Risk factors, diagnostic methods and treatment of infection in adult patients undergoing left ventricular assist device implantation: A scoping review.

BACKGROUND: Evidence on infection risk factors is scarce, and precise localization of the site of infection and its treatment remain clinically challenging. OBJECTIVES: This study aimed to map the recommendations for adult patients undergoing left ventricular assist device implantation. DESIGN: This is a scoping review, registered in the Open Science Framework under DOI10.17605/OSF.IO/Q76B3(https://osf.io/q76b3/). METHOD: This is a scoping review limited to the period between 2015 and 2022.The results of this scoping review are discussed and presented separately in 3 articles. This second paper synthesizes research evidence on the risk factors, diagnostic methods and treatment of infection in adult patients undergoing left ventricular assist device implantation. RESULTS: The initial searches identified 771 studies. Sixty-nine patients met the eligibility criteria and were included in the scoping review. Forty-three articles addressing the risk factors, diagnosis and treatment of infection were included to answer the questions of this review. CONCLUSION: Obesity has been shown to be the most common risk factor for the described process of infection by left ventricular assist devices.18F-fluorodeoxyglucose positron emission tomography showed high sensitivity in detecting cardiac device infection, and labeled leukocyte or gallium citrate-67 scintigraphy showed high specificity for left ventricular assist device infections; therefore, it can help differentiate infection from inflammation, particularly in patients with equivocal fluorodeoxyglucose positron emission tomography. Also, this review brings and discusses the limitations and strengths of diagnostic tests, the knowledge regarding the risk factors for left ventricular assist device infection, the therapeutic heterogeneity, the methodological issues of the studies, and the vast opportunity for future research on left ventricular assist device. IMPLICATIONS FOR CLINICAL PRACTICE: Ventricular assist device professionals should evaluate risk factors prior to device implantation and periodically.18F-fluorodeoxyglucose positron emission tomography should be considered as diagnostic tool in detecting superficial and deep driveline infections. Early treatment, including chronic suppressive therapy and serial surgical debridement, combined with driveline exteriorization and delayed driveline relocation may constitute a potential therapeutic strategy for deep driveline infections.

CONSTIPATION SCORING SYSTEM VALIDATED FOR THE PORTUGUESE LANGUAGE (ÍNDICE DE GRAVIDADE DA CONSTIPAÇÃO INTESTINAL): IS IT RELIABLE IN ASSESSING THE SEVERITY OF INTESTINAL CHRONIC CONSTIPATION IN OUR POPULATION?

BACKGROUND: There is a lack of valid and specific tools to measure chronic constipation severity in Brazil. AIMS: To validate the Constipation Scoring System for Brazilian spoken Portuguese. METHODS: Translation, cultural adaptation, and validation itself (reliability and convergent and divergent validation). Translation: definitive version from the original version's translation and evaluation by specialists. Cultural adaptation: score content analysis of the definitive version, as an interview to patients. Interobserver reliability: application by two researchers on the same day. Intraobserver reliability: same researcher at different times, in a 7-day interval. Divergent validation: non-constipated volunteers. Convergent validation: two groups, good response to clinical treatment and refractory to treatment. RESULTS: Cultural adaptation: 81 patients, 89% female, with mean age of 55 and seven years of schooling, and overall content validity index was 96.5%. Inter and intraobserver reliability analysis: 60 patients, 86.7% female, mean age of 56 and six years of schooling, and the respective intraclass correlation coefficients were 0.991 and 0.987, p<0.001. Divergent validation: 40 volunteers, 25 male, mean age of 49 years, and the mean global score was 2. Convergent validation of patients with good response to clinical treatment: 47 patients, 39 female, mean age of 60 and six years of schooling, and the pre- and post-treatment scores were 19 and 8, respectively (p<0.001). Convergent validation of refractory to clinical treatment patients: 75 patients, 70 female, mean age of 53 and seven years of schooling, and the global average score was 22. CONCLUSIONS: The Constipation Scoring System (Índice de Gravidade da Constipação Intestinal) validated for the Brazilian population is a reliable instrument for measuring the severity of intestinal chronic constipation.

Perioperative interventions for the prevention of surgical wound infection in adult patients undergoing left ventricular assist devices implantation: A scoping review.

