Evidências para o tratamento de feridas em recém-nascidos: revisão integrativa

Introdução: Diante das particularidades e desafios no manejo e tratamento de feridas em recém-nascidos torna-se importante para o enfermeiro conhecer, indicar e avaliar a eficácia e segurança das coberturas e produtos, inclusive na análise dos produtos para o público neonatal. Objetivo: Identificar na literatura as principais coberturas e produtos utilizados no tratamento de feridas em recém-nascidos. Metodologia: Trata-se de uma revisão integrativa de literatura, com artigos publicados entre os anos de 2018 a 2022, que abordaram os temas de coberturas e produtos utilizados no tratamento de feridas em recém-nascidos. A coleta de dados foi realizada por meio de consulta na Biblioteca Virtual de Saúde e Scientific Eletronic Library Online. Foram utilizados os descritores "newborn", "wounds" e "bandage". A análise foi realizada conforme a estratégia PICO e estruturados pelo PRISMA. Resultados: Diante dos achados foi possível identificar 13 artigos que abordavam produtos e coberturas destinados ao tratamento de feridas em neonatos. Foram encontrados 14 tipos de coberturas/produtos e dispositivos que utilizam a terapia por pressão negativa. Considerações finais: A literatura indica o uso de produtos e cobertura com princípios passivos, ativos e biológicos para o tratamento de feridas em neonatos, inclusive no prematuro, valendo destacar a importância em considerar o uso seguro de coberturas adequadas a esse público.

Introducción: Dadas las particularidades y desafíos en el manejo y tratamiento de heridas en recién nacidos, es importante que los enfermeros conozcan, indiquen y evalúen la efectividad y seguridad de apósitos y productos, incluido el análisis de productos para el público neonatal. Objetivo: Identificar en la literatura los principales apósitos y productos utilizados para el tratamiento de heridas en recién nacidos. Metodología: Se trata de una revisión integrativa de la literatura, con artículos publicados entre 2018 y 2022, que abordaron los temas de apósitos y productos utilizados en el tratamiento de heridas en recién nacidos. La recolección de datos se realizó mediante consulta en la Biblioteca Virtual en Salud y Biblioteca Científica Electrónica en Línea. Se utilizaron los descriptores "newborn", "wounds" y "bandage". El análisis se realizó según la estrategia PICO y estructurado por PRISMA. Resultados: Teniendo en cuenta los hallazgos, fue posible identificar 13 artículos que abordaron productos y apósitos destinados al tratamiento de heridas en recién nacidos. Se encontraron 14 tipos de revestimientos/productos y dispositivos que utilizan terapia de presión negativa. Consideraciones finales: La literatura indica el uso de productos y coberturas con principios pasivos, activos y biológicos para el tratamiento de heridas en recién nacidos, incluidos los prematuros, y cabe resaltar la importancia de considerar el uso seguro de coberturas adecuadas para esta población.

Introduction: Given the particularities and challenges in the management and treatment of wounds in newborns, it becomes important for nurses to know, indicate and evaluate the efficacy and safety of dressings and products, even in the analysis of products for the neonatal population. Objective: To identify in the literature the main dressings and products used to treat wounds in newborns. Methodology: This is an integrative literature review, with articles published between 2018 and 2022, which addressed the topics of dressings and products used in the treatment of wounds in newborns. Data collection was carried out through consultation in Biblioteca Virtual de Saúde and in the Scientific Electronic Library Online. The "newborn", "wounds" and "bandage" descriptors were used. The analysis was carried out according to the PICO strategy and structured following PRISMA. Results: Given the findings, it was possible to identify 13 articles that addressed products and dressings intended for treating wounds in newborns. Fourteen types of dressings/products and devices that use negative pressure therapy were found. Final considerations: The literature indicates the use of products and dressings with passive, active and biological principles for the treatment of wounds in newborns, including premature neonates, and it is worth highlighting the importance of considering the safe use of dressings that are suitable for this population.

Desenvolvimento de um Protocolo sobre Processamento de Produtos para Saúde em um Hospital Universitário / Elaboración de un Protocolo de Procesamiento de Productos Sanitarios en un Hospital Universitario / Development of a Protocol on the Processing of Health Products in a University Hospital

Objetivo:Desenvolver e validar um Protocolo sobre Processamento de Produtos para Saúde na Central de Material e Esterilização de um Hospital Universitário de São Paulo. Método: Trata-se de um estudo descritivo metodológico de desenvolvimento de um protocolo sobre processamento de produtos para a saúde.Realizada a revisão da literatura, elaboração do conteúdo escrito e de imagens. A validação foi feita por meio da Técnica Delphi com a participação de juízes. Para medir a concordância das respostas obtidas, foi utilizado o Índice de Validade de Conteúdo (IVC). Resultados: Após a segunda rodada do processo de validação pela Técnica Delphi, o IVC global do protocolo foi de 1.0, alcançando o nível de maior concordância. A versão final do protocolo possui 45 páginas, 8 itens abordados, 32 subitens e 20 ilustrações. Conclusão:O protocolo possibilitou reorganizar processos, estabelecer fluxos e padronizar condutas com embasamento científico para os profissionais de saúde.(AU)

Objective: To develop and validate a Protocol on the Processing of Health Products at the Material and Sterilization Center of a University Hospital in São Paulo. Method: This is a descriptive methodological study of the development of a protocol on the processing of health products. A literature review, written content and images were developed. Validation was performed using the Delphi Technique with the participation of judges. To measure the agreement of the answers obtained, the Content Validity Index (CVI) was used. Results: After the second round of the validation process using the Delphi Technique, the global CVI of the protocol was 1.0, reaching the highest level of agreement. The final version of the protocol has 45 pages, 8 items covered, 32 sub-items and 20 illustrations. Conclusion: The protocol made it possible to reorganize processes, establish flows and standardize scientifically based conducts for health professionals.(AU)

