Técnica modificada Mölndal/Jubilee frente a tratamiento tradicional en heridas quirúrgicas tras cirugía menor en atención primaria / The modified Mölndal/Jubilee technique versus traditional treatment for minor surgical wounds in primary care

Objetivos: General: Comparar la técnica de cura en ambiente húmedo Mölndal/Jubilee modificada para las suturas en cirugía menor ambulatoria, en relación con la cura seca. Específicos: a) medir el tiempo de cicatrización en días entre la técnica Mölndal/Jubilee modificada y la cura seca; b) número de curas realizadas en cada técnica y tiempo en minutos invertido en cada técnica; c) valorar el dolor en cada técnica, y d) comparar las complicaciones aparecidas en cada técnica. Metodología: Ensayo de intervención longitudinal prospectivo multicéntrico y aleatorizado, con grupo control, para evaluar la eficacia de una metodología de cura aplicada tras cirugía menor en atención primaria. La muestra se compone de los pacientes cuyo procedimiento quirúrgico finaliza con sutura. Resultados: Los días hasta la retirada de la sutura invertidos en el grupo intervención fueron de media 9,2 días, con una desviación típica de 2,1, mientras que en el grupo control se emplearon 10,5 días, con una desviación de 2,3. El número de curas que se realizaron en el grupo intervención hasta la retirada de la sutura resultaron de 2 en 45 pacientes (46,9%), 45 pacientes 3 visitas (46,9%) y 6 (6,2%) 4 visitas. En el grupo control no hubo ningún paciente que necesitara menos de 3 visitas; con 3 visitas 18 pacientes (18,8%) del grupo, 4 visitas 41 (42,7%), 5 visitas 30 pacientes (31,2%) y con 7 visitas 7 pacientes (7,3%). El tiempo medio invertido en cada visita para el grupo intervención fue de 2,7 min con una desviación de 0,6 y para el grupo control de 3,1 min con desviación de 0,6. El dolor medio, escala visual analógica, en el grupo intervención se posicionó en 0,5, con desviación típica de 1,0, y de 2,1 para el grupo control con desviación de 1,2. Las complicaciones supusieron el 6,2% en el grupo intervención, 6 complicaciones, en el grupo control se apreciaron 27, el 28,1% (AU)

Objectives: General: Compare the healing technique in a wet environment (Mölndal/Jubilee modified by Grupo Heridas Axarquia) for surgical wounds in minor outpatient surgery, in relation to a dry healing. Specific:a) measure the healing time between the modified technique Mölndal/Jubilee and the dry healing; b) number of cures in each technique and the time spent in both techniques; c) assess the pain in each technique; and d)compare the complications that appear in each technique. Methodology:Multicenter, randomized, control-group, prospective longitudinal intervention trial to evaluate the efficacy of a cure methodology applied after minor surgery in primary care. The sample includes patients whose surgical procedure ends up with suture. Results: The days up to the removal of the inverted suture in the intervention group were on average 9.2 days with a standard deviation of 2.1, while in the control group 10.5 days were used with a deviation of 2.3. The number of cures that were performed in the intervention group until the suture was removed was 2 in 45 patients (46.9%), 3 visits in 45 patients (46.9%) and 4 visits (6.2%) in 6 patients. In the control group there were no patients who needed less than 3 visits; with 3 visits, 18 patients (18.8%) of the group, 4 visits, 41 patients (42.7%), 5 visits 30 patients (31.2%) and with 7 visits 7 patients (7.3%). The average time spent on each visit for the intervention group was 2.7 minutes with a deviation of 0.6 and for the control group 3.1 with a deviation of 0.6. Average pain, analog visual scale, in the intervention group was positioned at 0.5 with standard deviation of 1.0 and 2.1 for control with deviation of 1.2. Complications accounted for 6.2% in the intervention group, 6 complications, and in the control, 27 and 28.1% (AU)

Prevalencia de lesiones de piel asociadas a la dependencia física en geriátricos e instituciones de salud de Tunja / Prevalence of skin lesions associated with physical dependence in nursing homes and health institutions in Tunja

