Incidence and risk factors associated with pressure injury in patients with traumatic brain injury.

AIM: To identify the prevalence of pressure injury in patients diagnosed with traumatic brain injury and analyse the risk factors involved during hospitalization. METHODS: This was a prospective study evaluating patients who were diagnosed with traumatic brain injury between November 2013 and September 2014. Patient characteristics, clinical and metabolic factors and therapeutic interventions, were evaluated within 30 days of hospital admission. RESULTS: Most of the 240 patients included in the study were male, young, and non-Caucasian. The incidence of pressure injury was 18.8%. In terms of severity classification, the incidence of pressure injury was 2.7%, 23.2%, and 42.6% in mild, moderate, and severe traumatic brain injury, respectively. Pressure injury development was more likely in the first 10 days of hospitalization. A moderate or severe traumatic brain injury classification, the use of noradrenaline, and older age were pressure injury risk factors. The presence of pressure injury was associated with mortality within 30 days of hospitalization (P < .001). CONCLUSION: The incidence of pressure injury was high in patients diagnosed with traumatic brain injury, especially in those whose injury was classified as severe. Older age, noradrenaline use, and a classification of moderate or severe traumatic brain injury were identified as pressure injury risk factors.

Patterns of Care and Temporal Trends in Ischemic Stroke Management: A Brazilian Perspective.

BACKGROUND AND PURPOSE: Demonstration of an improvement process of quality indicators in stroke care is essential to obtain certification as a primary stroke center (PSC). Our aim was to evaluate factors that influence temporal trends in quality indicators of ischemic stroke (IS) in a Brazilian hospital. METHODS: We evaluated patients discharged with IS from a tertiary hospital from January 2009 to December 2013. Ten predefined performance measures selected by the Get With the Guidelines-Stroke program were assessed. We also compared 5 quality indicators available from a secondary community hospital for the first year of the series to those found in the tertiary hospital. RESULTS: We evaluated 551 patients at the tertiary stroke center (median age 77.0 years [interquartile range 64.0-84.0]; 58.4% were men). The quality indicators that improved with time were the use of cholesterol-lowering therapy (P = .02) and stroke education (P = .04). The median composite perfect care did not consistently improve throughout the period (P = .13). After a multivariable adjustment, only thrombolytic treatment (odds ratio [OR] 2.06, P < .01), dyslipidemia (OR 2.03, P < .01), and discharge in a Joint Commission International's (JCI) visit year (OR 1.8, P < .01) remained as predictors of a perfect care index of 85% or higher. The quality indicators with worse performance (anticoagulation for atrial fibrillation and cholesterol reduction) were similar in the tertiary and secondary community hospitals. CONCLUSIONS: We found a significant improvement in some quality indicators across the years in a PSC located in Latin America. The overall perfect care measure did not improve and was influenced by being discharged in a JCI visit year, having dyslipidemia, and having undergone thrombolytic treatment.

Body piercing among Brazilian surgical patients.

The practice of body piercing is becoming more common worldwide. Surgical patients with body piercings require special preoperative assessment to ensure safety during and after surgery. In a study of Brazilian surgical patients at one facility, only 0.6% had body piercings. An RN or nursing student instructed each patient on piercing removal, and piercings were removed by the patients before surgery.

Lethality of endocarditis due to S. aureus among patients on hemodialysis.

This study evaluated the prevalence and risk factors for endocarditis in patients undergoing hemodialysis with central venous catheter (CVC) and to identify the microorganisms isolated from the bloodstream. This cohort study followed 94 patients with end stage renal disease (ESRD) who developed bacteremia after the insertion of a CVC for dialysis in the hospital São Paulo, UNIFESP, Brazil. They were divided into two groups: patients with endocarditis (E+) and patients without (E-). The prevalence of endocarditis was 29%. Among risk factors, the time of hospitalization and residence of the catheter were significantly higher (p < 0.001) in group E+. The mortality rate was 15%, and lethality of endocarditis was 55%. Of the 38 microorganisms isolated in group E+, 20 were S. aureus and 45% of those were MRSA. Group E+ with MRSA presented 100% mortality. High mortality and lethality in the E+ group was observed, and of the microorganisms isolated, MRSA was the most lethal. This article provides an overview of the findings of this study.

