Evaluating antibiotic prophylaxis adherence: Implications for surgical site infections and wound care management.

AIM: This study aimed to evaluate adherence to an antibiotic prophylaxis protocol and its impact on incidence of surgical site infection (SSI). MATERIALS AND METHOD: A prospective observational cohort study was conducted at a teaching hospital in São Paulo, Brazil, from September to November 2015. The population were adults who underwent surgery with surgical antibiotic prophylaxis. The main outcomes measured were incidence of SSI at 30-days postoperatively, protocol adherence and surgical wound complications. STROBE guidelines were followed. RESULTS: Among the 527 participants recruited, a 30-day follow-up was completed by 78.7 % (n = 415). Within this cohort, 57.6 % were females aged over 60 years (36.4 %). The incidence of SSI stood at 9.4 % (n = 39), with dehiscence being the most prevalent complication at 64.1 % (n = 25), followed by increased exudate at 51.3 % (n = 20). Notably, full adherence to the antibiotic prophylaxis protocol was low at 1.7 % (n = 7). The study observed a 60 % increased risk of SSI for every protocol mistake made. Alarmingly, 17.8 % (n = 74) of participants received antibiotic treatment exceeding the stipulated protocol duration. The overall mortality rate stood at 13.5 % (n = 56), with 1 % (n = 4) of these deaths attributed to SSI. CONCLUSION: There is a pressing global necessity to enhance antibiotic management, as underscored by this study's revelation of low adherence to the antibiotic prophylaxis protocol. This lack of adherence correlated with a notable incidence of SSI and subsequent wound complications. Nearly 20 % of participants received prolonged antibiotic treatment. Adhering strictly to the protocol could substantially impact SSI-related outcomes and enhance global antibiotic management.

Holding and restraining children for clinical procedures: A scoping review of health professional reported and observed practice.

Holding and restraining children during non-urgent clinical procedures continues to be surrounded by uncertainty and mired in controversy. This review aimed to locate, appraise and map the evidence related to health professionals reported and observed practice of holding and restraining children, from birth to 16 years, for clinical procedures. This scoping review, conducted in April 2022, was based on the Joanna Briggs Institute protocol. Screening and full text review resulted in the inclusion of 30 papers. In total, 14 different terms were used to refer to the act of holding or restraining a child for a procedure, in many papers the action of holding was not defined. Professionals report the main factors influencing their decisions to use restraint and/or holding were the age of a child, with younger children being restrained or held most frequently; a child's behaviour; and concerns around a child's safety. Professionals also report that they can perceive pressure from parent/carers to hold or restrain their child and describe how holding practices can be influenced by service and organisational pressures. Health professionals, mainly nurses, continue to report ethical and moral tensions linked to their involvement in the restraint or holding of a child against their will for a clinical procedure. Evidence indicates a need to move practice forward as the issues identified in paediatric practice are long-standing and historical.

Developing and validating a 2D digital version of the Brazilian Children's anxiety questionnaire.

PURPOSE: This study aims to transpose the printed Brazilian Children's Anxiety Questionnaire (CAQ BR) into a 2D digital format, validate it with nurses and hospitalized children, and analyze the association between the printed and 2D digital format versions. DESIGN AND METHOD: This is a descriptive and multicentric study, conducted from 2021 to 2022 on working in pediatric care at two hospitals in Brazil. The nurses analyzed the printed and digital instruments and subsequently applied them to a child and proposed suggestions. A cutoff score of 0.80 on the content validity index was used; items that scored an average lower than the CVI in the study were adequate. Eighty children responded to the questionnaires sequentially according to the randomization table. A 90% agreement rate was used. RESULTS: The digital instrument was validated in content by 51 experts, with a CVI of 0.95. Face validation data for 80 children (mean age = 7.9 years) shows a 90% agreement rate. The intraclass correlation index for the general score was 0.87 and 95% CI (0.79-0.91), which shows good stability of the children's responses in both questionnaires. In addition, 59% (n = 47) of the children reported a preference for the digital questionnaire. CONCLUSIONS: The digital CAQ BR can be used as an audiovisual instrument by nurses when implementing the systematization of nursing care in pediatrics. PRACTICAL IMPLICATIONS: The digital 2D version was successfully applied and can be used in hospitals to measure children's self-reported anxiety.

Use of the Virtual Environment as a Strategy for Disseminating Information during the COVID-19 Pandemic.

