Prevalence of Anxiety and Depression in Persons With Ostomies: A Cross-sectional Study.

PURPOSE: The purpose of this study was to measure the prevalence of anxiety and depression in adults with ostomies and to identify associated factors. DESIGN: A descriptive cross-sectional study. SUBJECTS AND SETTING: The sample comprised 120 adults; all reside in a health region in the state of Minas Gerais in southeastern Brazil. METHODS: Participants responded to a questionnaire designed for purposes of this study. The questionnaire included 2 validated instruments-the Beck Depression Inventory and the Beck Anxiety Inventory. In addition to measuring the prevalence of depression and anxiety, we used logistic regression models to identify factors associated with depression and anxiety. A backward method was adopted and the goodness-of-fit of the model was evaluated through the Hosmer and Lemeshow goodness-of-fit test. An odds ratio (OR) with a 95% confidence interval (95% CI) was used to measure the effect size of these associations. RESULTS: The prevalence of depression in our sample was 26.7% (n = 32; 95% CI, 18.6-34.6). Slightly more than half of respondents (53.1%, n = 17) had mild depression, 34.3% (n = 11) had moderate depression, and 12.6% (n = 4) had had severe depression. The prevalence of anxiety in our sample was 52.5% (n = 63; 95% CI, 43.4-61.5). Slightly less than half 47.6% (n = 30) had mild anxiety; 36.5% (n = 23) reported moderate and 15.9% (n = 10) reported severe anxiety. The final multiple logistic regression model indicated that respondents with less supportive family relationships were more likely to have depression than respondents with greater family support (OR, 3.83; 95% CI, 1.30-11.25). Similarly, respondents with anxiety were more likely to experience depression when compared to individuals reporting no anxiety (OR, 6.32; 95% CI, 2.26-17.65). CONCLUSIONS: Anxiety and depression are prevalent in adults living with an ostomy; anxiety was more prevalent than depression. Respondents with less support from their family and those with anxiety were more likely to experience depression.

Effect of Polyhexamethylene Biguanide Solution on Bacterial Load and Biofilm in Venous Leg Ulcers: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to investigate the effect of polyhexamethylene biguanide (PHMB) solution as a wound cleanser on bacterial load and bacterial biofilm in venous leg ulcers. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The target population was adults attending the dermatology outpatient clinic of the Clinical Hospital of the Federal University of Minas Gerais, Brazil. The sample comprised 44 patients with venous leg ulcers recruited over a 6-month period. METHODS: Participants were divided into 2 groups: the intervention group had their wounds cleansed with PHMB, and the control group had their wound cleansed with a 0.9% saline solution. Tissue fragments of the wounds were collected for bacteriological analysis; transmission electron microscopy was used to identify the presence of biofilm. RESULTS: The bacterial load was reduced in both groups compared to baseline values; no significant difference was found when groups were compared. Correlation analysis between wound duration (months), wound area (cm²), necrosis (%), variables, and bacterial count (colony forming units [CFUs]/g) after cleansing showed a significant relationship between area of the wound and CFUs/g (P = .0070, r = 0.51). Transmission electron microscopy revealed the presence of bacterial biofilm in the wounds after cleansing with both solutions. CONCLUSIONS: The results of this study indicate that both PHMB and saline solution are effective in reducing the bacterial load in venous leg ulcers. However, bacterial biofilm was present after cleansing with both solutions. These findings provide important evidence regarding effectiveness of 2 common wound cleansers on bacterial presence in wounds.

Costs of topical treatment of pressure ulcer patients.

