Rectal ulceration due to using the Fexi-Seal fecal management system: a case report

The Flexi-Seal Fecal Management System is a device designed to offer improved care to critical care patients with fecal incontinence. Studies have proven the safety and effectiveness of the device, but there are scarce reports on the adverse events. This article presents two cases of critical care patients who developed complications associated with the use of the Flexi-Seal FMS. The System proved to be effective for the treatment; however, it requires special care in the handling, particularly regarding the periodical relief of pressure from the retention balloon and the correct positioning of the collection bag on the bed, so as to avoid excessive traction. The Flexi-Seal is useful to manage diarrhoea in critical patients, improving their well-being and reducing associated complications. Nevertheless, there is a need to improve knowledge related to the complications that may occur.O Sistema Fexi-Seal é um dispositivo desenvolvido com o objetivo de proporcionar melhores cuidados aos pacientes críticos com incontinência fecal. Existem trabalhos que demonstram a segurança e a eficácia do dispositivo, sendo, porém, escassos os relatos relacionados aos eventos adversos. O presente artigo apresenta dois casos de pacientes críticos portadores de Fexi-Seal que desenvolveram complicações com seu uso. O Sistema mostrou-se eficaz para o tratamento, no entanto, é necessária atenção especial no seu manejo, particularmente quanto ao alívio periódico da pressão na ampola retal e o posicionamento correto da bolsa coletora na cama para evitar tração excessiva. O Sistema Fexi-Seal permite manejar adequadamente a diarreia em pacientes críticos, melhorando o bem-estar e diminuindo as complicações associadas a ela, porém faz-se necessário aumentar o conhecimento sobre as complicações relacionadas ao seu emprego.El Sistema Fexi-Seal es un dispositivo desarrollado para proporcionar mejores cuidados a los pacientes críticos con incontinencia fecal. Existen trabajos que demuestran la seguridad y eficacia del dispositivo, siendo escasos los relatos relacionados con eventos adversos. El presente artículo presenta dos casos de pacientes críticos portadores de Fexi-Seal que desarrollaron complicaciones con su uso. El sistema se mostró eficaz para el tratamiento, sin embargo, es necesaria atención especial en su manejo, particularmente en cuanto al alivio periódico de la presión de la ampolla rectal y al posicionamiento correcto de la bolsa colectora en la cama para evitar tracción excesiva. El Sistema Flexi-Seal permite manejar adecuadamente la diarrea en pacientes críticos, mejorando su bienestar y disminuyendo las complicaciones asociadas a ella, aunque se torna necesario aumentar el conocimiento sobre las complicaciones relacionadas con su empleo

Análisis de la utilización de la escala Nursing Activities Score en dos UCIS Españolas

Estudo prospetivo cujo objetivo foi analisar as diferenças no preenchimento da escala Nursing Activities Score (NAS) em duas UTI polivalentes de dois hospitais espanhóis. Dados relativos internados nas unidades durante o período de outubro a novembro de 2011. Os dados recolhidos de 103 pacientes produziram 941 medições na escala NAS. Diferenças significativas foram encontradas nos itens: monitoramento, procedimentos de higiene, mobilização e posicionamento, atividades administrativas e monitoramento auricular à esquerda (p < 0,001). Conclui-se que o uso de instrumentos padronizados é essencial quando se compara a carga de trabalho em unidades diferentes. A escala apresenta itens com uma componente de avaliação subjetiva, sendo por isso importante a unificação de critérios para a comparação de resultados entre diferentes unidades.Estudio prospectivo cuyo objetivo fue analizar las diferencias en el llenado de la escala Nursing Activities Score (NAS) en dos UCIs polivalentes de dos hospitales españoles. Datos relacionados a la carga de trabajo se recogieron diariamente, mediante la escala para los pacientes internados en las unidades durante el periodo de octubre a noviembre del 2011. Se recogieron datos de 103 pacientes obteniéndose un total de 941 medidas de la escala NAS. Diferencias significativas se encontraron en los ítems: monitorización, procedimientos de higiene, movilización y posición, tareas administrativas y monitorización de la aurícula izquierda (p < 0.001). Se concluyó que el empleo de instrumentos estandarizados es fundamental para poder comparar la carga de trabajo en diferentes unidades. La escala presenta ítems con un componente de valoración subjetiva, siendo importante la unificación de criterios para poder comparar los resultados entre las distintas unidades.The aim of this study was to analyze the discourse of health managers on aspects related to delay in tuberculosis diagnosis. This was a qualitative research study, conducted with 16 Family Health Unit managers. The empirical data were obtained through semi-structured interviews. The analysis was based on the theoretical framework of the French school of discourse analysis. According to the managers’ statements, the delay in tuberculosis diagnosis is related to patient and health service aspects. As for patient aspects, managers report fear, prejudice and lack of information as factors that may promote a delayed diagnosis. Regarding health service aspects, structural problems and lack of professional skills were reported. The discourse of managers should be considered to qualify tuberculosis control actions and to prevent delays in diagnosis