BACKGROUND: Surgical wound infection is the most frequent type of care health associated infection. Lack of knowledge about the prevention of surgical wound infection in patients undergoing left ventricular assist device implantation could significantly undermine the potential benefits of surgical intervention. OBJECTIVES: This study aimed to map the recommendations for adult patients undergoing left ventricular assist device implantation. DESIGN: This is a scoping review, being registered in the Open Science Framework under DOI https://doi.org/10.17605/OSF.IO/Q76B3 (https://osf.io/q76b3/). METHOD: Left ventricular assist device coordinators and nurse specialists in dermatology and stomatherapy conducted a scoping review in Scopus, The Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), limited to the period between 2015 and 2022. The results of this scoping review will be discussed and presented in separate articles. This paper will synthesize research evidence on the perioperative topic. RESULTS: The initial searches resulted in 771 studies. Sixty nine met the eligibility criteria and were included in the scoping review. Eight articles addressing the perioperative topic that answered the question of this article were included. CONCLUSION: Although this scoping review included heterogeneous, and scarce studies with left ventricular assist device patients. As such, there are many promising future research directions for this topic. IMPLICATIONS FOR CLINICAL PRACTICE: Infection surveillance should be an integral part of left ventricular assist device implantation programs in health care institutions. Velvet completely buried in subcutaneous tissues reduces transmission system infection. Triple tunnel method reduces transmission system infection risk.

Early Diagnosis of 46,XX Testicular Difference of Sexual Development: Unusual Presentation with Increased Nuchal Translucency.

INTRODUCTION: 46,XX testicular disorder of sexual development (DSD) may present prenatally as a mismatch between phenotype and karyotype. Enlarged nuchal translucency is an abnormal sign of many disorders. We present a first trimester fetus with increased nuchal translucency that was later determined to be a 46,XX testicular DSD. CASE PRESENTATION: A first-trimester pregnancy ultrasound revealed enlarged nuchal translucency. Chorionic villous sampling documented a 46,XX karyotype. Subsequent ultrasounds identified male external genitalia. FISH analysis documented a SRY gene translocation. At birth, the infant had normal male internal and external genitalia. CONCLUSIONS: 46,XX testicular DSD may present in the first trimester with an enlarged nuchal translucency.

Comprehensive high-performance thin-layer chromatography analysis of Monteverdia ilicifolia leaf and its adulterants.

The leaves of Monteverdia ilicifolia (syn. Maytenus ilicifolia) are widely used in traditional South American medicine to treat gastrointestinal problems such as gastritis and ulcers. Several herbal products containing the leaves of M. ilicifolia can be found in the market. However, other species with similar leaf morphology are confounding materials, e.g. Monteverdia aquifolia (Celastraceae), Citronella gongonha (Cardiopteridaceae), Jodina rhombifolia (Santalaceae), Sorocea bonplandii (Moraceae) and Zollernia ilicifolia (Fabaceae). This study aimed to identify M. ilicifolia and distinguish it from its potential adulterants using high-performance thin-layer chromatography (HPTLC) technique. Comprehensive HPTLC analysis revealed specific fingerprints that can be used to assess the minimum content of epicatechin and the quality of commercial espinheira-santa samples. The results of the study demonstrated that the HPTLC method is capable of detecting adulterations and distinguishing M. ilicifolia from all confounding materials in commercial products available on the market, showing that most of the products are of poor quality due to adulterations.

Efeito da Tele-enfermagem no Processo Adaptativo de Pessoas Com Estomia Intestinal: Ensaio Clínico / Effect of Telenursing on the Adaptive Process of People With Intestinal Stoma: Clinical Trial / Efecto de la Teleenfermería en el Proceso Adaptativo de Personas Con Estomía Intestinal: Ensayo Clínico

Objetivo:Analisar o efeito da tele-enfermagem no processo adaptativo de pessoas com estomia intestinal. Método: Ensaio clínico randomizado, unicego. Aplicou-se a escala de verificação do nível de adaptação da pessoa com estomia, e formaram-se dois grupos. O grupo controle recebeu atendimento convencional com profissionais do centro de referência, e o grupo intervenção obteve o acompanhamento convencional associado à intervenção complementar via telefone (três chamadas telefônicas realizadas no 20º, 40º e 60º dia após contato inicial). Ao final da intervenção, os participantes foram avaliados novamente pela escala. O recrutamento ocorreu desde o primeiro contato e contou com uma amostra de 16 participantes no grupo intervenção e 17 no grupo controle. Resultados: Notou-se semelhança nos níveis de adaptação no baseline entre os dois grupos, entretanto dados do pós-intervenção demonstraram diferença significante dos grupos no decorrer do estudo e menores valores das médias do grupo controle comparados às medidas do grupo intervenção, indicando maior nível de adaptação no grupo intervenção. Conclusão: O estudo verificou o efeito da tele-enfermagem no processo adaptativo da pessoa com estomia e sugere benefícios no acompanhamento complementar via tele-enfermagem no nível de adaptação de pessoas com estomia de tempo ≤ 12 meses de cirurgia.

