Nurses' perception of the impact of professional development sessions on their pre-hospital clinical practice with trauma victims.

Background: Continuing education is important for the quality of clinical practice because it complements it and focuses primarily on producing qualified pre-hospital nurses with operationally defined competence in nursing standards. The objective of this study was to assess pre-hospital nurses' opinion of the impact of professional development sessions on their clinical practice. Method: A descriptive and quantitative study was carried out involving Portuguese pre-hospital nurses. Six professional development sessions were presented in 2020 to pre-hospital registered nurses in four of Portugal's main cities. To collect the data, at the end of each session, we apply a questionnaire designed specifically for this study. This data collection instrument consists of 11 questions, six designed to evaluate the session and five designed to evaluate the trainer responsible for the session. A five-point Likert scale was used for each question, where 1 corresponds to very dissatisfied and 5 to extremely satisfied. Results: Two hundred and two nurses, which represents 55% of all Portuguese pre-hospital nurses, took part in the assessment of the professional development sessions. The nurses were from the Northern region of Portugal (51%; n = 102), the Centre region (29%; n = 59) and the Southern region of Portugal (20%; n = 41). Nurses found the session extremely satisfactory. All the assessment scores ranged between 4.4 and 4.7 points, on a scale of 1 to 5. 76.2% of the participants considered that the knowledge acquired could have a major impact [score = 5] on their future clinical practice. The majority of pre-hospital nurses (96.5%) felt that the session could have a major impact [score = 5; 76.2%, n = 154] or a very important impact [score = 4; 20.3%, n = 41] on their clinical practice. Conclusion: The professional development sessions provide pre-hospital nurses with the latest research findings and the majority of nurses considered that the training had a huge impact on their clinical practice. However, it is important that future research aims to explore the cause-effect relationship between training and improved clinical practice.

The relationship between acute pain and other types of suffering in pre-hospital trauma victims: An observational study.

BACKGROUND: Acute pain is an important complaint reported by trauma victims, however, the relationship between it and other types of discomfort, such as discomfort caused by cold, discomfort caused by immobilization, and psychological distress such as fear, anxiety, and sadness is limitedly studied and documented. AIM: To assess the relationship between acute trauma pain and other types of suffering in pre-hospital trauma victims. METHODS: This is a prospective multicentre cohort study conducted in Immediate Life Support Ambulances in Portugal. All adult trauma victims with a mechanism of blunt and penetrating injuries, falls, road accidents and explosions, were included. RESULTS: 605 trauma victims were included, mainly male, with a mean age of 53.4 years. Before the intervention of the rescue teams, 90.5 % of the victims reported some level of pain, 39.0 % reported discomfort caused by cold, while 15.7 % felt fear, 8.4 % sadness, 49.8 % anxiety and 4.5 % apathy. Victims with high discomfort caused by cold tend to have higher pain levels. Significantly higher pain intensity were observed in victims with fear and anxiety. Univariate and multivariate analysis indicates that immobilization is associated with increased pain levels. CONCLUSIONS: There is a statistically significant relationship between acute trauma pain, anxiety, fear, cold and immobilization.

Prehospital interventions to reduce discomfort caused by immobilization in adult trauma victims: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify the level of discomfort caused by immobilization as reported by trauma victims, and to map all the interventions in the prehospital context where they have been implemented and evaluated in order to reduce discomfort in adult victims of trauma. INTRODUCTION: Immobilization is a cause of discomfort for trauma victims, which has important implications for the deterioration of vital signs and quality of life. However, discomfort caused by immobilization remains an under-explored topic by the scientific community. INCLUSION CRITERIA: This scoping review will consider studies of adult victims of trauma, aged 18 years or over, in prehospital emergency care. Studies that focus on interventions designed to reduce immobilization discomfort, implemented and evaluated by health professionals, of any form, duration, frequency, and dose will be considered. METHODS: An initial search of PubMed and CINAHL will be undertaken, followed by a second search for published and unpublished studies without time restrictions, in major health care-related electronic databases. Studies in English, French, Spanish, and Portuguese will be included. Data extraction will be performed independently by 2 reviewers in a tabular format and will include details about the level of discomfort, interventions, populations, study methods, and outcomes of interest. A narrative synthesis will accompany the results and will describe how they relate to the review objectives. REVIEW REGISTRATION NUMBER: OSF https://osf.io/4scg5/.

Impact of emergent coronary angiography after out-of-the-hospital cardiac arrest without ST-segment elevation - A systematic review and meta-analysis.

