CONHECIMENTO DA EQUIPE DE ENFERMAGEM SOBRE HIGIENE ORAL EM PACIENTES CRITICAMENTE ENFERMOS

Objetivou-se avaliar o conhecimento dos profissionais de enfermagem, que realizam ou supervisionam os cuidados dehigiene oral em pacientes críticos e, secundariamente, verificar como julgam o cuidado prestado. Estudo exploratório,descritivo, com abordagem quantitativa, por meio de instrumento elaborado pelos autores, aplicado a enfermeiros etécnicos que atuam em uma Unidade de Terapia Intensiva (UTI) de médio porte de Porto Alegre. Os resultados mostramque 50% dos enfermeiros e 72,8% dos técnicos concordam que a higiene oral no paciente crítico é importante, mas nãohá relação com a pneumonia associada à ventilação mecânica (PAVM). Da amostra, 16,6% dos enfermeiros e 66,6% dostécnicos de enfermagem concordam que a rotina da instituição é adequada, sendo que 66,6% dos enfermeiros e 30,7%dos técnicos indicam novas práticas. Isso nos sugere que a higiene oral em pacientes internados não tem constituídouma preocupação evidente, tanto na assistência quanto nas práticas de educação em saúde.

Conocimiento del paciente diabético y cuidado de los pies : la importancia de la orientación

Todo paciente diabético, cuidador/familiar deve ser orientado sobre as alterações presentes nos pés, assim como ter esclarecimentos quanto às implicações da neuropatia, da doença vascular, cuidados de higiene, corte adequado de unhas e o calçado apropriado aser usado. Objetivou-se avaliar o conhecimento de pacientes diabéticos sobre o cuidado com os pés e verificar a adesão após intervenção educativa durante a hospitalização, a consulta no ambulatório e o pós-alta hospitalar. Trata-se de um estudo transversal, realizado com 20 pacientes diabéticos tipo 2, atendidos e orientados em um hospital geral de Porto Alegre, em dois momentos: pré-orientação e pós-orientação. Como resultado, 65% dos pacientes foram o sexo masculino e com idade média de 60,2 anos. Houvediferença estatisticamente significativa após intervenção educativa nas seguintes variáveis: exame diário dos pés (p = 0,008), cuidado com a temperatura adequada da água antes da lavagem (p=0,031), deixar os pés de molho (p=0,004), hidratar os pés (p=0,002), uso de meias com costura para fora ou sem costuras (p=0,008), corte da unha no formato reto (p= 0,002), retirada de cutícula (p=0,008) e o calçado com solado grosso e antiderrapante (p=0,008). A intervenção educativa contribuiu para melhorar o conhecimento e permitiu a mudança comportamental relatada pelos participantes sobre os cuidados com os pés.Every diabetic patient, caregiver / family member should be instructed on the changes present in the feet, as well as clarifying the implications of neuropathy, vascular disease, hygiene care, proper nail cutting and the appropriate footwear to be used. The objective was to evaluate the knowledge of diabetic patients about foot care and to verify adherence after educational intervention during hospitalization, consultation at the outpatient clinic and after hospital discharge. This is a cross-sectional study, carried out with 20 type 2 diabetic patients, attended and guided at a general hospital in Porto Alegre, in two moments: pre-orientation and post-orientation. As a result, 65% of the patients were male and the average age was 60.2 years. There was a statistically significant difference after educational intervention in the following variables: daily examination of the feet (p = 0.008), care for the proper water temperature before washing (p = 0.031), soaking the feet (p = 0.004), moisturizing the feet. feet (p = 0.002), use of socks with seam out orwithout seams (p = 0.008), cut the nail in the straight shape (p = 0.002), cuticle removal (p = 0.008) and shoes with thick soles and non-slip (p = 0.008). The educational intervention contributed to improve knowledge and allowed the behavioral change reported by the participants about foot care.Todo paciente diabético, cuidador / familiar debe ser instruido sobre los cambios presentes en los pies, así como aclarar las implicaciones de neuropatía, enfermedad vascular, cuidados higiénicos, corte adecuado de las uñas y calzado adecuado a utilizar. El objetivo fue evaluar el conocimiento de los pacientes diabéticos sobre el cuidado del pie y verificar la adherencia después de la intervención educativa durante la hospitalización, la consulta en el ambulatorio y después del alta hospitalaria. Se trata de un estudio transversal, realizado con 20 pacientes diabéticos tipo 2, atendidos y guiados en un hospital general de Porto Alegre, en dos momentos: preorientación y posorientación. Como resultado, el 65% de los pacientes eran varones y la edad media fue de 60,2 años. Hubo diferencia estadísticamente significativa después de la intervención educativa en las siguientes variables: examen diario de los pies (p = 0,008), cuidado de la temperatura adecuada del agua antes del lavado (p = 0,031), remojo de los pies (p = 0,004), hidratación de los pies. pies (p = 0,002), uso de calcetines con costura fuera o sin costuras (p = 0,008), cortede la uña en forma recta (p = 0,002), eliminación de cutículas (p = 0,008) y zapatos con suela gruesa y antideslizante (p = 0,008). La intervención educativa contribuyó a mejorar el conocimiento y permitió el cambio de comportamiento informado por los participantes sobre el cuidado de los pies

AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice.Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group.We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology (www.sign.ac.uk). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations.Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered.Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation).Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders.Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Background: Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90-90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods: A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results: Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions: This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied