CREATION AND VALIDATION OF AN INSTRUMENT ON NEOPLASTIC WOUND MANAGEMENT FOR NURSES' TRAINING

Objective: to create and validate the face and content of an instrument for training nurses in neoplastic wound care.Method: a methodological research study with a quantitative approach, carried out in three stages: scoping review; creation of the instrument; and face and content validation. Data collection took place between October 2021 and February 2022 in Niterói - RJ - Brazil. The Content Validation Index and Fleiss Generalized Kappa were used.Results: the final instrument consists of the following phases: definition of neoplastic wound; wound classification; staging; pain and odor rating scales; Nursing care; and management of signs and symptoms. The content was validated reaching a Content Validation Index > 0.80 and an agreement level between the judges > 75%, as established.Conclusion: validation of the instrument will contribute to reducing the gap indicated in the literature on Nursing care in relation to neoplastic wounds, in addition to its application to Nursing teaching and services

CONSTRUÇÃO E VALIDAÇÃO DE UM INSTRUMENTO SOBRE MANEJO DE FERIDA NEOPLÁSICA PARA CAPACITAÇÃO DE ENFERMEIROS

Objetivo: construir, validar o conteúdo e a aparência de instrumento para capacitação de enfermeiros no cuidado de ferida neoplásica.            Método: pesquisa metodológica, com abordagem quantitativa, realizada em três etapas - revisão de escopo; construção do instrumento; validação do conteúdo; e aparência. Coleta de dados ocorreu no período entre outubro de 2021 a fevereiro de 2022, em Niterói - RJ - Brasil. Foram utilizados o Índice de Validação de Conteúdo; Fleiss Generalized Kappa.          Resultados: o instrumento final é composto pelas fases: definição de ferida neoplásica; classificação da ferida; estadiamento; escalas de avaliação da dor e odor; cuidados de enfermagem; e manejo dos sinais e sintomas. O conteúdo foi validado, atingindo um índice de validação de conteúdo > 0.80 e um nível de concordância entre os juízes > 75%, conforme estabelecido.Conclusão: a validação do instrumento, contribuirá para a redução da lacuna expressa na literatura do cuidado de enfermagem em relação à ferida neoplásica, além da aplicação ao ensino e aos serviços de enfermagem

ELABORACIÓN Y VALIDACIÓN DE UN INSTRUMENTO SOBRE EL MANEJO DE HERIDAS NEOPLÁSICAS PARA CAPACITAR A LOS ENFERMEROS

Objetivo: elaborar, validar el contenido y la apariencia de un instrumento para capacitar a los enfermeros en el cuidado de heridas neoplásicas.Método: investigación metodológica, con enfoque cuantitativo, realizada en tres etapas: revisión de alcance; elaboración del instrumento; validación de contenido; y apariencia. La recolección de datos se realizó entre octubre de 2021 y febrero de 2022, en Niterói, RJ, Brasil. Se utilizó el Índice de Validación de Contenido; Fleiss Generalized Kappa.Resultados: el instrumento final consta de las fases: definición de herida neoplásica; clasificación de heridas; estadio; escalas de evaluación del dolor y olor; cuidados de enfermería; y manejo de signos y síntomas. Se validó el contenido, alcanzó un índice de validación de contenido > 0,80 y un nivel de concordancia entre los jueces > 75%, según lo establecido.Conclusión: la validación del instrumento contribuirá a reducir la brecha que hay en la literatura sobre el cuidado de enfermería de las heridas neoplásicas, además se aplicará en la enseñanza y los servicios de enfermería

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

Background\ud To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.\ud \ud Methods\ud This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).\ud \ud Results\ud Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).\ud \ud Conclusions\ud A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.We thank Mrs. Karianne Aroeira Davidson, Mrs. Anna Maria Ferreira, Mrs. Elisangela Santos and Sandro Sperandei for their technical assistance.This work was supported by grants from Farmanguinhos/Fundação Oswaldo Cruz/National Health Ministry, the Brazilian Diabetes Society, Fundação do Amparo à Pesquisa do Estado do Rio de Janeiro, and Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil

