La aplicación del proceso informático de enfermería: revisión integradora / A aplicação do processo de enfermagem informatizado: revisão integrative / The application of computerized nursing process: integrative review

Objetivo: Identificar en la literatura la evidencia del proceso de enfermería (PE) que se aplica al software. Metodología: Una revisión integradora, la búsqueda se realizó en las bases de datos PubMed, Lilacs y CINAHL y búsqueda inversa en el período de 28 de agosto al 09 de septiembre de 2016. Se utilizaron los descriptores enfermería, proceso de enfermería, sistemas de información en hospital, informática médica, aplicaciones de informática médica, informática en salud pública e informática aplicada a la enfermería. Muestra de 23 artículos. Resultados: Hubo un aumento en la producción a partir de 2000, la mayor parte se originó en Brasil, se caracterizaron por estudios descriptivos. Nos mostraron dos categorías de análisis: el desarrollo y uso del software. La mayoría de las publicaciones contemplan todas las etapas del PE, dos mencionan la teórica y tres utilizan el sistema para las dimensiones de atención y gestión. Las taxonomías utilizadas fueron CIPE, NANDA, NIC, NOC. Conclusión: El uso de software con el PE fortalece la práctica basada en la evidencia y consolida la enfermería como ciencia (AU)

Objetivo: Identificar na literatura evidências sobre o processo de enfermagem (PE) aplicado à softwares. Metodologia: Revisão integrativa, busca realizada nas bases de dados PubMed, LILACS e CINAHL e busca reversa, no período de 28 de agosto a 09 de setembro de 2016. Os descritores foram enfermagem, processo de enfermagem, sistemas de informação hospitalar, informática médica, aplicação de informática médica, informática em saúde pública, e informática em enfermagem. Amostra composta por 23 artigos. Resultados: Houve aumento nas produções a partir de 2000, a maioria das publicações originada do Brasil e caracterizados por estudos descritivos. Evidenciou-se duas categorias de análise: desenvolvimento e utilização de softwares. A maioria contemplava todas as etapas do PE, dois citam o referencial teórico e três utilizam o sistema para as dimensões assistencial e gerencial. As taxonomias utilizadas foram a CIPE, NANDA, NIC, NOC. Conclusão: o uso de softwares com o PE fortalece a prática baseada em evidência e consolida a enfermagem como ciencia (AU)

Objective: To identify in the literature evidences about the nursing process (PE) applied to software. Method: Integrative review, search performed in PubMed, LILACS and CINAHL databases and reverse search, from August 28 to September 9, 2016. The descriptors used were nursing, nursing process, hospital information systems, medical informatics, medical informatics application, public health informatics, and nursing informatics. The sample consisted of 23 articles. Results: There was an increase in productions from 2000, most of the publications originated in Brazil and characterized by descriptive studies. There were two categories of analysis: software development and its usage. Most contemplated all stages of the NP, two cite the theoretical reference and three use the system for the assistance and management dimensions. The taxonomies used were ICNP, NANDA, NIC, NOC. Conclusion: the software’s usage with the EP strengthens evidence-based practice and consolidates nursing as a science (AU)

Epidemiology and comorbidities of psoriasis patients in a national database in Taiwan.