Análise da utilização da escala Nursing Activities Score em duas UCIS Espanholas

The aim of this study was to analyze the discourse of health managers on aspects related to delay in tuberculosis diagnosis. This was a qualitative research study, conducted with 16 Family Health Unit managers. The empirical data were obtained through semi-structured interviews. The analysis was based on the theoretical framework of the French school of discourse analysis. According to the managers’ statements, the delay in tuberculosis diagnosis is related to patient and health service aspects. As for patient aspects, managers report fear, prejudice and lack of information as factors that may promote a delayed diagnosis. Regarding health service aspects, structural problems and lack of professional skills were reported. The discourse of managers should be considered to qualify tuberculosis control actions and to prevent delays in diagnosis.Estudio prospectivo cuyo objetivo fue analizar las diferencias en el llenado de la escala Nursing Activities Score (NAS) en dos UCIs polivalentes de dos hospitales españoles. Datos relacionados a la carga de trabajo se recogieron diariamente, mediante la escala para los pacientes internados en las unidades durante el periodo de octubre a noviembre del 2011. Se recogieron datos de 103 pacientes obteniéndose un total de 941 medidas de la escala NAS. Diferencias significativas se encontraron en los ítems: monitorización, procedimientos de higiene, movilización y posición, tareas administrativas y monitorización de la aurícula izquierda (p < 0.001). Se concluyó que el empleo de instrumentos estandarizados es fundamental para poder comparar la carga de trabajo en diferentes unidades. La escala presenta ítems con un componente de valoración subjetiva, siendo importante la unificación de criterios para poder comparar los resultados entre las distintas unidades.Estudo prospetivo cujo objetivo foi analisar as diferenças no preenchimento da escala Nursing Activities Score (NAS) em duas UTI polivalentes de dois hospitais espanhóis. Dados relativos internados nas unidades durante o período de outubro a novembro de 2011. Os dados recolhidos de 103 pacientes produziram 941 medições na escala NAS. Diferenças significativas foram encontradas nos itens: monitoramento, procedimentos de higiene, mobilização e posicionamento, atividades administrativas e monitoramento auricular à esquerda (p < 0,001). Conclui-se que o uso de instrumentos padronizados é essencial quando se compara a carga de trabalho em unidades diferentes. A escala apresenta itens com uma componente de avaliação subjetiva, sendo por isso importante a unificação de critérios para a comparação de resultados entre diferentes unidades

Carga de trabalho em três grupos de pacientes em uma UTI espanhola segundo Nursing Activites Score

The purpose of this study was to assess the nursing workload at admission to and discharge from intensive care of three groups of patients (i.e., acute coronary syndrome, acute respiratory failure, and sepsis). A prospective, descriptive study was performed over a 27-month period and included 563 patients. The workload was assessed using the Nursing Activities Score scale. Significant differences in the workload were determined on the days of admission and discharge: the workload was higher in both cases for patients with acute respiratory failure and sepsis compared with patients diagnosed with acute coronary syndrome. This difference was maintained over the first seven days of their hospital stay. From day 8 on, the difference disappeared, and a workload balance was achieved in the three groups. Good staffing requires adequate tools for measuring care needs and understanding the workload required in the groups of patients who are most frequently admitted to intensive care.Se objetivó valorizar la carga de trabajo al ingreso y al alta en tres grupos de pacientes (síndrome coronario agudo, insuficiencia respiratoria aguda y sepsis) en terapia intensiva. Estudio descriptivo, prospectivo, de 27 meses, incluyéndose 563 pacientes, valorando carga de trabajo según Nursing Activities Score. Existieron diferencias significativas en la carga de trabajo al ingreso y en el alta entre los grupos de pacientes, siendo superior en ambos momentos la de pacientes con insuficiencia respiratoria aguda y sepsis frente a pacientes coronarios. Durante los siete primeros días de estancia se mantuvo esta diferencia, desapareciendo a partir del octavo día, equilibrándose la carga de trabajo para los tres grupos. Para conseguir una adecuada dotación de personal es fundamental contar con instrumentos para medir las necesidades de cuidados y conocer la carga de trabajo de los distintos grupos de enfermos que ingresan con mayor frecuencia en las unidades de terapia intensiva.O objetivo deste estudo foi avaliar a carga de trabalho na admissão e alta dos pacientes de três grupos (síndrome coronária aguda, insuficiência respiratória aguda e sepsis) em cuidados intensivos. Trata-se de estudo prospectivo, descritivo, que decorreu durante 27 meses, incluindo 563 pacientes. Para a avaliação da carga de trabalho utilizou-se a escala Nursing Activities Score. A partir dos resultados do estudo parecem existir diferenças significativas na carga de trabalho no dia da admissão e alta entre os grupos de pacientes, sendo a carga maior em ambos os tempos a dos pacientes com insuficiência respiratória aguda e sepsis. Durante os primeiros sete dias de internamento essa diferença manteve-se, desaparecendo no oitavo dia, o que equilibrou a carga de trabalho para os três grupos. Conclui-se que para se conseguir os recursos adequados é essencial dispor de instrumentos para medir as necessidades de cuidados e conhecer a carga de trabalho dos diferentes grupos de pacientes que passam com mais frequência pelas unidades de cuidados intensivos