[Hair removal repercussions on patient's self-esteem in craniotomy]. / Repercussões na auto-estima provocadas pela tricotomia em craniotomia.

This quantitative-based, prospective-oriented study aims to evaluate the repercussion of hair removal in post-craniotomy's patient self-esteem. Data show that the majority of patients mentioned not having an altered self-esteem due to hair removal; self-esteem was kept the same among patients that were instructed about the hair removal process. The major part of patients made use of accessories as a strategy to hide shaved areas and believed that hair removal damaged neither their quality of life nor their social relationships. We conclude that the feelings directly related to the decrease of self-esteem are loss of physical attraction, insecurity and shame. The employment of accessories is made necessary towards improving self-esteem, and healthcare professionals must work with the psychosocial aspects of pre and post-surgery patients.

[Nursing diagnoses for patients with Acquired Immunodeficiency Syndrome]. / Diagnósticos de enfermagem em portadores da Síndrome da Imunodeficiência Adquirida.

This study aims at identifying the most frequent nursing diagnoses, according to the NANDA's taxonomy II in adult patients of HIV/AIDS and to check how often the defining characteristics, the related factors and the risk factors provided support for their development. Data survey was conducted by researchers in the 60 patients admitted with HIV/aids, followed by the finding out whether the NANDA's proposed requirements to develop the Nursing Diagnoses were appropriate. From the 38 diagnoses, 13 diagnoses were chosen with a frequency equal or higher than 80%. Results pointed to agreement and appropriateness for identification. But new studies will be necessary either to acknowledge the findings and bring new knowledge to the topic as well, besides encouraging research with this patients' population.

Status and nutritional therapy in elective and emergency neurosurgery patients.

OBJEVECT: To evaluate the Nutritional Status (NS) and follow the Enteral Nutritional Therapy (ENT) of patients in neurosurgical intervention. METHOD: Cohort study in emergency or elective surgery patients with exclusive ENT. Anthropometric measurements (Arm Circumference (AC and Triceps Skinfold (TSF)) were measured on the first, seventh and 14th day. For the ENT monitoring, caloric/protein adequacy, fasting, inadvertent output of the enteral probe and residual gastric volume were used. RESULTS: 80 patients, 78.7% in emergency surgery and 21.3% in elective surgery. There was a reduction in AC and Body Mass Index (BMI) (p>0.01), especially for the emergency group. The caloric/protein adequacy was higher in the emergency group (86.7% and 81.8%). CONCLUSION: The EN change was greater in the emergency group, even with better ENT adequacy. Changes in body composition are frequent in neurosurgical patients, regardless of the type of procedure.

Assessment of risk and incidence of falls in neurosurgical inpatients.

Neurosurgical patients may present motor, sensitive and balance impairment and increased risk of falling. The aim of this study was to evaluate the fall-related risk factors and the incidence of falls in the pre and post-operative period of neurosurgical patients. A prospective cohort study with a research population of patients undergoing elective neurosurgical procedures. Ninety-seven patients took part in the study. Eight (8.2%) have presented falls with a total of 12 falls (12.4%). In two falls (16.7%), bed side rails were down, whereas in six falls (50%), beds had no rails at all. There was no difference among fall-related risk factors during pre and the post-operative periods. We have concluded that most falls could have been prevented through an improvement in the hospital internal structure and with the introduction of a falls prevention program.

[Perioperative removal of body piercing]. / Remoção do piercing no perioperatório.