Objetivo: Desarrollar y validar un Protocolo de Procesamiento de Productos de Salud en el Centro de Material y Esterilización de un Hospital Universitario de São Paulo. Método: Se trata de un estudio metodológico descriptivo de la elaboración de un protocolo sobre el procesamiento de productos sanitarios. Se elaboró una revisión de literatura, contenido escrito e imágenes. La validación se realizó mediante la Técnica Delphi con la participación de jueces. Para medir la concordancia de las respuestas obtenidas se utilizó el Índice de Validez de Contenido (IVC). Resultados: Tras la segunda ronda del proceso de validación mediante la Técnica Delphi, el CVI global del protocolo fue de 1,0, alcanzando el mayor nivel de acuerdo. La versión final del protocolo tiene 45 páginas, 8 ítems cubiertos, 32 sub ítems y 20 ilustraciones. Conclusión: El protocolo permitió reorganizar procesos, establecer flujos y estandarizar conductas con base científica para los profesionales de la salud.(AU)

Inovação em cânula de lipoaspiração para coleta de enxerto de gordura para uso em reconstrução mamária / Innovation in liposuction cannula to harvest fat graft to use in breast reconstruction

Introdução: A evolução da técnica de lipoaspiração e da enxertia de gordura associada a segurança oncológica permitiram utilizar a gordura como preenchedor autólogo em pacientes com neoplasia de mama que eram submetidas a reconstrução mamária. O objetivo é apresentar uma inovação no instrumento de coleta de gordura que será utilizada como enxerto, para uso em reconstrução mamária. Métodos: Foi realizada a busca de anterioridade nos bancos de dados internacionais e nacional e a confecção de um protótipo de cânula de coleta de gordura de 35cm de comprimento, com diâmetro do tubo de 4mm, com 10 furos redondos na sua extremidade distal com 2mm de diâmetro. Foi realizado um experimento de aspiração de substância viscosa comparando o protótipo com dois modelos de cânulas com desenho padrão da indústria, de três furos tipo Mercedes e de cinco furos tipo Pitanguy. Resultados: Foram encontrados quatro patentes de alta relevância e uma patente de média relevância, que diferem do modelo de utilidade proposto quando se comparam o tipo de desenho da extremidade distal das cânulas estudadas e a função dos instrumentos identificados. Quando comparou-se a eficiência do protótipo, a cânula de cinco furos foi a mais eficiente na aspiração da substância viscosa, e não houve diferença estatística na velocidade de aspiração entre o protótipo e a cânula de três furos tipo Mercedes. Conclusão: A inovação apresentada para a coleta de enxerto de gordura para uso em reconstrução mamária apresentou a mesma eficiência que a cânula Mercedes de três furos neste modelo experimental.

Introduction: The evolution of liposuction and fat graft technique with the oncologic safety allowed to use the fat as autologous filler in patients with breast cancer and submitted to breast reconstruction. The objective is to introduce an innovation in the instrument used to harvest fat grafts for breast reconstruction. Methods: Search of anteriority and trademarks were performed at international and national databases, and a prototype was built as a fat harvest instrument with 35cm in length, 4cm in diameter, with 10 holes at the distal extremity, with 2mm diameter each. It was experimented with a harvest of a viscous substance, comparing the prototype with two regular industry cannulas types: three holes Mercedes' type and five roles Pitanguy's type. Results: Four high-relevance patents and one medium-relevance patent were found, which differ from the proposed utility model when comparing the type of design of the distal end of the studied cannulas and the function of the instruments identified. When the prototype's efficiency was compared with the other cannulas, the cannula with five holes in Pitanguy's type was the most efficient, and it was no statistical difference between the prototype and the cannula with three roles in Mercedes' type. Conclusion: The innovation presented to harvest fat graft for breast reconstruction had the same efficiency in harvesting the viscose substance as the cannula Mercedes type with three holes in this experimental model.

Educação continuada em enfermagem à distância para tratamento de feridas em prisões / Educación continua en enfermería a distancia para el tratamiento de heridas en prisiones / Distance continuing education in nursing for wound care in prisons

Resumo Objetivo: Desenvolver e validar um curso de educação continuada em enfermagem a distância para tratamento de feridas em prisões. Métodos: Estudo descritivo sobre o desenvolvimento, a configuração e a validação de um curso on-line para tratamento de feridas, destinado a profissionais de saúde do sistema prisional e realizado em três etapas. A primeira fase foi a busca de anterioridade, para verificar a existência de cursos de tratamento em feridas voltado ao sistema prisional e elaborar o conteúdo do curso, com base em um protocolo de tratamento de feridas e em artigos de bases de dados. A segunda fase consistiu na configuração do curso na plataforma Moodle. Na terceira fase, foram aplicadas duas rodadas da técnica Delphi para validação do curso, com consulta de sete especialistas convidados com titulação mínima de especialistas em tratamento de feridas (estomaterapia) ou com pelo menos um ano de experiência em atuação na área de cuidado com feridas. Resultados: O curso de tratamento de feridas foi configurado na plataforma Moodle, com seis módulos, seis exercícios e uma avaliação de aprendizagem. A validação do conteúdo do curso ocorreu após a realização de duas rodadas de avaliação dos juízes, com Índice de Validade de Conteúdo de 0,83 na primeira e 0,98 na segunda. Conclusão: Foi desenvolvido e validado o curso de educação continuada em enfermagem a distância para tratamento de feridas em prisões, denominado "Educação Permanente On-line sobre Tratamento de Feridas".

