Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients: A pilot randomised controlled trial.

BACKGROUND: In patients with short-term percutaneous central venous catheter (CVC), it is recommended that a dressing be applied to the catheter insertion site to prevent catheter-related infections. OBJECTIVES: The objective of this study was to assess the feasibility of a randomised controlled trial to compare the efficacy of chlorhexidine-impregnated dressing with that of polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients with short-term percutaneous CVC. METHODS: One hundred fifteen patients with a CVC were randomised to chlorhexidine-impregnated gel dressing (chlorhexidine gel group) or transparent polyurethane dressing (polyurethane group) between April and December 2014. Feasibility outcomes included data on eligibility, recruitment, missing data, and protocol violation. The primary outcome measure of efficacy was the presence of colonisation with the same microorganism in both the skin swab around catheter insertion site and the catheter tip. RESULTS: Of 526 patients assessed for eligibility, 411 (78%) did not meet inclusion criteria, and 115 (22%) were randomised. Among participants of both groups, there were 14 missing primary outcomes of which 10 were due to failure to collect the catheter tip (a protocol violation). The final sample had 47 and 54 individuals in the chlorhexidine and polyurethane groups, respectively. Skin and catheter tip were colonised by the same microorganism for 13% of the participants in the chlorhexidine group and 8% in the polyurethane group, although the difference was not statistically significant (p = 0.51). There were no differences between the two groups for catheter tip colonisation, skin site colonisation, catheter insertion site infection, catheter-related bloodstream infection, skin irritation, and the number of unplanned dressing changes. CONCLUSIONS: Our preliminary results found that a large randomised controlled trial would be feasible. This study provides valuable information that can be used to design more robust studies to prevent infection among patients with short-term percutaneous CVC when using either chlorhexidine or polyurethane dressing.

A randomized controlled trial of an educational programme to improve self-care in Brazilian patients following percutaneous coronary intervention.

AIMS: To test an educational programme with telephone follow-up to improve self-care in Brazilian patients who underwent percutaneous coronary intervention. BACKGROUND: Percutaneous coronary intervention has been established as a treatment for coronary disease. However, additional intervention is needed to improve self-care for individuals who undergo this procedure to reduce further disease. Telephone follow-up is one strategy that has been used to improve chronic disease self-care. DESIGN: Randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01341093. METHODS: Sixty patients who were preparing for their first percutaneous coronary intervention between 2011-2012 were randomly allocated to an educational programme with telephone follow-up (N = 30) or a control group (N = 30). Perceived health status was assessed with the Medical Outcomes Study 36-Item Short Form. Self-efficacy, symptoms of anxiety and depression and medication adherence were also assessed. Measures were collected before intervention (baseline) and 6 months later. RESULTS: Both groups improved from baseline to 6 months in the 'Physical Component Summary' and in the domains of 'Physical Functioning', 'Role-Emotional' and 'Role-Physical'. The educational programme group showed a reduction in anxiety from baseline to 6-month follow-up, while the control group showed a slight increase. No differences in symptoms in depression and self-efficacy were found and both groups reported high levels of medication adherence. CONCLUSION: The educational programme with telephone follow-up is a promising intervention as it led to reduction in anxiety for those receiving the educational programme. Further improvements in timing and focus of the educational programme, such as targeting emotional and social lifestyle changes, might be warranted.

Reliability of the Cardiac Patients Learning Needs Inventory (CPLNI) for use in Portugal.

AIMS AND OBJECTIVES: To perform the semantic validation and to evaluate the reliability and the presence of ceiling and floor effects of the Cardiac Patients Learning Needs Inventory in Portuguese patients with coronary artery disease. BACKGROUND: Information should be selected based on what patients know and need to learn, which means that the teaching process should be based on each person's needs. The Cardiac Patients Learning Needs Inventory is aimed at identifying the cardiac patients' individual learning needs. DESIGN: Methodological research design. METHODS: Two hundred patients hospitalised at the coronary intensive care unit or at the cardiothoracic surgery unit of a public hospital in Lisbon answered the adapted version of the Cardiac Patients Learning Needs Inventory. Internal consistency was estimated based on Cronbach's alpha. Scores above 0·50 were considered acceptable. Stability was measured through test-retest and calculated using student's t test. Significance was set at 0·05. RESULTS: Patients' mean age was 65 years (SD = 11·8), and most were men (152; 76%). Cronbach's alpha for the total scale was high in the first and second measurement (0·91), and for seven domains, it was acceptable in the first and second measurement (range from 0·50-0·89). No statistically significant difference was found between mean scores on the first and second measurement. Lower diversity was observed in the answers, most of which ranged between important and very important (ceiling-effect). CONCLUSION: The adapted version for use in Portugal maintained the conceptual, semantic and idiomatic equivalences of the original version and showed adequate reliability. RELEVANCE TO CLINICAL PRACTICES: Owing to the lack of validated instruments translated into Portuguese, to measure cardiac patients' learning needs, this study entails important clinical and theoretical implications.

Original research: telephone follow-up for patients after myocardial revascularization: a systematic review.

OBJECTIVE: To identify studies of telephone follow-up conducted with patients who had undergone myocardial revascularization, and to assess and synthesize the results. DESIGN AND METHODS: This is a systematic review; the literature search was conducted in six electronic databases. Controlled descriptors were health education, teaching, myocardial revascularization, coronary artery bypass, angioplasty, telenursing, telephone, and hotlines; the noncontrolled descriptor was needs information. Of 170 identified studies, seven met the inclusion criteria and were selected for analysis. The Jadad scale, which ranges from 0 to 5, was used to assess the methodological quality of studies, with scores of 3 to 5 indicative of higher quality. FINDINGS: Five of the seven studies found statistically significant positive changes in the outcome measures of health-related quality of life, pain, physical functioning, mood symptoms, anxiety, knowledge about self-care measures, medication compliance, and the lipid profile. Four of these five studies had a Jadad score of 3 and were of higher quality. CONCLUSIONS: This review provides nurses and other clinicians with a synthesis of research on telephone follow-up in patients after myocardial revascularization. Of the seven studies analyzed, five showed evidence of some benefit from telephone follow-up. Their findings support the use of telephone follow-up to periodically assess patient knowledge, discuss patient concerns and offer ways to address them, monitor mood symptoms and anxiety levels, and encourage behavioral and lifestyle changes. Although any telephone follow-up intervention must be adapted according to each patient's needs, the lack of similarity among and specific information about the interventions described in the analyzed studies made it difficult to evaluate specific elements. More research is needed to identify optimal content and frequency, number, and duration of calls.