OBJECTIVE: To evaluate the costs of a topical treatment of pressure ulcer (PU) patients in a hospital unit for treatment of chronic patients in 2014. METHOD: This is an activity-based costing study. This method encompasses the identification, measurement and pricing of physical and human resources consumed for dressings. RESULTS: Procedure costs varied between BRL 16.41 and BRL 260.18. For PUs of the same category, of near areas and with the same type of barrier/adjuvant, the cost varied between 3.5% and 614.6%. For most dressings, the cost increased proportionally to the increase of the area and to the development of PU category. The primary barrier accounted for a high percentage of costs among all items required to the application of dressings (human and material resources). Dressings applied in sacral PUs had longer application times. CONCLUSION: This study allowed us to understand the costs involved in the treatment of PUs, and it may support decision-makers and other cost-effectiveness studies. OBJETIVO: Realizar uma avaliação do custo do tratamento tópico de pacientes com úlceras por pressão (UP), em uma unidade hospitalar de atendimento a pacientes crônicos no ano de 2014. MÉTODO: Trata-se de um estudo de custos baseado no Sistema de custeio Baseado em Atividades. Este método contempla a identificação, mensuração e precificação dos recursos físicos e humanos consumidos para a realização de curativos. RESULTADOS: Os custos dos procedimentos variaram de R$16,41 a R$260,18. Para UP de mesma categoria, de áreas aproximadas e mesmo tipo de cobertura/adjuvante, a variação entre os custos foi de 3,5% a 614,6%. Para a maioria dos curativos, o custo aumentou proporcionalmente ao aumento da área e à progressão da categoria das UP. A cobertura primária representou elevado percentual nos custos entre todos os itens necessários para realizar os curativos (recursos humanos e materiais). Os curativos realizados nas UP sacrais foram os que apresentaram maiores tempos para execução. CONCLUSÃO: Este estudo permitiu conhecer os custos envolvidos no tratamento das UP e pode fornecer subsídios para os tomadores de decisão, assim como para a realização de estudos de custo-efetividade.

The use of occlusive dressings: influence on excisional wound healing in animal model.

PURPOSE: To analyze the influence of occlusive dressing on the healing of excisional skin wounds in mice. METHODS: Pre-clinical, comparative, and translational study. Mice were divided into three experimental groups: wounds occluded with hydrocolloid (HD) dressings, transparent polyurethane film (TF) dressings, and without occlusion (WO), monitored at three, six and 14 days, with eight animals each. Closure rate, infiltration of neutrophils and macrophages, measurement of tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) and, histologically, angiogenesis were evaluated. RESULTS: Wound closure was accelerated in the occlusive groups. There was a decrease in TNF-α levels in the HD group when compared to the WO and TF groups. Neutrophils accumulation decreased in the HD group. Increased dosages of macrophages were evidenced in the HD group, compared to the WO and TF groups. Levels of VEGF were increased in the TF and HD groups. CONCLUSIONS: It is suggested that the occlusion of wounds modulates the inflammatory response.

Prevalence of people with sickle cell disease and leg ulcers in Brazil: Socioeconomic and clinical overview.

OBJECTIVE: To identify the prevalence of people with leg ulcers resulting from sickle cell disease, as well as to describe the clinical, social, economic, and demographic conditions of these people. METHOD: Descriptive study, carried out at the Minas Gerais Hematology and Hemotherapy Center Foundation. The study population consisted of individuals over the age of 18 with a diagnosis of sickle cell disease in the State of Minas Gerais, Brazil. Data collection was performed from August 2019 to April 2020 through interviews. For the prevalence calculation, a census was taken of 5,379 people over the age of 18 with sickle cell disease, 77 of whom had active leg ulcers. Descriptive data analysis was performed using SPSS software (version 20.0, Chicago, IL, USA). RESULTS: The prevalence of people with leg ulcers in Minas Gerais, Brazil was 1.4%. Of the 72 respondents, the average age was 39 years (range 18-64 years), 41.7% were single, 48.6% said they were black, 84.7% lived in their own house, 38.9% were retired, 61.1% had an income of one minimum wage. The median years of education was 10.5, 50% cited the church as a place for leisure activities, 79.2% denied smoking. Regarding pain, the median score was 3, the median baseline hemoglobin was 7.7 g/dL, and 91.7% had the HbSS genotype. The median age of the first ulcer was 18 years, 77.8% of active ulcers were recurrent, and 59.7% had only one active ulcer. The median time of existence of the ulcer was 3 years. The ulcer prevented 80.6% of people from doing some activity. Prejudice was experienced by 48.6% of the participants. CONCLUSION: The estimated prevalence of leg ulcers was lower than what it reported in the literature, however, the recurrence and the duration of ulcers were high. These findings bring reflection about the assistance to people with leg ulcer.

Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient Clinic: Historical Cohort.

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.

Biofilm model on mice skin wounds.