INTRODUCTION: Coronary artery disease is a leading cause of out-of-the-hospital cardiac arrest (OHCA). However, there is no consensus on whether OHCA patients without ST-segment elevation (STE) benefit from emergent (ie < 2 h) coronary angiography (CAG). Our aim was to assess the impact of emergent CAG in no-STE OHCA patients. METHODS: We performed a systematic review and meta-analysis by searching the MEDLINE, Cochrane, Scopus, CINAHL and JBI databases for randomized controlled trials (RCTs) comparing emergent CAG versus standard of care (ie CAG >2 h after OHCA or not performed) in no-STE OHCA patients of presumed cardiac aetiology. The primary outcome was short term survival. Secondary outcomes included survival with good neurological outcome, mid-term survival, left ventricle ejection fraction (LVEF), acute kidney injury (AKI) and renal replacement therapy (RRT), ventricular arrhythmias and major bleeding during hospital stay. RESULTS: Seven RCTs met the inclusion and exclusion criteria and were included; one was included only in the analysis of mid-term survival and another in the LVEF analysis. Five studies (1278 patients, 643 with early CAG and 635 with no early CAG) were included in the analysis of the primary endpoint. The groups were balanced for all baseline characteristics but previous PCI, which was more frequent in the standard of care groups. There were no significant differences between groups for short-term survival (57 vs 61%; OR0.85, 95% CI0.68-1.07; I2 = 0%). There were also no differences for any of the secondary endpoints. CONCLUSION: Routine emergent CAG did not improve survival in comatose survivors of OHCA with shockable rhythm and no-STE.

Tratamento pré-hospitalar da dor traumática aguda: um estudo observacional / Tratamiento prehospitalario del dolor traumático agudo: un estudio observacional / Pre-hospital treatment of acute trauma pain: an observational study

Resumo Objetivo Descrever e analisar a eficácia das intervenções levadas a cabo pelos enfermeiros para reduzir a dor dos doentes com lesões traumáticas. Métodos Estudo de coorte prospetivo realizado junto das Ambulâncias de Suporte Imediato de Vida em Portugal, entre 1 de março de 2019 e 30 de abril de 2020. Foram recolhidos dados sobre o tipo de intervenções implementadas e sobre o tempo que durou a aplicação dos procedimentos de salvamento. De forma a poder estudar a evolução das dores traumáticas agudas, foi utilizada uma Escala de Classificação Numérica composta por 11 pontos. As alterações do nível de dor registadas ao longo dos três momentos de avaliação realizados foram estudadas utilizando modelos lineares mistos com interceptos aleatórios para se poder analisar as medidas repetidas aplicadas ao mesmo paciente. Estas alterações foram avaliadas antes e depois da aplicação das intervenções para alívio da dor. Resultados 596 pacientes foram incluídos neste estudo. A maioria era do sexo masculino (65,9%) e tinha média de idade de 53,05±19,72 anos. Houve redução na intensidade média da dor na ordem dos 2,44 pontos (p<0,005) entre o início e o fim da avaliação, e redução de 39,62% entre os pacientes que apresentavam nível de dor igual ou superior a 7 (46,7% contra 7,08%, p<0,05). As medidas que envolvem o uso de morfina, crioterapia e intervenções de suporte emocional provaram ser eficazes. As medidas de conforto como um todo não parecem ser capazes de ter um impacto significativo no alívio da dor. Conclusão As intervenções pré-hospitalares farmacológicas e não farmacológicas levadas a cabo pelos enfermeiros provaram ser eficazes na redução da dor. As medidas de conforto não provaram ser eficazes, pelo que o seu potencial deve ser repensado e reforçado.