Nursing Activities Score: an updated guideline for its application in the Intensive Care Unit

Objetivo Describir la carga de trabajo de enfermería en Unidades de Cuidados Intensivos (UCI) de diferentes países según el Nursing Activities Score (NAS) y establecer una guía estandarizada para su utilización en UCI. Método estudio observacional en 19 UCIs de siete países (Noruega, Países Bajos, España, Polonia, Egipto, Grecia y Brasil) incluyendo 758 pacientes adultos en Noviembre de 2012. Resultados La puntuación media total en la escala NAS fue de 72.81% com valores entre 44.46% (España) y 101.8% (Noruega). Las medias NAS en Polonia, Grecia y Egipto fue de 83.0%, 64.59% y 57.11% respectivamente. El NAS medio fue similar en Brasil (53.98%) y los Países Bajos (50.96%). De los 23 ítems de la escala hubo problemas en la interpretación de 5 de ellos (21.74%). Este problema se resolvió mediante el consenso entre los investigadores. Conclusión El presente estudio demuestra variación en la carga de trabajo en UCI de diferentes países. La guía estandarizada de puntuación del NAS puede servir como una herramienta para resolver dudas en futuras aplicaciones.Objetivo Descrever a carga de trabalho de enfermagem em Unidades de Terapia Intensiva (UTI) de diferentes países, segundo o Nursing Activities Score (NAS), e padronizar o manual do NAS para uso nessas Unidades. Método Estudo transversal realizado em 19 UTI de sete países (Noruega, Holanda, Espanha, Polônia, Egito, Grécia e Brasil) com um total de 758 pacientes adultos, em novembro de 2012. Resultados A média do NAS total da amostra foi 72.81%, com variação entre 44.46% (Espanha) e101.81% (Noruega). Nas UTI da Polônia, Grécia e Egito, as médias foram de 83.00%, 64.59% e 57.11%, respectivamente. As médias NAS no Brasil (53.98%) e na Holanda (50,96%) foram similares. Dos 23 itens da escala, houve dúvidas no entendimento de 5(21.74%), que foram solucionados por consenso entre os pesquisadores. Conclusão O estudo mostrou diferentes cargas de trabalho de enfermagem nas UTI estudadas. Um manual padronizado do NAS para uso nessas unidades contribuirá para sanar dúvidas em futuras aplicações.Objective To describe nursing workload in Intensive Care Units (ICU) in different countries according to the scores obtained with Nursing Activities Score (NAS) and to verify the agreement among countries on the NAS guideline interpretation. Method This cross-sectional study considered 1-day measure of NAS (November 2012) obtained from 758 patients in 19 ICUs of seven countries (Norway, the Netherlands, Spain, Poland, Egypt, Greece and Brazil). The Delphi technique was used in expertise meetings and consensus. Results The NAS score was 72.8% in average, ranging from 44.5% (Spain) to 101.8% (Norway). The mean NAS score from Poland, Greece and Egypt was 83.0%, 64.6% and 57.1%, respectively. The NAS score was similar in Brazil (54.0%) and in the Netherlands (51.0%). There were doubts in the understanding of five out 23 items of the NAS (21.7%) which were discussed until researchers’ consensus. Conclusion NAS score were different in the seven countries. Future studies must verify if the fine standardization of the guideline can have a impact on differences in the NAS results

Usage analysis of the Nursing Activities Score in two Spanish ICUS

The aim of this study was to analyze the discourse of health managers on aspects related to delay in tuberculosis diagnosis. This was a qualitative research study, conducted with 16 Family Health Unit managers. The empirical data were obtained through semi-structured interviews. The analysis was based on the theoretical framework of the French school of discourse analysis. According to the managers’ statements, the delay in tuberculosis diagnosis is related to patient and health service aspects. As for patient aspects, managers report fear, prejudice and lack of information as factors that may promote a delayed diagnosis. Regarding health service aspects, structural problems and lack of professional skills were reported. The discourse of managers should be considered to qualify tuberculosis control actions and to prevent delays in diagnosis

Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality?

