Educational interventions on preventing pressure injuries targeted at nurses: systematic review and meta-analysis.

BACKGROUND: Although preventable, pressure injuries are commonly observed in the hospital setting and are estimated to be the third most costly condition, after cancer and cardiovascular disease. AIM: Nurses play a crucial role in the prevention and management of pressure injuries, however, published evidence on the effectiveness of educational interventions, directed specifically at nurses in the hospital environment, is scarce. METHOD: The authors retrieved published studies on the subject from selected databases (Pubmed/Medline, Embase, Web of Science and the Cochrane Library) in a number of languages (Portuguese, English, French and Spanish). The search yielded randomised controlled trials, as well as quasi-experimental and comparative studies. FINDINGS: In total, 11 studies were selected. The outcomes analysed, following some type of educational intervention, included the attitudes and knowledge of the nursing professionals, as well as the incidence of pressure injuries. CONCLUSION: The present study demonstrated that different educational strategies can help prevent pressure injuries in the hospital environment.

Effects of Hydrogel With Enriched Sodium Alginate in Wounds of Diabetic Patients.

Objective of this study was to evaluate the efficacy of the autolytic debridement promoted by hydrogel with sodium alginate enriched with fatty acids and vitamins A and E in the healing of foot wounds in diabetic patients. A clinical study was conducted at an outpatient clinic of medical specialties. The sample comprised 8 patients supervised for a 3-month period, from April to July 2017, by means of a clinical history, photographic record, planimetry, and classification of the wound severity by the Pressure Ulcer Scale for Healing (PUSH) system. Of the 8 patients supervised, 1 dropped out and 7 were followed up for 12 weeks. Only 2 had complete wound healing, but all presented a reduction of the lesion area of approximately 22.2% and PUSH score of 9.8 to 6.6. This study found that hydrogel showed good results for the treatment of diabetic feet, reducing the area and overall PUSH score of the wounds.

Complicated Surgical Wounds and Associated Factors in Oncology Patients.

The objective of this study was to identify the occurrence of complicated surgical wounds (CSWs) and to analyze the associated factors in hospitalized patients at an oncology institution. This was an epidemiological, observational, cross-sectional, descriptive, and correlational study conducted in the intensive care and hospitalization units forming part of a large cancer hospital. Sociodemographic and clinical data were collected from medical records and physical examinations of the skin. Associations between the dependent variable (presence of CSWs) and the independent variables were obtained by chi-square tests and odds ratio (OR) calculations with a 95% confidence interval. Logistic regression (LASSO) was used to verify the possible predictors of the outcome. The sample consisted of 341 patients, specifically individuals who are White (46.9%), married (53.4%), and men (58.1%) with an average age of 59.2 years. Complicated surgical wounds were present in 3.2% of patients, and the most frequent types of complications were dehiscence (40%), infection (26.7%), and fistula (20%) present in the abdominal (40%), cephalic (26.7%), and cervical (13.3%) regions. Senile purpura, diaper use, and infection were the clinical variables associated with the occurrence of CSWs (p = .044, p = .001, and p < .001, respectively). Based on the logistic regression, the presence of infection (p < .001; OR = 90.8; 95% CI [18.42, 538.79]) persisted as a predictor of the occurrence of CSWs. From these observations, recommendations regarding best practices for the prevention of CSWs are made, specifically for patients with cancer.

Acute coronary syndrome: Relationship between genetic variants and TIMI risk.

Acute Coronary Syndrome (ACS) is a multifactorial disease, including the genetic factor, caused by coronary artery obstruction by atheroma. Some genetic variants have been described as risk factors for this disease. Its early diagnosis and stratification of risk of death by Thrombolysis in Myocardial Infarction (TIMI) are important. Therefore, we evaluated variants in the IL6R (c950-1722C>T), TNFa (c.-488G>A), LEPR (c.2673+1118C>T) and IL1b (c.-598T>C) genes in relation to TIMI risk, cytokine serum levels, and risk factors for ACS. We selected 200 patients with ACS, 50 without ACS from the Real Hospital Português, Recife - PE, and 295 blood donors at the Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope). Variants were determined by DNA sequencing or enzymatic cleavage. Cytokine levels were measured by ELISA. The most frequent risk factors found in the patients were dyslipidemia and hypertension, this latter associated with high TIMI risk (p = 0.003). Genotype frequencies of IL6R and TNFa differed between patients with ACS and the blood donors (p = 0.0002 and p = 0.01, respectively), and TNF-α levels differed between genotypes. The TT genotype of the IL6R gene is as a possible protective factor for ACS because it was significantly more present in blood donors (32.2%) than in patients with ACS (18.0%), and was more frequent in low TIMI risk (22.9%) than in the intermediate (20.2%) or high (4.9%). In patients with ACS, the TT genotype in IL6R was related to a lower concentration of c-reactive protein (p = 0.03) and troponin (p = 0.02), showing a less inflammatory reaction and tissue damage. The differences in the frequencies of variants in genes of medical interest among the groups show the importance of studies in specific populations groups to establish the relationship between genes and diseases.

