Intervención de enfermería durante el preoperatorio en cirugía cardiovascular / Nursing intervention during the pre-operative period in cardiovascular surgery

Introducción: La adecuada intervención de enfermería puede mejorar los resultados posoperatorios, el estrés y el conocimiento; y reducir las complicaciones. Objetivo: Exponer una intervención personalizada de enfermería para modificar los estados emocionales, y la capacidad de afrontamiento y adaptación durante el preoperatorio de cirugía cardiovascular en el Centro de Investigaciones Médico Quirúrgicas. Métodos: Se realizó un estudio longitudinal y preexperimental, que incluyó 88 personas que acudieron al Servicio de Cirugía Cardiovascular del Centro de Investigaciones Médico Quirúrgicas en un período de dos años. Se aplicaron los test Inventario de Ansiedad Rasgo-Estado y del Inventario de Depresión Rasgo-Estado, para medir la ansiedad y la depresión; así como el test ESCAPS (Instrumento de medición del proceso de afrontamiento y adaptación) y una entrevista semiestructurada que exploró conocimiento. Los resultados iniciales y finales se compararon, y se expresaron en números absolutos, porcentajes y media. Se aplicó la prueba de Chi cuadrado a las variables cualitativas y el test de Student para medias independientes a las variables cuantitativas, con un intervalo de confianza del 95 por ciento. Resultados: Predominaron los hombres (57,9 por ciento) con edad media de 57,73 ± 11,9 años. Luego de la intervención se redujeron la ansiedad en un 36,6 por ciento (p < 0,001) y la depresión en un 72,7 por ciento (p = 0). Aumentaron el conocimiento (76,1 por ciento; p = 0,037) y la capacidad de afrontamiento y adaptación (0,11 puntos). Solo se encontró asociación entre la ansiedad y la depresión con las complicaciones (p = 0,008 y p < 0,001 de forma respectiva). Conclusiones: La intervención de enfermería modificó de manera positiva la ansiedad y la depresión, al optimizar la capacidad de afrontamiento y adaptación(AU)

Introduction: Adequate nursing intervention can improve post-operative outcomes, stress and knowledge; and reduce complications. Objective: Present a personalized nursing intervention in the pre-operative period of cardiovascular surgery at the Center for Medical and Surgical Research. Methods: A longitudinal and pre-experimental study was conducted, which included 88 people who attended the Cardiovascular Surgery Service of the Center for Medical and Surgical Research in a period of two years. The Trait-State Anxiety Inventory and Trait-State Depression Inventory tests were applied to measure anxiety and depression; as well as the ESCAPS test (Instrument for measuring the coping and adaptation process) and a semi-structured interview that explored knowledge. A personalized nursing intervention was performed. The initial and final results were compared, and expressed in absolute numbers, percentages and average. The Chi-square test was applied to the qualitative variables and the Student test for independent means to the quantitative variables, with a 95 percent confidence interval. Results: Men (57.9 percent) with a mean age of 57.73 ± 11.9 years predominated. After the intervention, anxiety was reduced by 36.6 percent (p < 0.001) and depression by 72.7 percent (p = 0). Knowledge increased (76.1 percent; p = 0.037) and coping and adaptive capacity (0.11 points). Only an association was found between anxiety and depression with complications (p = 0.008 and p < 0.001 respectively). Conclusions: Nursing intervention positively modified anxiety and depression by optimizing coping and adaptation capacity(AU)

Recomendaciones pre- y posquirúrgicas en pacientes reumáticos / Pre and post-surgical recommendations in rheumatic patients

El acto quirúrgico constituye un elemento de estrés, principalmente en pacientes con enfermedades reumáticas en los que la actividad quirúrgica presenta características distintivas. Mantener un adecuado control de la actividad clínica de los pacientes con enfermedad reumática constituye un pilar fundamental para la recuperación posquirúrgica de las personas sometidas a cirugía electiva. Para ello es necesario orientar correctamente a los pacientes reumáticos tanto en el preoperatorio como en el posoperatorio. Solo de esta forma se logrará una adecuada recuperación quirúrgica sin poner en riesgo el control de la enfermedad reumática. El siguiente reporte tiene como objetivo describir las recomendaciones pre- y posquirúrgicas de la cirugía electiva en pacientes con enfermedades reumáticas, lo que permitirá orientar correctamente a las personas y disminuir la morbilidad relacionada con la realización de procedimientos quirúrgicos en los pacientes diagnosticados con enfermedades reumáticas(AU)