Objective: To analyze the effect of telenursing on the adaptive process of people with intestinal ostomy. Method: Randomized, single-blind clinical trial. The verification scale of the level of adaptation of the person with ostomy was applied, and two groups were formed. The control group received conventional care with professionals from the reference center, and the intervention group received conventional follow-up associated with the complementary intervention via telephone (three phone calls on the 20th, 40th and 60th day after initial contact). At the end of the intervention, the participants were evaluated again through the scale. Recruitment occurred from the first contact and had a sample of 16 participants in the intervention group and 17 in the control group. Results: There was a similarity in the levels of adaptation at baseline between the two groups. However, post-intervention data showed a significant difference between the groups during the study and lower values of the means of the control group compared to the measures of the intervention group, demonstrating a higher level of adaptation in the intervention group. Conclusion: The study verified the effect of telenursing on the adaptive process of the person with a stoma and suggests benefits in complementary monitoring via telenursing at the level of adaptation of people with a stoma after ≤ 12 months of surgery.

Objetivo:Analizar el efecto de la teleenfermería en el proceso adaptativo de personas con ostomía intestinal. Método: Ensayo clínico aleatorizado, simple ciego. Se aplicó la Escala de Verificación del Nivel de Adaptación de la Persona con Ostomía y se formaron dos grupos, el grupo control recibió atención convencional con profesionales del centro de referencia y el grupo intervención recibió seguimiento convencional asociado a la intervención complementaria vía telefónica (3 llamadas telefónicas los días 20, 40 y 60 después del contacto inicial). Al final de la intervención, los participantes fueron evaluados nuevamente mediante la escala. El reclutamiento se produjo desde el primer contacto y contó con una muestra de 16 participantes en el grupo de intervención y 17 en el grupo control. Resultados: Hubo similitud en los niveles de adaptación al inicio del estudio entre los dos grupos, sin embargo, los datos posteriores a la intervención mostraron una diferencia significativa entre los grupos durante el estudio y verificaron valores más bajos de las medias del grupo control en comparación con el medidas del grupo de intervención, demostrando un mayor nivel de adaptación en el grupo de intervención. Conclusión: El estudio verificó el efecto de la teleenfermería en el proceso adaptativo de la persona con estoma y sugiere beneficios en el seguimiento complementario a través de la teleenfermería a nivel de adaptación de la persona con estoma después de ≤ 12 meses de la cirugía

The Cardiorenal Effects of Piper amalago Are Mediated by the Nitric Oxide/Cyclic Guanosine Monophosphate Pathway and the Voltage-Dependent Potassium Channels.

Piper amalago L. is used in Brazilian traditional medicine to treat inflammation, chest pain, and anxiety. This study aimed to investigate the safety and the renal and cardiovascular effects of the volatile oil (VO) and the aqueous (AE) and hydroalcoholic (HE) extracts from P. amalago. The gas chromatography-mass spectrometry analyses identified 47 compounds in the VO, with ß-cyclogermacrene, spathulenol, ß-phellandrene, and α-pinene standing out. Among the 47 compounds also found in AE and HE by liquid chromatography-mass spectrometry, glycosylated flavones, organic acids, amino acids, and amides were highlighted. Some examples of these compounds are methoxy-methylenedioxy cis-cinnamoyl pyrrolidine, methoxy-methylenedioxy trans-cinnamoyl pyrrolidine, and cyclobutene-2,4-bis-(1,3-benzodioxol-5-methoxy-6-yl)-1,3-dicarboxapyrrolidide. The acute toxicity experiments were conducted on female rats (n = 5). The cardiorenal assays (n = 8) and evaluations of vasodilatory effects on the mesenteric vascular bed (n = 5) were conducted on male rats. In either extract or VO, there were no mortality or changes in relative weights or histopathological analysis of the organs. Urinary volume and renal electrolyte excretion were elevated significantly during repeated dose 7-day treatment with different preparations from P. amalago. None of the preparations induced hypotension or changes in cardiac electrical activity. Only HE promoted significant vasodilatory effects in rats' isolated mesenteric vascular beds. These effects were completely abolished in the presence of L-NAME plus 4-aminopyridine. Therefore, P. amalago leaves are safe and present diuretic activity after acute and repeated dose administration over 7 days. Moreover, the HE induced significant vasodilator response in rats' mesenteric vascular beds by NO/cGMP pathway and voltage-dependent K+ channels activation.