Biological effects of amniotic membrane on diabetic foot wounds: a systematic review.

OBJECTIVE: The amniotic membrane has biological properties that are beneficial to the wound healing process of diabetic foot ulcers (DFU). Our aim is to analyse the scientific evidence found in literature on the use of the amniotic membrane to stimulate DFU healing. METHOD: A systematic review of amniotic membrane's influence was undertaken, using the search terms 'placenta' 'diabetic foot' 'amnion' and biological dressing', assessing the outcomes 'wound healing' and 'wound healing time', in DFU. Following the inclusion and exclusion criteria, randomised controlled trials (RCT) were identified, and the risk of bias was analysed according to the Cochrane risk of bias tool. We conducted a meta-analysis of the two outcomes to evaluate the level of evidence. RESULTS: We identified six clinical trials, with a total of 331 patients. The most common risks of bias in the studies were selection, attrition, and detection biases. From the meta-analysis, the difference of the intervention group (amnion) in relation to the control group was statistically significant. We found that wound healing in the group treated with amniotic membrane occurs 2.32 times more often and is 32 days faster in comparison with the group that used conventional dressings. CONCLUSION: There is no statistical evidence to support the effectiveness of amniotic membrane in comparison with other conventional dressings. However, there is a clear tendency for the use of amniotic membrane treatment to result in a larger number of DFUs healing at a quicker rate.

Use of Oxidized Regenerated Cellulose/Collagen Matrix in Chronic Diabetic Foot Ulcers: A Systematic Review.

OBJECTIVE: Diabetic wounds that do not heal completely usually exhibit inflammatory markers, increased protease activity, and reduced levels of growth factors and cell count. A systematic review was performed to determine whether there is enough evidence to support the use of an oxidized regenerated cellulose/collagen matrix (ORC+C) to treat diabetic foot ulcers (DFUs). METHODS: Study authors analyzed randomized controlled trials (RCTs) on ORC+C dressings for the treatment of DFUs. A literature search was conducted for all available reports of relevant studies published in journals indexed in PubMed, LILACS, and SciELO databases. There were no restrictions based on date of publication. A population-intervention-comparison-outcome framework was built on MeSH terms and keywords. Two independent researchers analyzed all articles for data collection and used the Cochrane Collaboration tool for risk-of-bias assessment. RESULTS: At first, 316 related studies were located in the databases. After evaluating these studies for methodological similarities, only 3 were considered eligible for the review. One RCT was considered at high risk of bias. Results from this meta-analysis of 2 studies showed no significant improvement in wound healing rates of DFUs when ORC+C was compared with standard wound care. CONCLUSIONS: Because of several methodology flaws in the reviewed studies, these results suggest that there is currently no research evidence to suggest that the use of ORC+C improves wound healing rates of DFUs. Additional research with high-quality RCTs focused on diabetic ulcers is necessary.

The Role of Biological Skin Substitutes in Stevens-Johnson Syndrome: Systematic Review.

