Descrever o número de períodos em que recém-nascidos pré-termo de muito baixo peso estiveram em posição canguru durante internação na unidade neonatal e buscar relações entre variáveis maternas e neonatais com a realização da posição canguru. Estudo descritivo retrospectivo com todos os recém-nascidos pré-termo admitidos em 2012, com peso de nascimento igual ou inferior a 1500g e idade gestacional menor que 31 semanas, classificados como pacientes de maior risco clínico, segundo o Clinical Risk Index for Babies. Foram investigados 38 sujeitos, cujo período de hospitalização variou entre 18 a 136 dias. O início da posição canguru ocorreu em média aos 30,8 dias de vida pós-natal (DP=18,5) e a quantidade de períodos em que estiveram em posição canguru foi em média 10,7 vezes. A ocorrência da posição canguru foi menos frequente que as oportunidades advindas da presença materna e esteve relacionado ao maior oferecimento de leite em livre demanda.
Objective:To evaluate the relation between diabetes-related distress and the clinical and sociodemographic characteristics of type 2 diabetes mellitus patients.Methods:A cross-sectional study based on a secondary analysis of data collected at a specialized care outpatient center in Brazil. Participants completed a questionnaire on sociodemographic and clinical characteristics and the Brazilian version of the Diabetes Distress Scale (B-DDS).Results:About 31% of the 130 eligible patients reported diabetes distress, and the mean B-DDS score was 2.6. Multiple regression analysis showed the B-DDS score was positively correlated with marital status (p=0.0230), use of diet and physical activities for diabetes management (p=0.0180), and use of insulin therapy (p=0.0030). The “emotional burden”, “regimen-related distress”, and “interpersonal distress” domains from B-DDS were associated with the use of insulin therapy (p=0.0010), marital status (p=0.0110), and the presence of three or more comorbidities (p=0.0175).Conclusion:These findings suggest the clinical and sociodemographic variables are relatively weak predictors of diabetes-related distress. The highest scores in the B-DDS were observed in the emotional burden domain, indicating the presence of diabetes distress among the participants of the study.
Cyclosporine, a drug used in immunosuppression protocols for hematopoietic stem cell transplantation that has a narrow therapeutic index, may cause various adverse reactions, including nephrotoxicity. This has a direct clinical impact on the patient. This study aims to summarize available evidence in the scientific literature on the use of cyclosporine in respect to its risk factor for the development of nephrotoxicity in patients submitted to hematopoietic stem cell transplantation. A systematic review was made with the following electronic databases: PubMed, Web of Science, Embase, Scopus, CINAHL, LILACS, SciELO and Cochrane BVS. The keywords used were: “bone marrow transplantation” OR “stem cell transplantation” OR “grafting, bone marrow” AND cyclosporine OR cyclosporin OR “risk factors” AND “acute kidney injury” OR “acute kidney injuries” OR “acute renal failure” OR “acute renal failures” OR “nephrotoxicity”. The level of scientific evidence of the studies was classified according to the Oxford Centre for Evidence Based Medicine. The final sample was composed of 19 studies, most of which (89.5%) had an observational design, evidence level 2B and pointed to an incidence of nephrotoxicity above 30%. The available evidence, considered as good quality and appropriate for the analyzed event, indicates that cyclosporine represents a risk factor for the occurrence of nephrotoxicity, particularly when combined with amphotericin B or aminoglycosides, agents commonly used in hematopoietic stem cell transplantation recipients.
RESUMO Objetivo Mensurar a carga de trabalho de enfermagem requerida por pacientes submetidos ao transplante de células-tronco hematopoiéticas (TCTH), autólogo e alogênico e analisar as atividades do Nursing Activities Score (NAS) executadas pela equipe de enfermagem durante a internação para o TCTH. Método Coorte prospectiva realizada de janeiro/2013 a abril/2014 com 62 pacientes internados na unidade de TCTH de um hospital universitário de Campinas/SP, Brasil. Mediu-se a carga de trabalho por meio do NAS e analisaram-se os dados utilizando os testes Qui-quadrado ou Exato de Fisher, Mann-Whitney e o coeficiente de correlação de Spearman; considerou-se nível de significância de 5%. Resultados A média da carga de trabalho de enfermagem foi de 67,3% (DP 8,2) em pacientes de TCTH autólogo e de 72,4% (DP 13,0) no TCTH alogênico (p=0,1380). O item Monitorização e controles apontou, em mais de 50% das observações, que os pacientes demandaram intensificação deste cuidado, exigindo duas horas ou mais em algum turno de trabalho por motivos de segurança, gravidade ou terapia. Conclusão A carga de trabalho de enfermagem e os itens do NAS mais pontuados refletem a magnitude, complexidade e especificidade dos cuidados demandados pelos pacientes submetidos ao TCTH.