Controle de exsudato em feridas oncológicas de pacientes em cuidados paliativos: revisão sistemática

O câncer é um problema de saúde pública, especialmente entre os países em desenvolvimento, onde é esperado, nas próximas décadas, um impacto na população que corresponda a 80% dos mais de 20 milhões de casos novos estimados para 2025.Nesse cenário,as feridas oncológicas normalmente se desenvolvem durante os seis últimos meses de vida, em decorrência do tumor primário ou metastático. Como resultado da infiltração de células cancerosas nas estruturas da pele ocorre a formação de uma ferida, evolutivamente exofítica, com proliferação celular descontrolada. Cerca de 5% a 10% dos pacientes com câncer avançado irão desenvolver feridas oncológicas durante os seis últimos meses de vida .Dentre os sintomas prevalentes destacam-se dor, exsudato, odor, sangramento e necrose. Com base nesses dados foi delimitado como questão norteado de pesquisa: Qual o papel da enfermagem frente ao uso de coberturas para redução da exsudação em feridas oncológicas de pacientes em cuidados paliativo?, tendo como objeto de estudo a exsudação em feridas oncológicas de pacientes em cuidados paliativos. Trata-se de uma revisão sistemática com abordagem quantitativa. Os dados foram coletados na base de dados, MEDLINE -Medical Literature Analysis and Retrieval System Online e na LILACS ( Literatura Latino-americana e do Caribe em Ciências da Saúde) através da plataforma BVS (Biblioteca Virtual em Saúde) e na ferramenta Google Acadêmico. Foram analisados 15 estudos, os estudos tipo revisão de literatura foram os mais encontrados. A cobertura mais relatada é o alginato de cálcio com 19,40%.Dos 15 estudos, 11 foram classificados com nível de evidência e grau de recomendação 5D. Conclui-se que mais estudos do tipo ensaio clínico devem ser realizados nessa área, de modo a ter evidências científicas mais relevantes. Pode-se observar também que é de extrema importância que o enfermeiro saiba o tipo correto de cobertura a ser utilizada de acordo com o grau do exsudação presente na lesão para promover conforto ao paciente.Cancer is a public health problem, especially among developing countries, where it is expected that in the next decades, the impact of cancer on the population is going to be about 80% of the estimated 20 million new cases by 2025. In this scenario the fungating wounds usually develops during the last six months of life, due to the primary or metastatic tumor. As a result of the infiltration of cancerous cells into the skin structures the formation of an exophytic wound develops with uncontrolled cell proliferation. About 5% to 10% of patients with advanced cancer will develop fungating wounds during the last six months of life. Pain, exudate, odor, bleeding, and necrosis are among the prevalent symptoms. Based on these data was delimited as a research question: What is the role of nursing regarding the use of dressing to reduce the exudation in fungating wounds of patients in palliative care ? Having as object of study the exudation in fungating wounds of patients in care. This is a systematic review study with a quantitative approach. The data were collected in the database, MEDLINE -Medical Literature Analysis and Retrieval System Online and LILACS ( Literatura Latino americana e do Caribe em Ciências da Saúde) through the BVS (Biblioteca Virtual em Saúde) platform and in the Google Scholar tool. Fifteen studies were analyzed, of which the study type literature review was the most found. The most reported dressing is calcium alginate with 19.40%. Of the 15 studies, 11 were classified with level of evidence and degree of recommendation 5D. As a conclusion, more studies of the type clinical trial should be carried out in this area, in order to have more relevant scientific evidence. It can also be observed that it is extremely important that the nurse knows the correct type of dressing to be used according to the degree of the exudation present in the wound, in order to promote comfort to the patient.69 p

