Functional Independence of Children With Myelomeningocele: Is It Associated With the Informal Caregivers' Burden?

PURPOSE: This study aims to evaluate the association between the functional independence of children after postnatal spinal dysraphism correction and informal caregivers' burden. DESIGN AND METHODS: This is a cross-sectional study conducted in a child neurosurgery clinic at a University hospital. We included informal caregivers of children between six months and seven-and-a-half years old who were operated on for spinal dysraphism correction due to myelomeningocele. Functional independence was assessed using the Pediatric Evaluation of Disability Inventory (PEDI). Caregivers' burden was assessed through the Caregiver Burden Scale (CBS). RESULTS: Twenty-six caregivers were assessed, all mothers, aged 18-42years. Five provided child care and engaged in paid work. Regarding functional independence, 23.1% of the children were classified as needing supervision, 23.1% moderate assistance, 42.3% maximal assistance, and 11.5% total assistance. Median value for the overall CBS was 27.0 (22.0-53.0). The mean global CBS score was 1.42 and the mean PEDI score was 1.95. Correlations between PEDI and CBS scores were very close to zero. CONCLUSIONS: We found no association between the functional independence of children with myelomeningocele from 0 to 7years old and the burden of informal caregivers. PRACTICE IMPLICATIONS: The effect of functional independence of children with myelomeningocele may be balanced by the caregivers' resilience so that caregivers' burden is not dependent upon the child's independence.

[Time for cleaning and room preparation: connection between surgery size and professional perspectives]. / Tempo de limpeza e preparo de sala: relação com o porte cirúrgico e perspectivas profissionais.

The objective was to verify the association between time needed for room cleaning (TLPS) and the surgery size, and related advantages and difficulties faced by the circulator of the room asszgned to this task. A mixed method, with a transverse quantitative, retrospective approach, using a sample of 3095 surgeries performed,from January to June 2011, and a qualitative approach using a Thematic Content Analysis of statements from 11 circulators, was used. The average TLPS was smaller in size 1 surgeries, increasing in sizes 2, 3 and 4, with a significant difference. Advantages reported included organization and size of staff and difficulties reported related to sharp, bladed materials mixed with surgical instruments and a reduced number of cleaning professionals. The larger the size, the higher the TLPS. Surgical teams operating in the Surgical Center interfere directly in the process, facilitating or hindering the achievement of institutional goals related to quality and productivity.

Analysis of Urinary Incontinence in the Neurogenic Bladder and Its Relationship with the Satisfaction and Lifestyle of People with SCI.

One of the most common complications of neurogenic bladder secondary to spinal cord injury (SCI) is urinary incontinence, which is possibly related to bladder-emptying methods and changes in quality of life. This study aimed to identify the occurrence of this complication in adults with SCI and analyze its relationship with bladder-emptying methods, satisfaction, and lifestyle. This is a quantitative, exploratory, and cross-sectional study. The variables were collected using the Bowel and Bladder Treatment Index during a telephone interview with 290 participants from February to November 2021. According to the results, 70% of the participants were male and 74.1% performed clean intermediate catheterization (CIC) as the main bladder-emptying method. Moreover, 55.6% were considered incontinent in the last year. Emptying by normal urination and bladder reflex triggering had a statistically significant relationship with urinary incontinence. A statistical association was observed between all the variables of satisfaction and lifestyle with urinary incontinence. Although CIC reduced urine leakage, a considerable number of participants still presented with frequent urine leakage. Urinary incontinence had a negative impact on satisfaction with the bladder-emptying method, effectiveness of bladder management, quality of life, and personal and social relationships.

[Telephone confirmation of a patient's intent to be present for elective surgery as a strategy to reduce absenteeism]. / Confirmação de presença de usuário à cirurgia eletiva por telefone como estratégia para reduzir absenteísmo.

The objective of this quasi-experimental study was to evaluate the impact of telephone confirmation of attendance on the reduction of absenteeism of patients scheduled for elective surgery. The study was conducted at the Surgical Department of the Botucatu School of Medicine for 30 days and included 89 patients. Results showed the effectiveness of the intervention, which reduced absenteeism by 30.0%. Telephone confirmation two days prior to surgery is recommended, thus allowing enough time to place new calls to find patients at home, or schedule another patient in the event the patient cannot be reached. The creation of a service center could provide a communication channel between the institution and patients, and would enable the confirmation of patients' attendance, provide them with the opportunity to ask questions concerning the procedure and provide information regarding impediments to the surgery or preparations needed. The center would require a professional skilled and knowledgeable regarding the service, as it involves providing patients with information about their upcoming surgery during the telephone contact.

[Safe surgery checklist: analysis of the safety and communication of teams from a teaching hospital]. / Checklist de cirurgia segura: análise da segurança e comunicação das equipes de um hospital escola.