Anti-coagulant drugs for subcutaneous injection, like low-molecular-weight heparins (LMWH), are increasingly used to prevent and treat thromboembolic events, with local adverse reactions. The aim in this integrative review was to identify and analyze knowledge production about the most appropriate SC injection technique of LMWH to reduce hematomas, bruising and local pain. The following inclusion criteria were used: papers published in English, Spanish and Portuguese; between the first week of August 2001 and the last week of August 2012. Papers in which LMWH was compared with unfractionated heparin in the assessment of the outcomes and papers without statistical data analysis were excluded. The searches were undertaken in the electronic databases PubMed/MedLine, CINAHL, Scopus, Web of Science and LILACS/IBECS. The quality of the articles was assessed with the critical appraisal tool JBI MAStARI. The incidence of bruising ranged between 20%, when the application time of the injection was 30s, and 88.9% when it took 10s. In 50% of the studies, the authors concluded that LMWH injections taking 30s caused lower levels of bruising, with statistically significant differences, as well as a reduction in pain intensity in the injection site by up to 50%. The group that received LMWH through a prefilled syringe, with or without aspiration, showed lower levels of bruising. The formation of a skinfold, the 90º angle and the abdomen as the application site have been well documented in the literature. These findings are important for clinical nursing practice, as they found the elaboration of evidence-based care protocols and contribute to the improvement of patient care quality.
Objective: To evaluate the effect of educational strategies on sleep quality and its relation to diabetes-related distress and glycemic control in people with type 2 diabetes mellitus (DM2). Materials and methods: Randomized clinical trial involving two groups. Group 1 (G1, n = 45) received verbal guidance and leaflets on sleep hygiene strategies and group 2 (G2, n = 46) received usual health care guidelines on self-care with the feet. Sleep was assessed by the Pittsburgh Sleep Quality Inventory and diabetes-related distress by the Diabetes Distress Scale. Linear mixed-effects models and linear regression model were used for the statistical analysis. Results: At the end of the follow-up, sleep quality improvement (p = 0.02) was verified in G1. Low diabetes-related distress score (p = 0.03), being male (p = 0.02), belonging to G1 (p = 0.002), and age (p = 0.04) contributed to better sleep quality. Conclusion: Educational guidelines on sleep hygiene in patients with DM2 were effective in improving sleep quality, measured by the PSQI instrument and emotional stress related to diabetes as assessed by the Diabetes Distress Scale.
Objetivo: Identificar los factores relacionados con la carga de trabajo de enfermería generada por pacientes onco-hematológicos hospitalizados. <br />Método: Cohorte prospectivo realizado con 151 pacientes ingresados en unidad de Onco-Hematología de un hospital universitario, en el Estado de São Paulo, Brasil. Se utilizó para la colecta de datos una ficha con informaciones demográfico-clínicas y el Nursing Activities Score (NAS). En el análisis de los datos se utilizo estadística descriptiva, inferencial y modelos de regresión linear.<br />Resultados: La media del NAS en la unidad fue del 47,8% (11,5 horas). Pacientes con enfermedades oncológicas y hematológicas malignas demandaron mayor carga de trabajo de enfermería, comparados a aquellos con enfermedades no malignas (p=0,0034); los pacientes que murieron presentaron mayor puntuación de NAS, comparada con la de los supervivientes (p<0,0001); en la regresión linear, las variables, diagnóstico y condición de salida, determinaron un R2 de 0,26. Conclusión: Pacientes onco-hematológicos demandan asistencia semi-intensiva, información que ofrece subsidios al enfermero para planear recursos humanos en esta especialidad.<br /><br />
In this qualitative study, four nurses of a teaching hospital in the city of Campinas, São Paulo-Brazil, all of them working with oncological patients were interviewed in order to verify the situation that most caused mental suffering in the day by day with these patients. Data collection were performed as proposed by the ethnographic approach and the non-directive interview and the direct observation was employed. The contain analysis has been utilized to the data analysis. The results have shown that many situations of the relationship nurses-oncological patients cause mental suffering in that professional. Those situations are tied to the work of the nurses, to the kind of patient treated by those professionals and to the kind of sickness presented by the patient. That study has shown that, many times, the nurses utilize defense mechanisms against that mental suffering. This work aims to contribute to the knowledge of the subject and therefore be itself a base in which one could elaborate measures that can make these problems that occur with the nurses that work in the Oncology area lighter. With that study to contribute to the comprehension of the challenge that the cancer, sickness that make professional and population frightened, is.
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