PURPOSE: To evaluate a biofilm model of Pseudomonas aeruginosa in excisional cutaneous wound in mice. METHODS: Preclinical, translational study conducted with 64 C57BL/6 mice randomly assigned to control and intervention groups. Evaluation was on days D0, D3, D5, D7 and D10 of wound making. The profile of biofilm formation and induction was evaluated using wound closure kinetics, quantitative culture, and evaluation of wounds using transmission electron microscopy (TEM). Clinical evaluation was performed by liver tissue culture, weight variation, and quantification of leukocytes in peripheral blood. Analyses were performed with GraphPad Prism software. RESULTS: Bacterial load for induction of infection with P. aeruginosa and survival of animals was 104 UFC·mL-1. In D5 (p < 0.0001) and D7 (p < 0.01), animals in the intervention group showed a delay in the healing process and had their wounds covered by necrotic tissue until D10. Statistical differences were observed in wound cultures and weight at D5 and D7 (p < 0.01). Liver cultures and leukocyte quantification showed no statistical differences. No bacteria in planktonic or biofilm form were identified by TEM. CONCLUSIONS: The findings raise questions about the understanding of the ease of formation and high occurrence of biofilm in chronic wounds.

Medical adhesive-related skin injury in cancer patients: A prospective cohort study.

OBJECTIVE: to estimate the incidence of medical adhesive-related skin injury in the peripheral venous catheter fixation region in critical cancer patients, to identify risk factors, and to establish a risk prediction model for its development. METHOD: a prospective cohort study with a sample of 100 adult and aged patients hospitalized in an intensive care unit. The data were analyzed using descriptive, bivariate and multivariate statistics with Cox regression. RESULTS: the incidence of medical adhesive-related skin injury was 31.0% and the incidence density was 3.4 cases per 100 people-days. The risk factors were as follows: alcoholism, smoking habit, hospitalization due to deep vein thrombosis, acute respiratory failure, immediate postoperative period, heart disease, dyslipidemia, use of antiarrhythmics, blood transfusion, friction injury, pressure injury, turgor, edema, hematoma, petechiae, low values in the Braden scale, clinical severity of the patient, elasticity, moisture, texture and color. The predictive model consisted in the following: decreased skin turgor, presence of hematoma and edema. CONCLUSION: medical adhesive-related skin injury at the peripheral venous catheter insertion site has a high incidence in critical cancer patients and is associated with decreased turgor, presence of hematoma and edema, evidence that can support the clinical practice.

Patients who experience systemic lupus erythematosus and leg ulcer: phenomenological approach.

OBJECTIVE: To understand the experience of a woman with systemic lupus erythematosus and leg ulcers with cutaneous calcinosis. METHODS: An experience report based on the social phenomenology of Alfred Schutz, conducted with a young woman undergoing treatment in an outpatient service. RESULTS: The disease manifested itself in adolescence and brought emotional instability associated with body image concern and social isolation. The discontinuation of the studies triggered financial limitations with implications for treatment. The presence of ulcers aggravated by skin calcification makes the process of getting sick tiring and painful. Interpersonal relationships are resources for coping with situations experienced. FINAL CONSIDERATIONS: Patients with lupus may have social, affective, and family life, even in the face of the limitations imposed by the disease. However, the emergence of leg ulcer with calcinosis changes this situation.

Microbiological profile of leg ulcer infections: review study.

OBJECTIVES: to analyze the microbiological profile of leg ulcers of patients treated at outpatient clinics and hospitals regarding the type of microorganism, microbiological selection of antibiotics, and techniques for the collection of culture material. METHODS: literature review performed on LILACS, IBECS, MEDLINE, and CINAHL databases, resulting in a descriptive analysis of 27 studies. RESULTS: 35.7% of the studies occurred in an outpatient care scenario; and 64.2% in hospitals. There was a predominance of swab (100%) in outpatient care and biopsy (55.5%) in the hospital. Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were more common at both levels of assistance. Methicillin-resistant Staphylococcus aureus was isolated in both. CONCLUSIONS: the microbiological profile of infections was similar, with the presence of resistant bacteria in both environments. This fact causes concern and raises the need for research to elucidate it. The studies did not compare the effectiveness between biopsy and swab.

Criteria to evaluate the quality of alginate wound dressings.