Background: The virtual environment has democratized information and research in the health area, especially during the coronavirus disease 2019 (COVID-19) pandemic. Purpose: This study analyzed the boosting strategies of social networks and identified the most accessed posts from a previously developed and validated information portal aimed at people with disabilities. Methods: This quantitative, cross-sectional, descriptive, exploratory study used Google Analytics® to collect data on origins and access numbers; boost data were obtained from the Facebook® and Instagram® networks themselves, after the end of each boost. Conclusions: Greater interest in publications related to the acquisition of rights for persons with disabilities and about COVID-19 was identified. The virtual environment, especially social networks in Brazil, proved to be a useful tool for disseminating information during the COVID-19 pandemic, highlighting the importance of boosting access to health information. In addition, the investment in social networks was relevant due to the increase in the number of followers on the page. Implications for Practice: Social networks can be a valuable means of disseminating research, improving access to information based on scientific evidence in an inclusive way.

Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus.

Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020-2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.    Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child. What is Known: • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. • Professionals report uncertainty and tensions in applying evidence-based practice to children's procedural care. What is New: • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives. • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

How parents share and limit their child's access to information about COVID-19: A mixed methods online survey study.

This study aimed to understand the role that parents play in sharing or limiting their child's access to information about coronavirus disease 2019 (COVID-19). A subset of data from an international mixed methods online survey study was analysed to elucidate the findings from Brazil. An online survey, conducted between April and June 2020, gathered closed and open text views from parents of children aged 7-12 years old. Quantitative data were analysed using descriptive statistics. Qualitative open text data were analysed using the three stages of the Bardin content analysis framework: pre-analysis (data organisation and initial full-content reading); exploration of the material (thematic coding to identify major motifs and develop thematic categories) and interpretation (treating the data as significant and valid). The sample consisted of 112 (89%) mothers and 14 (11%) fathers. The analysis of the parents open text resulted in two categories: 'How parents share information with their children about COVID-19' and 'How parents limit information to their children about COVID-19'. Some parents reported adopting an honest and open approach on how they shared information with their children, whilst some parents chose to minimise their child's access to information about the pandemic over concerns of the mortality related to COVID-19.

Educational intervention through a comic book for preoperative anxiety in children, adolescents, and their parents: A randomized clinical trial.

BACKGROUND: Reducing preoperative anxiety can help optimize surgical care. AIM: To analyze the effectiveness of verbal guidance by nurses versus verbal guidance combined with a comic book on preoperative anxiety in children and their parents. METHODS: We conducted a randomized parallel, two-group controlled clinical trial in the pediatric ward and a blinded anxiety assessment in the operating room of a Brazilian hospital. Individuals aged 6-14 years undergoing surgical procedures of up to 4 h for the first time were included in the study. Parents who were adults, literate, and able to communicate verbally were included. The primary outcome was the children's anxiety, measured by the Children Anxiety Questionnaire (CAQ), Visual Analog Scale (VAS), and the modified Yale Preoperative Anxiety Scale (mYPAS); the secondary outcome was the parents' anxiety, assessed by the Hamilton Anxiety Rating Scale. Participants were divided into the intervention (IG; n = 60) and control (CG; n = 60) groups. FINDINGS: The two groups were homogeneous. The median age of the children was 8 years. No significant differences were observed in the CAQ and VAS scores between the two assessment time points or in the mYPAS scores between the IG and CG. However, parents' anxiety significantly decreased in both groups. APPLICATION TO PRACTICE: Preoperative guidance by nurses, either verbal only or verbal information with a comic book proved beneficial in reducing parental anxiety. However, both interventions, performed on the day of surgery, failed to reduce preoperative anxiety in children and adolescents upon admission to the operating room. We recommended the process of preparing the child should begin after scheduling the surgery.

Transcultural adaptation of the children's anxiety questionnaire in Brazil.

AIM: To describe the transcultural adaptation process of the Children's Anxiety Questionnaire (CAQ) for the Brazilian culture. DESIGN: This is a methodological study of cross-cultural adaptation. METHODS: Study conducted in Brazil and Sweden involved the following steps: preparation, translation, synthesis of translations, back-translation and review, and harmonization of the translations by a committee of 13 healthcare professionals using the content validity index (CVI). Cognitive debriefing, using children between 4-10 years old, was completed by 15 children to determine if the images corresponded with their meanings and 17 children to determine if they could understand the Global CAQ after listening. RESULTS: Convergences and discrepancies between the original instrument in Swedish, the English version and the Brazilian translation were compared. The process of culturally adapting the CAQ to Brazilian Portuguese was validated, as demonstrated by a satisfactory S-CVI (0.94) among professionals and an agreement of 95% and above by children.