Resumen Objetivo Describir y analizar la eficacia de las intervenciones llevadas a cabo por los enfermeros para reducir el dolor de los enfermos con lesiones traumáticas. Métodos Estudio de corte prospectivo realizado con las Ambulancias de Soporte Inmediato de Vida en Portugal, entre el 1º de marzo de 2019 y el 30 de abril de 2020. Se recopilaron datos sobre el tipo de intervenciones implementadas y sobre el tiempo que duró la aplicación de los procedimientos de salvamento. De forma a poder estudiar la evolución de los dolores traumáticos agudos, se utilizó una Escala de Clasificación Numérica compuesta por 11 puntos. Las alteraciones en el nivel de dolor registradas a lo largo de los tres momentos de evaluación realizados fueron estudiadas utilizando modelos lineales mixtos con interceptos aleatorios para posibilitar el análisis de medidas repetidas aplicadas con el mismo paciente. Estas alteraciones fueron evaluadas antes y después de la aplicación de las intervenciones para el alivio del dolor. Resultados 596 pacientes fueron incluidos en este estudio. La mayoría era del sexo masculino (65,9 %), con un promedio de edad entre de 53,05±19,72 años. Hubo una reducción en la intensidad promedio del dolor del orden de 2,44 puntos (p<0,005) entre el inicio y el fin de la evaluación y una reducción del 39,62 % entre los pacientes que presentaban un nivel de dolor igual o superior a 7 (46,7 % contra 7,08 %, p<0,05). Las medidas que involucran el uso de morfina, crioterapia e intervenciones de soporte emocional probaron que son eficaces. No parece que las medidas de confort, de forma general, sean capaces de tener un impacto significativo en el alivio del dolor. Conclusión Las intervenciones prehospitalarias farmacológicas y no farmacológicas llevadas a cabo por los enfermeros comprobaron que son eficaces en la reducción del dolor. Las medidas de confort no comprobaron ser eficaces, motivo este por el que se debe volver a pensar su potencial y reforzarlo.

Abstract Objective To describe and analyze the effectiveness of nurses' interventions in pain reduction among patients with traumatic injury. Methods Prospective cohort study conducted in the Immediate Life Support Ambulances in Portugal from March 1, 2019 to April 30, 2020. We have collected data on the kind of interventions implemented and the time elapsed during rescue procedures. To investigate the course of acute trauma pain, a 11-point Numeric Rating Scale was used. Changes in the level of pain registered throughout the three assessment moments were studied using linear mixed-effects models with random intercepts to account for the repeated measurements conducted on the same patient. These changes were assessed before and after the administration of the pain relief interventions. Results 596 patients were included in this study. Most of them were male (65.9%) and had a mean age of 53.05±19.72 years. There was a reduction in the average pain intensity of 2.44 points (p<0.005), between the beginning and end of the assessment, and a reduction of 39.62% among the patients who were experiencing a level of pain equal to or greater than 7 (46.7% vs 7.08%, p<0.05). Measures involving the use of morphine, cryotherapy and relationship-based measures have proven to be effective. Comfort measures as a whole do not seem to have a significant impact on pain relief. Conclusion Pre-hospital pharmacological and non-pharmacological nurses' interventions have proven to be effective in reducing pain. Comfort measures have not been proved to be effective, so their potential must be rethought and enhanced.

PRO-Trauma: Protocolo para promoção do conforto às vítimas de trauma imobilizadas / Pro-trauma: protocol to promoting comfort in immobilised trauma victims / Pro-trauma: protocolo para promover la comodidad en las víctimas de traumas inmovilizados

Objetivo: Apresentar o protocolo de um estudo que procura desenvolver uma escala para avaliação do desconforto provocado pela imobilização nas vítimas de trauma e um modelo de maca eficaz na imobilização da vítima de trauma em desenvolvimento. Método: Realizar-se-ão quatro estudos sequenciais: Estudo descritivo, exploratório de abordagem quantitativa para avaliar o grau de desconforto provocado pela imobilização na maca de vácuo e/ou plano duro; Estudo psicométrico para construir e validar um instrumento que permita avaliar o desconforto provocado pela imobilização na maca de vácuo e plano duro; Construção da ImoConfort Mattress para imobilização e transporte de vítimas; e Ensaio clínico randomizado para avaliar a eficácia da ImoConfort Mattress quanto ao conforto, imobilização, aquecimento e controlo da trepidação/vibração provocada pelo transporte. Considerações finais: A criação de um instrumento que monitorize o desconforto durante o socorro e transporte com imobilização, contribuirá para melhorar o tratamento implementado às vítimas de trauma. Espera-se que a ImoConfort Mattress contribua para a melhoria da qualidade da assistência clínica durante o socorro extra-hospitalar. (AU)

Objective: To present the protocol of a study that seeks to develop a scale to assess the discomfort caused by immobilisation in trauma victims and an effective mattress model for immobilization of trauma victims, in desenvolviment. Methods: Four sequential studies will be carried out: Descriptive, exploratory quantitative approach study to assess the degree of discomfort caused by the vacuum mattress splint and/or spine board; Psychometric study to construct and validate an instrument to assess the discomfort caused by immobilization on vacuum mattress splint and/or spine board; Construction of the ImoConfort Mattress for immobilization and transportation of victims; Randomized clinical trial to assess the effectiveness of the mattress in terms of comfort, immobilization, rewarming and control of trepidation/vibration caused by transportation. Final considerations: The creation of an instrument to monitor discomfort during rescue and transport with immobilisation will help to improve all the treatment implemented for trauma victims. The construction of ImoConfort Mattress will improve the quality of clinical care during out-of-hospital rescue. (AU)