OBJECTIVES: to validate an instrument with criteria to evaluate the quality of calcium alginate wound dressings to treat skin injuries. METHODS: methodological study, developed in two stages: the elaboration of criteria to evaluate the quality of the alginate wound dressing based on literature; validation of these criteria by a group of evaluators in two moments. Data was analyzed using descriptive statistics, central tendency measures and the Content Validity Index. RESULTS: seven articles were selected, leading to the elaboration of 7 criteria and 11 expected results. The Content Validity Index was 0.98 in stage 1 and 0.93 in stage 2. After adjustments, 8 criteria were validated, and 13 results were expected. FINAL CONSIDERATIONS: the study allowed the validation of criteria to evaluate the quality of calcium alginate wound dressings, helping the nurses to choose with more autonomy and assertiveness.

Estimated costs in treating sickle cell disease leg ulcer.

OBJECTIVE: To identify the costs of treating leg ulcers due to sickle cell disease from the perspective of the Unified Health System. METHOD: An observational, descriptive, cost-effective economic assessment study conducted in a single center with ulcer patients. The data collected were extracted from the participant's medical records and recorded in a form prepared for this purpose. The cost of the products used in ulcer treatment was provided by the Solicitation/Purchasing Section and Pharmacy Sector of the study institution. The variables studied were ulcer area, number and interval between visits, patient's length of stay in the service, materials used in each visit, and the number of nurse appointments. RESULTS: The sample consisted of 29 patients. The average initial area of ulcers was 14.47 cm2, 79% of the cases had complete epithelialization in an average time of 8.02 months, with an average cost of R$ 1,288.06. The average cost to reduce 1 cm2 of the lesion area was R$ 102.20. Silver activated carbon coating was the most cost-effective treatment. CONCLUSION: The average cost for complete healing of a sickle cell ulcer with an average area of 14.95 cm2 was R$ 1,288.06.

Doença falciforme: cuidado com pessoas com úlcera da perna nos serviços de atenção à saúde / Sickle cell disease: caring for people with leg ulcers in heal-thcare services / Enfermedad falciforme: cuidado de personas con úlcera de pierna en los servicios de atención a la salud

Objetivo: identificar o local e os cuidados diretos recebidos por pessoas com úlceras da perna por doença falciforme nos serviços de atenção à saúde. Método: estudo transversal, realizado em 11 centros, no período de agosto de 2019 a abril de 2020. Fizeram parte do estudo 72 pessoas com úlcera da perna ativa. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultado: apresentavam anemia falciforme 91,7% dos participantes, com mediana de três anos de existência da úlcera; 77,8% eram redicivantes; 40,3% compravam os insumos; 66,7% trocavam o próprio curativo no domicílio; 52,8% realizavam uma ou mais trocas diárias; 45,8% dos tratamentos foram prescritos pelo médico; 37,5% eram pomada (colagenase ou antibiótico); 89% não utilizavam compressão para o manejo do edema. Conclusão: a maioria dos participantes não estava inserida na Rede de Atenção à Saúde para o tratamento da úlcera, e não recebia assistência sistematizada e nem insumos apropriados.

Objective: to identify the location and direct care received by people with leg ulcers due to sickle cell disease in health care services. Method: a cross-sectional study carried out in 11 centers from August 2019 to April 2020. The study included 72 people with active leg ulcers. The study was approved by the Research Ethics Committee. Results: a total of 91.7% of the participants had sickle cell anemia, with a median of three years of ulcer existence; 77.8% were recurrent; 40.3% bought the supplies; 66.7% changed their own dressings at home; 52.8% did one or more changes a day; 45.8% of the treatments were prescribed by physician; 37.5% were ointments (collagenase or antibiotics); and 89% did not use compression to manage edema. Conclusion: most of the participants were not included in the Health Care Network for ulcer treatment and did not receive systematized care or appropriate supplies.

Objetivo: identificar el lugar y los cuidados directos recibidos por personas con úlceras de pierna por enfermedad falciforme en los servicios de atención a la salud. Método: estudio transversal, realizado en 11 centros, en el período de agosto de 2019 a abril de 2020. Participaron 72 personas con úlcera de pierna activa. El estudio fue aprobado por el Comité de Ética en Investigación. Resultado: presentaban anemia falciforme 91,7% de los participantes, con una mediana de tres años de existencia de la úlcera; 77,8% eran recidivantes; 40,3% compraban los insumos; 66,7% cambiaban su propio vendaje en el domicilio; 52,8% realizaban uno o más cambios diarios; 45,8% de los tratamientos fueron prescritos por el médico; 37,5% eran pomada (colagenasa o antibiótico); y 89% no utilizaban compresión para el manejo del edema. Conclusión: la mayoría de los participantes no estaba integrada en la Red de Atención a la Salud para el tratamiento de la úlcera, y no recibía asistencia sistematizada ni insumos apropiados.