Background & aims: The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients. Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for >= 72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for <= 14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were reported. Results: We included 639 patients among whom 448 (70.1%) and 191 (29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following char-acteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6 +/- 3.3 vs 8.4 +/- 3.7; P < 0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8 +/- 2.1 vs 5.2 +/- 1.7; P < 0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008-1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036-1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025-1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168-4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015-1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263-0.977; P=0.042). Conclusions: Old age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism

Nursing Activities Score: an updated guideline for its application in the Intensive Care Unit

ABSTRACT Objective To describe nursing workload in Intensive Care Units (ICU) in different countries according to the scores obtained with Nursing Activities Score (NAS) and to verify the agreement among countries on the NAS guideline interpretation. Method This cross-sectional study considered 1-day measure of NAS (November 2012) obtained from 758 patients in 19 ICUs of seven countries (Norway, the Netherlands, Spain, Poland, Egypt, Greece and Brazil). The Delphi technique was used in expertise meetings and consensus. Results The NAS score was 72.8% in average, ranging from 44.5% (Spain) to 101.8% (Norway). The mean NAS score from Poland, Greece and Egypt was 83.0%, 64.6% and 57.1%, respectively. The NAS score was similar in Brazil (54.0%) and in the Netherlands (51.0%). There were doubts in the understanding of five out 23 items of the NAS (21.7%) which were discussed until researchers’ consensus. Conclusion NAS score were different in the seven countries. Future studies must verify if the fine standardization of the guideline can have a impact on differences in the NAS results

Differences in childbirth satisfaction in relation with sociodemographic and clinical variables

A lot research has focused on the study of women satisfaction with delivery. Different events are related to childbirth satisfaction, unplanned cesarean deliveries, instrumental vaginal deliveries, pain and lack of control during labor can generate a negative delivery experience. The aim of the present study was to assess the relationship between mode of delivery and childbirth satisfaction. The final sample was composed of 106 women in early postpartum, which voluntarily agreed to participate in the study. A total of 34,9% were instrumental deliveries, and 17% were cesarean sections. The Mackey Childbirth Satisfaction Rating Scale was used to measure women’ satisfaction. A significant difference was found in the baby scale between the groups of eutocic and non-eutocic delivery (p = ,045). A significant difference was found in the baby scale (p < ,001) and the partner scale (p = ,006) between the groups of vaginal and cesarean section delivery. Mode of delivery can be a variable that affects the childbirth experience, influencing the overall experience in a negative way, thus conditioning women’ mode of delivery in future pregnancies

Diferencias en la satisfacción de la madre con el nacimiento de su hijo en función de variables sociodemográficas y clínicas

A lot research has focused on the study of women satisfaction with delivery. Different events are related to childbirth satisfaction, unplanned cesarean deliveries, instrumental vaginal deliveries, pain and lack of control during labor can generate a negative delivery experience. The aim of the present study was to assess the relationship between mode of delivery and childbirth satisfaction. The final sample was composed of 106 women in early postpartum, which voluntarily agreed to participate in the study. A total of 34,9% were instrumental deliveries, and 17% were cesarean sections. The Mackey Childbirth Satisfaction Rating Scale was used to measure women’ satisfaction. A significant difference was found in the baby scale between the groups of eutocic and non-eutocic delivery (p = ,045). A significant difference was found in the baby scale (p < ,001) and the partner scale (p = ,006) between the groups of vaginal and cesarean section delivery. Mode of delivery can be a variable that affects the childbirth experience, influencing the overall experience in a negative way, thus conditioning women’ mode of delivery in future pregnancies.Numerosas investigaciones se han centrado en el estudio de la satisfacción de la mujer con el nacimiento de su nuevo hijo. Existen diferentes acontecimientos relacionados con la satisfacción materna respecto al parto, como cesáreas no planificadas, partos vaginales instrumentales de emergencia, dolor o falta de control pueden generar una experiencia negativa del parto. El objetivo del presente estudio fue analizar la relación entre el tipo de parto y la satisfacción con el nacimiento. La muestra final fue de 106 mujeres en el postparto inicial, con participación de manera voluntaria en el estudio. El porcentaje de partos no eutócicos fue de 34,9%, mientras que el porcentaje de cesáreas fue del 17%. El instrumento utilizado para valorar la satisfacción fue la Mackey Childbirth Satisfaction Rating Scale. Se encontró una diferencia significativa en las subescalas de satisfacción con el recién nacido entre los grupos de parto eutócico y no eutócico (p = 0,045). Se encontró una diferencia significativa en la subescala de satisfacción con el recién nacido entre los grupos de parto vaginal y cesárea (p <0,001), así como en la subescala de satisfacción con la pareja (p = 0,006). El tipo de parto podría ser una variable influyente en una experiencia negativa del nacimiento, lo que puede llegar a condicionar a la mujer en la elección del tipo de parto en posteriores embarazos