Stevens-Johnson syndrome (SJS) is a disease that causes skin exfoliative lesions, characterized by fever, necrosis, and epidermal detachment. Biological skin substitutes may be considered interesting options for the treatment of this disease. This study aims at identifying in the literature the evidence on the current role of these biomaterials in the treatment of SJS and its related diseases. A systematic review with a search period between 2003 and 2017 was carried out, consulting the Lilacs, BVS, and PubMed databases. The quality of the included studies was evaluated by the Oxford Center for Evidence-Based Medicine Classification, for evaluating levels of evidence from the scientific publications. Ninety-five publications were found, and after applying inclusion and exclusion criteria, they resulted in 9 articles. In total, 20 patients with 73.87% average of body surface affected received SJS skin treatment with some biological substitutes, among them are cutaneous allograft, amnion, and xenograft. Mortality rate was 10%, and in these situations, literature indicates mortality rates ranging from 25% to 70%. Effectiveness of the use of biological dressings may be a possible explanation for this finding. Findings indicate the use of these biomaterials may favor reepithelialization, reduce water loss, decrease the chance of infection, and, consequently, improve the survival of patients with SJS and toxic epidermal necrolysis. Biological skin substitutes have characteristics that make them very promising in the topical treatment of these wounds, but their use remains very restricted in the treatment of SJS.

Functional independence in teenage patients with burns.

The purpose of this study was to assess the functional independence of teenagers undergoing a process of rehabilitation. A cross-sectional study was carried out on a sample of 63 teenagers, aged 12 to 20, who had suffered burns and were going through a process of rehabilitation, with the application of the Functional Independence Measurement (FIM). The data was analysed using descriptive statistics and also a test for comparison of means (Student's t-test), as well as Cronbach's reliability test. There was proof of a high degree of independence in FIM. Analysis of the location of the burn and also the performance of work and/or study activities showed these not to interfere with functional independence. The results indicate the reliability of the instruments applied, making it possible to conduct an assessment of the functional independence of the teenagers during the rehabilitation process.

Assessment of health status of adolescent burn victims undergoing rehabilitation: a cross-sectional field study.

Teenagers may experience physiological and psychological changes when they suffer from a severe burn. The aim of this study was to assess the state of health of teenagers who were undergoing a rehabilitation process following a severe burn. A cross-sectional field study was carried out with 63 teenagers and young adults who had suffered burns. The tests applied were social, demographic, and clinical instruments. The specific tests included the Burn Specific Health Scale-Revised, Beck Depression Inventory, Rosenberg's Self-Esteem Scale, and Functional Independence Measurement. The results were analyzed by using descriptive statistics, multivariate analysis of variance, variance analysis, and Cronbach's reliability analysis. The social and demographic analysis of the population has shown a prevalence of female (60.3%), single subjects (93.7%), and ages between 12 and 20 years (mean age of 15.95 years). The mean total body surface area burn was 23.84%, with accidents as the main causative factor (92.10%). More than half (52.4%) reported functional and aesthetic effects after the burn, with 81% concerned about the visible scar. Cronbach's reliability analysis has shown statistically confident results for all the instruments as applied. The multivariate analysis showed a correlation between the work domain and marital status, whereas there was no evidence to show a correlation between sex, age, physical or aesthetic sequelae or visibility of burns, and depression, self-esteem, functional independence, or current state of health. The results obtained prove the reliability of the instruments applied, making it possible to assess the state of teenagers and young adults health during the rehabilitation process.

Retrospective Evaluation of Characteristics of Patients with Burn Injuries Treated at the Largest Reference Hospital in Brazil.

Burn injuries are a significant cause of morbidity and mortality in the Brazilian population. We conducted this study in a tertiary hospital in Brazil to discover the epidemiological characteristics of patients with burn injuries. We conducted a cohort review of patients admitted to the burn unit of our institute during a 5-year period. For each patient, we collected data that included age, gender, total percentage of burned body surface area, burn location, burn mode, and burn cause. We analyzed the data using the R programming language. We included a total of 496 patients in our study. The mean age of the patients was 28 ± 14.7 years. The median length of hospital stay was 2 weeks. We found a significant correlation between the total percentage of burned body surface area and the length of hospitalization (p < .001) and the length of hospitalization in the intensive care unit (p < .001). A total of 427 patients (86%) were discharged from the hospital after successful treatment. In contrast, 43 patients (8.67%) died. The mortality rate was highest in patients who had more than 70% of their total body surface area burned. The average length of hospitalization aligned with global and national statistics presented in the literature. The main causes of the burn injuries were thermal (e.g., fire, hot liquids). We found inhalation injuries present in more than one third of the patients who were hospitalized in the intensive care unit with thermal burns.

IFN-gamma and IL-12B polymorphisms in women with cervical intraepithellial neoplasia caused by human papillomavirus.

