing care

Objetivo: descrever a elaboração e a avaliação do blog interativo sobre reparo de feridas e os cuidados de enfermagem. Método: relato de experiência do projeto inserido no programa de monitoria da disciplina Fundamentos de Enfermagem I da EEAAC-UFF. O público alvo foram acadêmicos e profissionais de enfermagem de maio a julho de 2011. O formulário contém os seguintes itens: tema; figuras do blog e seu conteúdo; disposição das cores e adequação; enquête e suas reflexões; disponibilidade dos artigos e links de pesquisa. Resultados: o blog visa à interatividade, divulgação e debate informações que são fontes de atualização sobre pesquisas e especificidades dos cuidados de enfermagem desenvolvidos com base: nos cuidados fundamentais e específicos sobre tecnologia da informação e comunicação com o conhecimento científico da enfermagem. Conclusão: a construção do conhecimento digital na Enfermagem potencializa o aprendizado dos acadêmicos de enfermagem e profissionais, apresentando ideias novas pela troca de conhecimentos

Objective: To describe the design and evaluation of the interactive blog on wound repair and nursing care. Method:experience report of the project entered into the monitoring program of the course Fundamentals of Nursing I EEAACFFU. The target audience was academics and nurses from May to July 2011. The form contains the following items: theme; figures of the blog and its contents; arrangement of colors and adequacy; survey and their reflections; availability of research articles and links. Results: The blog aims to interactivity, information dissemination and debate that are sources of update on research and specific nursing care developed based: basic and specific care information technology and communication with the scientific knowledge of nursing. Conclusion: The construction of knowledge in digital Nursing enhances the learning of nursing students and professionals, presenting new ideas for knowledge exchange

Objetivo: Describir el diseño y evaluación del blog interactivo en la reparación de heridas y cuidados de enfermería. Método: relato de experiencia del proyecto entró en el programa de monitoreo de los curso de Fundamentos de Enfermería I EEAAC-FFU. El público objetivo eran académicos y personal de enfermería, de mayo a julio de 2011. El formulario contiene los siguientes elementos: Tema, figuras del blog y sus contenidos, combinación de colores y la adecuación de la encuesta, y sus reflexiones, la disponibilidad de artículos de investigación y enlaces. Resultados: El blog tiene como objetivo la interactividad, la difusión de información y debate que son fuentes de información actualizada sobre la investigación y los cuidados de enfermería específica desarrollada basada en: la tecnología de información de atención básica y específica y la comunicación con el conocimiento científico de la enfermería. Conclusión: La construcción del conocimiento en Enfermería digital, mejora el aprendizaje de los estudiantes de enfermería y profesionales, presentando nuevas ideas para el intercambio de conocimientos

Wire vascular closure device: evaluation of an evidence-based protocol for post-endovascular procedure patients.

Vascular closure devices (VCDs) can shorten the time to hemostasis, ambulation and discharge and improve patient comfort.(1) An evidence-based practice (EBP) project was initiated to assess impact of a shortened postoperative compression and bed rest protocol on patients undergoing arteriotomy using a wire vascular closure device (WVCD). Following protocol development, a post-implementation evaluation was initiated to assess selected outcomes including compression and bed rest time, complication rate and possible related variables. Following implementation of the new protocol, clinicians were able to shorten both compression and bed rest times by 50%, and Post-Anesthesia Care Unit (PACU) length of stay decreased to a maximum of 5 hours.

Construção e validação de um módulo educativo virtual para terapia tópica em feridas crônicas / Construction and validation of a virtual educational module for topical treatment of chronic wounds / Construcción y validación de un módulo educativo virtual para terapia tópica en heridas crónicas

Estudo descritivo exploratório que objetivou a produção e validação de um módulo educativo para terapia tópica em feridas crônicas a ser ministrado em ambiente virtual de aprendizagem (AVA) a estudantes de enfermagem de uma universidade pública do interior do Estado de São Paulo. O desenvolvimento do módulo, entre 2009 e 2010, seguiu o ciclo para criação de um curso à distância através da web, que foi estruturado em unidades temáticas, a partir das recomendações das Diretrizes da Wound, Ostomy and Continence Nurses Society. O módulo foi submetido à validação, quanto aos aspectos pedagógicos e técnicos, por 13 especialistas e foi adequado conforme as sugestões. O módulo educativo para terapia tópica em feridas crônicas, implementado pelo AVA, tem o potencial para difundir diretrizes para a prática baseada em evidências e contribuir para a formação dos estudantes da área da saúde.