The remaining of piercing in intraoperative can cause damages. This paper had as purpose defining the nursing interventions in the intraoperative and evaluates the complications caused by piercing in the intraoperative. This literature review had 16 articles published from 1994 to 2006. Nine articles (56.2%) were about nursing interventions in the intraoperative, four (25.0%) were concerning complications in the intraoperative and three (18.8%) were about the use of piercing in the intraoperative, not presenting complications. We concluded that wearing oral piercing in the intraoperative increases the risk of swallowing and injuries. Furthermore, wearing body jeweIry can cause injuries on the skin during the patient's moving and burns after electrosurgery. Therefore, it is necessay to withdraw the piercing in the preoperative.

[Neurological disorders and dependence of nursing care in patients with brain tumor]. / Alterações neurológicas e grau de dependência de enfermagem em pacientes com tumores intracranianos.

The aim of this study was to identify neurological disorders in 32 patients with diagnosis of brain tumor, and to evaluate the dependency of nursing care before and after the surgery. This study was carried out at the Neurosurgery Unit of São Paulo Hospital, Brazil, from June to December, 2004. One instrument was used to collect physical and neurological data, and another to evaluate the dependence degree. An increase of the dependence degree was observed after surgical intervention, which therefore needs to be correlated with nursing team size in order to optimize care.

Quality of life of family caregivers of elderly patients on hemodialysis and peritoneal dialysis.

BACKGROUND: Despite the growing number of elderly patients with end-stage renal disease who need support, there are few studies about their caregivers. The objective of this study is to describe caregivers' characteristics and evaluate their burden and quality of life. METHODS: We studied caregivers of elderly patients (>or=65 years) on hemodialysis (HD) therapy (n = 84), on peritoneal dialysis (PD) therapy (n = 40), and a group of caregivers (n = 77) of nonelderly HD patients. Their quality of life was evaluated by using the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire, Caregiver Burden scale, and Cognitive Index of Depression. RESULTS: Most caregivers of the elderly were women (78%) aged 55 +/- 15 years and sons or daughters (41%) or wives or husbands (50%) of patients. Caregivers' Emotional Aspect, Vitality, and Mental Health were the most affected dimensions. The Mental Component Summary mean score, adjusted for patient race, educational level, primary diagnosis, hematocrit, comorbidities, and physical functional status, was worse for caregivers of PD than HD elderly patients (36.3 +/- 1.9 versus 44.8 +/- 1.5; P < 0.01). The most affected Caregiver Burden scale dimensions were General Strain and Environment. Thirty-two percent of caregivers showed signs of depression. CONCLUSION: Caregivers of elderly dialysis patients, especially of those on PD therapy, experience a significant burden and adverse effects on their quality of life. Educational, social, and psychological support interventions should be considered to improve the quality of life of caregivers.

[Intestinal constipation in patients with intracranial tumors]. / Constipação intestinal em pacientes com tumores intracranianos.

The effort that occurs during the Valsalva maneuver provokes a raise in intracranial pressure and may decompensate patients with increased intracranial pressure. The aims of this study were to evaluate the incidence of intestinal constipation in the preoperative period of patients with intracranial tumors and establish a relationship between constipation and intracranial pressure decompensation. This study was performed at the neurosurgery unit of Hospital São Paulo, from August to October 2003, evaluating 37 patients. Preoperative time varied from 2 to 34 days (mean 12 days). During this period, 6 (16.2%) patients underwent constipation; all of them received dietary fiber and lactulose, 2 (33.3%) needed enema administration. All patients performed the Valsalva maneuver during defecation and none of them developed intracranial hypertension decompensation.

Assessment and nutrition education in patients with amyotrophic lateral sclerosis.

Neurological patients with amyotrophic lateral sclerosis (ALS)often deteriorate to a worsening nutritional status. The aim of this study was to compare the nutritional status and food intake after nutrition education in patients with ALS. Clinical, anthropometric and functional variables were analyzed. Fifty-three patients were monitored at an early stage of the disease. The average score on the functionality scale was 33 points. Initially only 3.8% were classified as low body weight. After three months, 50% showed significant variation in anthropometric measures related to muscle mass and body fat reserves without association with clinical variables. After nutritional guidance, there was an increase in the intake of all food groups, especially the dairy group (p <0.05).The change of the nutritional status occurs early in patients with amyotrophic lateral sclerosis, even in those previously eutrophic or over weight. There was an increase in food intake after nutritional guidance according to the food guide adapted to the Brazilian population.