BACKGROUND: Recent findings in psoriasis research have shown that psoriasis is frequently associated with systemic comorbidities. OBJECTIVES: This study aims to describe the epidemiology of psoriasis and the prevalence of comorbidities in patients with psoriasis in Taiwan. METHODS: Patients who had at least one outpatient visit or admission with ICD-9-CM diagnosis code 696.0-1 in the Taiwan National Health Insurance (NHI) claims database during 2006 were identified as psoriasis cases. The cases were further classified into moderate to severe psoriasis (sPsO) for those who had previously received systemic therapy during the study period and mild psoriasis (mPsO) for those who had not. The cases were matched in a 1:4 ratio with controls from a sample cohort of 997,771 enrolees representative of the Taiwan population. Matching variables included age, gender and residential area. Prevalence of comorbidities was assessed using prevalence relative risk (RR) based upon a Cox proportional regression model. RESULTS: 51,800 psoriasis cases were identified (prevalence=0.235%; mean age=46.4±18.6; male:female=1.6:1) and 17.5% of cases were sPsO type. Psoriasis was associated with a significantly increased prevalence ratio (RR; [95% confidence interval]) for hypertension (1.51; [1.47, 1.56]), diabetes (1.64; [1.58, 1.70]), hyperglyceridaemia (1.61; [1.54, 1.68]), heart disease (1.32; [1.26, 1.37]), hepatitis B viral infection (1.73; [1.47, 2.04]), hepatitis C viral infection (2.02; [1.67, 2.44]), rheumatoid arthritis (3.02; [2.68, 3.41]), systemic lupus erythematosus (6.16; [4.70, 8.09]), vitiligo (5.94; [3.79, 9.31]), pemphigoid (14.75; [5.00, 43.50]), pemphigus (41.81; [12.41, 140.90]), alopecia areata (4.71; [2.98, 7.45]), lip, oral cavity and pharynx cancer (1.49; [1.22, 1.80]), digestive organs and peritoneum cancer (1.57; [1.41, 1.74]), depression (1.50; [1.39, 1.61]), fatty liver (2.27; [1.90, 2.71]), chronic airways obstruction (1.47; [1.34, 1.61]), sleep disorder (3.89; [2.26, 6.71]), asthma (1.29; [1.18, 1.40]), and allergic rhinitis (1.25; [1.18, 1.33]). Conversely, psoriasis was not associated with an increased risk of Crohn's disease. CONCLUSIONS: Psoriasis was associated with a significantly increased risk of comorbidities, especially for those patients with moderate to severe disease. These health associations should be taken into consideration when evaluating the burdens of psoriasis and designing effective treatment plans.

Comparison of commission on cancer-approved and -nonapproved hospitals in the United States: implications for studies that use the National Cancer Data Base.

BACKGROUND: The Commission on Cancer (CoC) designates cancer programs on the basis of the ability to provide a wide range of oncologic services and specialists. All CoC-approved hospitals are required to report their cancer diagnoses to the National Cancer Data Base (NCDB), and the cancer diagnoses at these hospitals account for approximately 70% of all new cancers diagnosed in the United States annually. However, it is unknown how CoC-approved programs compare with non-CoC-approved hospitals. METHODS: By using the American Hospital Association Annual Survey Database (2006), CoC-approved and non-CoC-approved hospitals were compared with respect to structural characteristics (ie, accreditations, geography, and oncologic services provided). RESULTS: Of the 4,850 hospitals identified, 1,412 (29%) were CoC-approved hospitals, and 3,438 (71%) were not CoC-approved hospitals. The proportion of CoC-approved hospitals varied at the state level from 0% in Wyoming to 100% in Delaware. Compared with non-CoC-approved hospitals, CoC-approved programs were more frequently accredited by the Joint Commission, designated as a Comprehensive Cancer Center by the National Cancer Institute, and affiliated with a medical school or residency program (P < .001). CoC-approved hospitals were less likely to be critical access hospitals or located in rural areas (P < .001). CoC-approved hospitals had more total beds and performed more operations per year (P < .001). CoC-approved programs more frequently offered oncology-related services, including screening programs, chemotherapy and radiation therapy services, and hospice/palliative care (P < .001). CONCLUSION: Compared with non-CoC-approved hospitals, CoC-approved hospitals were larger, were more frequently located in urban locations, and had more cancer-related services available to patients. Studies that use the NCDB should acknowledge this limitation when relevant.

Increased risk of acute myocardial infarction for patients with panic disorder: a nationwide population-based study.

OBJECTIVE: To examine prospectively the relationship between a diagnosis of panic disorder and the risk of acute myocardial infarction within 1 year of follow-up. Panic disorder is associated prospectively with coronary artery disease, but the risk of acute myocardial infarction associated with panic disorder has not been specifically investigated. METHOD: This nationwide population-based study used data from the Taiwan National Health Insurance Research Database covering the years 2000 to 2005. A total of 9641 patients diagnosed with panic disorder in 2004 were included, together with 28,923 matched nonpanic disorder enrollees as a comparison cohort. Cox proportional hazard regressions were conducted to compute hazard ratios, after adjustment for comorbid medical disorders and sociodemographic characteristics. RESULTS: Results indicated that 4.77% of patients with panic disorder (approximately one in 21) experienced an acute myocardial infarction episode within a year, compared with 2.73% of patients in the comparison cohort. The adjusted hazard of acute myocardial infarction was significantly higher (1.75 times, 95% Confidence Interval = 1.55-1.97) for patients with panic disorder, relative to the comparison cohort. The association persisted in further analyses stratified by hypertension, coronary heart diseases, and age. CONCLUSION: Panic disorder was identified as an independent risk factor for subsequent acute myocardial infarction. Comprehensive multidisciplinary approaches are needed to optimize primary and secondary prevention of acute myocardial infarction among patients with panic disorder.