Resumen Objetivo: Desarrollar y validar un curso de educación continua en enfermería a distancia para el tratamiento de heridas en prisiones. Métodos: Estudio descriptivo sobre el desarrollo, la configuración y la validación de un curso en línea para el tratamiento de heridas, destinado a profesionales de salud del sistema penitenciario y realizado en tres etapas. La primera fase fue la búsqueda de la anterioridad, para la verificación de la existencia de cursos de tratamiento de heridas direccionados al sistema penitenciario y elaborar el contenido del curso con base a un protocolo de tratamiento de heridas y a artículos de bases de datos. La segunda fase consistió en la configuración del curso en la plataforma Moodle. En la tercera fase, se aplicaron dos rondas del método Delphi para la validación del curso, con la consulta a siete especialistas invitados con titulación mínima de especialistas en el tratamiento de heridas (estomaterapia) o con un mínimo de un año de experiencia en la actuación en el área de cuidado con heridas. Resultados: El curso de tratamiento de heridas se configuró en la plataforma Moodle, con seis módulos, seis ejercicios y una evaluación de aprendizaje. La validación del contenido del curso se dio después de la realización de dos rondas de evaluación de los jueces, con Índice de Validez de Contenido de 0,83 en la primera y de 0,98 en la segunda. Conclusión: Se desarrolló y validó el curso de educación continua en enfermería a distancia para el tratamiento de heridas en prisiones, denominado "Educación Permanente en línea sobre el Tratamiento de Heridas" (Educação Permanente On-line sobre Tratamento de Feridas).

Abstract Objective: To develop and validate a distance continuing education course in nursing for wound care in prisons. Methods: Descriptive study on the development, configuration and validation of an online course in wound care aimed at health professionals in the prison system performed in three steps. The first step was the search for anteriority to check the existence of courses of wound care aimed at the prison system and prepare the course content based on a wound care protocol and on articles from databases. The second step consisted of setting up the course on the Moodle platform. In the third step, two rounds of the Delphi technique were applied to validate the course, including the consultation of seven invited experts with a minimum qualification of specialists in wound care (stomatherapy) or with at least one year of experience in the area of wound care. Results: The wound care course was set up on the Moodle platform with six modules, six exercises and a learning assessment. The course was validated after two rounds of evaluation by the judges with a Content Validity Index of 0.83 in the first round and 0.98 in the second. Conclusion: The distance continuing education course in nursing for wound care in prisons called "Online Continuing Education in Wound Care" was developed and validated.

Algoritmos para manejo de cicatrizes: a importância da sistematização de condutas / Algorithms for the management of scars: the importance of systematizing behaviors

■ RESUMO Introdução: As cicatrizes patológicas ocorrem a partir de hiperproliferaçãoo de fibroblastos, podendo ser classificadas em cicatrizes hipertróficas e queloides, basicamente as cicatrizes hipertróficas não crescem além dos limites da ferida original, enquanto os queloides crescem horizontalmente de forma nodular. Apesar da diversidade de instrumentos utilizados para orientar a prevenção, tratamento e seguimento de cicatrizes patológicas, existe a necessidade de instrumentos que contemplem realidades locais. O objetivo é realizar uma revisão narrativa de literatura sobre algoritmos para manejo de cicatrizes e criar um algoritmo atualizado. Métodos: Estudo descritivo de revisão narrativa de literatura, sendo realizado uma pesquisa nas bases de dados PubMed, SciELO, LILACS, MEDLINE e Cochrane, no período de novembro de 2010 até novembro de 2020, publicados nos idiomas inglês, português e espanhol. Os descritores utilizados foram: "cicatrix", "keloid", "algorithms" e "wound healing". A seleção da amostra consistiu da identificação dos artigos, leitura dos títulos e resumos e seleção de estudos relacionados ao tema e, posteriormente, foi realizada a leitura na íntegra dos estudos selecionados e classificação segundo os critérios de elegibilidade. Resultados: Foram encontrados 209 artigos sendo eliminados 116 devido duplicidade resultando em 45 artigos. Foram identificados um total de 8 artigos que preencheram os critérios de inclusão e após análise e reunião de consenso foram excluídos quatro artigos devido à ausência de algoritmos com rigor científico sendo este estudo composto de quatro artigos. Conclusão: Foram encontrados quatro algoritmos na revisão de literatura que resultaram na elaboração de um algoritmo atualizado para cicatrizes.

■ ABSTRACT Introduction: Pathological scars occur from the hyperproliferation of fibroblasts and can be classified into hypertrophic scars and keloids. Basically, hypertrophic scars do not grow beyond the limits of the original wound, while keloids grow horizontally in a nodular form. Despite the diversity of instruments used to guide the prevention, treatment and follow-up of pathological scars, there is a need for instruments that address local realities. The objective is to carry out a narrative review of the literature on scar management algorithms and create an updated algorithm. Methods: Descriptive study of narrative literature review, with a search in PubMed, SciELO, LILACS, MEDLINE and Cochrane databases, from November 2010 to November 2020, published in English, Portuguese and Spanish. The descriptors used were: "cicatrix," "keloid," "algorithms," and "wound healing." The sample selection consisted of identifying the articles, reading the titles and abstracts, and selecting studies related to the topic. Subsequently, the full reading of the selected studies and classification according to the eligibility criteria were carried out. Results: 209 articles were found, and 116 were eliminated due to duplicity, resulting in 45 articles. A total of 8 articles that met the inclusion criteria were identified. Four articles were excluded after analysis and consensus meeting due to the absence of algorithms with scientific rigor; this study is composed of four articles. Conclusion: Four algorithms were found in the literature review that resulted in the development of an updated algorithm for scars.