Objetivo: Presentar el protocolo de un estudio que pretende desarrollar una escala para evaluar las molestias causadas por la inmovilización en las víctimas de trauma y un modelo de una camilla efectiva para la inmovilización de la víctima de trauma en desenvolvimiento. Métodos: Se llevarán a cabo cuatro estudios secuenciales: Estudio descriptivo y exploratorio del enfoque cuantitativo para evaluar el grado de incomodidad causado por la camilla de vacío y/o plano duro; Estudio psicométrico para construir y validar un instrumento para evaluar la incomodidad causada por la inmovilización; Construcción del ImoConfort Mattress para la inmovilización y el transporte de las víctimas; Ensayo clínico aleatorio para evaluar la eficacia de la camilla respecto a la comodidad, la inmovilización, el calentamiento y el control de las trepidaciones/vibraciones causadas por el transporte. Consideraciones finales: La creación de un instrumento para monitorizar la incomodidad durante el rescate y el transporte con inmovilización contribuirá a mejorar todo el tratamiento aplicado a las víctimas de trauma. La construcción del ImoConfort Mattress mejorará la calidad de la atención clínica durante la ayuda extrahospitalaria. (AU)

A autonomia funcional como determinante da qualidade de vida em pessoas com artrite reumatóide / Functional autonomy as a determinant of quality of life in people with rheumatoid arthritis / La autonomía funcional como determinante de la calidad de vida en personas con artritis reumatoide

Resumo Enquadramento: A artrite reumatóide (AR) é uma doença autoimune, crónica, progressiva e potencialmente incapacitante. As atividades de autocuidado aliviam os sintomas e complicações das doenças, reduzem o tempo de recuperação e a taxa de hospitalização. Objetivos: Avaliar a relação da autonomia funcional com a qualidade de vida (QDV) em pessoas com AR. Metodologia: Estudo descritivo, analítico-correlacional e transversal, desenvolvido na região norte de Portugal, com amostra de 139 pessoas com AR (79,86% mulheres). Instrumento de colheita de dados, onde consta: caracterização sociodemográfica; escala Health Assessment Questionnaire (avaliação da autonomia funcional) e Questionário EQ-5D (avaliação da QDV). Resultados: O valor médio de incapacidade foi de 1,029 (incapacidade moderada), apresentando 48,9% da amostra incapacidade leve, 43,2% moderada e 7,9% elevada. Pontuaram com razoável QDV 90,6% dos participantes e 9,4% com fraca. As pessoas com maior incapacidade, logo menor autonomia funcional, apresentam menor QDV. Conclusão: A autonomia funcional impacta a QDV, influenciando-a positivamente. As intervenções de enfermagem carecem de ser ajustadas às necessidades da pessoa com AR na promoção da autonomia.

Abstract Background: Rheumatoid arthritis (RA) is a chronic, progressive, and potentially disabling autoimmune disease. Self-care activities relieve symptoms and complications of diseases and reduce recovery time and hospital admission rates. Objective: To assess the association between functional autonomy and quality of life (QOL) in people with RA. Methodology: Descriptive, analytical-correlational, and cross-sectional study, developed in the northern region of Portugal, with a sample of 139 people with RA (79.86% women). The data collection instrument included a sociodemographic characterization, the Health Assessment Questionnaire (assessment of functional autonomy), and the EQ-5D Questionnaire (assessment of QOL). Results: The mean value of disability was 1.029 (moderate disability), with 48.9% of the sample showing mild disability, 43.2% moderate disability, and 7.9% severe disability. 90.6% of participants had a reasonable QOL, and 9.4% had a poor QOL. People with greater disability and consequently less functional autonomy have lower QOL. Conclusion: Functional autonomy impacts QOL, influencing it positively. Nursing interventions need to be adjusted to the needs of patients with RA to promote their autonomy.