Deficiencies in reporting inclusion/exclusion criteria and characteristics of patients in randomized controlled trials of therapeutic interventions in pressure injuries: a systematic methodological review.

Wound care is a complex procedure and the related research may include many variables. Deficiencies in the sample inclusion and exclusion criteria may limit the generalizability of randomized controlled trials (RCTs) for wound patients in the real world. This study aimed to evaluate deficiencies in reporting the inclusion and exclusion criteria and the characteristics of patients in RCTs of pressure injuries (PI) therapeutic interventions. We conducted a systematic methodological review in which 40 full text RCTs of PI treatment interventions published in English, from 2008 to 2020, were identified. Data on the general characteristics of the included RCTs and data about inclusion/exclusion criteria and characteristics of patients were collected. The inclusion/exclusion criteria were categorized into five domains (definition of disease, precision, safety, ethical/legal and administrative). Study duration (in weeks) was 8.0 (quartile 1: 2.0; quartile 3: 48.0); only 5.0% of the trials mentioned race, skin colour or ethnicity, and 37.5% reported the duration of the wound. Only 9 (22.5%) studies reported the drugs that the included patients were using and 10 (25.0%) RCTs reported adverse events. The presence of the five domains was observed only in 12.5% of RCTs and only 12 (30.0%) had the precision domain. Much more research is required in systematic assessments of the external validity of trials because there is substantial disparity between the information that is provided by RCTs and the information that is required by clinicians. We concluded that there are deficiencies in reporting of data related to inclusion/exclusion criteria and characteristics of patients of RCTs assessing PI therapeutic interventions.

Authentication and Quality Control of the Brazilian Traditional Herb "Espinheira-Santa" (Monteverdia ilicifolia) by Morpho-Anatomy and Microscopy.

The leaves of Monteverdia ilicifolia (syn. Maytenus ilicifolia), commonly called espinheira-santa, are widely used in South American traditional medicines to treat gastritis and ulcers. Several products labeled as espinheira-santa are sold as dietary supplements in retail stores and via e-commerce. Many different species with similar leaf morphology are often mistaken for Monteverdia ilicifolia and used as espinheira-santa, including Monteverdia aquifolia (Celastraceae), Citronella gongonha (Cardiopteridaceae), Jodina rhombifolia (Santalaceae), Sorocea bonplandii (Moraceae), and Zollernia ilicifolia (Fabaceae). This study aimed to characterize M. ilicifolia and distinguish it from adulterants using morphological and microscopic techniques. In addition, foreign matter and powder characteristics of botanical materials sold as "espinheira-santa" were analyzed. The morphoanatomical studies of the leaves and stems of M. ilicifolia and its five adulterant species have revealed noteworthy features that can help species identification and quality control of commercial espinheira-santa. This study showed that many commercial espinheira-santa materials were adulterated and of inferior quality.

Exploring the mycobiota of bromeliads phytotelmata in Brazilian Campos Rupestres.

The phytotelmata is a water-filled tank on a terrestrial plant, and it plays an important role in bromeliad growth and ecosystem functioning. Even though previous studies have contributed to elucidate the composition of the prokaryotic component of this aquatic ecosystem, its mycobiota (fungal community) is still poorly known. In the present work, ITS2 amplicon deep sequencing was used to examine the fungal communities inhabiting the phytotelmata of two bromeliads species that coexist in a sun-exposed rupestrian field of Southeastern Brazil, namely Aechmea nudicaulis (AN) and Vriesea minarum (VM). Ascomycota was the most abundant phylum in both bromeliads (57.1 and 89.1% in AN and VM respectively, on average), while the others were present in low abundance (< 2%). Mortierellomycota and Glomeromycota were exclusively observed in AN. Beta-diversity analysis showed that samples from each bromeliad significantly clustered together. In conclusion, despite the considerable within-group variation, the results suggested that each bromeliad harbor a distinct fungi community, what could be associated with the physicochemical characteristics of the phytotelmata (mainly total nitrogen, total organic carbon, and total carbon) and plant morphological features.

Oxidized Regenerated Cellulose Versus Calcium Alginate in Controlling Bleeding From Malignant Wounds: A Randomized Controlled Trial.