Educação continuada e metodologias ativas em cursos a distância em enfermagem: revisão integrativa da literatura / Continuing education and active methodologies in distance courses in nursing: integrative literature review / Educación continua y metodologías activas en cursos de enfermería a distancia: una revisión integradora de la literatura

Objetivo: Verificar e discutir as metodologias ativas de ensino adotadas na educação de enfermeiros em cursos à distância. Método: A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Universidade Federal de São Paulo. Realizou-se revisão integrativa da literatura em bases de dados utilizando os seguintes descritores e suas combinações: Educação a Distância, Enfermagem e Metodologias ativas. Resultados: Observou-se que 33,3% dos estudos promoviam aprendizagem por meio de ambiente virtual de aprendizagem, 30,3% usavam o formato e-learning e 12,1% utilizavam método híbrido. Considerações finais: As metodologias ativas de ensino têm sido empregadas em cursos de capacitação de profissionais de saúde, inclusive enfermagem, e têm contribuído positivamente na qualidade da assistência prestada aos pacientes. (AU)

Objective: To verify and discuss the active teaching methodologies adopted in the education of nurses in distance learning courses. Method: The research was approved by the Research Ethics Committee of the Federal University of São Paulo. An integrative literature review was carried out on databases using the following descriptors and their combinations: Distance Education, Nursing and Active Methodologies. Results: It was observed that 33,3% of the studies promoted learning through a virtual learning environment, 30,3% used the e-learning format and 12.1% used a hybrid method. Conclusion: Active teaching methodologies have been used in training courses for health professionals, including nursing, and have contributed positively to the quality of care provided to patients.(AU)

Objetivo: Verificar y discutir las metodologías activas de enseñanza utilizadas en los cursos de educación a distancia para la educación en enfermería. Métodos: El estudio fue aprobado por el Comité de Ética en Investigación de la Universidad Federal de São Paulo. Se realizó una revisión bibliográfica integradora utilizando los siguientes descriptores y sus combinaciones: educación a distancia, enfermería y metodologías activas. Resultados: Se observó que el 33,3% de los estudios promovió el aprendizaje a través del entorno de aprendizaje virtual, el 30,3% utilizó el formato de aprendizaje electrónico y el 12,1% utilizó el método híbrido. Consideraciones finales: Se han empleado metodologías de Aprendizaje Activo en cursos de capacitación para profesionales de la salud, incluida la enfermería, que han contribuido positivamente a la calidad de la atención brindada a los pacientes.(AU)

Qualidade de vida e autoestima de pacientes com úlcera venosa / Quality of life and self-esteem of patients with venous ulcer / Calidad de vida y autoestima de pacientes con úlcera venosa

Objetivo: Avaliar a qualidade de vida e autoestima de pacientes com úlcera venosa. Método: Estudo primário, exploratório, observacional, transversal e descritivo realizado com 75 pacientes atendidos na Atenção Primária de Conselheiro Lafaiete-MG no período de dezembro de 2018 a maio de 2019 com a aplicação da Escala de autoestima de Rosenberg e o questionário de qualidade de vida SF-36. Resultados: O gênero feminino foi mais prevalente (60%), idade média de 68,9 anos e predomínio de doenças crônico-degenerativas. O levantamento das médias da Escala de Autoestima de Rosenberg teve maiores pontuações foram relacionadas ao gênero feminino, raça branca, aposentados, tabagistas, etilistas, com HAS e DM. Conclusão: A presença de úlcera venosa interferiu negativamente na autoestima de ambos os gêneros, entretanto o gênero masculino apresenta melhores escores quando comparados ao gênero feminino.(AU)

To assess the quality of life and self-esteem of patients suffering from venous ulcer. Method: Cross-sectional study regarding 75 patients, seen in the family health units in the Conselheiro Lafaiete municipality-MG. The individual basic care registration form, Rosenberg's self-esteem scale and the SF-36 quality of life survey were utilized for the data gathering. Results: Attested female predominance(60%), with a median age of 68,9 years. The Rosenberg's self-esteem scale attested an average of 9,7, the greatest average of the SF-36 test was 57,7. The Overall Health Status variable indicated the highest score among those evaluated, correlating to improvement, while the Physical Aspect corresponded to worsening, especially when associated with the female sex and the presence of comorbid conditions. Conclusion: The presence of venous ulcers interfered the self-esteem of both genders.(AU)

Objetivo: Evaluar la calidad de vida y la autoestima de pacientes con úlceras venosas. Método: Estudio primario, exploratorio, observacional, transversal y descriptivo realizado con 75 pacientes atendidos en la Atención Primaria de Conselheiro Lafaiete-MG entre diciembre 2018 y mayo 2019 con la aplicación de la escala de autoestima de Rosenberg y el cuestionario de calidad de vida SF-36. Resultados: el sexo femenino tuvo mayor prevalencia (60%), con edad promedia de 68,9 años y predominio de enfermedades crónico-degenerativas. Los promedios de la escala de Rosenberg con mayor puntuación fueron los relacionados al género femenino, de raza blanca, jubilados, fumadores, usuarios de bebidas alcohólicas, con HSA y DM. Conclusión: la presencia de úlceras venosas interfirió negativamente en la autoestima de ambos sexos, sin embargo, el sexo masculino presenta mejores puntajes cuando comparados al sexo femenino.(AU)

Development of a Manual on the Technique of Applying the Unna Boot in Patients With Venous Leg Ulcers.