Risk strata and quality of care for the elderly in Primary Health Care. / Estratos de risco e qualidade do cuidado à pessoa idosa na Atenção Primária à Saúde.

OBJECTIVE: to identify patterns of associations between the degree of compliance to laboratory test requests by risk strata and the parameters of quality of care outcomes in primary health care (PHC). METHOD: a cross-sectional study involving 108 elderly patients with hypertension and/or diabetes treated in PHC. A semi-structured questionnaire and electronic medical record data were used. To evaluate the quality of care, the Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used. Descriptive analysis, multiple correspondence analysis and k-means grouping were performed. RESULTS: it was observed low compliance of the care practice, standing out as the worst parameter the evaluation of the diabetic foot (2.2%). Three clusters were identified, with cluster 1 having the highest number of individuals (37.0%), with better indicators of quality of care, evidenced by above 50% of compliance with laboratory tests (75.0%), high PACIC score (47.2%), control of blood pressure (70.0%) and metabolic levels (95.0%), and satisfaction with health (92.5%) and health access (90.0%). In contrast, cluster 3 (29.6%) was made up of individuals with worse outcomes of care. CONCLUSION: low compliance of care practice and asymmetries among health actions and users' needs were observed, indicating failures in the care process in PHC.

Prevalence and Management of Urinary Incontinence in a Brazilian Hospital: A Prospective, Descriptive Study.

Although urinary incontinence (UI) in hospitalized patients is a frequent health problem, research on the subject is limited. PURPOSE: A prospective, descriptive study was conducted to evaluate the prevalence of UI, care implemented among hospitalized adult patients, and impact of UI on quality of life (QoL) in a large private institution in Brazil. METHODS: All patients admitted during November 2018 who were at least 18 years of age, sufficiently conscious and oriented to answer questions, able to undergo skin inspection, and had the ability to urinate (ie, did not use an indwelling bladder catheter or have a nephrostomy, cystostomy, urostomy, or vesicostomy) were eligible to participate. Data were collected through interviews, physical examinations, chart review, and completion of the International Consultation on Incontinence Questionnaire-Short Form (ICQI-SF), a self-diagnostic, 6-item survey of UI frequency, amount of leakage, and overall impact of UI; answers for items 3 (6 answer options), 4 (4 answer options), and 5 (Likert scale ranging from 0 to 10) were considered individually and summed for a total score ranging from 0 to 21. Data were collected using paper forms and then double-entered and validated in a spreadsheet for statistical analysis. Continuous variables were described as mean/median and standard deviation. Categorical variables were described in absolute numbers and percentages. Pearson's chi-squared test and Fischer's exact test were used to investigate the variable statistical differences. The level of significance was 5%, and the intervals were obtained with 95% confidence. Prevalence was defined as the percentage of people with UI over the study period in all admitted patients. RESULTS: Of the 858 eligible patients, 114 were incontinent (13.3%), but 61 were unable to answer the research questions, 2 used catheterization, and 9 refused to participate; therefore 42 patients (age 80 [range 77.6-82.3] years, 30 [71.4%] women) completed the study. All patients (100%) were managed using diapers. Twenty-one (21, 50%) were married, 24 (57.1%) were white, and 25 (59.5%) were retired. Sixteen (16, 38.1%) had urine loss several times a day, and 17 (40.5%) had urine loss in large amounts; 10 (23.8%) had incontinence-associated dermatitis. The ICQI-SF item regarding interference of urine loss in daily life had a reported mean of 4.1 ± 4.0, inferring urine loss interfered with life; mean ICQI-SF score was 12.1 ± 5.86, implying UI had a moderate impact on QoL. CONCLUSION: The 13.3% prevalence of UI was similar to previous studies. The absence of a protocol for incontinence management was identified. The results suggest additional, larger sample UI prevalence studies need to be conducted.