The Human Papillomavirus (HPV) is a sexually transmitted organism associated with Cervical Intraepithelial Neoplasia (CIN) and cervical cancer, the second main cause of malignancy in women worldwide. The virus itself, however, is not enough to cause lesions on the cervix. Several studies suggest that some polymorphic sites changes the cytokines levels and influence the cancer development in HPV infected patients. In this study, we evaluated the presence of functional polymorphisms at +874 (T/A) IFNG and +1188 (A/C) IL-12B genes in cervical smears samples from 76 healthy women and 162 women, HPV positive, with CIN lesion--CIN I (45), CIN II (55), CIN III (53) and cervical cancer (9)--in Brazilian population. There was no significant differences in genotype (p = 0.4192) and allele (p = 0.370; OR = 1.20) distributions between CIN patients and control groups on IFNG allelic polymorphism. Moreover, for IL-12B gene, there was a significant difference in genotype (p = 0.015) and allele distribution (p = 0.014; OR = 0.5754) between the groups. When samples were stratified according to grade of cervical lesion, the AA genotype and A allele were less frequent in the group with low-grade cervical lesions than in group with high-grade cervical lesions (p = 0.0036 and p = 0.0010; OR = 0.3819, respectively), suggesting that the C allele (mutant) may protect against the emergence of CIN lesions and its progression.

Clinical trial comparing 3 different wound dressings for the management of partial-thickness skin graft donor sites.

PURPOSE: A review of the literature reveals a lack of consensus regarding local management of skin graft donor sites. This study was undertaken to determine the effects of 3 different dressings on healing of donor sites and patient discomfort related to donor sites. DESIGN: This study is a comparison cohort study. SUBJECTS AND SETTING: We recruited 34 burn patients scheduled for partial-thickness skin grafts; their mean age was 36 ± 18 years (mean ± SD, range 20 to 54 years), and 63% were male. All subjects were managed at Burn Unity Care, located in Sao Paulo, Brazil. MATERIALS AND METHODS: Subjects were randomly allocated to 1 of 3 groups: (1) a study group (group A) whose donor sites were dressed with a bovine collagen calcium-alginate dressing covered with transparent polyurethane film; (2) a second intervention group (group B), whose donor sites were dressed only with transparent polyurethane film dressing; and (3) a control group whose donor sites were dressed with rayon soaked in 0.9% saline (group C). Two independent observers assessed donor site wounds for epithelialization, scabbing, quantity and characteristics of exudate, and complications. Pain was measured using the visual analog scale, the brief pain inventory, and Index of Pain Management. RESULTS: Subjects managed with the bovine collagen calcium-alginate dressing covered with transparent polyurethane film (group A) achieved the greatest epithelialization (6.3 vs 8.2 for thin film dressing only P < .02 and 6.3 vs 11.7 days for control group P < .01). Patients managed with the bovine collagen calcium-alginate dressing covered with transparent polyurethane film also reported less pain that subjects allocated to the control (group C) or thin film only group (group B), (P < .05). Ninety percent of subjects allocated to the calcium alginate covered with thin film dressing reported mild pain intensity on the Visual Analog Scale, 85% of did not report pain localized to the donor site on the brief pain inventory, and scores on the Index of Pain Management ranged from 23 to 11. CONCLUSION: Study findings suggest that use of a collagen calcium-alginate dressing with a transparent film covering reduces the time for complete epithelialization and may reduce pain related to skin graft donor sites.

Retrospective Evaluation Of The Accuracy Of Five Different Severity Scores To Predict The Mortality In Burns Patients.

BACKGROUND: Patients with great clinical impairment, due to extensive burns, need to be admitted to intensive care units, in these treatment sites, indices are used to classify the severity of patients. The aim of the study was to compare the accuracy of the FLAMES score in relation to the Acute Physiologic and Chronic Health Evaluation II (APACHE II), the Simplified Acute Physiologic Score II (SAPS II), the Logistic Organ Dysfunction System (LODS) and the Abbreviated Burn Severity Index (ABSI) applied to the severe burn patient facing mortality in an ICU of a reference center for burns in Brazil. METHODS: A retrospective study conducted in ICU comparing the accuracy the APACHE II, SAPS II, LODS, ABSI and FLAMES instruments were applied to all the selected medical records. To evaluate the accuracy of the SIs, the Receiver Operating Characteristic curve was calculated and the area under the curve (AUC). RESULTS: Among the 574 patients included in the study, male individuals (70.13%), with an average age of 44.01 ± 28.64 prevailed and the majority of the burns were caused by accidents (76.53%). The outcome accounted for 35.29% of deaths. It was observed that the FLAMES and ABSI presented the two largest areas under the ROC curves and the highest sensitivities (96% and 89%, respectively). The APACHE II, SAPS II and LODS presented sensitivities equal to or greater than 80%. CONCLUSIONS: It has been demonstrated that indices specifically developed for burn patients, specifically the FLAMES and ABSI indices, presented better accuracies and prediction performances.