This exploratory descriptive study examined the development and validation of an educational moduleon topical therapy for chronic wounds, to be administered through a virtual learning environment to nursing studentsat a public university in São Paulo State. The module, developed between 2009 and 2010 following the cycle for on-the-web distance learning courses, was structured into thematic units based on Wound, Ostomy, and Continence Nurses Society Guidelines. It was then subjected to technical and pedagogical validation by 13 experts, and adjusted as necessary. Implemented through the virtual learning environment, this educational module on the topical treatment of chronic wounds has the potential to spread evidence-based practice guidelines, and contribute to the training of health science students.

Estudio exploratorio descriptivo tuvo como objetivo la construcción y validación de un módulo educativo para terapia tópica en heridas crónicas que será ofrecido en ambiente virtual de aprendizaje (AVA) a estudiantes de enfermería en una universidad pública en el estado de São Paulo-Brasil. El desarrollo del módulo, entre 2009 y 2010, siguió el ciclo de creación de un curso a la distancia a través de la web. Fue estructurado en unidades temáticas a partir de recomendaciones de las Normas de la Wound, Ostomy and Continence Nurses Society. El módulo fue sometido a la validación, cuanto a los aspectos técnicos y pedagógicos, por 13 expertos y fue adecuado conforme las sugerencias. El módulo educativo para terapia tópica en heridas crónicas, implementado por el AVA, posee el potencial para difundir directrices para la práctica basada en evidencias y contribuir para la formación de los estudiantes del área de la salud.

Skin tears: achieving positive clinical and financial outcomes.

Skin tears are one of the most common wounds found among frail, older individuals, and are considered to be largely preventable. Skin tears occur frequently in those with fragile skin, in neonates and the elderly; particularly those with comorbidities affecting their balance, e.g. postural hypotension, motor neurone disease, diabetes and cerebral vascular accident (CVA). Those taking oral medications including steroids and anticoagulants are also at risk of developing skin tears. The increase in the population of older people is likely to produce a concurrent rise in the number of skin tears. Health professionals and health care assistants have a significant role to play in skin tear prevention, assessment and management.

Timing of dressing removal in the healing of surgical wounds by primary intention: quantitative systematic review protocol.

AIM: The purpose of this systematic review is to evaluate the efficacy of different lengths of time of postoperative dressing removal in the healing of surgical wounds by primary intention. BACKGROUND: It is generally practiced and recommended in clinical guidelines to cover surgical incisions which are healing by primary intention postprocedure. However, the timing of dressing removal in relation to the prevention of surgical site infections has not yet been sufficiently examined. METHODS: The systematic review and meta-analyses will be performed according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Randomized controlled trials will be included. Comparisons will be made between different durations of leaving dressings in place, including not dressing the surgical site at all, and covering wounds until suture removal. Primary outcome measure is the rate of surgical site infections. Funding of the review was confirmed in March 2010. DISCUSSION: The results of the review can put the timing of dressing removal for wounds which are healing by primary intention into perspective. Because of the widespread use of surgical dressings, clinical practice could be changed in various settings.

Percepção do enfermeiro sobre a realização e registro de curativos / Nurses' perception of the implementation and dressings record

O trabalho teve como objetivo identificar a percepção dos enfermeiros na realização e registro de curativos. Trata-se de um estudo de natureza qualitativa. A população foi representada por sete enfermeiros que atuam em unidades de duas clínicas de internação. As enfermeiras entrevis- tados conhecem o conceito de anotação de enfermagem e suas finalidades, porém, no desenvolvimento de suas atividades práticas percebem- se lacunas que denotam desatualização quanto ao processo cicatricial e o tratamento de feridas...

The study aimed to identify the perceptions of nurses about performing dressings and recording them. This is a qualitative study. The population was represented by seven nurses working in inpatient units from two clinics. The nurses interviewed know the concept of nursing annotation and its purposes, however, the development of their practical activities show gaps denoting outdated concepts on the and treatment and healing of wounds...

El estudio tuvo como objetivo identificar la percepción de los enfermeros sobre la realización y registro de aderezos. Este es un estudio cualitativo. La población estuvo representada por siete enfermeros que trabajan en unidades de hospitalización. Los enfermeros entrevistados conocen el concepto de la anotación de enfermería y sus propósitos. Sin embargo, en el desarrollo de sus actividades prácticas, se perciben deficiencias que denotan desactualización cuanto al tratamiento de heridas e al proceso de cicatrización...