OBJETIVOS: Determinar la prevalencia puntual de lesiones de piel asociadas a la dependencia física, realizar caracterización sociodemográfica de las personas afectadas, caracterizar las lesiones con base en disposiciones del Grupo Nacional para el Estudio y Asesoramiento en Úlceras por Presión y Heridas Crónicas (GNEAUPP), el National Pressure Ulcer Advisory Panel (NPUAP) y el European Pressure Ulcer Advisory Panel (EPUAP) y establecer la habilidad del personal de salud para el reconocimiento y clasificación de las lesiones de piel asociadas a dependencia. METODOLOGÍA: Estudio multicéntrico descriptivo de prevalencia puntual en instituciones de servicios de salud de tercer nivel y centros gerontológicos de Tunja, Colombia. RESULTADOS: Participaron cuatro instituciones. La muestra fue de 409 personas, 24 de las cuales presentaron lesiones de piel asociadas a la dependencia para una prevalencia del 5,86%. De los afectados, el 41,6% eran hombres y el 58,4% mujeres; el 79,1% con 50 años o más; en cuanto a la procedencia, el 53,8% pertenecía al área urbana y el 46,2% a la rural; un 56,6% de los pacientes pertenecían al régimen subsidiado, el 30% al contributivo y 13,4% al especial. La etiología de las lesiones estuvo discriminada de la siguiente manera: por presión, 67,3%; LESCAH, 13,4%; MARSI, 11,5% y desgarros cutáneos, 7,7%. CONCLUSIONES: la prevalencia encontrada se relaciona con resultados de estudios colombianos previos, la afectación es mayor en mujeres y la mayor frecuencia de ocurrencia de lesiones corresponde a las ocasionadas por la presión y cizalla; las lesiones de piel asociadas a la dependencia se presentaron con mayor frecuencia en personas de procedencia urbana. El 75% de las personas que diligenciaron la encuesta reportaron no haber recibido capacitación institucional para identificación y clasificación de lesiones de piel asociadas a la dependencia

OBJECTIVES: To determine the exact prevalence of skin lesions associated with dependence physical, conduct socio-demographic characterization of those affected, characterizing lesions based on provisions of the National Group for the Study and advice on Pressure Ulcers and Chronic Wounds (GNEAUPP), the National Pressure Ulcer Advisory Panel (NPUAP) and the European Pressure Ulcer Advisory Panel (EPUAP), establish the ability of health personnel to recognize and classify lesions associated with dependence. METHODOLOGY: descriptive multicenter point prevalence in third level health care institutions and gerontology centers from Tunja, Colombia. RESULTS: four institutions participated, the sample was 409 people, 24 had lesions associated with dependence for a prevalence of 5.86%; of those affected 41.6% were men and 58.4% women, 79.1% with ≥50 years regarding the origin 53.8% belonged to urban zones and 46.2% rural zones; 56.6% of patients belonged to the subsidized health scheme, 30% to contributory health scheme 13.4% to special. The etiology of lesions was discriminated as follows: pressure 67.3%; LESCAH 13.4%; MARSI 11.5% and 7.7% skin tears. CONCLUSIONS: The prevalence found is related to results of Colombian previous studies, the effect is greater in women and increased frequency of occurrence of injuries corresponds to those caused by pressure and mechanical friction, LPAD occurred more often in people of origin urban. 75% of people who completed the survey reported not having received institutional training for identification and classification (LPAD)

Radiofrecuencia en la cicatrización de heridas crónicas. Una revisión en hospital de media estancia / Radiofrequency in the healing process in chronic wounds. A review in a half-stay hospital

Las heridas crónicas son un problema de salud significativo. Parece que la estimulación eléctrica produce una reducción significativamente mayor en el área de superficie y cicatrización más completa de las úlceras de difícil cicatrización y de evolución tórpida en comparación con la terapia habitual, sin vendaje compresivo. OBJETIVOS: Evaluar el efecto que la radiofrecuencia a baja intensidad y con efectos no térmicos tiene sobre los diferentes componentes del mecanismo del proceso de cicatrización. METODOLOGÍA: Para el tratamiento, se utilizó un dispositivo de tecarterapia (CAPENERGY C200). Se aplicaron un total de 10 sesiones de radiofrecuencia con una periodicidad de 1 vez a la semana con una potencia del 60% y una frecuencia de 1,2 MHz durante 30 minutos. RESULTADOS: La presencia de edema, observada en todos los pacientes en la región de la extremidad inferior, desapareció en 30 de los 36 pacientes (Wilcoxon p = 0,004). Este resultado fue confirmado por ultrasonido. El edema celular subcutáneo medio disminuyó en 1,73 cm (Friedman p = 0,000). La temperatura del área tomada antes y después del tratamiento se incrementó en un promedio de 1,4 °C. Estas diferencias son estadísticamente significativas (Wilcoxon p = 0,000). CONCLUSIONES: La radiofrecuencia parece que puede reducir el largo proceso de cicatrización de las lesiones de evolución tórpida, y nos encontramos con unas diferencias significativas a lo largo del tratamiento y con una reducción progresiva en las mediciones de las lesiones y mayor rapidez en la cicatrización de las heridas complejas

Chronic wounds are a significant health problem. Electrical stimulation seems to produce a significantly greater reduction in surface area and more complete healing of difficult-to-heal and poorly healing ulcers compared to standard therapy without compressive bandaging. OBJECTIVES: To evaluate the effect that radiofrequency at low intensity and with non-thermal effects has on the different components of the mechanism of the healing process. METHODOLOGY: A tecartherapy device (CAPENERGY C200) was used for the treatment. A total of 10 radiofrequency sessions were applied once a week with a power of 60% and a frequency of 1.2 MHz for 30 minutes. RESULTS: The presence of oedema, observed in all patients in the lower extremity region, disappeared in 30 of the 36 patients (Wilcoxon p = 0.004). This result was confirmed by ultrasound. The mean subcutaneous cellular oedema decreased by 1.73 cm (Friedman p = 0.000). The temperature of the area taken before and after treatment increased by an average of °C. These differences are statistically significant (Wilcoxon p = 0.000). CONCLUSIONS: Radiofrequency appears to be able to reduce the long healing process of torpidly evolving lesions, and we found significant differences throughout the treatment and a progressive reduction in lesion measurements and faster healing of complex wounds