Fisioterapia en el linfedema tras cáncer de mama y reconstrucción mamaria / Physiotherapy in the lymphedema alter breast cancer and breast reconstruction

La detección precoz y los nuevos tratamientos están reduciendo la mortalidad que conlleva el cáncer de mama; si bien persisten las secuelas, especialmente relacionadas con los efectos secundarios de la cirugía, la quimioterapia y la radioterapia. El linfedema de extremidad superior, secundario a la alteración estructural linfática de la zona tumoral, en general, cursa con un aumento de volumen que interfiere con la funcionalidad de la extremidad, amén de los efectos psicológicos negativos, entre otros, en la mujer si no se trata correctamente. Sin embargo, al no ser mortal, a menudo ha sido poco estudiado, diagnosticado y tratado correctamente. Búsqueda realizada en MEDLINE, Cancerlit, CINAHL, Cochrane Library y PEDro. Los términos utilizados principalmente fueron ®breast cancer», ®lymphedema», ®clinical trial», ®physiotherapy» y ®reconstruction». El tratamiento fisioterapéutico posibilita el control de esta modalidad de linfedema, y es fundamental conocer la situación de la investigación en este campo para poder establecer tratamientos eficaces que minimicen cualquier tipo de complicación(AU)

Early detection and new treatment are reducing the mortality associated with breast neoplasm, although the aftermath persist, especially related to the side effects of surgery, chemotherapy and radiotherapy. Upper limb lymphedema, secondary to lymph node structural alteration of the tumor zone general evolves with an increase in volume that interferes with limb functionality in addition to the negative psychological effects, among others, in the women if they are not adequately treated. However, given that it is not fatal, it is often not studied, or is not correctly diagnosed and treated. A search was conducted in MEDLINE, Cancerlit, CINAHL, and Cochrane Library PEDro. The terms used were mainly ®breast neoplasm», ®lymphedema», ®clinical trial», ®physical therapy» and ®reconstruction». Physical therapy make sit possible to control this form of lymphedema, it being essential to know the status of research in this field in order to establish effective therapies that minimize any complication(AU)

Higiene de manos de los fisioterapeutas: prevención de infecciones nosocomiales / Hand hygiene in physiotherapists: prevention of nosocomial infections

Introducción: se entiende por infección nosocomial aquella que se adquiere en el hospital y que no estaba presente ni en período de incubación cuando el paciente ingresó. Las infecciones nosocomiales producen una alta morbimortalidad en los pacientes e incrementan los costes relacionados con los cuidados sanitarios. En una unidad de fisioterapia, se produce un aumento en el número de sesiones de tratamiento, y una limitación de la mejora funcional conseguida tras la finalización de éste.Objetivo: destacar la importancia de la correcta higiene de manos, tanto por su alta eficacia como por su bajo coste, como medida de prevención de la transmisión de microorganismos patógenos.Material y métodose realiza una búsqueda bibliográfica en las bases de datos de PubMed, PEDro y en The Cochrane Library.Conclusiones: la desinfección higiénica de manos con soluciones hidroalcohólicas es la más efectiva para reducir la contaminación bacteriana de las manos(AU)

Introduction:Nosocomial infection is defined as that acquired in the hospital that was not present in either the incubation stage or on admission. Nosocomial infection causes high morbidity and mortality in patients and an increase in health care costs. This causes a rise in the number of treatment sessions and places a limitation on the functional improvement achieved after its completion in a physiotherapy unit.Objective: To draw attention on the importance of appropriate hand hygiene due to its high effectiveness as well as its low cost in order to prevent transmission of pathogenic microorganisms.Material and methodA research of the literature was carried out through PubMed, PEDro, and The Cochrane library.Conclusions: Hand disinfection with an alcohol-based solution is the most effective measure to remove bacterial hand contamination(AU)

Multiple episodes in children and adolescents with bipolar disorder: comorbidity, hospitalization, and treatment (data from a cohort of 8,129 patients of a national managed care database).