[Postoperative pain in craniotomy]. / Dor pós-operatória em craniotomia.

In the postoperative period, 47% to 75% of the patients report some degree of pain. This study aimed to evaluate pain in the pre and postoperative period of patients submitted to craniotomy. This prospective research was carried out at the neurosurgery unit of a large Brazilian hospital. For a quantitative evaluation of pain, the verbal numeric 0-10 rating scale was used. Forty patients with a mean age of 36 years were evaluated. In the preoperative period, 34 (85%) patients indicated headache as the main cause of pain. In the postoperative period, 37 (93%) patients complained of pain while three (7%) reported absence of pain. Pain peaks were observed on the 2nd postoperative day, when 12 (32%) of the patients reported severe pain and 10 (27%) moderate pain. Absence of severe pain occurred after the 8th postoperative day. It was concluded that protocols of analgesia in craniotomy are needed, such as training nurses to better evaluate and handle pain.

[Infection incidence in patients with tunneled peridural catheter]. / Incidência de infecção em pacientes com cateter peridural tunelizado.

The tunneled epidural catheter as an administration access for opiates has been used since the beginning of 1980. Patients with chronic pain, who does not get relief with medication through other accesses are benefited with infusion of opiate associated to a local anesthetic through epidural access. However, there are still doubts on the efficacy of the method in the handling and, consequently, over the risk for infection and other complications. As nursing is fundamental to make effective the relieve pain treatment, this study proposes to demonstrate how to keep safe the technique. Twenty-seven patients with chronic pain using epidural catheter for 18 days were followed between 2002 and 2004. Catheters were implanted in thoracic or lumbar level. No complications like epidural abscess, meningitis our epidural haematoma were observed. Patients' satisfaction related to analgesia was evident.

Status and nutritional therapy in elective and emergency neurosurgery patients / Estado y terapia nutricional en pacientes de neurocirugía electiva y urgencia / Estado e terapia nutricional em pacientes de neurocirurgia eletiva e urgência

ABSTRACT Objevect: To evaluate the Nutritional Status (NS) and follow the Enteral Nutritional Therapy (ENT) of patients in neurosurgical intervention. Method: Cohort study in emergency or elective surgery patients with exclusive ENT. Anthropometric measurements (Arm Circumference (AC and Triceps Skinfold (TSF)) were measured on the first, seventh and 14th day. For the ENT monitoring, caloric/protein adequacy, fasting, inadvertent output of the enteral probe and residual gastric volume were used. Results: 80 patients, 78.7% in emergency surgery and 21.3% in elective surgery. There was a reduction in AC and Body Mass Index (BMI) (p>0.01), especially for the emergency group. The caloric/protein adequacy was higher in the emergency group (86.7% and 81.8%). Conclusion: The EN change was greater in the emergency group, even with better ENT adequacy. Changes in body composition are frequent in neurosurgical patients, regardless of the type of procedure.

RESUMEN Objetivo: Evaluar el Estado Nutricional (EN) y acompañar la Terapia Nutricional Enteral (TNE) de pacientes en intervención neuroquirúrgica. Método: Estudio tipo cohorte en pacientes de cirugía de urgencia o electiva, con TNE exclusiva. Se midieron medidas antropométricas (Circunferencia del Brazo (CB) y Pliegue Cutáneo Tricipital (PCT)) en el primer, séptimo y decimocuarto días. Para el monitoreo de la TNE: adecuación calórica/proteica, desayuno, salida inadvertida de la sonda enteral y volumen residual gástrico. Resultados: 80 pacientes, 78,7% en cirugía de urgencia y 21,3% en electiva. Hubo reducción de la CB y del Índice Masa Corporal (IMC) (p> 0,01), en especial para el grupo de urgencia. La adecuación calórica/proteica fue superior en el grupo de urgencia (86,7% y 81,8%). Conclusión: La alteración del EN fue más alta en el grupo de urgencia mismo con mejor adecuación de la TNE. La alteración de la composición corporal es frecuente en pacientes neuroquirúrgicos independientemente del tipo de procedimiento.