Uso de jabón en heridas: encuesta a profesionales sanitarios / Use of soap in wounds: a health professionals survey

OBJETIVOS: General: conocer el uso de jabón en las heridas por parte de los profesionales sanitarios. Específicos: conocer las características de las heridas tratadas con jabón, conocer el tipo de jabón utilizado en el tratamiento de heridas y conocer los documentos en los que se basan los profesionales para el uso de jabón en las heridas. METODOLOGÍA: Estudio descriptivo observacional de carácter transversal. Se ha realizado un cuestionario ad hoc a profesionales sanitarios de tres asociaciones relacionadas con el tratamiento de personas con heridas. Los cuestionarios se cumplimentaron on-line a través de la plataforma Google Drive. RESULTADOS: Se cumplimentaron un total de 179 cuestionarios. Utilizan jabón para el tratamiento de las heridas un 74% de los encuestados (de estos, lo usan de forma habitual un 43% y ocasional el 57%), mientras que se refirió el uso de jabón en heridas sucias (96,7%), con presencia o sospecha de infección (55,4%) o superficiales (50%). Los principales tipos de jabón utilizados fueron antisépticos jabonosos (65,4%) y geles (22%), y un 82% refirió desconocer protocolos o guías que recomienden el uso de jabón para las heridas. Se recogieron respuestas en texto libre que mostraron gran variedad de opiniones. DISCUSIÓN Y CONCLUSIONES: Los resultados del estudio muestran un uso habitual de jabón para el tratamiento de las heridas, así como falta de consenso y una práctica clínica heterogénea. Los datos señalan la experiencia de los profesionales como principal fuente de conocimiento

OBJECTIVES: General: to know the use of soap in wounds by health professionals. Specific: to know the characteristics of the wounds treated with soap, the type of soap used in the treatment of wounds and the documents on which professionals rely for the use of soap in wounds. METHODOLOGY: Cross-sectional descriptive observational study. An ad hoc questionnaire was carried out to health professionals from three associations related to the treatment of people with injuries. The questionnaires were completed online through the Google Drive platform. RESULTS: A total of 179 questionnaires were completed. 74% of respondents use soap for the treatment of wounds (of these, they use it regularly 43% and occasionally 57%), also the use of soap was referred in dirty wounds (96'7%), with presence or suspicion of infection (55,4%) or superficial (50%). The main types of soap used were soapy antiseptics (65,4%) and gels (22%), and 82% reported not knowing protocols or guidelines that recommend the use of soap for wounds. Other responses were collected in free text, which showed a wide variety of opinions. DISCUSSION AND CONCLUSIONS: The results of the study show a habitual use of soap for the treatment of wounds, as well as a lack of consensus and a heterogeneous clinical practice. The data points to the experience of professionals as the main source of knowledge

Teleconsulta como sistema de información en el cuidado de pacientes con deterioro de la integridad cutánea / Teleconsultation as an information system in the care of patients with cutaneous integrity deterioration

OBJETIVOS: Evaluar los beneficios de la teleconsulta frente a la consulta presencial convencional en pacientes con deterioro de la integridad cutánea. METODOLOGÍA: Estudio piloto de intervención controlado, aleatorizado, abierto. Sujetos de estudio: pacientes con deterioro de la integridad cutánea pertenecientes a los centros de salud urbanos. Se crearon dos grupos, uno sobre el que se realizó la intervención a través de la teleconsulta y otro grupo control donde la consulta y la valoración se hizo de forma presencial. Recogida de los datos mediante observación, entrevistas, cuestionarios y escalas validadas. RESULTADOS: Se realizaron un total de 31 consultas desde los centros de salud, 12 de las cuales fueron de forma presencial (38,7%) y 19 a través de la teleconsulta (61,3%). Las lesiones consultadas fueron en su mayoría de etiología venosa. Estos pacientes presentaban alteración de su calidad de vida. Se obtuvo una media de mejoría de 6 puntos en la escala PUSH en la modalidad presencial frente a 8 puntos en la teleconsulta, siendo menor el tiempo en que se consigue la epitelización de las lesiones en esta última. CONCLUSIONES: La teleconsulta se perfila como un nuevo sistema organizativo, una nueva manera de organizar y gestionar la provisión de los servicios sanitarios en beneficio de los pacientes, profesionales y sistema sanitario en general, estableciendo un canal de comunicación rápido, fluido, efectivo y eficiente que repercuta directamente en el paciente disminuyendo tiempos para la resolución de su problema de salud, evitando desplazamientos innecesarios y disminuyendo los costes