A Sanger-based approach for scaling up screening of SARS-CoV-2 variants of interest and concern.

The global spread of new SARS-CoV-2 variants of concern underscore an urgent need of simple deployed molecular tools that can differentiate these lineages. Several tools and protocols have been shared since the beginning of the COVID-19 pandemic, but they need to be timely adapted to cope with SARS-CoV-2 evolution. Although whole-genome sequencing (WGS) of the virus genetic material has been widely used, it still presents practical difficulties such as high cost, shortage of available reagents in the global market, need of a specialized laboratorial infrastructure and well-trained staff. These limitations result in SARS-CoV-2 surveillance blackouts across several countries. Here we propose a rapid and accessible protocol based on Sanger sequencing of a single PCR fragment that is able to identify and discriminate all SARS-CoV-2 variants of concern (VOCs) identified so far, according to each characteristic mutational profile at the Spike-RBD region (K417N/T, E484K, N501Y, A570D). Twelve COVID-19 samples from Brazilian patients were evaluated for both WGS and Sanger sequencing: three P.2, two P.1, six B.1.1 and one B.1.1.117 lineage. All results from the Sanger sequencing method perfectly matched the mutational profile of VOCs and non-VOCs RBD's characterized by WGS. In summary, this approach allows a much broader network of laboratories to perform molecular surveillance of SARS-CoV-2 VOCs and report results within a shorter time frame, which is of utmost importance in the context of rapid public health decisions in a fast evolving worldwide pandemic.

Evaluation of the body image of patients with facial palsy before and after the application of botulinum toxin.

BACKGROUND: The face is responsible for nonverbal communication. Facial nerve paralysis, which is the weakness or paralysis of the nerve responsible for the innervation of the muscles that perform these movements, is a condition that can raise serious physical, psychological, social, professional, aesthetic, and functional disorders. The physical aspect has a disastrous effect on the patient's self-image and emotional state. This study aimed to evaluate the self-image of patients with facial paralysis through the Body Image Quality Life Index (BIQLI), pre- and postclinical treatment with botulinum toxin. METHOD: A prospective, exploratory, comparative cohort was carried out, with quantitative analysis of the variables with 40 patients with facial paralysis treated by the Ambulatory of Plastic Surgery of Hospital das Clínicas, Faculty of Medicine, University of São Paulo. The Sociodemographic and clinical instrument and the BIQLI were applied. Descriptive statistics and statistical inference were used to perform the analyses. RESULTS: It was found that the majority of the paralysis occurred in female individuals (55%), with an average age of 47,875 (DP), single and married (38.88%), and with secondary education completed (16.66%). CONCLUSION: The body image evaluation of patients with facial paralysis submitted to the botulinum toxin treatment showed an ability to identify the positive impact of therapy in the period between 15 and 180 days by the BIQLI.

Speech and Swallowing Data in Individual Patients Who Underwent Glossectomy after Prosthetic Rehabilitation.

Maintaining oral function in patients undergoing glossectomy boosts interventions such as prosthetic rehabilitation. However, current literature still fails in the presentation of results of prosthetic rehabilitation in relation to speech or swallowing. The objective of this research is to evaluate the effectiveness of prosthetic rehabilitation on voice, speech, and swallowing in patients undergoing glossectomy by performing a systematic literature review and meta-analysis of individual cases. Studies were identified by relevant electronic database and included all dates available. The criteria used were sample with any n; resection due to malignant tumors, restricted to tongue and/or floor of mouth; type of prosthetic rehabilitation; and description of the oral functions outcomes with prosthesis. For the meta-analysis of individual data, associations between the variables of interest and the type of prosthesis were evaluated. Thirty-three of 471 articles met the selection criteria. Results on speech and/or voice and swallowing were reported in 27 and 28 articles, respectively. There were improvement of speech intelligibility and swallowing in 96 patients and in 73 patients, respectively, with prosthesis. Based on the available evidences, this article showed that prosthetic rehabilitation was able to improve oral functions and can be a strategy used with surgical reconstruction in selected cases.