This study aimed to apply the WHO surgical safety checklist in the surgical specialties of a university hospital and to evaluate the opinion of the team regarding the influence of its application on the safety of the surgical process and on the interpersonal communication of the team. It is a descriptive, analytical qualitative field study conducted in the surgical center of a university hospital Data were collected by applying the checklist in a total of 30 surgeries. The researcher conducted its application in three phases, and then members of the surgical team were invited to voluntarily participate in the study, signifying their agreement to participate by signing an informed consent form and answering guiding questions. Bardin's Content Analysis Method was used to organize and analyze the data. The subjects did not notice any changes in their interpersonal communication when using the checklist; however, they gave suggestions and reported that its use provided greater safety to the procedure.

Use of the Virtual Environment as a Strategy for Disseminating Information during the COVID-19 Pandemic.

Background: The virtual environment has democratized information and research in the health area, especially during the coronavirus disease 2019 (COVID-19) pandemic. Purpose: This study analyzed the boosting strategies of social networks and identified the most accessed posts from a previously developed and validated information portal aimed at people with disabilities. Methods: This quantitative, cross-sectional, descriptive, exploratory study used Google Analytics® to collect data on origins and access numbers; boost data were obtained from the Facebook® and Instagram® networks themselves, after the end of each boost. Conclusions: Greater interest in publications related to the acquisition of rights for persons with disabilities and about COVID-19 was identified. The virtual environment, especially social networks in Brazil, proved to be a useful tool for disseminating information during the COVID-19 pandemic, highlighting the importance of boosting access to health information. In addition, the investment in social networks was relevant due to the increase in the number of followers on the page. Implications for Practice: Social networks can be a valuable means of disseminating research, improving access to information based on scientific evidence in an inclusive way.

Transcultural adaptation of the children's anxiety questionnaire in Brazil.

AIM: To describe the transcultural adaptation process of the Children's Anxiety Questionnaire (CAQ) for the Brazilian culture. DESIGN: This is a methodological study of cross-cultural adaptation. METHODS: Study conducted in Brazil and Sweden involved the following steps: preparation, translation, synthesis of translations, back-translation and review, and harmonization of the translations by a committee of 13 healthcare professionals using the content validity index (CVI). Cognitive debriefing, using children between 4-10 years old, was completed by 15 children to determine if the images corresponded with their meanings and 17 children to determine if they could understand the Global CAQ after listening. RESULTS: Convergences and discrepancies between the original instrument in Swedish, the English version and the Brazilian translation were compared. The process of culturally adapting the CAQ to Brazilian Portuguese was validated, as demonstrated by a satisfactory S-CVI (0.94) among professionals and an agreement of 95% and above by children.

Development and Validation of an Age-Appropriate Website for Children Requiring Clean Intermittent Catheterization.

PURPOSE: This study describes the development and validation of an age-appropriate website for preschool children who require clean intermittent catheterization (CIC). METHODS: An age-appropriate website was developed at an academic medical center in Brazil and included child-friendly characters, details of the urinary system anatomy and physiology, hand-washing, and the CIC procedure. Content was validated by physicians, nurses, and health informatics professionals. Face validity was assessed by parents. FINDINGS: Content and face validity indices were 0.94 and 0.92, respectively. CONCLUSIONS: The free website (www.doutorbexiga.com.br) was successfully validated and considered suitable and user-friendly for the health education of children requiring CIC. CLINICAL RELEVANCE: Physicians and nurses can use the website as a model for developing similar materials. The website can be a resource for health professionals and parents of children with spinal cord injury or other neurological disorders to encourage children to learn about CIC through animated educational materials.

Evaluating Educational Material from the Perspective of Informal Caregivers of Children with Hydrocephalus: A Qualitative Study.

OBJECTIVE: We evaluated whether educational material about hydrocephalus and its treatment previously developed by health professionals corresponded with the daily life of caregivers of children with hydrocephalus. METHODS: We conducted a qualitative study at a university hospital in Brazil, interviewing 32 informal caregivers of children with hydrocephalus. The methodological framework of Bardin content analysis was used to analyze the data. RESULTS: The educational material adequately represented caregivers' experience regarding daily life, surgery experiences, and care needed by children with hydrocephalus. In addition, the educational material may help to identify the signs and symptoms of ventriculoperitoneal shunt. However, the material did not address the limitations of children disabled with hydrocephalus in daily life. CONCLUSIONS: From the perspective of informal caregivers of children with hydrocephalus, the educational material corresponded with families' daily life and surgical experience and may be used by health professionals to reinforce important points for the care for children with hydrocephalus, facilitating the health education process.

Long-term follow-up of patients undergoing decompressive hemicraniectomy for malignant stroke: Quality of life and caregiver's burden in a real-world setting.