Eventos adversos e queixas técnicas de tecnologias para o manejo de estomias de eliminação no Brasil / Adverse Events and Technical Complaints of Technologies for the Management of Elimination Ostomies in Brazil / Eventos adversos y quejas técnicas de tecnologías para el manejo de ostomías de eliminación en Brasil

Objetivo: Describir los eventos adversos y las quejas técnicas relacionadas con tecnologías para el manejo de ostomías de eliminación reportadas en Brasil. Método: Estudio descriptivo y transversal realizado con datos secundarios registrados en Notivisa. Los datos representan eventos adversos y quejas técnicas reportadas desde enero de 2007 hasta agosto de 2023. Se utilizaron recursos de estadística descriptiva para el análisis. Resultados: Se identificaron un total de 2.812 notificaciones, de las cuales 101 (3,6%) fueron eventos adversos y 2.711 (96,4%) quejas técnicas. El estado de São Paulo representó 884 (31,4%) de las notificaciones. Las bolsas recolectoras fueron los productos más reportados, con 2.688 (95,6%) notificaciones, incluyendo 84 (3,1%) eventos adversos y 2.604 (96,9%) quejas técnicas. En cuanto a los resultados, hubo falta de información en 2.718 (96,7%) de las notificaciones, retención urinaria en 19 (0,67%), dermatitis en 13 (0,46%) y lesiones cutáneas en 9 (0,32%). Conclusión: El número de notificaciones ha seguido aumentando en los últimos años, pero la calidad sigue siendo baja, representada por un alto índice de información omitida. Las quejas técnicas sobre las bolsas recolectoras representan el mayor número de notificaciones en Brasil. La descripción de los resultados en el uso de productos para el tratamiento de las ostomías no es clara y puede llevar a un subregistro de eventos adversos importantes, como la dermatitis. (AU)

Objetivo: Descrever os eventos adversos e as queixas técnicas de tecnologias para o manejo de estomias de eliminação notificados no Brasil. Método: Estudo transversal, descritivo, realizado por meio de dados secundários registrados no Notivisa. Os dados representam eventos adversos e queixas técnicas notificados no período de janeiro de 2007 a agosto de 2023. Para análise, utilizaram-se recursos da estatística descritiva. Resultados: Identificaram-se 2.812 notificações, das quais 101 (3,6%) eram eventos adversos e 2.711 (96,4%) queixas técnicas. O estado de São Paulo foi responsável por 884 (31,4%) notificações. As bolsas coletoras foram os produtos mais notificados, apresentando 2.688 (95,6%) notificações, sendo 84 (3,1%) eventos adversos e 2.604 (96,9%) queixas técnicas. Sobre os desfechos, verificou-se a ausência de informações em 2.718 (96,7%) notificações, 19 (0,67%) notificações de retenção urinária, 13 (0,46%) de dermatite e 9 (0,32%) de lesão cutânea. Conclusão: O número de notificações permanece em ascendência nos últimos anos; entretanto, a qualidade ainda é baixa, representada por alta taxa de omissão de informações. As queixas técnicas de bolsas coletoras representam maior número de notificações no Brasil. A descrição dos desfechos na utilização de produtos para manejo de estomias não é clara e pode gerar subnotificação de eventos adversos importantes, como a dermatite. (AU)

Objective: To describe adverse events and technical complaints involving technologies for the management of elimination ostomies reported in Brazil. Method: This cross­sectional descriptive study used secondary data recorded in the Notivisa system. The data encompass adverse events and technical complaints reported from January 2007 to August 2023. Descriptive statistical tools were used for the analysis. Results: A total of 2,812 notifications were identified, of which 101 (3.6%) were adverse events, and 2,711 (96.4%) were technical complaints. The state of São Paulo accounted for 884 (31.4%) notifications. Collection bags were the most frequently reported products, with 2,688 (95.6%) notifications, including 84 (3.1%) adverse events and 2,604 (96.9%) technical complaints. Regarding outcomes, 2,718 (96.7%) notifications lacked information, 19 (0.67%) reported urinary retention, 13 (0.46%) reported dermatitis, and 9 (0.32%) reported skin injury. Conclusion: The number of notifications has continued to rise in recent years; however, the quality remains low, as evidenced by the high rate of omitted information. Technical complaints about collection bags represent the largest number of notifications in Brazil. The description of outcomes in the use of products for ostomy management is unclear and may lead to the underreporting of significant adverse events such as dermatitis. (AU)

Custo Direto com Tecnologias Para Manejo da Colostomia Definitiva em um Serviço Especializado / Direct Cost of Technologies for Management of Definitive Colostomy in a Specialized Service / Costo Directo de Tecnologías Para el Manejo de la Colostomía Definitiva en un Servicio Especializado