[Medication errors and consequences for nursing professionals and clients: an exploratory study]. / Erros na medicação e conseqüências para profissionais de enfermagem e clientes: um estudo exploratório.

The purpose of this study was to analyzed the consequences for the patients and professionals involved in medication. The author adopted as the methodological reference the Critical Incident Technique modificated. The study was developed at a University Hospital at the state of São Paulo, Brazil. Data were collected through interviews with 7 nurses, 4 nursing technicians and 23nursing auxillaries. The analysis enabled the identification consequences for the patient and consequences for the professional involved.

A quantitative, cross-sectional study of depression and self-esteem in teenage and young adult burn victims in rehabilitation.

Burns can have a negative physiological and emotional impact, particularly among teenage victims. To assess the presence of depression and level of self-esteem, a cross-sectional study was conducted among 63 teenage and young adult burn victims ages 12 to 20 years undergoing physical and psychological rehabilitation at the Outpatient Unit for Plastic Surgery and Burns at the Central Institute of the Clínicas Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil. Assessment instruments included Beck's Depression Inventory (BDI) and the Rosenberg Self-Esteem Scale (RSE). Internal consistency within and between the two scales was established via Cronbach's-α coefficient. All variables were analyzed using descriptive statistics, and the statistical difference between means was compared using Student's t-test. The majority of participants were female (38, 60.3%) and unmarried (59, 93.7%) with a mean total body surface area (TBSA) burn of 23.84%. Most burns (58, 92.10%) were the result of accidents and were located on the trunk (47, 74.6%), head (43, 68%), arms (41, 65%), hands (38, 60%), neck (34, 54%), and forearm (29, 46%). Participants had received physical and psychological rehabilitation for an average of 124.74 months (SD 63.67) from a multidisciplinary team. The majority of participants (33, 52.4%) reported functional and aesthetic after-effects and appraised their scar as visible (51, 81.0%). BDI results showed low levels or absence of depression (mean = 7.63, SD 8.72; scale 0 = no depression to 63 = serious depression); the RSE showed adequate levels of self-esteem (mean = 8.41, SD 4.74; scale 0-30, where higher scores indicate worst levels of self-esteem). Burn location did not affect depression (BDI: P = 0.26) or self-esteem (RSE: P = 0.21). However, depression and self-esteem were more significant in participants who were not able to work and/or go to school than in those who were (BDI: P = 0.04 and self-esteem RSE: P = 0.03). Contrary to the initial hypothesis, this population of teenage burn victims did not experience depression and low self-esteem compared with the normal population described in the literature, which may demonstrate the importance of multidisciplinary rehabilitation programs.

Mattis dementia rating scale (DRS) normative data for the brazilian middle-age and elderly populations.

OBJECTIVE: To expand norms for the Mattis Dementia Rating Scale (DRS) for the Brazilian middle-age and elderly populations. METHODS: The DRS was administered to 502 individuals without cognitive deficits, 312 women and 190 men, aged 50 years or over and with educational level ranging from 0 to 13 years or more. The sample was composed of subjects who participated in other studies, from Caeté (Minas Gerais state), Ribeirão Preto (São Paulo state) and São Paulo (São Paulo state). Participants were divided into four schooling groups (illiterate, 1 to 4 years, 5 to 12 years and 13 years or more). The subjects were divided into four groups according to age (50 to 60, 61 to 70, 71 to 80, and 80 years or over). RESULTS: Normative data for DRS scores are expressed as percentile values. The group with lowest schooling and subjects older than 80 years had the worst scores. CONCLUSION: As expected, age and education were strongly correlated with DRS scores. Illiterates and older old individuals performed worse than the other groups. These data might help to improve the accuracy of the diagnosis of cognitive impairment and dementia in Brazilian middle-age and elderly populations.