Resumen Marco contextual: La artritis reumatoide (AR) es una enfermedad autoinmune, crónica, progresiva y potencialmente incapacitante. Las actividades de autocuidado alivian los síntomas y las complicaciones de la enfermedad, reducen el tiempo de recuperación y la tasa de hospitalización. Objetivo: Evaluar la relación de la autonomía funcional con la calidad de vida (CDV) en personas con AR. Metodología: Estudio descriptivo, analítico-correlacional y transversal, desarrollado en la región norte de Portugal, con una muestra de 139 personas con AR (79,86% mujeres). Se usó un instrumento de recogida de datos, donde consta: caracterización sociodemográfica; escala Health Assessment Questionnaire (evaluación de la autonomía funcional) y Cuestionarios EQ-5D (evaluación de la CDV). Resultados: El valor medio de incapacidad fue de 1,029 (incapacidad moderada), el 48,9% de la muestra presentó incapacidad leve, el 43,2% moderada y el 7,9% elevada. El 90,6% de los participantes puntuaron la CVD como razonable y el 9,4% como mala. Las personas con mayor incapacidad, por lo tanto, menor autonomía funcional, presentan menor CDV. Conclusión: La autonomía funcional impacta la CDV e influye en ella de forma positiva. Las intervenciones de enfermería deben ajustarse a las necesidades de la persona con AR para promover su autonomía.

Trauma Prehospital Hypothermia Prevention and Treatment: An Observational Study.

BACKGROUND: Hypothermia in trauma patients causes increased morbidity and mortality. Swift recognition and treatment are important to prevent any further heat loss. In addition, patient discomfort from cold decreases satisfaction with care. The administration of active and passive rewarming measures is important in the prevention and treatment of hypothermia, but their use in prehospital trauma patients in Portugal has not been previously reported. OBJECTIVE: To assess the prevalence of hypothermia, the impact of rewarming measures, and the management of the discomfort caused by cold. METHODS: This is a prospective cohort study conducted in Immediate Life Support Ambulances in Portugal between March 1, 2019, and April 30, 2020. RESULTS: This study included records of 586 trauma patients; of whom, 66.2% were men. Cranioencephalic trauma was the most common trauma observed, followed by lower limb and thoracic traumas. Mean body temperature increased 0.12 °C between the first and last assessments (p < .05). Most patients experiencing a level of discomfort of 5 or more on a 0-10 scale reported improvement (from 17.2% to 2.4% after nurses' intervention). Warmed intravenous fluids proved to be effective (p < .05) in increasing body temperature, and passive rewarming measures were effective in preventing hypothermia. CONCLUSIONS: Hypothermia management has to consider the initial temperature, the season, the available rewarming measures, and the objectives to be achieved. The optimization of resources for the monitoring and treatment of hypothermia should be a priority in prehospital assistance. The implementation of rewarming measures improves patients' outcomes and decreases the discomfort caused by cold in prehospital care.

Eficácia da intervenção da enfermagem pré-hospitalar na estabilização das vítimas de trauma / Effectiveness of prehospital nursing interventions in stabilizing trauma victims / Eficacia de la intervención de enfermería prehospitalaria en la estabilización de víctimas de traumatismos

Resumo Enquadramento: O trauma é um problema de saúde pública com considerável impacto social e económico. Contudo, a evidência nacional sobre a sua caracterização e o papel da enfermagem na sua gestão é ainda escassa. Objetivos: Avaliar a eficácia da intervenção de enfermagem na estabilização da pessoa vítima de trauma, prestada pelos enfermeiros das Ambulâncias de Suporte Imediato de Vida em Portugal. Metodologia: Estudo observacional, prospetivo e descritivo-correlacional. Dados colhidos pelos enfermeiros das Ambulâncias de Suporte Imediato de Vida de Portugal continental, de 01/03/2019 a 30/04/2020, e nos Açores, de 01/10/ 2019 a 30/04/2020. Avaliaram-se índices de gravidade do trauma antes e após as intervenções dos enfermeiros. Resultados: Incluíram-se 606 casos (79,4% trauma fechado; 40,8% por acidentes rodoviários) reportados por 171 enfermeiros. Para gerir as vítimas de trauma, o enfermeiro realizou maioritariamente intervenções de suporte hemodinâmico (88,9%) e de controlo não-farmacológico da dor (90,6%). A intervenção dos enfermeiros melhorou os índices de gravidade RTS e SI (p < 0,001). Conclusão: A intervenção pré-hospitalar dos enfermeiros melhora o quadro clínico das vítimas de trauma.

