Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta-analysis.

BACKGROUND: Pelvic floor muscle training (PFMT) is reportedly able to reduce risk factors for perineal trauma. However, the effects of these exercises on perineal injuries are unclear. OBJECTIVE: To investigate the effectiveness of PFMT in the prevention of perineal laceration. SEARCH STRATEGY: Searches were conducted in PubMed/Medline, LILACS, Scopus, Cochrane Library, Web of Science, and CINAHL. For search strategies, we combined the terms PFMT, tear, laceration, perineum, and delivery. SELECTION CRITERIA: We included randomized controlled trials that evaluated the effectiveness of PFMT for the prevention of perineal laceration during vaginal delivery. There were no period or language limitations. DATA COLLECTION AND ANALYSIS: We conducted data extraction and synthesis. We performed a quality appraisal, a qualitative synthesis, and for meta-analysis we used the Software R. MAIN RESULTS: Nine studies were included. In most studies, PFMT was performed daily, with a wide range of the number of contractions and sustainability. Prevalence of perineal laceration had a wide range and information on laceration degree was limited. Meta-analysis showed that PFMT was not effective to prevent perineal laceration. CONCLUSION: Pelvic floor muscle training does not prevent perineal laceration. Further studies are needed to investigate different protocols and interventions.

Caracterização alimentar de crianças com cardiopatias congênitas / Caracterización alimentaria de los niños con cardiopatías congénitas / Food characteristics of children with congenital heart disease

Caracterizar dados sociodemográficos e história alimentar das crianças portadoras de cardiopatias congênitas com até 24 meses de vida. Estudo transversal e observacional desenvolvido em duas instituições de saúde: ambulatorial e hospitalar. Coleta de dados em janeiro a junho de 2009, utilizando formulário contendo dados sociodemográficos, dados relativos à situação de saúde-doença e dados da história alimentar das crianças. Respeitaram-se os aspectos éticos. Avaliaram-se 132 crianças predominantemente de Fortaleza-CE, sexo masculino, mediana até 8,5 meses de vida. A história alimentar evidenciou uso de leite industrializado e complementos alimentares (49,6 por cento), leite materno (11,9 por cento) e leite materno com leite industrializado (7,7 por cento). Problemas durante alimentação: náuseas, vômitos, refuxo gastroesofágico, tosse, dispnéia e cianose. Segundo as mães, as crianças apresentavam apetite preservado (74,2 por cento) e sem dificuldades de mastigação, sucção e deglutição (93,8 por cento. Para minimizar o problema da desnutrição dessas crianças, os enfermeiros podem atuar de forma decisiva mediante o ajuste de medidas alimentares da criança consoante adequação do hábito alimentar.

Objective: To characterize the demographics and dietary history of children up to 24 months old with congenital heart disease. Methodology: Cross-sectional observational study carried out in a Hospital and Ambulatory care setting. Data Collection was conducted from January to June 2009 using a form that includes the socio demographic characteristics, health and disease status and feeding history of children, as well. Ethical aspects were observed. Results: From the 132 children evaluated, most of them were predominantly from Fortaleza, male, and median age of 8.5 months. The feeding history revealed intakes of industrialized milk and food supplements (49.6 percent), breastfeeding (11.9 percent), and breastfeeding along with industrialized milk (7.7 percent). Problems during feeding: nausea, vomiting, gastroesophageal refux, cough, dyspnoea and cyanosis. According to the mothers, children had preserved appetite (74.2 percent) and no difficulty for chewing, sucking and swallowing (93.8 percent). Conclusion: In order to minimize malnutrition problem in these children, nurses can act decisively by adjusting diet measures depending on the adequacy of child feeding practices.