OBJECTIVE: The purpose of this study was to delineate the prevalence, demographic characteristics, comorbidity, hospitalization, and medication use of a large cohort of patients with and without multiple episodes per year. We hypothesized that children and adolescents with multiple episodes per year would have a higher comorbidity and require more hospitalizations and pharmacological treatment than their counterparts without multiple episodes. METHODS: Analysis was conducted on a cohort of 8,129 children and adolescents patients (< or = 18 y.o.) with bipolar disorders (BD), from the Integrated Healthcare Information Services (IHCIS) identified from June 30, 2000 to July 1, 2003. Demographics variables, type of hospitalization, and psychotropic medication used in the year of follow-up were compared between children and adolescents with multiple and those without multiple episodes per year. RESULTS: Included were 58 patients with multiple episodes (defined as: > or = 4 or more reports of inpatient treatment for any affective disorders per year) and 8,071 without multiple episodes. Children and adolescents with multiple episodes versus those without multiple episodes were differentiated as follows: more comorbid attention deficit disorder (ADD) (80.9% versus 29.4%) (chi2 = 70.61, df = 1, p < 0.0001); higher rate of hospital admission for depression (12.1% vs. 1.8%, chi2 = 27.86, df = 1, p < 0.0001); for other psychiatric conditions (48.3% vs. 11.2, chi2 = 74.47, df = 1, p < 0.0001) and for medical conditions (22.4% vs. 3.9%, chi2 = 46.26, df = 1, p < 0.0001). Patients with multiple episodes per year were more likely than those without multiple episodes to be given mood stabilizers (91.4% vs. 60.3%, chi2 = 22.02, df = 1, p < 0.0001), antidepressants (79.3% vs. 59.2%, chi2 = 8.82, df = 1, p = .0003), and antipsychotics (89.7% vs. 45.8%, chi2 = 42.91, df = 1, p < 0.0001). The use of stimulants did not differ between the two groups (24.1% vs. 23.0%), chi2 = 0.02, df = 1, p = 0.96). CONCLUSIONS: Our findings support previous studies demonstrating that children and adolescents with multiple episodes per year present a higher comorbidity and require more hospitalizations and pharmacological treatment than those without multiple episodes. The diagnosis and treatment of children and adolescents with BD will have to take into account the high comorbidity of ADD mainly in children and adolescents with multiple episodes. Future prospective studies will help to better characterize the impact of multiple episodes in the course of pediatric BD and facilitate appropriate treatment strategies.

[Application of modern imformation technology in study of traditional Chinese medicine presciptions].

With the imformation technology getting a great progress in recent years, the modem imformation technology is extensively employed in the study of traditional Chinese medicine (TCM) prescriptions. In this article a summary is given, which includes applications of modern imformation technology in the study of TCM presciptions. It focus on the introduction of the databse technology, data-mining technology and chemometrics, and brief virtual screening technology, experimental design, innovation design, study of complexity and bioinformatics technology, all of which deployed in the study of TCM presciptions, so as to enligten researchers on modernized study of TCM prescription and its development in the future.

A pesquisa em enfermagem oncológica no Brasil: uma revisão integrativa / Brazilian research on oncology nursing: an integrative review