OBJECTIVES: To evaluate the benefits of teleconsultation compared to the conventional face-to-face consultation in patients with cutaneous integrity deterioration. METHODOLOGY: Pilot study of controlled, randomized, open intervention. Subjects of study: patients with deterioration of the cutaneous integrity belonging to the urban health centers. Two groups were created, one on which the intervention will be carried out through teleconsultation and another control group where the consultation and Assessment was done in person. Collection of data through observation, interviews, questionnaires and validated scales. RESULTS: A total of 31 consultations were carried out from the health centers, 12 of which were in person (38.7%) and 19 through teleconsultation (61.3%). The lesions consulted are mostly of venous origin. These patients present altered quality of life. A mean improvement of 6 points is obtained in the PUSH scale in the face-to-face modality versus 8 points in the teleconsultation, the time in which the epithelialization of the lesions in the latter is achieved. CONCLUSIONS: Teleconsultation is emerging as a new organizational system, a new way of organizing and managing the provision of health services for the benefit of patients, professionals and the health system in general. Establishing a fast, fluid, effective and efficient communication channel that has a direct impact on the patient, reducing time for the resolution of his health problem, avoiding unnecessary movements and reducing costs

Uso de antisépticos y antibióticos en el manejo de la carga bacteriana de heridas crónicas / Use of antiseptics and antibiotics in the management of the bacterial load of chronic wounds

OBJETIVO: El objetivo de esta revisión es analizar la eficacia de diferentes apósitos antisépticos y antibióticos locales tópicos en heridas crónicas infectadas o con signos de colonización crítica. METODOLOGÍA: Para la elaboración de esta revisión exploratoria se han empleado varias bases de datos (PubMed, CINAHL, Scopus, Cuiden, Cochrane y LILACS), utilizando cadenas de búsqueda adaptadas a cada base. Se han incluido diferentes tipos de estudios originales y revisiones sobre la cicatrización, la curación completa y/o el coste-beneficio, realizando una estimación de los costes de los tratamientos según la disponibilidad de datos. Se han excluido estudios sobre quemaduras, literatura gris, casos clínicos o series de casos. RESULTADOS: Se han seleccionado 20 artículos, de los cuales 17 son estudios originales y 3 son revisiones; 19 artículos tratan sobre apósitos antisépticos y 3 sobre antibióticos locales tópicos utilizados en heridas crónicas infectadas o con signos de colonización crítica, obteniéndose datos sobre el efecto que producen en la cicatrización, la curación completa y/o el coste-beneficio. Todos los productos hallados tienen buenos resultados, aunque el más utilizado y eficaz en estas heridas es la plata. CONCLUSIONES: La plata es el producto más eficaz para la curación completa o la disminución del tamaño; resulta muy rentable, ya que los costes de los tratamientos con plata son menores y se obtienen mayores beneficios para el paciente. El cloruro de diaquilcarbamilo es una buena alternativa, debido a que es un producto muy eficaz y rentable

OBJECTIVE: The objective of this review is to analyze the efficacy of different antiseptic dressings and local topical antibiotics in infected chronic wounds or with signs of critical colonization. METHODOLOGY: For the elaboration of this exploratory review several databases have been used (PubMed, CINAHL, Scopus, Cuiden, Cochrane and LILACS), using search chains adapted to each base. Different types of original studies and reviews on healing, complete healing and/or cost-benefit have been included, making an estimate of the costs of the treatments according to the availability of data. Studies on burns, gray literature, clinical cases or cases series have been excluded. RESULTS: 20 articles have been included, of which 17 are original studies and 3 are reviews, obtaining that 19 articles treat on antiseptic dressings and 3 on local topical antibiotics used in infected chronic wounds or with signs of critical colonization, obtaining data on the effect that they produce in healing, complete healing and/or cost-benefit. All the products found have good results, although the most used and effective in these wounds is silver. CONCLUSIONS: Silver is the most effective product for the complete healing or reducing size, being very profitable, since the costs of silver treatments are lower, obtaining greater benefits for the patient. The dialkylcarbamoyl chloride is a good alternative, because it is a very effective and profitable product

Caracterización de las úlceras por presión en adultos con gérmenes multirresistentes / Characterization of pressure lesions in adults with multidrug resistant germs / Caracterização das lesões por pressão em adultos portadores de germes multirresistentes