Objetivo: Caracterizar condiciones sociodemograficas y la historia de la alimentación de los niños con cardiopatías congénitas hasta los 24 meses de vida. Material y método: Estudio transversal y observacional desarrollado en dos instituciones de salud: ambulatoria y hospitalaria. Recolección de datos desde enero a junio de 2009 utilizando un formulario que recoge las características sociodemográficas, datos sobre la situación de salud y enfermedad y acerca de la historia alimentaria de los niños Los aspectos éticos fueron respetados. Se evaluaron 132 niños predominantemente de Fortaleza-CE, varones, con mediana hasta 8,5 meses de vida. La historia alimentaria reveló el uso de leche industrializada y complementos alimenticios (49,6 por ciento), leche materna (11,9 por ciento) y la leche materna con leche industrializada (7,7 por ciento). Problemas durante la alimentación: náuseas, vómitos, reflujo gastroesofágico, tos, disnea y cianosis. De acuerdo con las madres, los niños presentaban apetito conservado (74,2 por ciento) y sin dificultad para masticación, succión y deglución (93,8 por ciento). Para minimizar el problema de la desnutrición de estos niños, los enfermeros pueden actuar de manera decisiva mediante el ajuste de las medidas alimentarias de niños en función de la adecuación del hábito alimentario.

Risk for decreased cardiac output: validation of a proposal for nursing diagnosis.

AIM: To verify the content validity of the nursing diagnosis risk for decreased cardiac output (RDCO). BACKGROUND: DCO is a phenomenon that is not restricted to individuals or environments that specifically focus on cardiovascular care. It is not only prevalent in cardiovascular care units, but also in post-anaesthesia units and non-cardiac care units among individuals with non-cardiogenic disorders. A significant decrease in cardiac output is a life-threatening situation, demonstrating the need for developing a risk nursing diagnosis for early intervention. The development of this diagnosis requires the construction of a diagnosis label, a definition of the diagnostic concept and the risk factors associated with the diagnosis. METHODS: The research was carried out in two methodological stages based on the Fehring diagnosis content validation model. The quantitative analysis consisted of the calculation of the weighted mean of the values attributed by experts to each risk factor, the level of agreement/disagreement between the experts regarding the operational definitions of risk factors and the index of diagnostic content validity (DCV). RESULTS: The label 'risk for decreased cardiac output' was considered representative of a nursing diagnosis defined as 'at risk of developing a health status characterized by an insufficient quantity of blood pumped by the heart to meet physical metabolic demands'. Critical risk factors (DCV ≥ 0·7) were myocardial dysfunction (0·887), blood loss (0·875), increase in intrapericardial pressure (0·825), condition that leads to changes in cardiac rhythm and/or electrical conduction (0·812), deficient fluid volume (0·725), plasma loss (0·712), ineffective tissue perfusion (0·712) and electrolyte imbalance (0·7). CONCLUSIONS: The research identified eight risk factors with valid content for assessment of RDCO. IMPLICATIONS FOR NURSING PRACTICE: The identification of risk factors for DCO assists nurses to intervene early and minimize the consequences of a deficient cardiac function.

[Nursing diagnoses in children with congenital heart disease: differences by gender and age]. / Diagnósticos enfermeros en niños con cardiopatías congénitas: diferencias por género y edad.

AIMS: To assess the relationship between gender and age and development of nursing diagnoses in children with congenital heart disease. METHOD: Cross-sectional study conducted on forty five children with congenital heart disease. Those nursing diagnoses with a frequency greater than 50% were selected for the association analysis, to which the chi-squared or Fisher tests were applied. The Levene test for homogeneity of variance and then the t-test was used to compare the mean age between children with and without the nursing diagnosis. RESULTS: The children had mean age of 4.74 months (SD=3.78 months) and 66.7% (30) were boys. The female gender was associated with the nursing diagnosis activity intolerance (P=.009) and delayed growth and development (P=.013). The presence of the nursing diagnoses impaired gas exchange, ineffective breathing pattern, ineffective tissue perfusion, decreased cardiac output and activity intolerance was associated with younger children. On the other hand, the children who presented risk of infection and delayed growth and development had higher mean of age. CONCLUSIONS: The population of girls had a higher risk for activity intolerance and delayed growth and development. Furthermore, younger children showed a higher risk for diagnoses related to respiratory and cardiovascular problems.