Abstract Background: Trauma is a public health issue with a significant social and economic impact. However, national data on its characterization and the role of nursing in its management is still scarce. Objective: To assess the effectiveness of prehospital nursing interventions in stabilizing trauma victims provided by nurses of Immediate Life Support Ambulances in Portugal. Methodology: Observational, prospective, and descriptive-correlational study. Data were collected by nurses of the Immediate Life Support Ambulances in mainland Portugal, from 01/03/2019 to 30/04/2020, and the Azores, from 01/10/2019 to 30/04/2020. Trauma severity indices were assessed before and after the nursing interventions. Results: This study included 606 cases (79.4% blunt trauma; 40.8% road accidents) reported by 171 nurses. Nurses performed mostly interventions for hemodynamic support (88.9%) and non-pharmacological pain control (90.6%) of trauma victims. The nursing interventions improved the Revised Trauma Score and the Shock Index (p<0.001). Conclusion: Prehospital nursing interventions improve trauma victims' clinical status.

Resumen Marco contextual: Los traumatismos son un problema de salud pública con un considerable impacto social y económico. Sin embargo, los datos nacionales sobre su caracterización y el papel de la enfermería en su gestión son todavía escasos. Objetivos: Evaluar la eficacia de la intervención de enfermería en la estabilización de la víctima de traumatismo, proporcionada por los enfermeros de las Ambulancias de Soporte Vital Inmediato en Portugal. Metodología: Estudio observacional, prospectivo y descriptivo-correlacional. Datos recogidos por los enfermeros de las Ambulancias de Soporte Vital Inmediato de Portugal continental del 01/03/2019 al 30/04/2020, y en las Azores del 01/10/2019 al 30/04/2020. Se evaluaron los índices de gravedad de los traumatismos antes y después de las intervenciones de los enfermeros. Resultados: Se incluyeron 606 casos (79,4% traumatismos cerrados; 40,8% por accidentes de tráfico) notificados por 171 enfermeros. Para tratar a las víctimas de traumatismos, el enfermero realizó principalmente intervenciones de soporte hemodinámico (88,9%) y de control no farmacológico del dolor (90,6%). La intervención de los enfermeros mejoró los índices de gravedad de RTS y SI (p < 0,001). Conclusión: La intervención prehospitalaria de los enfermeros mejora el cuadro clínico de las víctimas de traumatismos.

Non-pharmacological interventions for acute pain management in adult trauma victims: a scoping review.

OBJECTIVE: This scoping review aimed to map non-pharmacological interventions to reduce acute pain in adult trauma victims. INTRODUCTION: Acute pain is a consequence of a pathological or traumatic event, and a result of invasive or non-invasive health care procedures. Acute trauma pain, as well as its treatment, is one of the least-studied areas of acute pain. Although non-pharmacological interventions are responsible for pain relief among a significant number of patients, only a small percentage of patients receive non-pharmacological interventions. INCLUSION CRITERIA: This scoping review considered all studies conducted on adult victims of trauma, aged 18 years or over, in pre-hospital emergency care, emergency rooms, and trauma-center settings. Studies were considered if they focused on non-pharmacological interventions designed to reduce acute pain, and were implemented and evaluated by health professionals. Non-pharmacological interventions of any type, duration, frequency, and intensity were considered. METHODS: A comprehensive search strategy across 11 bibliometric databases and gray literature sources was developed. Full texts of selected citations were assessed in detail for eligibility by two independent reviewers. No other relevant studies were identified by searching the references of the included articles. Data extraction was performed independently by two reviewers using an instrument previously developed, and those reviewers were later responsible for its validation. Findings were then extracted directly into tables that are accompanied by a narrative summary to show how they relate to the objectives of the review conducted. RESULTS: This scoping review included nine studies: two retrospective cohort studies, five randomized controlled trials, one case report, and one literature review for five different countries. Non-pharmacological interventions identified and administered to trauma victims in pre-hospital settings, emergency services, and trauma centers were as follows: acupressure, auricular acupressure, auricular acupuncture, transcutaneous electrical nerve stimulation, repositioning, use of pressure relief devices, massage, heat therapy, music therapy, relaxation therapy, immobilization, ice therapy, compression, elevation, and bandage. Non-pharmacological interventions were mainly developed by nurses, physicians, and paramedics. They were, in most studies, poorly described in terms of their efficacy and were mostly reported in minor traumas, such as simple fractures or small wounds. CONCLUSIONS: Currently, there is no consensus for the implementation of non-pharmacological interventions in the treatment of acute trauma pain. Their application is primarily used for minor traumas, and their potential for the treatment of major traumas is yet unknown. No studies on the use of non-pharmacological interventions aimed at reducing the impact of traumatic adverse environments were identified. Further investigation on the effects of these interventions should be encouraged so that robust decisions and recommendations can be made.

