Objetivos: Correlacionar a incidência de lesão por pressão (LP) com o tempo médio de assistência de enfermagem em unidade de terapia intensiva (UTI). Método: Estudo epidemiológico, observacional, retrospectivo, realizado em uma UTI de um hospital universitário. Os dados foram coletados pela consulta aos bancos de dados de incidência de LP e tempo médio de assistência de enfermagem entre 2010 e 2014. Utilizou-se medidas de tendência central e variabilidade, e coeficiente de correlação de Pearson para análise dos dados. Resultados: A média de incidência de LP entre 2010 e 2014 foi de 10,83% (DP = 2,87) e o tempo médio de assistência de enfermagem despendido aos pacientes internados em UTI foi de 15 horas (DP = 0,94). Não houve correlação estatisticamente significante entre incidência de LP e o tempo de assistência de enfermagem (r = -0,17; p = 0,199), porém os resultados sugeriram sobrecarga da equipe. Conclusão: Este estudo confirma a importância da implementação e reavaliação da eficácia de protocolos de cuidados preventivos para LP, além de alertar sobre a sobrecarga de trabalho de enfermagem na assistência aos pacientes críticos.
Introduction.-Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is an accepted treatment for peritoneal mesothelioma. In this study, we evaluated QOL after HIPEC for peritoneal mesothelioma.Methods.-This was a prospective study performed after HIPEC for peritoneal mesothelioma between 2002 and 2015. Patients completed QOL surveys, including the Short Form-36 (SF-36), Functional Assessment of Cancer Therapy + Colon (FACT-C), Brief Pain Inventory (BPI), and Center for Epidemiologic Studies Depression Scale (CES-D) preoperatively and at 3, 6, 12, and 24 months postoperatively.Results.-Overall, 46 patients underwent HIPEC for peritoneal mesothelioma and completed QOL surveys. Mean age was 52.8 ± 13.8 years and 52% were male. Good preoperative functional status was 70%. Median survival was 3.4 years, and 1, 3, and 5-year survivals were 77.4, 55.2, and 36.5%, respectively. CES-D score decreased at 3 months postoperatively, but increased at 24 months (p = 0.014); SF-36 physical functioning scale decreased at 3 months but returned to baseline at 12 months (p = 0.0045); and the general health scale decreased at 3 months, then improved by 6 months (p = 0.0034). Emotional well-being (p = 0.0051), role limitations due to emotional problems (p = 0.0006), social functioning (p = 0.0022), BPI (p = 0.025), least pain (p = 0.045), and worst pain (p < 0.0001) improved. FACT-C physical well-being decreased at 3 months but returned to baseline at 6 months (p = 0.020), and total FACT-C score improved at 6 months (p = 0.052).Conclusion.-QOL returned to baseline or improved from baseline between 3 months and 1 year following surgery. Despite the risks associated with this operation, patients may tolerate HIPEC well and have good overall QOL postoperatively.Malignant peritoneal mesothelioma (MPM) is a rare neoplasm, typically diagnosed after extensive peritoneal dissemination.
BACKGROUND AND OBJECTIVES:Fibromyalgia is a non-inflammatory rheumatic syndrome, characterized by diffuse chronic musculoskeletal pain, usually accompanied by other symptoms not related to the locomotor system such as depression, fatigue, cognitive alterations, impaired sleep quality, and headache. This study aimed to evaluate the impact of a nursing intervention in the control of pain and depressive symptoms of patients with fibromyalgia. METHODS: A quasi-experimental study conducted through the electronic database review of a private chronic patients monitoring service. The sample included 353 patients with fibromyalgia who were attended in the period from 2014 to 2017. The nursing intervention included a home visit and the application of educational strategies over the telephone for 6 months. Participants were assessed using the verbal numerical rating scale and the Patient Health Questionnaire scale. The comparison between the continuous variables was performed by the t-paired test, and the comparison between the categorical variables was performed using the McNemar-Bowker test. The level of significance was set at p<0.05. RESULTS: Nursing intervention promoted a significant reduction in the average pain intensity (p<0.001) after the intervention. The reduction in the average depression score, however, was not significant (p=0.093), but the intervention significantly reduced the cases of moderate and very severe depression (p=0.01). CONCLUSION: Nursing intervention by telephone showed a positive impact on pain control and reduction of depressive symptoms in patients with fibromyalgia.
Objectives: To correlate the incidence of pressure injury (PI) with the average time of nursing care in an intensive care unit (ICU). Method: Epidemiological, observational, retrospective study, carried out in the ICU of a university hospital. Data were collected by consulting the PI incidence and the average nursing care time from ICU databases between 2010 and 2014. Measures of central tendency and variability, and Pearson’s correlation coefficient were used for data analysis. Results: The average incidence of PI between 2010 and 2014 was 10.83% (SD = 2.87) and the average time spent in nursing care for patients admitted to the ICU was 15 hours (SD = 0.94). There was no statistically significant correlation between the incidence of PI and the nursing care time (r = -0.17; p = 0.199), however, the results suggested an overload on the nursing team. Conclusion: This study confirms the importance of implementing and reassessing the effectiveness of preventive care protocols for PI, in addition to warning about the work overload of nursing in assisting critically ill patients.
Amputations associated with trauma carry significant morbidity in addition to risk of limb loss due to tissue damage, contamination, and risk of infection. The timing of formal amputation closure in this situation varies among surgeons, with some allowing the wound to remain open for some time after debridement, whereas others perform formal amputation and closure at the index operation if debridement is adequate. The presence of infection after closure of an amputation has the potential to result in a higher amputation ( i.e., a below-knee amputation to an above-knee amputation). Our goal was to examine the relationship of timing of closure to stump infection and eventual level of amputation. A review was performed of all patients admitted to a Level I trauma center over a six-year period with amputations during the initial admission after trauma. Amputations of either an arm (above or below the elbow) or a leg (above or below the knee) were included. The number of days between adequate debridement as judged by the operating surgeon and closure of the amputation and whether there was an infection after closure were evaluated. Also investigated was the relationship between infection after closure and a higher level of amputation. Between January 1, 2010, and December 31, 2015, 63 patients (ages 15–81 years, mean age 45.1 ± 18.4) underwent an amputation of a leg or an arm. Fifty-four were male, nine were female, the mean injury severity score was 20.9 ± 10.4, and the mean lactate level at admission was 3.4 ± 1.7. Of the 63 patients, 53 patients had an amputation of a leg and 10 had an amputation of an arm. The overall infection rate was 32 per cent, and the mean time until closure was 6.7 ± 11.1 days. Comparing closure times in those with and without infection after closure, the mean intervals were 3.1 ± 9.7 and 8.4 ± 11.4 days, respectively ( P = 0.01). The receiver operating characteristic curve c-statistic was 0.69 ( P = 0.04). Sensitivity of various times to closure for avoiding infection was examined and was optimized at five days with infection rates above five days of 5.3 per cent versus at or below five days to closure of 43.2 per cent ( P = 0.0029). Infection resulted in a higher level of amputation in 40 per cent of those who had an infection. Based on these data, delay in closure of an amputation even after debridement appears adequate was associated with a lower rate of infection and the presence of infection resulted in a higher amputation level in more than a third of studied patients. Delay of formal amputation closure for at least five days after adequate debridement is acheived is associated with a significantly reduced rate of infection.
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