OBJETIVO: Describir las características de las lesiones por presión en pacientes adultos con gérmenes multirresistentes. MÉTODO: Este es un estudio transversal realizado con pacientes hospitalizados en la unidad de pacientes hospitalizados por gérmenes resistentes a múltiples fármacos de un hospital público en el sur de Brasil. Se seleccionaron pacientes con lesión por presión del estadio II. Los datos se recopilaron en 2017 de una muestra de 110 lesiones en 36 pacientes utilizando la Herramienta de evaluación de heridas Bates-Jensen (BWAT). Los datos se analizaron mediante estadísticas descriptivas y analíticas. RESULTADOS: La edad promedio de los individuos fue de 45.4 (± 21.3) años y el 89.1% había sido hospitalizado con una lesión por presión, que ocurrió en el hogar o en otras instituciones de salud. El valor medio de BWAT fue de 35.5 ± 8.9 puntos y hubo una correlación positiva débil (r = 0.228 p = 0.017) con el tamaño de la lesión, correlación positiva moderada con el estadio de la lesión (r = 540 p <0.001). y con el resultado de la escala de Braden (r = 0.44 p = 0.651). CONCLUSIÓN: Los resultados muestran la enfermedad de pacientes jóvenes. Los pacientes con gérmenes multirresistentes presentaron lesiones por presión con una mayor participación de las estructuras, lo que sugiere la necesidad de apoyo en el hogar

OBJECTIVE: To describe the characteristics of the pressure lesions in adult patients with multiresistant germs. METHOD: This is a cross-sectional study conducted with patients admitted to the inpatient unit for multidrug resistant germs in a public hospital in Brazil. Patients with pressure lesions from stage II were selected. Data collection took place in 2017, in a sample of 110 injuries, in patients, through the Pressure Ulcer State Assessment Instrument (Bates-Jensen Wound Assessment Tool - BWAT). RESULTS: The average age of the individuals was 45.4 (± 21.3) years old and 89.1% had already suffered pressure lesions, such as those that occurred at home or in other health institutions. The mean BWAT value was 35.5 ± 8.9 points and there was a weak positive correlation (r = 0.228 p = 0.017) with lesion size, moderate positive correlation with lesion stage (r = 540 p <0.001), and with the result of the Braden scale (r = 0.44 p = 0.651). CONCLUSION: The results indicated the illness of young patients. Patients with multiresistant germs suffered pressure lesions with greater involvement of structures, which suggests the need for home support

OBJETIVO: Descrever as características das lesões por pressão em pacientes adultos portadores de germes multirresistentes. MÉTODO: Trata-se de um estudo transversal, realizado com pacientes hospitalizados na unidade de internação para portadores de germes multirresistentes de um hospital público do sul do Brasil. Foram selecionados pacientes portadores de lesão por pressão a partir de estágio II. A coleta de dados ocorreu em 2017, em uma amostra de 110 lesões, através do Instrumento de Avaliação do estado da Úlcera por Pressão (Bates-Jensen Wound Assessment Tool - BWAT. Os dados foram analisados através de estatística descritiva e analítica. RESULTADOS: A idade média dos indivíduos foi 45,4 (± 21,3) anos e 89,1% já internaram com lesão por pressão, as quais ocorreram no domicílio ou em outras instituições de saúde. O valor médio da BWAT foi de 35,5 ± 8,9 pontos e houve correlação positiva fraca (r=0,228 p = 0,017) com o tamanho da lesão, correlação positiva moderada com o estágio da lesão (r= 540 p < 0,001) e com o resultado da escala de Braden (r= 0,44 p = 0,651). CONCLUSÃO: Os resultados apontam o adoecimento de pacientes jovens. Pacientes portadores de germes multirresistentes apresentaram lesões por pressão com maior acometimento de estruturas, o que sugere necessidade de aporte domiciliar

Etiologia e tratamento de queimaduras provocadas por agente químico: scoping review / Etiology and treatment of chemical burns: scoping review

It is estimated that over 60,000 different chemicals might be used in industry, agriculture and the home environment. Chemical burns account for only 3% of the total, yet account for approximately 30% of burn deaths. The aim of the study was to identify the latest evidence on treatment of skin burns caused by chemical agents.A scope review was chosen, and articles published between 2013 and 2019 were selected. The research was conducted with the following descriptors: chemical burn and skin burn or skin injury or burn care or treatment burn and therap. CINAHL, MEDLINE, MedicLatina and Cochrane Database were searched. The survey was conducted in January and February 2019. Eleven articles were selected, such as case studies, retrospective and prospective studies. The circumstances in which the burns occurred were workplace accidents, home accidents and personal attacks. The chemical agents used were acid and base type. The burned body area was between 30% and 0.5%. The most severe outcome was three deaths. The first-line treatment approach to the lesion was prolonged lavage or H2O. Continuity of treatment integrates systemic, topical pharmacological measures, pain control, surgical and non-pharmacological therapies.The etiology of skin burns by chemist is multiple. The treatment integrates particularities that distinguish it from other burn types, and an appropriate approach has significant results in survival and recovery of the person with chemical burn

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Clinical supervision: analysis of postoperative pain evaluation in the ambulatory surgery setting / Supervisão clínica: análise da avaliação da dor pós-operatória em cirurgia de ambulatório