The surgical act constitutes an element of stress, mainly in patients with rheumatic diseases in whom the surgical activity presents distinctive characteristics. Maintaining adequate control of the clinical activity of patients with rheumatic disease constitutes a fundamental pillar for the post-surgical recovery of people undergoing elective surgery. For this, it is necessary to correctly guide rheumatic patients both preoperatively and postoperatively. Only from this will an adequate surgical recovery be achieved without jeopardizing the control of the rheumatic disease. The objective of the following report is to describe the pre and post-surgical recommendations for elective surgery in patients with rheumatic diseases, which will allow people to be correctly oriented and reduce the morbidity related to the performance of surgical procedures in patients diagnosed with rheumatic diseases(AU)

Qual o papel dos testes rápidos de diagnóstico de COVID-19 IgM/IgG no pré-operatório de cirurgia plástica estética? / What is the role of rapid diagnostic tests for COVID-19 IgM/IgG in the pre-operative period of cosmetic plastic surgery?

Introdução: A doença pelo novo coronavírus 2019 (COVID-19) surgiu na China e se espalhou globalmente com transmissão mundial sustentada de humano para humano. Os testes de diagnóstico rápido COVID-19 IgM/IgG realizados no momento da admissão hospitalar, antes de cirurgia eletiva, estão entre os métodos de rastreamento pré-operatórios mais amplamente utilizados. Objetivos: O objetivo deste estudo é avaliar o papel do teste rápido de anticorpos COVID-19 como triagem em pacientes ambulatoriais em cirurgia plástica estética. Métodos: Uma revisão sistemática foi realizada para estudos publicados desde dezembro de 2019, com vários termos de pesquisa relacionados ao teste rápido de anticorpos para COVID-19 e SARS-CoV-2. Os artigos relevantes foram selecionados por meio da avaliação de títulos e resumos. Artigos pertinentes foram revisados. Dados sobre o nível de evidência, sensibilidade e especificidade foram coletados. Resultados: A estratégia de revisão produziu 409 manuscritos. Um total de 357 estudos foram duplicados ou mostraram-se não relevantes para a questão de pesquisa. Entre os artigos restantes, 28 eram estudos sem informações sobre precisão e 24 eram manuscritos descrevendo medidas de precisão. A sensibilidade variou de 18,4 a 100%, o valor preditivo positivo variou entre 19,7 e 100%, a especificidade variou entre 94 e 100%, e o valor preditivo negativo ficou entre 20 e 100%. Conclusão: Os testes de diagnóstico rápido COVID-19 IgM/IgG podem ser imprecisos. Não encontramos nenhuma evidência para apoiar o teste rápido de anticorpos COVID-19 ou SARS-CoV-2 para pacientes ambulatoriais em cirurgia plástica estética.

Introduction: The disease by the new coronavirus 2019 (COVID-19) emerged in China and spread globally with sustained worldwide transmission from human to human. The COVID-19 IgM/IgG rapid diagnostic tests performed at the time of hospital admission, before elective surgery, are among the most widely used pre-operative screening methods. Objectives: This study aims to evaluate the role of the rapid test of COVID-19 antibodies as screening in outpatients in aesthetic plastic surgery. Methods: A systematic review was carried out for studies published since December 2019, with several search terms related to the rapid antibody test for COVID-19 and SARS-CoV-2. The relevant articles were selected through the evaluation of titles and abstracts. Relevant articles have been revised. Data on the level of evidence, sensitivity, and specificity were collected. Results: The review strategy produced 409 manuscripts. A total of 357 studies were duplicated or proved to be irrelevant to the research question. Among the remaining articles, 28 were studies without precision information, and 24 were manuscripts describing precision measures. The sensitivity varied from 18.4 to 100%; the positive predictive value between 19.7 and 100%; specificity between 94 and 100%; and the negative predictive value between 20 and 100%. Conclusion: COVID-19 IgM / IgG rapid diagnostic tests may be inaccurate. We found no evidence to support the rapid antibody test COVID-19 or SARS-CoV-2 for outpatients in cosmetic plastic surgery.