BACKGROUND: There is no consensus on the best intervention for topical management of bleeding in malignant wounds. Although surgical hemostatic dressings are recommended, the use of calcium alginate (CA) is frequent among practitioners. OBJECTIVE: The aim of this study was to evaluate the hemostatic efficacy of oxidized regenerated cellulose (ORC) and CA dressing in the management of bleeding from malignant wounds resulting from breast cancer. METHODS: This was a randomized open clinical trial. The outcomes measured were total time to hemostasis and the number of hemostatic products used. RESULTS: Sixty-one patients were potentially eligible for the study, 1 did not consent, and 32 were assessed to be ineligible, resulting in a sample of 28 who were randomized to 2 study groups. Total time to hemostasis was 93.8 seconds in the ORC group, with an average of 30.1 seconds (95% confidence interval, 18.6-189 seconds), and 67 seconds in the CA group, with an average of 30.4 seconds (confidence interval, 21.7 seconds to imprecise upper limit). The main difference was 26.8 seconds. Kaplan-Meier log-rank test, and Cox model showed no statistical significance (P = 0.894). A total of 18 hemostatic products were used in the CA group and 34 in the ORC group. No adverse effects were identified. CONCLUSIONS: Although no significant differences were identified in terms of time, more hemostatic products were used in the ORC group, highlighting the effectiveness of CA. IMPLICATIONS FOR PRACTICE: Calcium alginate may be the first choice in the management of bleeding in malignant wounds, favoring nursing in the most immediate hemostatic actions.

Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese.

PURPOSE: To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version. DESIGN: Psychometric (methodologic) evaluation of the instrument. SUBJECTS AND SETTING: Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order. METHODS: The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors. RESULTS: The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study. CONCLUSION: This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.

Gradenigo's Syndrome With Septic Lateral Sinus Thrombosis.

Gradenigo's syndrome (GS) is a rare but life-threatening complication of acute otitis media (AOM). It is classically defined as a clinical triad of acute otitis media, ipsilateral sixth (abducens) nerve palsy, and pain in the distribution of the first and second branches of the trigeminal nerve. Another rare but serious complication of AOM is venous sinus thrombosis, which is often associated with GS. The diagnosis of these conditions requires clinical suspicion, sound interpretation of signs and symptoms, and the use of the correct imaging techniques. Here, we present the case of an 81-year-old man with a previous history of recurrent otitis media, who presented with GS and septic lateral sinus thrombosis. The clinical presentation, physiopathology, and management of these conditions are discussed.

Mycotic Aortic Aneurysm As A Rare Case Of Constipation And Weight Loss.

Mycotic aortic aneurysm is a rare entity, manifesting with nonspecific symptoms of abdominal pain, fever, general malaise. We present a case of an 83-years-old-man, with hematemesis, generalized abdominal pain, and a six-month history of constipation, anorexia, and involuntary weight loss. Upper endoscopy revealed an erosion with oozing hemorrhage and hemostasis was performed. Later he developed a hemorrhagic shock. Abdominal computed tomography disclosed a 3,7x2,5x- 2,5cm aneurysm of the abdominal aorta with an aortoduodenal fistula, inducing an inflammatory plastron that encompassed the descending colon and duodenum. The inflammatory plastron prompted partial duodenal and colonic obstruction and led to an atypical presentation of an aortic aneurysm. Mycotic aneurysms complicated with aorto-enteric fistulas are potentially life-threatening conditions. We highlight the rarity of this case, as the clinical manifestations were prolonged and atypical. The goal is to drive awareness to maintain a high clinical suspicion, as early detection is critical to avoid a tragic outcome.

Incidence and Predictive Factors for Amputations Derived From Charcot's Neuroarthropathy in Persons With Diabetes.

Charcot's neuroarthropathy (CN) is the progressive destruction of the bones and joints of the feet, as a consequence of severe peripheral neuropathy, which predisposes patients to amputations. The purpose of this study was to measure the cumulative incidence of amputations resulting from CN and risk factors among amputated people with diabetes mellitus (DM). This was an epidemiological, observational, and retrospective study of 114 patients with DM who had an amputation involving the lower limbs. Data were collected from 2 specialized outpatient clinics between 2015 and 2019, including socio-demographic and clinical variables (cause of amputation: CN, peripheral arterial disease [PAD], infected ulcers, fracture, osteomyelitis, and others; body mass index [BMI]; 1 or 2 DM, time since DM diagnosis, insulin treatment, glycated hemoglobin; creatinine; smoking and drinking; systemic arterial hypertension, diabetic retinopathy, diabetic kidney disease, diabetic peripheral neuropathy, acute myocardial infarction, PAD, and stroke; characteristics of amputation [level and laterality], in addition to the specific variables related to CN [time of amputation in relation to the diagnosis of CN, diagnosis of CN in the acute phase, and treatment implemented in the acute phase]). We compared socio-demographic and clinical characteristics, including types of amputation, between patients with and without CN. Statistical analyses were performed using the 2 sample t-test or Wilcoxon-Mann-Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the possible association of predictive factors for a CN amputation was carried out through logistic regression. The amputation caused by CN was present in 27 patients with a cumulative incidence of 23.7% in 5 years. There was a statistically significant association between BMI and the occurrence of CN (odds ratio: 1.083; 95% confidence interval: 1.001-1.173; P = .048); higher values of BMI were associated with a higher occurrence of amputations secondary from CN.