Efetividade das intervenções de telemedicina no impacto da artrite reumatóide: protocolo de uma revisão umbrella / Effectiveness of telemedicine interventions in the impact of rheumatoid arthritis: an umbrella review protocol / Eficacia de las intervenciones de telemedicina en el impacto de la artritis reumatoide: protocolo de una revisión paraguas

Contexto: Crónica e potencialmente incapacitante, com uma baixa qualidade de vida descrita, a artrite reumatoide (AR) afeta 0,5% da população adulta mundial. As intervenções de telemedicina apresentam-se como uma medida que melhora os cuidados de saúde, reduzindo os custos e o impacto da doença. Objetivo: Avaliar a efetividade das intervenções de telemedicina no autocuidado, gestão da dor e da fadiga, literacia e qualidade de vida, nas pessoas com AR. Método de revisão: Será utilizada a metodologia do Joanna Briggs Institute para revisões umbrella. A localização, seleção e extração dos estudos será realizada por dois revisores independentes. Apresentação e interpretação dos resultados: Pretende-se obter dados sobre a efetividade das intervenções de telemedicina no impacto da AR nas pessoas, contribuindo para a divulgação da melhor evidência disponível. Conclusão: O protocolo estabelecido possibilita uma execução precisa por parte de todos os investigadores, contribuindo para o planeamento de intervenções de enfermagem que minorizem o impacto da AR nos autocuidados, gestão da dor e da fadiga, literacia em saúde e qualidade de vida.

Context: Rheumatoid arthritis (RA) is a chronic and potentially disabling disease associated with a poor quality of life that affects 0.5% of the adult population worldwide. Telemedicine interventions are a measure for improving health care, reducing the costs and the impact of the disease. Objective: To assess the effectiveness of telemedicine interventions in improving the self-care, pain and fatigue management, health literacy, and quality of life of people with RA. Method of review: The Joanna Briggs Institute methodology for umbrella reviews will be used. Two independent reviewers will identify, select, and extract the studies. Presentation and interpretation of results: The aim is to obtain data on the effectiveness of telemedicine interventions in the impact of RA on people, contributing to the dissemination of the best available evidence. Conclusion: This protocol will contribute to an effective planning of nursing interventions that minimize the impact of RA on self-care, pain and fatigue management, health literacy, and quality of life.

Marco contextual: Crónica y potencialmente discapacitante, con una baja calidad de vida descrita, la artritis reumatoide (AR) afecta al 0,5% de la población adulta mundial. Las intervenciones de telemedicina se presentan como una medida que mejora la atención de la salud, reduciendo así los costes y el impacto de la enfermedad. Objetivo: Evaluar la efectividad de las intervenciones de telemedicina en el autocuidado, manejo del dolor y fatiga, la alfabetización y la calidad de vida en personas con AR. Método de revisión: La metodología del Instituto Joanna Briggs se utilizará para las revisiones umbrella. La ubicación, selección y extracción de los estudios será realizada por dos revisores independientes. Presentación e interpretación de los resultados: El objetivo es obtener datos sobre la eficacia de las intervenciones de telemedicina en el impacto de la AR en las personas, contribuyendo así a la difusión de las mejores pruebas disponibles. Conclusión: El protocolo establecido permite una ejecución precisa por parte de todos los investigadores, lo que contribuye a la planificación de intervenciones de enfermería que minimicen el impacto de la AR en el autocuidado, la gestión del dolor y la fatiga, la alfabetización en la salud y la calidad de vida.

Non-pharmacological interventions for pain management in adult victims of trauma: a scoping review protocol.

OBJECTIVE: This scoping review aims to map non-pharmacological interventions for reducing acute pain for adult victims of trauma. INTRODUCTION: Acute pain, as a consequence of either a pathological or traumatic event or even due to invasive and non-invasive healthcare procedures, is highly prevalent in critically ill patients. However, specific acute pain as a direct consequence of trauma is one of the least studied areas of acute pain. INCLUSION CRITERIA: This scoping review will consider studies on adult victims of trauma, aged 18 years or over, in prehospital emergency care, emergency departments and trauma centers. All studies that focus on non-pharmacological interventions designed to reduce acute pain, implemented and evaluated by health professionals in any form, duration, frequency and intensity, will be considered. METHODS: An initial search of PubMed and CINAHL will be undertaken, followed by a second search for published and unpublished studies from 2000 to the present in major healthcare related electronic databases. Studies in English, French, Spanish and Portuguese will be included. Data extraction will be performed independently by two reviewers in tabular form and include details about the interventions, populations, study methods and outcomes of interest. A narrative synthesis will accompany the results and will describe how they relate to the review objectives.