Objetivos:Identificar o custo direto de um serviço especializado com o uso de equipamentos coletores e adjuvantes e compará-lo com o custo simulado da autoirrigação intestinal em pessoas com colostomia definitiva. Método: Estudo descritivo-exploratório conduzido por meio da abordagem quantitativa nos moldes de estudo de casos múltiplos. A amostra por conveniência foi composta de 22 participantes cadastrados em um serviço especializado do norte de Minas Gerais. A coleta de dados foi realizada em prontuários do período de janeiro de 2019 a janeiro de 2020. Resultados: Dos participantes, 59,1% apresentaram complicações relacionadas à estomia e pele periestomia. Em relação aos equipamentos coletores/adjuvantes, o custo variou de 2.340,00 a R$ 5.535,00, custo médio de R$ 4.050,01 e desvio padrão amostral de R$ 770,31. O custo direto médio com autoirrigação de colostomia foi de R$ 3.793,44. Conclusão: O custo direto médio dos equipamentos coletores/adjuvantes foi superior ao da autoirrigação de colostomia, impactado pela presença de complicações e pelo valor do protetor de colostomia.

Objectives:To identify the direct cost of a specialized service with the use of collection equipment and adjuvants and to compare it with the simulated cost of intestinal self-irrigation in people with permanent colostomy. Method: Descriptive-exploratory study conducted through a quantitative approach in the form of multiple-case studies. The convenience sample consisted of 22 participants registered in a specialized service in the north of Minas Gerais, Brazil. Data collection was carried out in medical records from January 2019 to January 2020. Results: Among the participants, 59.1% had complications related to the ostomy and peristomal skin. Regarding collector/adjuvant equipment, the cost ranged from R$ 2,340.00 to R$ 5,535.00, average cost of R$ 4,050.01, and sample standard deviation of R$ 770.31. The average direct cost with colostomy self-irrigation was R$ 3,793.44. Conclusion: The average direct cost of collection/adjuvant equipment was higher than that of colostomy self-irrigation, impacted by the presence of complications and the value of the colostomy protector.

Objetivos:Identificar o custo direto de um serviço especializado com o uso de equipamentos coletores e adjuvantes e compará-lo com o custo simulado da autoirrigação intestinal em pessoas com colostomia definitiva. Método: Estudo descritivo-exploratório conduzido por meio da abordagem quantitativa nos moldes de estudo de casos múltiplos. A amostra por conveniência foi composta de 22 participantes cadastrados em um serviço especializado do norte de Minas Gerais. A coleta de dados foi realizada em prontuários do período de janeiro de 2019 a janeiro de 2020. Resultados: Dos participantes, 59,1% apresentaram complicações relacionadas à estomia e pele periestomia. Em relação aos equipamentos coletores/adjuvantes, o custo variou de 2.340,00 a R$ 5.535,00, custo médio de R$ 4.050,01 e desvio padrão amostral de R$ 770,31. O custo direto médio com autoirrigação de colostomia foi de R$ 3.793,44. Conclusão: O custo direto médio dos equipamentos coletores/adjuvantes foi superior ao da autoirrigação de colostomia, impactado pela presença de complicações e pelo valor do protetor de colostomia.

Diagnósticos e Intervenções de Enfermagem em Pacientes Com Ferida Crônica na Atenção Primária e Secundária / Nursing Diagnoses and Interventions in Patients With Chronic Wound in Primary and Secondary Care / Diagnósticos e Intervenciones de Enfermería en Pacientes con Heridas Crónicas en Atención Primaria y Secundaria

Objetivo:Identificar os diagnósticos e as intervenções de enfermagem relacionados a pacientes com ferida crônica produzidos por um sistema específico na atenção primária e secundária. Método: Estudo descritivo, quantitativo, realizado entre julho e outubro de 2022. Utilizaram-se os dados do sistema Sistematização da Assistência de Enfermagem em Feridas ­ gerencial (SAEFg). O estudo foi aprovado pelo Comitê de Ética em Pesquisa sob Parecer nº 4.329.008/2020. Resultados: No total, foram 314 registros de diagnósticos e 1.300 de intervenções de enfermagem. Os principais diagnósticos de enfermagem foram: úlcera venosa (17,6%), cicatrização da ferida prejudicada e ansiedade (7,6%), risco de queda (7,1%), risco de infecção (6,7%) e prurido (6,4%). As intervenções foram: prescrever/orientar a elevação das pernas (9,3%), orientar não coçar ou usar produtos abrasivos (8,3%), examinar condições da pele (7%), descrever/documentar as características da ferida (5,5%). Conclusão: Os principais diagnósticos e intervenções de enfermagem versaram sobre os aspectos tegumentares, emocionais e de riscos como queda e infecção. A maior ocorrência de registros foi na atenção secundária.