Topical therapy for pain management in malignant fungating wounds: A scoping review.

AIMS AND OBJECTIVES: To map and synthesise the existing literature on topical therapies for malignant fungating wounds pain management and the gaps involved. BACKGROUND: Most cancer patients with malignant fungating wounds suffer from wound-related pain, affecting their quality of life. Unfortunately, even though pain is a relevant symptom in cancer and palliative care, little is currently known about topical treatments' availability and impact on pain management. DESIGN: A scoping review following JBI® methodology METHODS: Searches were performed in CINAHL, LILACS, Embase, Web of Science, PubMed, Cochrane, NICE, Scopus, JBISRIR and grey literature, in English, Portuguese and Spanish, with no time limit. Two authors independently reviewed all citations and a third was called in case of divergence, and studies in adults with malignant fungal wounds reporting topical pain interventions were included. In addition, a data extraction tool for synthesis and thematic analysis was developed. This study followed the PRISMA-ScR Checklist. RESULTS: Seventy publications were selected from 796 records retrieved from databases. The studies mainly included non-systematic reviews and case studies with only six clinical trials. According to the narrative synthesis, twenty therapies were identified, including the use of wound dressings (58.6%), analgesic drugs (55.7%), topical antimicrobials (25.7%), skin barriers (15.7%), cryotherapy (5.7%) and negative pressure wound therapy (4.3%). Therapies were recommended to be applied to the wound bed or the periwound skin. In 68.5% of the studies, a standardised assessment for pain was not described. CONCLUSIONS: Topical therapies applied to malignant fungating wounds or periwound areas had been examined for pain management. However, their effectiveness was analysed in a few interventional studies, indicating the need for further primary studies to inform evidence-based practice. IMPLICATION FOR PRACTICE: Highlighted topical therapies for clinical practice consideration are opioids, anaesthetics and antimicrobials, with positive results described in randomised clinical trials. This study did not include patients.

Constipation scoring system validated for the portuguese language (índice de gravidade da constipação intestinal): is it reliable in assessing the severity of intestinal chronic constipation in our population? / O instrumento constipation scoring system validado para a língua portuguesa (índice de gravidade da constipação intestinal): é confiável na avaliação da gravidade da constipação intestinal crônica em nossa população?

ABSTRACT BACKGROUND: There is a lack of valid and specific tools to measure chronic constipation severity in Brazil. AIMS: To validate the Constipation Scoring System for Brazilian spoken Portuguese. METHODS: Translation, cultural adaptation, and validation itself (reliability and convergent and divergent validation). Translation: definitive version from the original version's translation and evaluation by specialists. Cultural adaptation: score content analysis of the definitive version, as an interview to patients. Interobserver reliability: application by two researchers on the same day. Intraobserver reliability: same researcher at different times, in a 7-day interval. Divergent validation: non-constipated volunteers. Convergent validation: two groups, good response to clinical treatment and refractory to treatment. RESULTS: Cultural adaptation: 81 patients, 89% female, with mean age of 55 and seven years of schooling, and overall content validity index was 96.5%. Inter and intraobserver reliability analysis: 60 patients, 86.7% female, mean age of 56 and six years of schooling, and the respective intraclass correlation coefficients were 0.991 and 0.987, p<0.001. Divergent validation: 40 volunteers, 25 male, mean age of 49 years, and the mean global score was 2. Convergent validation of patients with good response to clinical treatment: 47 patients, 39 female, mean age of 60 and six years of schooling, and the pre- and post-treatment scores were 19 and 8, respectively (p<0.001). Convergent validation of refractory to clinical treatment patients: 75 patients, 70 female, mean age of 53 and seven years of schooling, and the global average score was 22. CONCLUSIONS: The Constipation Scoring System (Índice de Gravidade da Constipação Intestinal) validated for the Brazilian population is a reliable instrument for measuring the severity of intestinal chronic constipation.