Intervenções de Enfermagem pré-hospitalar: revisão narrativa / Pre-hospital nursing interventions: narrative review

Objetivo: Construir algoritmos de intervenção de enfermagem pré-hospitalar a vítimas de trauma. Metodologia: Revisão Narrativa da Literatura, entre 2008 e 2019, nas principais bases de dados. Dois revisores independentes realizaram a avaliação crítica, extração e síntese dos dados. A construção dos algoritmos resultou do processo interpretativo da revisão narrativa por três peritos na área. Utilizou-se o modelo teórico de Virgínia Henderson. Resultados: Obtiveram-se 17 documentos, seis foram incluídos no desenvolvimento dos metaparadigmas Saúde, Pessoa e Ambiente e 16 para a elaboração e construção de Algoritmos de avaliação, diagnóstico e intervenções de enfermagem às vítimas de trauma. Conclusões: A revisão possibilitou a operacionalização do modelo teórico de Henderson para a assistência pré-hospitalar permitindo a criação de algoritmos orientadores da prática de enfermagem. (AU)

Objective: To construct pre-hospital nursing intervention algorithms for trauma victims. Methodology: Literature Narrative Review, between 2008 and 2019, in the main databases. Two independent reviewers carried out the critical evaluation, extraction and synthesis of data. The construction of the algorithms resulted from the interpretive process of the narrative review by three experts. The theoretical model of Virginia Henderson was used. Results: Seventeen documents were obtained, six were included in the development of the metaparadigm Health, Person and Environment and 16 were included in the development and construction of assessment, diagnosis and nursing interventions algorithms for trauma victims. Conclusions: The review enabled the operationalization of Henderson's theoretical model for pre-hospital care, allowing the creation of algorithms to guide nursing practice. (AU)

Objetivo: Construir algoritmos de intervención de enfermería prehospitalaria para víctimas de traumatismos. Metodología: Revisión narrativa de literatura, entre 2008 y 2019, en las principales bases de datos. Dos revisores independientes realizaron la evaluación crítica, extracción y síntesis de los datos. La construcción de los algoritmos fue el resultado del proceso interpretativo de la revisión por parte de tres expertos. Se utilizó el modelo de Virginia Henderson. Resultados: Se obtuvieron diecisiete documentos, seis se incluyeron en el desarrollo de los metaparadigmas y 16 se incluyeron en el desarrollo y construcción de algoritmos de evaluación, diagnóstico e intervenciones de enfermería. Conclusiones: La revisión permitió la operacionalización del modelo de Henderson para la atención prehospitalaria, permitiendo la creación de algoritmos. (AU)

Risk factors for acute coronary syndrome - systematic review of the literature

Introduction: Acute Coronary Syndrome (ACS) is a cardiovascular emergency with high morbidity and mortality rates. The objective of this study is to evaluate the evolutionary trend of modifiable and non-modifiable risk factors for ACS. Methodology: The Cochrane methodology was applied. We included studies that evaluated risk factors, electrocardiographic and clinical presentation of ACS. Two independent reviewers performed the critical evaluation, data extraction and synthesis. Results: We included 32 observational studies (n = 1299381), from the American, African, Asian, European and Oceanian continents, since 1994 to 2014. It was verified that there are no significant changes in the prevalence of risk factors Age and Gender, with age > 65 years exceeding 50% in only 2 of the 10 studies that looked at this variable. The most prevalent gender is male (> 60%) and family his-tory shows an increase in percentage with the course of the studies. Discussion: Modifiable risk factors go through the timeline with some homogeneity, with hypertension being the most prevailing, followed by smoking, dyslipidemia and Diabetes Mellitus. Smoking tends to be more frequent in younger patients, and hypertension, dyslipidemia and diabetes mellitus are more frequent in the elderly patients. Obesity is the risk factor least prevailing and also the least studied. Conclusions: All the 32 studies present very similar results, regardless of the date of data collection and the region/country where the data was collected, showing a clear cause-effect relationship between these risk factors and ACS

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