INTRODUCTION: Providing adequate care for people with venous leg ulcers (VLUs) can be a challenge. Numerous publications have discussed the importance of compression therapies on the treatment of VLUs, but few have described the necessary materials and techniques for applying the Unna boot, contributing to the underutilization of this therapy. The use of manuals is one of the strategies in the training of health professionals. OBJECTIVE: The aim of this study was to develop and validate a manual on the technique of applying the Unna boot in patients with VLUs. The manual was created to improve the education and training of health professionals in the control of chronic VLUs. MATERIALS AND METHODS: This was a descriptive study involving 3 stages. The selection of content for the manual was based on a literature review of articles in the Portuguese, Spanish, and English languages published from January 2000 through December 2018, in which 8 key terms were searched across the Cochrane Library, MEDLINE, and SciELO databases, and Google Scholar search engine. The text, illustrations, and layout design of the manual as well as a video demonstration of the technique were created. The manual then was validated for content by an expert panel using the Delphi Technique and the content validity index (CVI). RESULTS: The manual showed an overall CVI of 0.98 after 2 rounds of consultation and its content, presentation, and relevance were rated as very adequate by the expert panel. The final version of the manual features 29 pages of text and illustrations and includes a video demonstration of the technique. CONCLUSIONS: A manual on the technique of applying the Unna boot in patients with VLUs was developed and validated for content by an expert panel.

Manual sobre cuidados com a ferida pós-pleurostomia aberta / Manual on wound care after open-window thoracostomy

Objetivo: Produzir e validar um manual sobre cuidados com a ferida pós-pleurostomia aberta para profissionais de saúde. Métodos:Trata-se de um relato de experiência. Inicialmente, foram selecionados artigos em português, espanhol e inglês no período de 2010 a 2018 nas bases de dados bibliográficos e sites de busca da Cochrane, SciELO, LILACS, PubMed e Google Acadêmico para o desenvolvimento do material. Foram utilizados os descritores: "toracotomia", toracostomias", "cavidade torácica", "pleura", "cavidade pleural", "ferimentos e lesões". Após consulta, o texto foi elaborado, seguido das ilustrações e a diagramação. O manuscrito concluído foi encaminhado aos especialistas para validação. O índice de validade de conteúdo (IVC) foi utilizado para validar o manual. Resultados: O manual desenvolvido possui trinta e seis páginas e sete capítulos com os seguintes temas: introdução, cuidados com a ferida pós-pleurostomia aberta, limpeza da ferida/debridamento, coberturas, registro dos cuidados, considerações finais e bibliografia. Conclusão: Foi possível desenvolver e validar um manual de cuidados com a ferida pós-pleurostomia aberta para a consulta de profissionais de saúde.

"Sem Pressão": aplicativo com orientações para identificação, estadiamento e prevenção de lesões por pressão / ESTIMA, Braz. J. Enterostomal Ther., São Paulo, v18, e3120, 20201"Sem Pressão": application with guidelines for identification, staging and prevention of pressure injuries

Objetivo: desenvolver aplicativo com orientações sobre identificação, estadiamento e prevenção de lesões por pressão em adultos. Método: o método descritivo utilizado iniciou com a busca de aplicativos na área de lesões por pressão nas plataformas Google© e Apple©. Após, foi desenvolvido o conteúdo, baseado, principalmente, nas recomendações da National Pressure Injury Advisory Panel. Foi criado um protótipo em www.fábricadeaplicativos.com.br e enviado para avaliação de forma e conteúdo. Seis profissionais de saúde preencheram um questionário avaliando o aplicativo e dois deles sugeriram alterações. O aplicativo foi adequado às sugestões e reavaliado por três enfermeiros estomaterapeutas que não sugeriram alterações. Resultados: o aplicativo foi desenvolvido no site "fábrica de aplicativos" e denominado "Sem Pressão", com sete abas. Conclusão: foi criado o aplicativo com orientações sobre identificação, estadiamento e prevenção de lesões por pressão em adultos, e disponibilizado para download gratuito.

Objective: develop an application with guidance on the identification, staging and prevention of pressure injuries in adults. Method: the descriptive method used started with the search for applications in the area of pressure injuries on the Google © and Apple © platforms. Afterwards, the content was developed, based mainly on the recommendations of the National Pressure Injury Advisory Panel. A prototype was created at www.fábricadeaplicativos.com.br and sent for evaluation of form and content. Six health professionals completed a questionnaire evaluating the application and two of them suggested changes. The application was adequate to the suggestions and reassessed by three stomatherapist nurses who did not suggest changes. Results:the application was developed on the "application factory" website and named "Sem Pressão" (No Pressure), with seven tabs. Conclusion:the application was created with guidelines on identification, staging and prevention of pressure injuries in adults, and made available for free download.

Experimental models of scald burns. A scope review.

PURPOSE: To conduct a scope review of the experimental model described by Walker and Mason, by identifying and analyzing the details of the method. METHODS: The authors searched Pubmed-Medline, Cochrane-Bireme and PEDro databases for articles published between January 2016 and December 2018, using the following search queries: burns, burn injuries, models animal, and animal experimentation. All articles whose authors used Walker and Mason's model - with or without changes to the method in Wistar rats - were included in this study. RESULTS: The search identified 45 mentions of Walker and Mason's model; however, after reading each summary, 20 were excluded (of which 5 due to duplicity). The inconsistencies observed after the scope review were: water temperature, length of time of exposure of the experimental model's skin to water, extent of the burnt area, and the description of the thickness/depth of the injury. CONCLUSIONS: Reproducibility of a scientific method is the basis to prove the veracity of the observed results. Thus, it is necessary to have a greater number of publications that adopt a reproducible scientific method, for this review found inconsistencies in the description of Walker and Mason's model.