RESUMO RACIONAL: No Brasil há escassez de instrumentos específicos e validados para a avaliação da gravidade da constipação intestinal crônica. OBJETIVOS: Validar o instrumento Constipation Scoring System para pacientes com constipação crônica. MÉTODOS: Tradução, adaptação cultural e validação propriamente dita. Tradução: versão definitiva a partir de traduções do original avaliadas por especialistas. Adaptação cultural: avaliação do conteúdo por entrevista a pacientes. Confiabilidade interobservadores: entrevista por dois pesquisadores no mesmo dia. Confiabilidade intraobservador: duas entrevistas pelo mesmo pesquisador (intervalo de 7 dias). Validação divergente: voluntários não constipados. Validação convergente: dois grupos, boa resposta e refratários ao tratamento clínico. RESULTADOS: Adaptação cultural: 81 pacientes, sendo 89% do sexo feminino, com média de idade de 55 anos e 7 anos de escolaridade. O índice de validade de conteúdo global foi de 96,5%. Confiabilidade interobservadores e intraobservador: 60 pacientes, sendo 86,7% do sexo feminino, com média de idade de 56 anos e 6 anos de escolaridade. O coeficiente de correlação intraclasse foi de 0,991 e 0,987 (p<0,001), respectivamente. Validação divergente: 40 voluntários, sendo 62,5% do sexo masculino, com média de idade de 49 anos e pontuação média: 0. Validação convergente dos pacientes com boa resposta do tratamento clínico: 47 pacientes, sendo 83% do sexo feminino, com média de idade de 60 anos e 6 anos de escolaridade. Os índices pré e pós-tratamento foram 19 e 8 (p<0,001), respectivamente. Validação convergente dos pacientes refratários ao tratamento clínico: 75 pacientes sendo 93% do sexo feminino, com média de idade de 53 anos e 7 anos escolaridade. A pontuação média foi 22. CONCLUSÕES: O Constipation Scoring System validado para população brasileira (Índice de Gravidade da Constipação Intestinal), é instrumento confiável para a aferição da gravidade da constipação intestinal crônica.

Percepção de alunos de fonoaudiologia e pedagogia acerca das experiências e práticas de leitura e escrita de textos pertencentes ao gênero acadêmico / Perception of speech therapy and education students about their experiences and practices in reading and writing academic genre texts

RESUMO Objetivo Analisar a percepção de alunos dos cursos de Fonoaudiologia e de Pedagogia a respeito de suas experiências e práticas de leitura e escrita de textos pertencentes ao gênero do discurso na esfera acadêmica. Método Pesquisa de caráter quanti-qualitativo, de corte transversal e do tipo analítico. Para o levantamento dos dados, foi aplicado um questionário com perguntas que abrangiam a relação dos alunos com a leitura e com a escrita de textos pertencentes ao gênero acadêmico e as dificuldades enfrentadas no uso desse gênero do discurso. Resultados Muitos alunos supõem que apresentam alguma dificuldade no uso dos gêneros discursivos usados na universidade, o que pode indicar lacunas no trabalho com a linguagem escrita nos níveis de ensino que antecederam sua entrada no Ensino Superior. Alguns discentes referiram que se sentem culpados por não acompanharem, de forma efetiva, as atividades de leitura e de escrita propostas em seus respectivos cursos universitários, subentendendo que isso se deve a um distúrbio inerente aos mesmos. Conclusão Apesar do aumento do número de alunos no Ensino Superior, muitos ainda sentem-se excluídos da vida acadêmica, especialmente, por não usarem, de maneira proficiente, textos próprios deste nível de ensino. Cabe à Universidade e a todos os atores envolvidos na formação superior promoverem ações que considerem o direito a educação de todos os alunos.

ABSTRACT Purpose to analyze the perception of Speech-Therapy and Education undergraduates regarding their experiences and practices in reading and writing texts from academic discourse genres. Methods It´s a mixed crosscut study, with data collected by the application of a semi-structured questionnaire with open and closed questions about students' relation towards reading and writing of academic texts, their difficulties in the use of these genres and how they cope with such difficulties. Results The results show that a significant number of the students assume that they have some difficulty in reading and writing these discourse genres in academic settings, which may be an indication of gaps in working with reading and writing during previous educational levels. Some of these students even blame themselves for not effectively following the reading and writing proposals in higher education, implying that this is due to an intrinsic disorder. Conclusion The data allow us to state that, despite the increase in the number of students in higher education, many still feel excluded from academic life, especially for not using academic discourse genres in a proficient way. It is the University responsibility, along with all actors involved in higher education, to promote actions that consider the right to education for all students.