Correlation between Surgical Risk Scales with Respiratory Muscle Strength and Functional Independence in Patients Submitted to Coronary Artery Bypass Grafting

Abstract Background The European Heart Surgery Risk Assessment System (EuroSCORE) and InsCor have been used to predict complications of cardiac surgery. However, their application to predict lung function and functionality is still uncertain. Objective To correlate surgical risk scales with functional independence and pulmonary function in patients undergoing coronary artery bypass grafting. Methods This was a prospective cohort study. In the preoperative period, the two surgical scales were applied, the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak expiratory flow (PEF) were measured, and functionality was assessed using the functional independence measure (FIM). On the seventh postoperative day, the pulmonary function and functionality variables were reevaluated, compared with the preoperative values (delta) and correlated with the risk scales. Correlations of pulmonary function, functional independence and muscle strength variables with the surgical scales were made by Pearson correlation test. The significance level adopted was 5%. Results Thirty-one patients were studied; most were male (77%), with a mean age of 56±8 years. Mean EuroSCORE was 2.3±0.5 and mean InsCOR was 1.2±0.5. MIP, MEP, and PEF reduced 30% (p<0.001), 33% (p<0.001) and 10% (p=0.23), respectively. The EuroSCORE correlated with MIP (r-0.78; p = 0.02) and FIM (r-0.79; p <0.01), and the InsCor correlated with MIP (r-0.77), MEP (r-0.73) and MIF (r-0.89; p=0.02). Conclusion The EuroSCORE showed a strong negative correlation with MIP and FIM, while InsCor had a strong negative correlation with MIP, MEP and FIM. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Ciclo pdca para elaboração de checklist de segurança cirúrgica / Pdca cycle for preparing a surgical safety checklist* / Ciclo pdca para elaboración de checklist de seguridad quirúrgica

O estudo objetivou utilizar metodologia de melhoria contínua da qualidade na elaboração de checklist de segurança cirúrgica para os períodos pré e pós-operatório em unidades de internação. Realizou-se pesquisa participante com 16 enfermeiras, em oito unidades cirúrgicas de um hospital universitário do sul do Brasil, entre março de 2013 e outubro de 2014. A elaboração conjunta do checklist foi norteada pelo ciclo de melhoria contínua e Programa Cirurgias Seguras Salvam Vidas. O checklist foi submetido a teste piloto com 450 instrumentos preenchidos e analisados por estatística descritiva. Após ajustes decorrentes da avaliação, foi aprovado com o título "Checklist de Segurança Cirúrgica Pré e Pós-operatório", com 85 indicadores agrupados em seis categorias: I) Identificação, II) Pré-operatório, III) Pós-operatório Imediato, IV) Pós-Operatório Mediato, V) Complicações e VI) Alta Hospitalar/transferência. O instrumento pode contribuir para ações preventivas de erros, monitorar sinais e sintomas e produzir indicadores para assistência segura ao paciente cirúrgico (AU).

The aim of this study was to use the continuous quality improvement methodology in preparing a surgical safety checklist for the pre- and postoperative periods in inpatient units. The research was carried out with 16 nurses participating from 8 surgical units at a university hospital in south Brazil between March 2013 and October 2014. The joint elaboration of the checklist was guided by the continuous improvement cycle and by the Safe Surgery Saves Lives program. The checklist was subjected to a pilot test with 450 instruments filled out and analyzed by descriptive statistics. After adjustments made from the evaluation, it was approved with the title "Pre- and Postoperative Surgical Safety Checklist" with 85 indicators grouped into 6 categories: I) Identification, II) Pre-operative, III) Immediate Postoperative, IV) Mediate Postoperative, V) Complications, and VI) Hospital Discharge/transfer. The instrument can contribute to preventive actions of errors, monitor signs and symptoms, and produce indicators for safe assistance for the surgical patient (AU).