Clinical supervision, as a formal process of monitoring professional practice, aims to improve decision-making to contribute to safety and quality of care through reflection processes and analysis of clinical practice. This study aimed to compare the postoperative pain evaluation and clinical recording procedures performed by nursing staff and clinical supervisors in ambulatory surgery patients.The study was integrated into the research project "SAFECARE". It was developed a descriptive cross-sectional quantitative study in an ambulatory surgery unit of a University Hospital in Oporto, Portugal. The study population was the nursing staff with an intentional non-probabilistic sampling method. A questionnaire was constructed and evaluation of postoperative pain, patient clinical and demographic variables was included. This instrument was applied in 116 patients matched by 12 surgical specialties. Results were compared between nursing staff, clinical supervisors and electronic nursing records. Patients had an average age of 48.6 years, being mostly female. Regarding pain evaluation, the scale most used by nurses (62.1%) and clinical supervisors (67.2%) was the "Numerical Scale". Postoperative pain evaluation scores ranged from 0 to 7, with score 0 (no pain) presenting more frequently by nurses, electronic nursing records and clinical supervisors. 34.5% of results were not documented in electronic nursing records. These findings support the importance of an intervention of clinical supervision in the indicator "pain" for the outpatient surgery setting. Local protocols of clinical supervision practice would contribute to improve postoperative pain evaluation, as well as standardization and optimization of nursing records, thus ensuring quality care

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Intervention beamin prevention of local surgical infection

Introduction: Surgical site infections are frequent complications that affect patients undergoing surgery. These are preventable infections that constitute a loss of reputation for healthcare systems worldwide, with consequences for the patient in terms of morbidity, mortality, excessive length of stay, and additional costs to the system and the community. They aggravate their functional disability, increase the emotional stress of patients and families, leading to decreased quality of life.Nurses, as members of the multidisciplinary team, play a crucial role as promoters of adherence to the best practices for prevention and control of surgical site infection called "intervention bundle". Objective: Evaluate the adhesion of nurses to the intervention bundle in the prevention of Surgical Site Injury. Methods: Descriptive, cross-sectional, quantitative study. Sample of convenience, made up to 54 nurses. The data collection instrument was the checklist of the DGS of 2015. Results: The results revealed low adhesion in the presurgical bath with 2% chlorhexidine. Regarding trichotomy, it was avoided in about 59% of the cases. In the maintenance of capillary glycemia and normothermia, these were not met by 33% of professionals. Regarding adherence to surgical antibiotic prophylaxis, it was obeyed by 63% of the professionals, respecting the ideal timing of administration, 120 minutes before surgery. Conclusion: The implementation of programs of continuing education, accountability and awareness of the management bodies for the implementation of a safety culture are substantial in the prevention of surgical site disruption

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A eficácia da terapia por pressão negativa para o tratamento da ferida no pé diabético: uma revisão de revisões / The effectiveness of negative pressure therapy for the treatment of diabetic foot wound: an umbrella study

Introduction and objectives: Diabetic foot is one of the disabling complications of diabetes affecting more than one million people in Portugal. Negative pressure therapy is relatively recent, describing itself as facilitating wound bed preparation and inducing granulation and angiogenesis. It is our goal to provide an overview of available evidence on the clinical efficacy of negative pressure in the treatment of diabetic foot in adults. Methodology: This is an umbrella review, with research in Scopus, Web of Science and Ebsco (Cinahl Complete and Medline), with the time limit (2014-2019), English and Spanish language, after defining the PICO review question, descriptors and inclusion and exclusion criteria. Two investigators performed methodological quality assessment, independently using JBI Critical Assessment Instrument. Results and discussion: 14 systematic reviews were identified, 3 were duplicated, 9 were eliminated after application of the inclusion criteria. Two articles were included, one with meta-analysis. The reviews included 23 studies indicating that negative pressure therapy is effective and safe, generally reflecting greater amounts of granulation tissue and shorter healing time. The existence of few randomized controlled trials and small samples are some of the limitations mentioned. Conclusions: The availability of evidence synthesized with this review may support clinical decision-making leading to an improvement in the quality of health care provided to people with diabetic foot injury

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The Effectiveness of Advanced Practice Nurses with Respect to Complex Chronic Wounds in the Management of Venous Ulcers.

This study aims to evaluate the effectiveness of advanced practice nurses with respect to complex chronic wounds (APN-CCWs) in the care of patients with venous ulcers. A multicentric, quasi-experimental pre-post study was conducted without a control group in the sanitary management areas where the APN-CCW program is being piloted. The intervention consisted of a mass training of clinical nurses from the participating districts on the proper management of injuries and the use of compression therapy. The data were collected through a specifically constructed questionnaire with questions regarding descriptive variables of injuries and their treatment. A total of 643 professionals responded (response rate of 89.1%), attending to a total population of 707,814 inhabitants. An increase in multilayer bandage use by 15.67%, an increase in elastic bandage use by 13.24%, and a significant decrease in the referral of patients to consultation with hospital specialists was achieved, from 21.08% to 12.34%. The number of patients referred to the APNs was 13.25%, which implied a resolution rate of 94.08% of their injuries. In conclusion, the coordination by the APN-CCWs in patients with venous ulcers was effective in improving the continuity of care, in the optimization of resources, and in their care role.