Diagnóstico de imagem radiológica como protocolo de certificação na prevenção de eventos adversos após sondagem naso/oro enteral / Diagnosis of radiological imaging as a certification protocol in the prevention of adverse events after naso/enteral oro probing / Diagnóstico de la imagen radiológica como protocolo de certificación en la prevención de eventos adversos tras el sondeo naso/enteral oro

Objetivo. Apontar para a forma como a sonda nasoenteral serve a várias finalidades, entre as quais estão a própria alimentação enteral, a administração de drogas, como meio de contraste ou carvão ativado, para fins de aspiração do conteúdo do estômago para descomprimir o estômago de fluido, ar ou sangue, para reduzir o risco de vômito ou aspiração e para outros fins. Método: Revisão de literatura, descritiva exploratória, escolhidas, pois descreve, discute e analisa de forma ampla a literatura publicada sobre o tema, sob o ponto de vista teórico ou contextual a respeito da relevância do diagnóstico por imagem radiológica nestes casos. Resultados: Deve-se garantir a segurança do paciente, para isso é essencial confirmar que a sonda foi introduzida de maneira correta e está no devido local (estômago ou parte do intestino), uma vez que a sonda pode inadvertidamente ter sido inserida nos pulmões, o que pode passar desapercebido em pacientes de alto risco. Conclusão: Deve-se usar a sonda naso/oro para terapia nutricional, além de se prevenir eventos adversos para que o processo seja efetivo.

Objective. Point out how the nasoenteral tube serves various purposes, among which are enteral feeding itself, administration of drugs such as contrast medium or activated charcoal, for the purpose of aspiration of stomach contents to decompress the stomach of fluid, air or blood, to reduce the risk of vomiting or aspiration, and for other purposes. Method: Literature review, descriptive and exploratory, chosen because it describes, discusses and analyzes widely the published literature on the subject, from a theoretical or contextual point of view regarding the relevance of radiological imaging diagnosis in these cases. Results: Patient safety must be ensured, for this it is essential to confirm that the tube has been inserted correctly and is in the right place (stomach or part of the intestine), since the tube may have been inadvertently inserted into the lungs, which may go unnoticed in high-risk patients. Conclusion: The naso/oro tube should be used for nutritional therapy, in addition to preventing adverse events for the process to be effective

Objetivo. Señalar cómo la sonda nasoenteral sirve para varios fines, entre los que se encuentran la alimentación enteral en sí, la administración de fármacos como medio de contraste o carbón activado, con el fin de aspirar el contenido del estómago para descomprimir el estómago de líquido, aire o sangre, para reducir la riesgo de vómito o aspiración, y para otros fines. Método: Revisión bibliográfica, descriptiva y exploratoria, elegida porque describe, discute y analiza ampliamente la literatura publicada sobre el tema, desde un punto de vista teórico o contextual respecto a la relevancia del diagnóstico por imágenes radiológicas en estos casos. Resultados: Se debe garantizar la seguridad del paciente, para ello es fundamental confirmar que la sonda se ha insertado correctamente y está en el lugar correcto (estómago o parte del intestino), ya que la sonda puede haber sido introducida inadvertidamente en los pulmones, que puede pasar desapercibido en pacientes de alto riesgo. Conclusión: La sonda naso/oro debe ser utilizada para la terapia nutricional, además de prevenir eventos adversos para que el proceso sea efectivo.

Prevalence of pressure injury and associated factors in hospitalized adult patients with cancer.

INTRODUCTION: Hospitalized cancer patients experience limitations in their daily activities resulting from the severity of their condition. Such changes alter patients' sensory perception and hinder their mobility, thus predisposing them to the development of PI. OBJECTIVE: The goal of this study was to analyze the prevalence of PI and associated factors in hospitalized cancer patients. MATERIALS AND METHODS: This observational, epidemiological, cross-sectional, descriptive study was carried out in the inpatient and ICU settings of an oncological hospital in São Paulo, Brazil. RESULTS: A total of 341 patients who met the inclusion criteria and agreed to participate in the study were interviewed and assessed. Data obtained in the interviews were analyzed for logistic regression analysis. Pressure injury prevalence was 10% (34 patients). The use of disposable diapers was significantly associated with the development of PI, with a 6.077 increased chance of PI in such patients in the ICU setting. In this epidemiologic study of 341 hospitalized cancer patients, the prevalence of PI was 10%. The use of disposable diapers was the only factor associated with the presence of PI after logistic regression analysis. CONCLUSION: Knowing the risk factors of this specific population was essential to implement actions and optimize indications of disposable diaper use. There is an absence of epidemiologic records due to limited publications available on the subject; creating a program to prevent PI development within the inpatient, assisted population.