Development and Validation of a Manual of Skin Care for Persons Deprived of Liberty in the São Paulo State Prison System: A Descriptive Study.

Brazil has the third largest prison population in the world. Studies on the health status of prisoners have shown that skin diseases, especially infectious skin diseases, are prevalent in this population. Because some skin diseases can be prevented, strategies to inform and guide incarcerated persons may be helpful. PURPOSE: The purpose of this study was to develop and validate a manual of skin care for use by prisoners in the São Paulo State Prison System. METHODS: To develop the manual, a Google search to ensure originality of the concept was conducted, followed by an integrative literature search of the MEDLINE and the Latin American and Caribbean Health Science Literature, and the medical records of the prison system were reviewed for content. The Delphi technique was used to validate content; the content validity index (CVI) was determined based on the ratings of an expert panel of 10 prison employees who were health professionals and have experience providing care to prisoners. Twenty (20) target-users (prisoners) also evaluated the manual. The experts responded to questionnaires (sent by email) containing 19 items related to the manual's objective, structure and presentation, and relevance. Items were rated on a Likert-type scale where 1 = inadequate, 2 = partially inadequate, 3 = adequate, 4 = very adequate, and NA = not applicable, and participants also could provide suggestions and comments on the manual. The prisoners used a paper-and-pencil questionnaire to assess the manual that included 14 items with 3-choice answers (agree, undecided, disagree) on the utility and ability to understand the manual topics and space to write concerns and suggestions regarding the utility of the content; they also could offer their thoughts and opinions about the manual. The proportion of agreement among responses was calculated. RESULTS: The overall CVI of the first round of evaluations was 1.0. Suggested changes were to include guidelines on the proper use of medications and modify some wording. The overall CVI of the next round was 1.0 (100% agreement). The evaluation by target users showed an agreement of 98.6%. The final version of the manual has 8 topics, 12 subtopics, and 29 illustrations; topics include skin, hair, and nail care and skin diseases. A printed version is available in the prison library and an electronic copy was sent to all prisons in the State of São Paulo to be printed as needed. CONCLUSION: A manual providing guidelines on skin care for prison populations was developed and validated with the intent to improve prisoner quality of life and care. Research to examine overall manual usage and the effect of the information and guidance on healthy behaviors, prevention, and management of skin diseases is warranted.

Development of an Illustrated Guide to Techniques of Dressing Application in the Patient With Burns.

INTRODUCTION: Burns are complex, difficult-to-treat wounds associated with high rates of morbidity and mortality. OBJECTIVE: The aim of this study is to develop and validate an illustrated guide to techniques of dressing application for use in the initial management of the patient with burn wounds. METHODS: The construction of the illustrated guide was based on a literature review conducted of publications between 2001 to 2017 in MEDLINE/PubMed, Scientific Electronic Library Online, Cochrane Library, and Google Scholar. No similar work was found in the literature. Standardized photographs were taken using a manikin to illustrate the step-by-step procedures. The content validity of the illustrated guide was assessed by a panel of 7 burn specialists through a questionnaire in the search for a consensus opinion according to the Delphi technique. The questionnaire assessed 3 main components: Objective, Structure and Presentation, and Relevance of the guide. RESULTS: The final version of the illustrated guide showed an excellent overall content validity index (CVI) of 0.99. The CVI was 1.0 for the component Objective, 0.98 for Structure and Presentation, and 1.0 for Relevance. The guide has 79 pages, 86 illustrations, and 10 chapters on techniques of dressing application for patients with burn wounds. Topics including material preparation, gowning and gloving procedures, and techniques of dressing application for different parts of the body were addressed. CONCLUSIONS: An illustrated guide for dressing application in burn wounds was developed and validated for content by an expert panel.

Experimental models of scald burns. A scope review

Abstract Purpose: To conduct a scope review of the experimental model described by Walker and Mason, by identifying and analyzing the details of the method. Methods: The authors searched Pubmed-Medline, Cochrane-Bireme and PEDro databases for articles published between January 2016 and December 2018, using the following search queries: burns, burn injuries, models animal, and animal experimentation. All articles whose authors used Walker and Mason's model - with or without changes to the method in Wistar rats - were included in this study. Results: The search identified 45 mentions of Walker and Mason's model; however, after reading each summary, 20 were excluded (of which 5 due to duplicity). The inconsistencies observed after the scope review were: water temperature, length of time of exposure of the experimental model's skin to water, extent of the burnt area, and the description of the thickness/depth of the injury. Conclusions: Reproducibility of a scientific method is the basis to prove the veracity of the observed results. Thus, it is necessary to have a greater number of publications that adopt a reproducible scientific method, for this review found inconsistencies in the description of Walker and Mason's model.

Hydrocellular Foam Versus Hydrocolloid Plate in the Prevention of Pressure Injuries.