Validación de juego educativo para la enseñanza de la valoración cardiovascular / Validation of an educational game for teaching cardiovascular assessment / Validação de jogo educativo para o ensino da valoração cardiovascular

Objetivo: evaluar un material educativo utilizado como recurso didáctico para apoyo a la enseñanza de la valoración cardiovascular. Metodología: el material educativo fue analizado por enfermeros expertos en cardiovascular y se aplicó a 30 estudiantes de enfermería de la Universidad Federal del Ceará (Brasil), en el período de enero a junio de 2006. Para el análisis de la consistencia interna fue calculado el coeficiente alfa de Cronbach. Para estudiar el rendimiento de los alumnos, se compararon los puntajes de una prueba que evaluaba el tema enseñado, antes y después de la intervención. Resultados: todos los expertos destacaron que el juego presenta consonancia, interactividad, coherencia, validez pedagógica y que motiva al alumno a participar en su proceso de aprendizaje. La diferencia de las medias de las evaluaciones pre y post intervención fue estadísticamente significativa. Conclusión: Se confirmó la validez y aplicabilidad del uso del juego como recurso pedagógico.

Objective: to evaluate an educational material used as a didactic resource to support the teaching of cardiovascular assessment. Methodology: the educational material was analyzed by experts in cardiovascular nursing and applied to 30 nursing students at the Federal University of Ceara (Brazil) in the period January - June of 2006. To analyze the internal consistency Cronbach alpha coefficient was calculated. To analyze the students performance the scores of a test that evaluated the taught topic applied before and after the intervention were compared. Results: all the experts highlighted that the game features are consistent, is interactive, coherent, has pedagogic validity and allowed the student to participate in his learning process. The direffence in the means of the pre and post intervension assessment was statistically significant. Conclusion: the validity and applicability of the game as a pedagogic resource was confirmed.

Objetivo: avaliar um material educativo utilizado como recurso didático para apoio ao ensino da valoração cardiovascular. Metodologia: o material educativo foi analisado por enfermeiros experientes em cardiovascular e se aplicou a 30 estudantes de enfermagem da Universidade Federal do Ceará (Brasil) no período dejaneiro a junho de 2006. Para análise da consistência interna foi calculado o coeficiente alfa de Cronbach. Para analisar o rendimento dos alunos se compararam as pontuações de uma prova que avaliava o tema ensinado antes e depois da intervenção. Resultados: todos os experientes destacaram que o jogo apresenta consonância, interatividade, coerência, validez pedagógica e que fazia participar ao aluno em seu processo de aprendizagem. A diferença das médias das avaliações pré e pós intervenção foi estatisticamente significante. Conclusão: confirmou-se a validez e aplicabilidade do uso do jogo como recurso pedagógico.

Nursing diagnoses in children with congenital heart disease: a survival analysis.

PURPOSE: To analyze the relationship between nursing diagnoses and survival rates in children with congenital heart disease. METHODS: A total of 270 observations were carried out in 45 children with congenital heart disease who were followed for 15 days. FINDINGS: Differences in mean survival times were identified in children not more than 4 months of age with respect to the following diagnoses: impaired gas exchange, ineffective breathing pattern, activity intolerance, delayed growth and development, and decreased cardiac output. CONCLUSIONS: The main diagnoses are identified early in the hospitalization period and are conditions resulting from hemodynamic alterations and prescribed medical treatment. IMPLICATIONS FOR NURSING PRACTICE: Congenital heart disease provokes serious hemodynamic alterations that generate human responses, which should be treated proactively.

Evaluation of the growth percentiles of children with congenital heart disease.

The purpose of this study was to evaluate the correlation between anthropometric measures of children with congenital heart disease with percentiles that represent their growth indicators. Anthropometric evaluations of 135 hospitalized children with congenital heart disease were performed in a hospital specialized in cardiac diseases in Fortaleza, CE, Brazil. For the growth evaluation, percentiles of height by age, weight by height and weight by age were calculated. Children's average age was 4.74 months (+ 3.78) and 66.7% of the children were male. The medians of the three percentiles presented values below percentile 10, indicating a high proportion of values considered of risk. The subscapular thickness presented positive correlation with the three percentiles. The values of percentiles studied indicated growth delay.