Objective:To identify nursing diagnoses and interventions related to patients with chronic wound produced by a specific system in primary and secondary care. Method: Descriptive study conducted between July and October 2022. We used data from the Systematization of Nursing Care in Wounds­anagerial (SAEFg) system. The study was approved by the Ethics and Research Committee, under Opinion no. 4.329.008/2020. Results: There were 314 records of diagnoses and 1,300 of nursing interventions. The main nursing diagnoses were: venous ulcer (17.6%), impaired wound healing and anxiety (7.6%), risk of falling (7.1%), risk of infection (6.7%), and pruritus (6.4%). The interventions were: prescribe/guide leg elevation (9.3%), guide not to scratch or use abrasive products (8.3%), examine skin conditions (7%), and describe/document wound characteristics (5.5%). Conclusion: The main nursing diagnoses and interventions were about tegumentary, emotional and risk aspects such as fall and infection. The highest occurrence of records was in secondary care.

Objetivo:Identificar los diagnósticos de enfermería y las intervenciones relacionadas con los pacientes con herida crónica producidas por un sistema específico en Atención Primaria y Secundaria. Método: Estudo descritivo, realizado entre julho e outubro de 2022. Se utilizaron los datos del Sistema "Sistematización de la Asistencia de Enfermería en Ferias - gerencial (SAEFg)". El estudio fue aprobado por el Comité de Ética e Investigación con el Dictamen nº 4.329.008/2020. Resultados: Hubo un total de 314 registros de diagnósticos y 1.300 de intervenciones de enfermería. Los principales diagnósticos de enfermería fueron: úlcera venosa (17,6%), deterioro de la cicatrización y ansiedad (7,6%), riesgo de caídas (7,1%), riesgo de infección (6,7%) y prurito (6,4%). Las intervenciones fueron: prescribir/guiar la elevación de las piernas (9,3%), guiar para no rascarse ni utilizar productos abrasivos (8,3%), examinar las condiciones de la piel (7%), describir/documentar las características de la herida (5,5%). Conclusión: Los principales diagnósticos e intervenciones de enfermería fueron sobre aspectos tegumentarios, emocionales y de riesgo como caídas e infecciones. El mayor número de registros se produjo en la atención secundaria.

Factors associated with complex surgical wounds in breast and abdomen: a case-control observational study.

OBJECTIVE: to identify factors associated with complex surgical wounds in the breasts and abdomen in outpatients. METHOD: observational case-control study involving 327 patients, distributed into 160 cases (complex surgical wound) and 167 controls (simple surgical wound). Data were extracted from the medical records and a binary logistic regression model was used for analysis, considering a significance level of 5%. RESULTS: the factors associated with greater chance of occurrence of complex surgical wound were 18 to 59 years of age (p = 0.003), schooling < 8 years (p = 0.049), radiotherapy (p < 0.001), hysterectomy (p = 0.003), glycemia (≤ 99 mg/dL) and arterial hypertension (p = 0.033), while quadrantectomy (p = 0.025) served as a protective factor. CONCLUSION: radiotherapy was the most significant factor for surgical wound complications. Glycemic alteration was an unexpected result and shows the need for further studies related to this topic.

Systematic review of topic treatment for venous ulcers.

Venous ulcer patients can experience this situation for several years without achieving healing if treatment is inadequate. Evidence-based professional practice generates effective results for patients and services. This research aimed to carry out a systematic review to assess the most effective method to improve venous return and the best topic treatment for these ulcers. Studies were collected in eight databases, using the following descriptors: leg ulcer, venous ulcer and similar terms. The sample consisted of 33 primary studies and two Meta-analyses. A wide range of treatments was identified, grouped in compression therapy (54.3%) and topical treatment (45.7%). It was evidenced that compression therapy increases ulcer healing rates and should be used in patients with intact arteries. There is no consensus about the best topical treatment, although different options should be associated with compression therapy.