INTRODUCTION: Pressure injury is one of the most prevalent skin injuries and a great challenge in the hospital environment. The implementation of preventive measures contributes to reducing its occurrence. OBJECTIVE: This study compares the protective effect of 2 adhesive dressings used in the prevention of pressure injuries in at-risk patients. MATERIALS AND METHODS: This case series was conducted at a university hospital in southeastern Brazil with 80 hospitalized adult patients at risk for pressure injuries, as per the Braden Scale for Predicting Pressure Sore Risk. Patients were randomized to preventive intervention with either hydrocellular foam (n = 40) or hydrocolloid plate (n = 40) dressing, which was applied to the intact skin over the sacrum and trochanters and changed weekly over 8 weeks. RESULTS: Of the patients, 56.5% were women, 64.5% were 60 years of age or older, 58.1% were admitted to an intensive care unit, and 63.9% were at high risk for pressure injuries. None of the patients developed a pressure injury. However, the presence of blanchable erythema, desquamation, pruritus, discomfort during dressing removal, and skin damage caused by the strong adhesiveness of the dressings were observed in both groups. In the hydrocolloid plate group, patients reported significantly more discomfort during dressing removal due to its strong adhesion to the skin (P = .004) than those in the hydrocellular foam group. CONCLUSIONS: Standard preventive measures combined with the use of either hydrocellular foam or hydrocolloid plate contributed to the prevention of pressure injuries in at-risk patients, with hydrocolloid plate being associated with significantly more discomfort during dressing removal.

Avaliação clínica e epidemiológica do paciente com feridas em uma unidade prisional do Estado de São Paulo / Clinical and epidemiological evaluation of patients with wounds in a prison unit in the State of São Paulo

Resumo Objetivo: O objetivo do estudo é realizar levantamento de dados clínicos e epidemiológicos dos pacientes com feridas em uma unidade do sistema prisional no estado de São Paulo. Metodologia: Estudo retrospectivo e descritivo onde foram coletados dados dos prontuários de uma unidade prisional anotados em livros de registros e prontuários de saúde entre janeiro de 2015 e janeiro de 2016. Resultados: Foram analisados 52 prontuários de pacientes com feridas. Todos os pacientes eram do sexo masculino, sendo 51,92 % brancos e 53,85 % possuíam entre 30-39 anos. Foram encontradas lesões de 10 etiologias diferentes, sendo as queimaduras as mais frequentes (22,95 %), seguidas de lesões por pressão (21,31 %). A doença mais constante nos pacientes em tratamento de feridas foi lesão medular. Conclusão: Os pacientes com feridas no sistema prisional eram em sua maior parte brancos, do sexo masculino, com idade média de 37,21 anos, sendo mais frequentes as queimaduras e as lesões por pressão.

Resumen Objetivo: Realizar el levantamiento de los datos clínicos y epidemiológicos de los pacientes con heridas en una unidad del sistema penitenciario en el estado de São Paulo. Metodología: Estudio retrospec-tivo-descriptivo donde se recolectan datos de los prontuarios de una unidad penitenciaria registrados en libro-acta y prontuarios de salud entre enero de 2015 y enero de 2016. Resultados: Fueron analizados 52 prontuarios de pacientes con heridas. Todos los pacientes fueron del sexo masculino, 51,92 % blancos, 53,85 % tenían entre 30-39 años. Se encontraron lesiones de 10 etiologías diferentes, siendo las quemaduras las más frecuentes 22,95 %, seguidas de lesiones por presión 21,31 %. La enfermedad más común de los pacientes en tratamiento de heridas fue lesión medular. Conclusión: Los pacientes con heridas en el sistema penitenciario eran en su mayor parte blancos, todos del sexo masculino, con una edad media de 37,21 años, siendo más frecuentes las quemaduras y las lesiones por presión.

Abstract Objective: To perform the lifting of the epidemiological and clinical data of patients with wounds in a unit of the prison system in the State of São Paulo. Methodology: Retrospective and descriptive study where there are collected data of compendium of a prison unit registered in a record book and health compendium between January 2015 and January 2016. Results: 52 compendia of patients with wounds were analyzed. All patients were male, 51.92 % white, 53.85 % were between 30 and 39 years old. Injuries of 10 different etiologies were found, being burns the most frequent (22.95 %), followed by lesions by pressure (21.31 %). The most common disease among patients in treatment of wounds was spinal cord injury. Conclusion: In the prison system, patients with wounds are predominantly white, all male, with an average age of 37.21 years old, being more frequent burns and injuries by pressure.

Development of a Manual for the Prevention and Treatment of Skin Tears.

A skin tear is a partial-thickness wound whose main characteristic is the presence of a skin flap. There are many contributing factors to skin tears, but few practical guidelines are available in the literature for their prevention and management. OBJECTIVE: The aim of this study is to develop a manual for the prevention and treatment of skin tear injuries. METHODS: A literature review on skin tears was conducted. The manual was organized into 7 chapters of topics of interest to health care professionals. Its content validity was assessed in 2 rounds of consultation by 7 health professionals with a master's or doctoral degree who were experienced in skin lesions. RESULTS: The manual was successfully validated for content by the expert panel. The content validity index (CVI) was 0.96 for the topic Objective, 0.96 for Structure and Presentation, and 0.93 for Relevance. The final version of the manual showed an excellent overall CVI of 0.95. CONCLUSIONS: A content-validated manual for the prevention and treatment of skin tears was created to guide nursing professionals in the management of patients with skin tears, which contributes to the identification of risk factors and development of preventive measures.