El estudio objetivó utilizar metodología de mejora continua de calidad para elaborar un checklist de seguridad quirúrgica para los períodos pre y posoperatorio en unidades de internación. Se realizó investigación participante con dieciséis enfermeras en ocho quirófanos de hospital universitario del sur de Brasil, de marzo 2013 a octubre 2014. La elaboración conjunta del checklist estuvo orientada por el ciclo de mejora continua y el Programa Cirurgias Seguras Salvam Vidas. El checklist fue sometido a prueba piloto con 450 instrumentos completados y analizados por estadística descriptiva. Luego de ajustes determinados por la evaluación, fue aprobado como "Checklist de Seguridad Quirúrgica Pre y Posoperatoria", con 85 indicadores agrupados en seis categorías: I) Identificación, II) Preoperatorio, III) Posoperatorio Inmediato, IV) Posoperatorio Mediato, V) Complicaciones, y VI) Alta Hospitalaria/ Transferencia. El instrumento puede contribuir en acciones preventivas de errores, a monitorear signos y síntomas y a producir indicadores para atención segura del paciente quirúrgico (AU).

Perceived needs of patients undergoing coronary artery bypass graft surgery during perioperative period

Introduction: Perioperative care is nursing care provided by perioperative nurses to surgical patients during the perioperative period. Its role is important as patients especially those who had undergone coronary artery bypass graft (CABG) surgery encounter high levels of psychological and physical stress. Objective: To determine the needs of CABG patients throughout the perioperative period and how well those needs were met. Methods: This is a cross sectional descriptive survey. A total of 88 patients who had undergone coronary artery bypass graft were recruited through census sampling. The instrument which was adapted and used with permission for this study was “Survey of Patient Needs and Experiences during the Perioperative Period’ questionnaire (Davis et al., 2014). Results: The patients perceived the perioperative needs in the post-anaesthesia care unit area to be the most important (M = 2.89, SD = 0.06). Perioperative needs which were rated the highest for each of the four time periods were “Having information about the surgical procedure itself”, “Having your family member or significant other with you in the pre-surgical area complications”, “Being treated with respect and with dignity by hospital personnel” and “Having your family member or significant other visit you in the recovery room”. Overall, patients perceived their needs during perioperative period to be partly met (M = 2.73, SD = 0.07) with post-anaesthesia care unit area being rated the highest (M = 2.81, SD = 0.06). Conclusion: The results of this study highlighted the perceived needs of patients undergoing coronary artery bypass graft surgery throughout their perioperative period. In order to improve the quality of perioperative care for patients, nurses need to take into consideration the important needs identified by the patients and address the items which were not meeting the needs of the patients.

Autocuidado no pré-operatório de revascularização miocárdica: um estudo descritivo / Self-care during the coronary artery bypass graft preoperative period: a descriptive study / Autocuidado en el preoperatorio de revascularización miocárdica: un estudio descriptivo

OBJETIVO: relacionar os fatores condicionantes básicos do autocuidado à capacidade de autocuidado no pré-operatório de revascularização miocárdica. MÉTODO: pesquisa descritiva, transversal, tendo como referencial a Teoria do Autocuidado. Coletaram-se dados de 62 participantes por meio de entrevista individual. Aplicaram-se testes para análise de proporções, para comparação de médias e o modelo de regressão de Poisson. RESULTADOS: a capacidade de autocuidado foi de 87,5 (±10,5), relacionando-se à renda e à idade dos participantes. DISCUSSÃO: a associação entre os fatores estudados e a capacidade de autocuidado pode revelar uma habilidade para adaptação e enfrentamento de problemas cardiovasculares, que demandam procedimentos cirúrgicos. CONCLUSÃO: a aplicação da Teoria do Autocuidado é uma possibilidade em indivíduos no pré-operatório de revascularização miocárdica, fortalecendo a integração entre pesquisa, prática e teoria, contribuindo na delimitação, no norteamento e na autonomia do processo de trabalho em Enfermagem.