OBJETIVO: Expandir normas para o Mattis Dementia Rating Scale (MDRS) na população brasileira de meia idade e idosa. MÉTODOS: A MDRS foi aplicada em 502 indivíduos, 312 mulheres e 190 homens, com idade de 50 anos ou mais e escolaridade de 0 a 13 anos ou mais anos. A amostra foi composta de sujeitos que participaram de outros estudos: Caeté (Minas Gerais), Ribeirão Preto (São Paulo) e São Paulo (São Paulo). Participantes foram divididos em quatro grupos de escolaridade (analfabetos, 1 a 4 anos, 5 a 12 anos e 13 anos ou mais). Os sujeitos foram divididos em quatro grupos de idade (50 a 60, 61 a 70, 71 a 80 e acima de 80 anos). RESULTADOS: Dados normativos dos escores da MDRS são apresentados em percentis. O grupo com menos escolaridade e sujeitos acima de 80 anos apresentaram escores mais baixos. CONCLUSÃO: Como esperado, idade e escolaridade foram fortemente correlacionados aos escores da MDRS. Analfabetos e indivíduos muito idosos apresentaram pior desempenho que os outros grupos. Os dados podem ajudar a melhorar a acurácia para o diagnóstico de prejuízo cognitivo e demência na população brasileira de meia-idade e idosos.

Manejo da dor em crianças queimadas: Revisão integrativa / Management of pain in burned children: An integrative review / Manejo del dolor en niños quemados: Revisión integrativa

A dor e o sofrimento estão associados com queimaduras, trazem efeitos fisiológicos e emocionais adversos, principalmente em crianças. O controle adequado da dor é um fator importante na melhora dos resultados clínicos. Este estudo tem como objetivo identificar na literatura os princípios ativos mais utilizados para a analgesia em crianças vítimas de queimaduras. Foi realizada uma revisão com um período de busca entre 2008 e 2018, consultando as bases de dados LILACS, Scielo e Medline/PubMed. Duzentas e vinte e cinco publicações foram encontradas e, após a aplicação dos critérios de inclusão e exclusão, 12 artigos relatavam os princípios ativos medicamentosos utilizados para analgesia em crianças queimadas. Os medicamentos mais encontrados foram paracetamol, morfina, ketamina, propofol, AINEs e fentanil. Os profissionais de saúde precisam reconhecer o significado da dor relacionada às crianças queimadas e estar atualizados sobre as várias opções farmacológicas disponíveis. Assim, ter aprofundamento sobre dosagem e via de administração, bem como o conhecimento com queimaduras pediátricas, pode romper barreiras para beneficiar o paciente com o início precoce da administração de analgésicos.

Pain and suffering are associated with burns, they bring adverse physiological and emotional effects mainly on children. Adequate pain control is an important factor in improving clinical outcomes. This study aims to identify in the literature the active principles most used for analgesia in children victims of burns. A review was conducted with a search period between 2008 and 2018, consulting the LILACS, Scielo and Medline / PubMed databases. Two hundred and twenty five publications were found and, after the application of the inclusion and exclusion criteria, 12 articles reported the active drug principles used for analgesia in burned children. The most commonly found drugs were paracetamol, morphine, ketamine, propofol, NSAIDs and fentanyl. Health professionals need to recognize the meaning of pain related to burned children and be up to date on the various pharmacological options available. Thus, having in-depth dosing and route of administration as well as knowledge with pediatric burns can break down barriers to benefit the patient with the early onset of analgesic administration.

El dolor y el sufrimiento están asociados con quemaduras, traen efectos fisiológicos y emocionales adversos principalmente en los niños. El control adecuado del dolor es un factor importante en la mejora de los resultados clínicos. Este estudio tiene como objetivo identificar en la literatura los principios activos más utilizados para la analgesia en niños víctimas de quemaduras. Se realizó una revisión con un período de búsqueda entre 2008 y 2018, consultando las bases de datos LILACS, Scielo y Medline / PubMed. Se encontraron doscientas veinticinco publicaciones y, después de la aplicación de los criterios de inclusión y exclusión, 12 artículos relataban los principios activos medicamentosos utilizados para la analgesia en niños quemados. Los medicamentos más encontrados fueron paracetamol, morfina, ketamina, propofol, AINES y fentanil. Los profesionales de la salud deben reconocer el significado del dolor relacionado con los niños quemados y estar al día sobre las diversas opciones farmacológicas disponibles. Así, tener profundización sobre dosificación y vía de administración, así como el conocimiento con quemaduras pediátricas pueden romper barreras para beneficiar al paciente con el inicio precoz de la administración de analgésicos.