Foi realizada uma revisão integrativa da literatura com o objetivo de caracterizar as pesquisas na área de enfermagem oncológica. O levantamento bibliográfico abrangeu as publicações nacionais em enfermagem oncológica, de 1980 a 2004, disponível nos bancos de dados Lilacs e BDENF. Foram identificados 91 artigos, dos quais 84 compuseram a amostra final do estudo. A análise dos estudos permitiu identificar que os mesmos foram publicados com maior freqüência na Revista Brasileira de Cancerologia e que as publicações se intensificaram após o ano 2000. Em relação à identificação dos autores, a maioria é docente (41,5%); 85,3% dos pesquisadores são enfermeiros; 33,4% procedem da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo e da Universidade Federal de São Paulo. Os estudos, em sua maioria, foram desenvolvidos na região Sudeste e 52,4% deles foram localizados na base de dados Lilacs; as palavras-chave mais utilizadas foram enfermagem e câncer (72,6%); 66,7% dos estudos apresentaram os objetivos de forma clara, 23,8% não apresentaram objetivos, 9,5% não apresentaram adequadamente os objetivos e 19,0% eram derivados de dissertação ou tese. Entre os desenhos de pesquisa, 36,9% utilizaram a abordagem metodológica qualitativa e 21,4% a quantitativa; 9,5% realizaram estudos quanti-qualitativos e 32,1% não discriminaram o método utilizado. Em relação à ética, 41,7% dos estudos não fizeram nenhuma referência; 65,5% apresentaram as características da amostra estudada e 34,5% não apresentaram; 45,2% dos estudos investigaram pacientes com diferentes tipos de câncer, sendo a enfermagem em ginecologia a área com maior número de investigações. ...

Using HIPE data as a research and planning tool: limitations and opportunities.

BACKGROUND: The Hospital Inpatient Enquiry (HIPE) system is an important information source for research and health service planning activities. However, as it was not designed explicitly for these purposes, some limitations exist. AIMS: To make recommendations that would increase the value of HIPE as a research and planning tool. METHODS: Experiences of using HIPE for research and planning exercises were analysed so as to identify its limitations and their impact on research and planning. RESULTS: Limitations were identified regarding data quality, policy issues and the general system. CONCLUSIONS: To increase the utility of HIPE as a research and planning tool, a number of changes are recommended, including: expanding the system to cover private hospitals and outpatient and emergency services; adopting routine small area and socio-economic coding; adopting unique personal identifiers; publishing regular detailed reports with in-depth analyses; and considering making hospital identifiers available in certain circumstances.

A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see commetns].

BACKGROUND: The National Cancer Data Base (NCDB) represents a national electronic registry system now capturing nearly 60% of incident cancers in the U. S. In combination with other Commission on Cancer programs, the NCDB offers a working example of voluntary, accurate, cost-effective "outcomes management" on a both a local and national scale. In addition, it is of particular value in capturing clinical information concerning rare cancers, such as those of the thyroid. METHODS: For the accession years 1985-1995, NCDB captured demographic, patterns-of-care, stage, treatment, and outcome information for a convenience sample of 53,856 thyroid carcinoma cases (1% of total NCDB cases). This article focuses on overall 10-year relative survival and American Joint Committee on Cancer (AJCC) (3rd/4th edition) stage-stratified 5-year relative survival for each histologic type of thyroid carcinoma. Care patterns also are discussed. RESULTS: The 10-year overall relative survival rates for U. S. patients with papillary, follicular, Hürthle cell, medullary, and undifferentiated/anaplastic carcinoma was 93%, 85%, 76%, 75%, and 14%, respectively. For papillary and follicular neoplasms, current AJCC staging failed to discriminate between patients with Stage I and II disease at 5 years. Total thyroidectomy +/- lymph node sampling/dissection represented the dominant method of surgical treatment rendered to patients with papillary and follicular neoplasms. Approximately 38% of such patients receive adjuvant iodine-131 ablation/therapy. At 5 years, variation in surgical treatment (i.e., lobectomy vs. more extensive surgery) failed to translate into compelling differences in survival for any subgroup with papillary or follicular carcinoma, but longer follow-up is required to evaluate this. NCDB data appeared to validate the AMES prognostic system, as applied to papillary cases. Younger age appeared to influence prognosis favorably for all thyroid neoplasms, including medullary and undifferentiated/anaplastic carcinoma. NCDB data also revealed that unusual patients diagnosed with undifferentiated/anaplastic carcinoma before age of 45 years have better survival. CONCLUSIONS: The NCDB system permits analysis of care patterns and survival for large numbers of contemporaneous U. S. patients with relatively rare neoplasms, such as thyroid carcinoma. In this context, it represents an unsurpassed clinical tool for analyzing care, evaluating prognostic models, generating new hypotheses, and overcoming the volume-related drawbacks inherent in the study of such neoplasms. [See editorial on pages 2434-6, this issue.]