AIM: to relate the basic conditioning factors of self-care to the self-care capability of patients in the preoperative period of coronary artery bypass graft (CABG). METHOD: a descriptive, cross-sectional study, using the Self Care Theory as a reference. Data from 62 participants were collected through individual interviews. Tests were applied to analyze ratios comparing the means and using the Poisson regression model. RESULTS: The self-care capability was 87.5% (± 10.5) and was related to income and the age of the participants. DISCUSSION: the association between treatment and self-care capability may relate to an ability to adapt to, and cope with, cardiovascular problems that require surgical procedures. CONCLUSION: The application of Self-Care Theory is a possibility for patients in the CABG preoperative period. This strengthens the integration between research, theory and practice, and contributes to the definition and autonomy of the work process in nursing.

OBJETIVO: relacionar los factores condicionantes básicos del autocuidado a la capacidad de autocuidado en el preoperatorio de revascularización miocárdica. MÉTODO: pesquisa descriptiva, transversal, teniendo como referencial la Teoría del Autocuidado. Se recogieron datos de 62 participantes por medio de entrevista individual. Se aplicaron tests para análisis de proporciones, para la comparación de medias y el modelo de regresión de Poisson. RESULTADOS: la capacidad de autocuidado fue de 87,5 (±10,5), relacionándose al ingreso y a la edad de los participantes. DISCUSIÓN: la asociación entre los factores estudiados y la capacidad de autocuidado puede revelar una habilidad para la adaptación y enfrentamiento de problemas cardiovasculares, que demandan procedimientos quirúrgicos. CONCLUSIÓN: la aplicación de la Teoría del Autocuidado es una posibilidad en individuos en el preoperatorio de revascularización miocárdica, fortaleciendo la integración entre búsqueda, práctica y teoría, contribuyendo a la delimitación, en el norteamiento y en la autonomía del proceso del trabajo en Enfermería.

nfluences of DNA Ploidy and Pre-operative CEA Level on the 5 Year Survival Rate in Colorectal Cancer

PURPOSE: The role of DNA ploidy in colon cancer as a prognostic factor and the correlation of DNA ploidy with the established prognostic factors have been studied for the past 20 years. The purpose of this study was to look into the correlation of DNA ploidy with the prognostic factors and to assess the influence of pre-operative CEA level and DNA ploidy on survival in colorectal cancer. METHODS: A total of 319 patients with colorectal cancer received radical operations, and DNA flow cytometric analyses of DNA ploidy patterns were performed at the Department of Surgery, Inha University Hospital, from June 1996 to July 2002. The patients were divided into 2 groups according to the DNA ploidy patterns. RESULTS: The DNA ploidies of the colorectal tumors were compared to various prognostic factors, the pre-operative CEA level and lymph-node metastasis. The latter two showed correlations to the DNA ploidy. The 5-year survival rate for patients with a normal pre-operative CEA level and DNA diploidy was 85.6% compared to 47.8% for patients with both high pre-operative CEA level and DNA aneuploidy, a statistically significant correlation (P= 0.0003). CONCLUSIONS: This study suggests that DNA ploidy in patients with colon cancer has a significant correlation with pre-operative CEA level and lymph-node metastasis. Especially, the pre-operative CEA level and DNA ploidy in patients with colorectal cancer may play a role as useful prognostic factors.

Unidade de Transplante: relato de experiência sobre as ações da enfermeira no cuidado do paciente em pré-operatório de transplante de pâncreas / Transplant unit: report of experience in nursing unidad de transplante: relato de la experiencia actions in pancreas transplant pre-operative care / De las acciones de enfermería em el cuidado del paciente en preoperatorio de transplante de páncreas

O presente trabalho discorre sobre a experiência do enfermeiro junto aos pacientes em pré-operatório de transplante de pâncreas em um hospital geral de grande porte de Belo Horizonte. Neste estudo, a autora relata desde as ações na primeira consulta até o encaminhamento à Unidade de Centro Cirúrgico

This study reports about nurse's experience in pancreas transplantation recipients and the pre-operative protocol in a general hospital at Belo Horizonte. It specifies the steps from the first appoitment up to arrival at the Unit Cirurgical

El actual trabajo transcurre en la experiencia junto del cuidado a los pacientes en diario paga-operatorio del transplante de páncreas en un hospital general de la mayor parte de Belo Horizonte. En este estudio, el autor dice desde acciones en la primera consulta hasta la guía a la unidad del centro quirúrgico