RESUMO Objetivo: Avaliar o Estado Nutricional (EN) e acompanhar a Terapia Nutricional Enteral (TNE) de pacientes em intervenção neurocirúrgica. Método: Estudo tipo coorte em pacientes de cirurgia de urgência ou eletiva, com TNE exclusiva. Foram aferidas medidas antropométricas (Circunferência do Braço (CB) e Dobra Cutânea Tricipital (DCT)) no primeiro, sétimo e 14º dia. Para o monitoramento da TNE, utilizou-se: adequação calórico/proteica, jejum, saída inadvertida da sonda enteral e volume residual gástrico. Resultados: 80 pacientes, 78,7% em cirurgia de urgência e 21,3% em eletiva. Houve redução da CB e do Índice de Massa Corporal (IMC) (p>0,01), em especial para o grupo de urgência. A adequação calórica/proteica foi superior no grupo de urgência (86,7% e 81,8%). Conclusão: A alteração do EN foi maior no grupo de urgência mesmo com melhor adequação da TNE. A alteração da composição corporal é frequente em pacientes neurocirúrgicos, independentemente do tipo de procedimento.

Complicações pós-operatórias em neurocirurgia eletiva e não eletiva / Postoperative complications in elective and non-elective neurosurgery

Resumo Objetivo Avaliar a incidência de complicações pós-operatorias e mortalidade entre pacientes submetidos a neurocirurcia eletiva e não eletiva. Metodos Estudo de coorte prospectivo com pacientes adultos, acompanhados desde o período pré-operatório até a alta hospitalar ou óbito. Resultados Foram incluídos 127 pacientes no grupo cirúrgico eletivo e 75 pacientes no grupo cirúrgico não eletivo. O grupo eletivo teve mais vômitos (p=0,010) e dor (p<0,001) e o grupo não eletivo apresentou mais hipertensão intracraniana (p=0,001), anisocoria (p=0,002), vasoespasmo cerebral (p=0,043), pupilas não fotorreagentes (p=0,006) e reoperação (p=0,046). A taxa de mortalidade foi de 5,5% no grupo de cirurgia eletiva e 26,7% no grupo de cirurgia não eletiva (p<0,001). Conclusão Os procedimentos eletivos em neurocirurgia estão relacionados a maior frequência de complicações sistêmicas, enquanto as cirurgias não eletivas tiveram taxas significativamente mais altas de complicações neurológicas e mortalidade.

Abstract Objective To evaluate the incidence of postoperative complications and mortality among patients submitted to elective or non-elective neurosurgery. Methods Prospective cohort study in adult patients, followed from preoperative period until hospital discharge or death. Results One hundred and twenty seven patients were included in elective surgery group and 75 patients in non-elective surgery group. The elective group had more vomiting (p=0.010) and pain (p<0.001) and the non-elective group presented more intracranial hypertension (p=0.001), anisocoria (p=0.002), cerebral vasospasm (p=0.043), light-unresponsive pupil (p=0.006) and reoperation (p=0.046). The mortality rate was 5.5% in the elective surgery group and 26.7% in the non-elective surgery group (p<0.001). Conclusion Elective procedures in neurosurgery are related to higher frequencies of systemic complications while non-elective surgeries had significantly higher rates of neurological complications and mortality.

Interference of nail polish on the peripheral oxygen saturation in patients with lung problems during exercise.