Era difícil imaginar que las úlceras y heridas fueran titular / No disponible

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Unidades de heridas / Units of wounds

Dentro de las respuestas que han surgido a la problemática ocasionada por las heridas crónicas, la creación de unidades clínicas especializadas ha sido una de las que mayor interés ha despertado en los últimos años. Estas unidades están conformadas por profesionales de diferentes disciplinas que se organizan de acuerdo con un servicio-departamento unificado. A través de enfoques interdisciplinarios-transdisciplinarios consiguen una atención integral a estos pacientes, identificando todos los factores que pueden afectar a la cicatrización de heridas crónicas y paliando los problemas asociados a la complejidad y heterogeneidad de estas lesiones. La implantación de este modelo todavía no está completamente desarrollada en nuestro país a pesar de su conveniencia y la creación de nuevas unidades de heridas a menudo acarrea dificultades y dudas. Este trabajo aporta algunas claves de las ventajas de la adopción de este modelo organizativo y sugiere algunas ideas para aquellas personas u organizaciones que estén planteándose la instauración de este modelo

Among the responses to the problems caused by chronic wounds, the creation of specialized clinical units has been one of the most interesting in recent years. These units are made up of professionals from different disciplines who are organized on the topic of a unified department-service. Through interdisciplinary-transdisciplinary approaches, they achieve comprehensive care for these patients, identifying all the factors that can affect the healing of chronic wounds and alleviating the problems associated with the complexity and heterogeneity of these lessions. The implementation of this model is not yet fully developed in our country despite its desirability and the creation of new wounds units often carry difficulties and doubts. This work provides some keys to the advantages of adopting this organizational model and suggests some key points for those people or organizations that are considering the establishment of this model

Heridas en pediatría: Úlceras por presión, dermatitis asociada a incontinencia y lesiones por extravasación / Pediatric wounds: pressure ulcers, incontinence associated dermatitis and extravasation injures

En comparación con los adultos, la piel de los pacientes pediátricos presenta importantes diferencias que les hacen susceptibles de padecer determinadas lesiones con mayor facilidad, especialmente los neonatos. Entre ellas destacan las úlceras por presión (UPP), las dermatitis asociadas a incontinencia (DAI) y las lesiones por extravasación periférica. En todas ellas el papel de la enfermera es vital. El presente artículo describe y aporta pautas de actuación basadas en las últimas evidencias científicas para el diagnóstico precoz, la prevención y el tratamiento de estas lesiones que sirvan de ayuda a las enfermeras que atienden población pediátrica que presenta o tiene riesgo de presentar estas lesiones

Comparing to adults, children's skin has important differences that make them liable to suffer some skin lesions easily, specially neonates. Among these lesions stand out pressure ulcers, incontinence associated dermatitis and extravasation injuries. In all of them Nursing rol is vital. This article describes and provide standards of practice based in last scientific evidences for early diagnosis, prevention and treatment that are useful to nurses who cares pediatric patients with or at risk of these lesions

Valoración y manejo de una quemadura de espesor parcial en atención primaria / Evaluation and management of a partial thickness burn in primary care

Las quemaduras son heridas que presentan un aspecto muy diverso. Además, pueden comportar niveles de gravedad muy distintos, tratándose de heridas leves que evolucionan favorablemente en algunos casos (quemaduras «menores»), o causando graves lesiones cutáneas y trastornos sistémicos en otros (quemaduras graves o grandes quemados). Las quemaduras graves deberán ser derivadas de inmediato a unidades de quemados, mientras que las quemaduras «menores», se pueden manejar en atención primaria. No obstante, pueden presentarse algunas complicaciones, que deben prevenirse o detectarse precozmente para evitar secuelas mayores. A propósito de este caso, se mencionan algunos aspectos importantes sobre el manejo de estas lesiones en atención primaria, citando algunos errores que suelen cometerse frecuentemente y la forma de evitarlos. Destacaremos los beneficios que aportan algunos materiales modernos, que contribuyen al cierre más rápido de la herida, con lo que se obtiene un mejor resultado estético y funcional de la cicatriz resultante

Burns are wounds that have a very different appearance. In addition, they can behave very different levels of severity, in the case of minor wounds that progress favorably in some cases («minor» burns), or causing severe skin lesions and systemic disorders in others (severe burns or large burns). Serious burns should be immediately referred to burn units, while «minor» burns can be handled in primary care. However, some complications can occur, which must be prevented or detected early to avoid major sequelae. Regarding this case, some important aspects of the management of these injuries in primary care are mentioned, citing some errors that are frequently committed and how to avoid them. We will highlight the benefits provided by some modern materials, which contribute to the faster closure of the wound, which results in a better aesthetic and functional outcome of the resulting scar

Dermatitis asociada a la incontinencia.: Estado actual del conocimiento / Incontinence-associated dermatitis. Current state of knowledge