BACKGROUND AND PURPOSE: Decompressive hemicraniectomy is a life-saving procedure for the treatment of space-occupying middle cerebral artery infarctions (malignant stroke); however, patients may survive severely disabled. Comprehensive data on long-term sequelae outside randomized controlled trials are scarce. METHODS: We retrospectively evaluated the survival rates, quality of life, ability to perform activities of daily living, and caregiver burden of 61 patients (aged from 37 to 83) who had previously undergone decompressive hemicraniectomy for malignant stroke between 2012 and 2017. RESULTS: The mortality rate was higher among patients older than 60 years than among younger patients (71.0 % vs 36.7 %, p = 0.007; odds ratio 4.222, 95 % confidence interval 1.443-12.355). The mean survival time was 37.9 ± 6.0 months for 19 survivors of the younger group and 22.6 ± 5.7 months for 9 survivors of the older group. Among the 28 surviving patients, 22 (78.6 %) were interviewed, and we found that age was a determining factor for functional outcome (Barthel indices of 65.7 ± 10.6 for younger patients vs 48.0 ± 9.3 for older patients, p < 0.001), but not for quality of life. The caregiver burden was significantly correlated (R = -0.53, p < 0.01) with the severity of disability and age (R = 0.544, p = 0.011) of the patients. CONCLUSION: Our findings show that the degree of impairment, as well as caregiver burden, is higher in patients older than 60 years than in younger patients.

Cirurgias realizadas em idosos em um hospital público do interior de São Paulo / Surgeries performed on elderly patients in a public hospital in the state of São Paulo / Cirugías realizadas en idosos en un hospital público del interior de São Paulo

Objetivo: Identificar a prevalência dos procedimentos cirúrgicos realizados em idosos em um centro cirúrgico de um hospital público do interior do estado de São Paulo e caracterizar tais procedimentos. Método: Estudo transversal, retrospectivo, quantitativo. A amostra constou de 7.483 procedimentos cirúrgicos em idosos, realizados entre 2013 e 2015. Os dados foram coletados a partir do sistema de cirurgia da instituição sede do estudo. Resultados: A faixa etária na qual prevaleceram os procedimentos foi entre 60 e 70 anos de idade; a maior média de tempo para recuperação da anestesia foi entre 71 e 80 anos. As especialidades que mais realizaram procedimentos foram: ortopedia, urologia e oftalmologia. As anestesias mais empregadas foram: geral inalatória, endovenosa, local com sedação e raquideana; 37,3% usaram o serviço de anestesia, porém não estava descrito em prontuário qual foi o tipo de anestesia realizada. Os óbitos decorrentes dos procedimentos ou complicações das cirurgias foram 1.140; três deles ocorreram no centro cirúrgico e os demais, em enfermarias ou unidades de cuidados intensivos. Conclusão: Os dados aqui apresentados reforçam a necessidade de novos modelos de assistência, com melhorias da assistência multidisciplinar geriátrica, no atendimento perioperatório aos pacientes idosos

Objective: To identify the prevalence of surgical procedures performed in the elderly in a surgical center of a public hospital in the state of São Paulo and to characterize such procedures. Method: Cross-sectional, retrospective, quantitative study. The sample consisted of 7,483 surgical procedures performed in the elderly, between 2013 and 2015. Data were collected from the surgical information system of the institution under study. Results: The age range was between 60 and 70 years of age; the highest average anesthesia recovery time was between 71 and 80 years. The specialties that performed the most procedures were: orthopedics, urology and ophthalmology. The most commonly used anesthesias were: general inhalation, intravenous, local with sedation and spinal; 37,3% used anesthesia, however the type was not described in the patient medical records. There were 1,140 deaths resulting from the procedures or complications; three of them occurred in the surgical center, while the others occured in the intensive care unit or ward. Conclusion: The data presented here reinforce the need for new models of care, with improvements in geriatric multidisciplinary care, in perioperative care for the elderly

Objetivo: Identificar la prevalencia de los procedimientos quirúrgicos realizados en ancianos en un centro quirúrgico de un hospital público del interior del estado de São Paulo y caracterizar tales procedimientos. Método: Estudio transversal, retrospectivo, cuantitativo. La muestra constató de 7.483 procedimientos quirúrgicos en ancianos, realizados entre 2013 y 2015. Los datos fueron recolectados a partir del sistema de cirugía de la institución sede del estudio. Resultados: El grupo de edad en el que prevalecieron los procedimientos fue entre 60 y 70 años de edad; la mayor media de tiempo para la recuperación de la anestesia fue entre 71 y 80 años. Las especialidades que más realizaron procedimientos fueron: ortopedia, urología y oftalmología. Las anestesias más empleadas fueron: general inhalatoria, endovenosa, local con sedación y raquídea; 37,3% usaron el servicio de anestesia, pero no estaba descrito en prontuario cuál fue el tipo de anestesia realizada. Las muertes derivadas de los procedimientos o complicaciones de las cirugías fueron 1.140; Y tres de ellos ocurrieron en el centro quirúrgico y los demás, en enfermerías o unidades de cuidados intensivos. Conclusión: Los datos aquí presentados refuerzan la necesidad de nuevos modelos de asistencia, con mejoras de la asistencia multidisciplinaria geriátrica, en la atención perioperatoria a los pacientes ancianos.