AIM: To assess the interference of nail polish on the reading of peripheral oxygen saturation in patients with chronic obstructive pulmonary disease on the step exercise. METHODS: In this study, there was the inclusion of patients with chronic obstructive pulmonary disease, current non-smokers, of both sexes. Four different colours of nail polish were used in the present study (base, light pink, red and brown), randomly distributed among the fingers of the right hand, with the corresponding fingers on the opposite hand being controls. Saturation was measured at rest, with and without the polish, and also during the 4th, 5th and 6th minutes of the exercise programme. RESULTS: The experimental universe included 42 patients with ages of 62.9±8.7 years. In the exercise considered, the red colour reduced it in the fourth minute of the exercise (p=0.047). In contrast, the brown colour reduced saturation at rest and also during the course of exercise (p=0.01). CONCLUSION: In patients with chronic obstructive pulmonary disease, the red and brown colours interfered with the reading of the peripheral oxygen saturation during exercise. This study is registered at the Brazilian Register of Clinical Trials (Registro Brasileiro de Ensaios Clínicos) under No. RBR-9vc722.

Sucesso do transplante hepático de acordo com o tempo em lista / Success of the hepatic transplant according to the time in list

Objetivo: identificar se o tempo em lista de espera e valor do MELD pré-transplante tem relação com o prognóstico dos pacientes no período pós-operatório de transplante hepático. Método: estudo transversal e retrospectivo, com abordagem quantitativa, realizado em 85 prontuários de pacientes atendidos no hospital público terciário de alta complexidade, referência em transplante de fígado. Resultados: foram analisados 85prontuários, dos quais, 52 pacientes eram transplantados, que foram a óbito pós-transplante 32, óbito pré-transplante 1 e 40 prontuários com letras ilegíveis, com rasuras e não disponíveis no setor. A média do MELD no momento da listagem variou de oito a 40, com prevalência de 13 a 20. Conclusão: o estudo possibilitou o entendimento sobre a aplicação do MELD nos pacientes em lista de espera e que a mortalidade demonstrou-se mais baixa (1%) nestes. Quanto ao percentual pós-transplante(38%), este um eficiente método a ser utilizado em lista de espera.

Assessment and nutrition education in patients with amyotrophic lateral sclerosis / Avaliação e educação nutricional em pacientes com esclerose lateral amiotrófica

ABSTRACT Neurological patients with amyotrophic lateral sclerosis (ALS)often deteriorate to a worsening nutritional status. The aim of this study was to compare the nutritional status and food intake after nutrition education in patients with ALS. Clinical, anthropometric and functional variables were analyzed. Fifty-three patients were monitored at an early stage of the disease. The average score on the functionality scale was 33 points. Initially only 3.8% were classified as low body weight. After three months, 50% showed significant variation in anthropometric measures related to muscle mass and body fat reserves without association with clinical variables. After nutritional guidance, there was an increase in the intake of all food groups, especially the dairy group (p <0.05).The change of the nutritional status occurs early in patients with amyotrophic lateral sclerosis, even in those previously eutrophic or over weight. There was an increase in food intake after nutritional guidance according to the food guide adapted to the Brazilian population.

RESUMO Pacientes neurológicos com esclerose lateral amiotrófica frequentemente evoluem com piora do estado nutricional. O objetivo desse estudo foi comparar o estado nutricional e a ingestão alimentar depois da orientação nutricional em pacientes com ELA. Variáveis clínicas,antropométricas e funcionais foram analisadas. 53 pacientes foram avaliados na fase inicial da doença. A pontuação média da escala de funcionalidade foi de 33 pontos. Inicialmente apenas 3,8% foram classificados como baixo peso. Após três meses, 50% apresentaram variação significativa nas medidas antropométricas relacionadas com reservas de massa muscular e gordura corporal, sem associação com variáveis clínicas. Após orientação nutricional, houve um aumento na ingestão de alimentos de todos os grupos com relevância para o grupo de lacticínios (p <0,05). A mudança do estado nutricional ocorre precocemente em pacientes com ELA, mesmo naqueles anteriormente eutróficos ou sobrepeso. Houve um aumento na ingestão de alimentos após orientação nutricional de acordo com o guia alimentar adaptado da população brasileira.