La dermatitis asociada a la incontinencia (DAI) es un tipo de dermatitis de contacto irritante, que se observa frecuentemente en pacientes con incontinencia fecal o urinaria. Se manifiesta como una inflamación de la superficie de la piel caracterizada por eritema, y en ocasiones erosión cutánea. Es una condición prevalente y clínicamente relevante, con serias repercusiones sobre el estado de salud y la calidad de vida del paciente. Su etiología es compleja y multifactorial y sus complicaciones implican la infección cutánea y la aparición de otras lesiones añadidas. Es fundamental la correcta diferenciación entre las DAI y otras lesiones cutáneas similares como paso principal para su prevención y tratamiento, y el uso de instrumentos validados para su valoración, seguimiento y monitorización. La ausencia de estudios bien planteados hace que las recomendaciones para el abordaje de la DAI se apoyen en la opinión de expertos y las mejores prácticas disponibles. Las bases de la prevención y tratamiento de la DAI son el abordaje de la incontinencia y la aplicación de un programa o protocolo estructurado de cuidados de la piel que incluya la limpieza suave, la aplicación de productos barrera y el uso de agentes tópicos hidratantes. El presente artículo intenta recoger el estado actual del conocimiento sobre los aspectos fundamentales de la DAI y su implicación para la práctica enfermera

Incontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis, which is frequently observed in patients with fecal and/or urinary incontinence. It manifests as an inflammation of the surface of the skin characterized by erythema, and occasionally skin erosion. It is a prevalent and clinically relevant condition, with serious repercussions on the patient's state of health and quality of life. Its etiology is complex and multifactorial and its complications involve cutaneous infection and the appearance of other lesions added. The correct differentiation between IAD and other similar skin lesions is fundamental as the main step for their prevention and treatment, and the use of validated instruments for their assessment, follow-up and monitoring. The absence of well-designed studies means that the recommendations for the approach to the IAD are based on expert opinion and best practices available. The bases of the prevention and treatment of the IAD are the approach to incontinence and the application of a structured program or protocol of skin care that includes gentle cleansing, the application of barrier products and the use of topical moisturizing agents. The present article tries to collect the current state of knowledge about the fundamental aspects of the IAD and its implication for nursing practice

Topical ozone therapy effectiveness in the treatment of venous leg ulcers: systematic review

Background: Topical ozone has been recently used in the treatment of venous leg ulcers due to its immunological, antimicrobial and oxygenation properties, but its efficacy still lacks evidence. Objectives: To determine the effectiveness of topical ozone therapy in the healing rate, healing time reduction and in the decrease of bacterial load in venous leg ulcers. Methods: A systematic literature review with meta-analysis of studies published between January 2000 and November 2016 was carried out on PubMed, EBSCO, Scielo, and grey literature. The methodology proposed by Cochrane was followed. Critical appraisal, data extraction, and data synthesis were performed by two inde-pendent reviewers.results. Among 275 studies screened, three controlled trials (one of which rando-mized) were included, corresponding to a total of 133 participants. All these trials demonstrated that ozone therapy is more effective than conventional therapy in healing rate, as well as in reducing healing time and signs of infection (bacterial load). The meta-analysis confirmed the higher efficacy of ozone therapy in the healing rate (Odds Ratio = 7.28; CI 95% = 3.56 to 14.89; p < 0.001). For the other outcomes it was not possible to perform meta-analysis due to the use of different assessment methods. Conclusions: Topical ozone therapy may be a therapeutic option for the treatment of venous leg ulcers. However, more randomized and controlled studies are ne-eded to evaluate its efficacy in reducing healing time and bacterial load, as well as on the safety of this therapy. It is also important that these studies use uniform therapeutic and assessment methods

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Pressure ulcer (risk) assessment: recommendations to improve nursing practice

Pressure ulcer (risk) assessment is complex and multifactorial. National and inter-national guidelines give orientations about pressure ulcer (PU) management and provide important recommendations. However, it's necessary to know our reality in order to improve Evidence-Based Nursing. The main aim of this study was to pro-vide some recommendations to improve clinical practice, clinical research, clinical management and continuous education on PU domain. The study was designed as a retrospective cohort analysis of electronic health record database from adult patients admitted to general wards in a Portuguese hospital during one year. The study had a sample of 8147 participants where 34.4% had "high risk" of PU deve-lopment at the first PU risk assessment, 7.9% had (at least) one PU at the first skin and tissue assessment and 3.4% developed (at least) one PU during the length of inpatient stay. (Im)"mobility" was the major risk factor assessed through Braden Scale for PU development. The systematic PU risk assessment: is sensitive to patient clinical changes; should be performed since the hospital admission; and should be used in combination with nursing clinical judgement. The systematic skin and tissue assessment: identifies early changes in skin and tissue condition; should be performed since the hospital admission; and should identify wounds of different aetiologies. The PU assessment could be improved with the implementation of a validated tool in order to standardised data record, to monitor PU/wounds charac-teristics and their evolution

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