Construção e validação de um instrumento sobre manejo de ferida neoplásica para capacitação de enfermeiros

Introdução: Cerca de 5% a 10% dos pacientes com câncer avançado irão desenvolver feridas neoplásicas durante os seis últimos meses de vida. O tratamento das feridas neoplásica é complexo, pois exige avaliação de etiologia oncológica, características e estadiamento da lesão, estado físico, emocional, social e espiritual do paciente, bem como produtos e coberturas específicos para o controle dos sinais e sintomas. O conhecimento de enfermeiros sobre avaliação e tratamento de feridas neoplásicas, apresenta limitações, bem como déficit de capacitação para a assistência à pessoa com esse tipo de lesão. Objetivo: Propor um instrumento para capacitação de enfermeiros no manejo de ferida neoplásica. Métodos: Pesquisa metodológica. O estudo compreendeu a construção do instrumento por meio de revisão de escopo da literatura; validação do conteúdo e aparência por juízes especialistas. A coleta de dados ocorreu entre outubro/2021 e fevereiro/2022, a análise foi feita pelo Índice de Validação de Conteúdo e Fleiss generalized Kappa. Este projeto de pesquisa, foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade Federal Fluminense (FMUFF) com o registro CAAE: 50525121.0.0000.5243, atendendo à Resolução nº 466/12, das Diretrizes e Normas de Pesquisa Envolvendo Seres Humanos do Conselho Nacional de Saúde. Resultados: Os juízes especialistas recrutados validaram o conteúdo e aparência do instrumento relacionado a exatidão científica, conteúdo, apresentação textual e diagramação, ilustração e compreensão do instrumento, atingindo um IVC > 0.80, kappa satisfatório e nível de concordância entre os juízes > 75%. Conclusões: As categorias de validação atingiram o índice de validação de conteúdo e de aparência adequados, além de reunir as evidências para o manejo adequado da ferida neoplásica e contribuir para a capacitação dos enfermeiros na aérea, gerando um produto – material didático - a ser utilizado na assistência de enfermagem. Como limitação o estudo apresenta a ausência de validação clínica do instrumento. Como perspectivas futuras, esta pesquisa proporciona a oportunidade de expandir as informações contidas no instrumento, englobando os aspectos sociais e emocionais que envolvem o cuidado da pessoa com ferida neoplásica. Também há a implementação do instrumento como material didático de programas de educação permanente que abordem esta temática.Introduction: About 5% to 10% of patients with advanced cancer will develop malignant fungating wounds during the last six months of life. The treatment of malignant fungating wounds is complex, as it requires evaluation of oncological etiology, characteristics, and staging of the lesion, physical, emotional, social, and spiritual state of the patient, as well as specific products and dressings for the control of signs and symptoms. The knowledge of nurses about the assessment and treatment of malignant fungating wounds presents limiting factors, as well as lower training to take care of people with this type of injury. Objective: Propose an instrument for training nurses in malignant fungating wound management. Methods: Methodological research. The study comprised the construction of the instrument through a literature scoping review; content and appearance validation by expert judges. Data collection occurred between October/2021 and February/2022, analysis was done by the Content Validation Index and Fleiss generalized Kappa. This research project was approved by the Research Ethics Committee of the Faculdade de Medicina of Universidade Federal Fluminense (FMUFF) with CAAE registration: 50525121.0.0000.5243, meeting Resolution No. 466/12, of the Guidelines and Standards for Research Involving Human Beings of the National Health Council. Results: The expert judges recruited validated the content and appearance of the instrument related to scientific accuracy, content, textual presentation and layout, illustration, and understanding of the instrument, reaching the CVI > 0.80, a satisfactory kappa, and agreement level among the expert judges > 75%. Conclusions: The validation categories reached the appropriate content and appearance validation index, in addition to gathering evidence for the proper management of the neoplastic wound and contributing to the training of nurses in the field, also developed a product -courseware- to help out at nursing care.80 f