Manual educativo de cuidados à criança com gastrostomia: construção e validação / Child care educational manual with gastrostomy: construction and validation / Manual educativo sobre el cuidado de niños con gastrostomía: construccion y validación

Introdução: a gastrostomia é um procedimento no qual um cateter é inserido no estômago, através de uma abertura na parede abdominal anterior. Há escassez de trabalhos voltados para orientações e cuidados com do uso da gastrostomia e a influência para os familiares e cuidadores. Objetivo: desenvolver e validar um manual educativo sobre cuidados com gastrostomia em crianças. Método: realizado levantamento bibliográfico para desenvolvimento do conteúdo do manual e validação do mesmo realizada com 11 especialistas com base na técnica de Delphi e com cinco pais e cuidadores de crianças com gastrostomias mensurado por meio da escala de Likert. Resultados: o material elaborado foi validado por especialistas em dois ciclos por meio da técnica de Delphi, com a participação de 11 juízes no primeiro ciclo e seis juízes no segundo ciclo. A porcentagem de concordância absoluta de todo o manual alcançou valor de 97,91%. O menor valor encontrado no segundo ciclo foi de 83,3%, com sete de oito questões apresentando concordância de 100%. A validação com público-alvo apresentou taxa de concordância de 100% e todos os participantes pontuaram três na escala de Likert para todas as questões. O manual validado possui registro em ISBN de número: 978-85-924327-0-6, com 21 páginas, oito capítulos e 38 figuras de linguagem simples e acessível, abordando temas como o conceito e indicação da gastrostomia, o cuidado domiciliar e a prevenção de complicações. Conclusão: elaborado manual educativo de cuidado da criança com gastrostomia, validado por especialistas e por pais e cuidadores.(AU)

INTRODUCTION: the gastrostomy is a procedure in which a catheter is inserted into the stomach through an opening in the anterior abdominal wall. There is a shortage of work focused on guidelines and care with the use of gastrostomy and the influence for family members and caregivers. Goal: to develop and validate an educational manual regarding gastrostomy care with children. METHOD: it was carried out a bibliographical survey for the development of the content of the manual and validation of it, which was conducted with 11 experts based on the Delphi technique and with 5 parents and caregivers of children with gastrostomies, measured using the Likert scale. RESULTS: the elaborated material was validated by specialists in two cycles through the Delphi technique, with the participation of 11 judges in the first cycle and six judges in the second cycle. The absolute agreement percentage of the whole manual reached 97.91%. The lowest value found in the second cycle was 83.3%, with seven of eight questions showing agreement of 100%. The validation with target audience showed a 100% concordance rate and all participants scored three points on the Likert scale for all questions. The validated manual has ISBN (International Standard Book Number) registration number: 978-85-924327-0-6, with 21 pages, eight chapters and 38 simple and accessible figures of speech, addressing topics such as the concept and indication of gastrostomy, home care and the prevention of complications. CONCLUSION: elaborated educational manual of child care with gastrostomy, validated by specialists, by parents and caregivers.

Prevalence and incidence of pressure injuries in pediatric hospitals in the city of São Paulo, SP, Brazil.

OBJECTIVE: To identify the incidence and prevalence of pressure injuries (PIs) in children admitted to hospitals in the city of São Paulo, and assess the association between sociodemographic and clinical characteristics with hospital-acquired pressure injuries (HAPIs). MATERIALS AND METHODS: A total of 543 children were evaluated, and their sociodemographic and clinical data were recorded. Student's t, Wilcoxon, chi-square, and Fisher's exact tests were used to assess associations between risk factors and the occurrence of HAPIs. The proportion comparison test was used to assess the difference between the prevalence assessments performed at 2 different time points. RESULTS: The mean prevalence was 7.1% and the mean incidence was 21.8%. Stage 1 PIs totaled 55% of the occurrences, followed by deep tissue injury, stage 2 PIs, and unstageable PIs. Twenty-five percent of PIs were associated with the use of medical devices. The sociodemographic characteristics significantly associated with HAPIs were white skin color and the absence of a parent or guardian as the patient's companion, whereas the clinical characteristics most significantly associated with HAPIs were hospitalization time greater than 30 days, enteral nutrition pathway, a chronic illness of the central nervous system, vasomotor medication, and mechanical ventilation (p < 0.05). CONCLUSION: The prevalence of PIs among pediatric patients admitted to hospitals in São Paulo was similar to, and the incidence was higher than the reported international rates. Patients not accompanied by a parent, hospitalized for longer periods and in critical condition were those most affected by PIs.

Direct variable cost of the topical treatment of stages III and IV pressure injuries incurred in a public university hospital.

AIM: to estimate the direct variable costs of the topical treatment of stages III and IV pressure injuries of hospitalized patients in a public university hospital, and assess the correlation between these costs and hospitalization time. MATERIALS AND METHODS: Forty patients of both sexes who had been admitted to the São Paulo Hospital, São Paulo, SP, Brazil, from 2011 to 2012, with pressure injuries in the sacral, ischial or trochanteric region were included. The patients had a total of 57 pressure injuries in the selected regions, and the lesions were monitored daily until patient release, transfer or death. The quantities and types of materials, as well as the amount of professional labor time spent on each procedure and each patient were recorded. The unit costs of the materials and the hourly costs of the professional labor were obtained from the hospital's purchasing and human resources departments, respectively. Spearman's correlation coefficient and the Mann-Whitney and Kruskal-Wallis tests were used for the statistical analyses. RESULTS: The mean topical treatment costs for stages III and IV PIs were significantly different (US$ 854.82 versus US$ 1785.35; p = 0.004). The mean topical treatment cost of stages III and IV pressure injuries per patient was US$ 1426.37. The mean daily topical treatment cost per patient was US$ 40.83. There was a significant correlation between hospitalization time and the total costs of labor and materials (p < 0.05). There was no significant difference between hospitalization time periods for stages III and IV pressure injuries (40.80 days and 45.01 days, respectively; p = 0.834). CONCLUSION: The mean direct variable cost of the topical treatment for stages III and IV pressure injuries per patient in this public university hospital was US$ 1426.37.