Development and Validation of an Age-Appropriate Website for Children Requiring Clean Intermittent Catheterization.

PURPOSE: This study describes the development and validation of an age-appropriate website for preschool children who require clean intermittent catheterization (CIC). METHODS: An age-appropriate website was developed at an academic medical center in Brazil and included child-friendly characters, details of the urinary system anatomy and physiology, hand-washing, and the CIC procedure. Content was validated by physicians, nurses, and health informatics professionals. Face validity was assessed by parents. FINDINGS: Content and face validity indices were 0.94 and 0.92, respectively. CONCLUSIONS: The free website (www.doutorbexiga.com.br) was successfully validated and considered suitable and user-friendly for the health education of children requiring CIC. CLINICAL RELEVANCE: Physicians and nurses can use the website as a model for developing similar materials. The website can be a resource for health professionals and parents of children with spinal cord injury or other neurological disorders to encourage children to learn about CIC through animated educational materials.

Construction and validation of a Brazilian educational comic book for pediatric perioperative care.

PURPOSE: Educational material can facilitate familiarization with the hospital and surgical contexts for children and guardians and minimize potential difficulties experienced during hospitalization. This study aimed to construct and validate a comic book for guiding children in perioperative care. DESIGN AND METHODS: A descriptive study was conducted at a pediatric ward in a university hospital in Brazil. A content validity index with a concordance of 0.8 was used for validation. RESULTS: The content was validated with the participation of 19 content judges (nurses, anesthesiologists, and surgeons); face validity was achieved with the participation of 22 parents and their respective children aged 7-12 years old. The contents of the comic book included perioperative care (hospitalization, fasting, surgical team, operating room, and anesthesia). Universal content validity indices of 0.89 and 0.99 were obtained for content and face validity, respectively. Free Portuguese educational material titled "Getting to know the Surgery Center" was created in the form of a 19-page comic book in print and digital formats. The comic book was face and content validated and considered relevant for children in perioperative care. The suggestions of the healthcare professional and families who participated contributed toward the final version of this educational comic book. PRACTICE IMPLICATIONS: This study aimed to further the development of educational materials that help alleviate stress, fear, and anxiety among children awaiting surgery, as well as their parents/guardians. As such, it offers a positive and appropriate contribution to perioperative nursing. The study further contributes to a discussion on pediatric nursing, which goes beyond clinical care and procedure. In the context of pediatric surgery and the children themselves, the results indicate that the family must be included in the surgical process and that the language employed must be appropriate to the target audience. Our comic book can be used by nurses to develop similar resources for diverse needs.

Children's Anxiety and Factors Related to the COVID-19 Pandemic: An Exploratory Study Using the Children's Anxiety Questionnaire and the Numerical Rating Scale.

The repercussions of the COVID-19 pandemic on children's lives deserve attention. This study aimed to assess the prevalence of anxiety among Brazilian children and its associated factors during social distancing during COVID-19. We used a cross-sectional design with an online survey from April to May 2020 in Brazil. We included children aged 6-12 years and their guardians. The Children's Anxiety Questionnaire (CAQ; scores 4-12) and the Numerical Rating Scale (NRS; scores 0-10) were used to measure anxiety. We enrolled 157 girls and 132 boys, with a mean age of 8.84 (±2.05) years; 88.9% of respondents were mothers. Based on CAQ ≥ 9, the prevalence of anxiety was 19.4% (n = 56), and higher among children with parents with essential jobs and those who were social distancing without parents. In logistic regression, the following variables were associated with higher CAQ scores: social distancing without parents; more persons living together in home; and education level of guardians. Based on NRS > 7, the prevalence of anxiety was 21.8% (n = 63); however, no associations with NRS scores were found with the investigated variables. These findings suggest the necessity of implementing public health actions targeting these parents and their children at the population level.

Long-term follow-up of patients undergoing decompressive hemicraniectomy for malignant stroke: Quality of life and caregiver's burden in a real-world setting.

BACKGROUND AND PURPOSE: Decompressive hemicraniectomy is a life-saving procedure for the treatment of space-occupying middle cerebral artery infarctions (malignant stroke); however, patients may survive severely disabled. Comprehensive data on long-term sequelae outside randomized controlled trials are scarce. METHODS: We retrospectively evaluated the survival rates, quality of life, ability to perform activities of daily living, and caregiver burden of 61 patients (aged from 37 to 83) who had previously undergone decompressive hemicraniectomy for malignant stroke between 2012 and 2017. RESULTS: The mortality rate was higher among patients older than 60 years than among younger patients (71.0 % vs 36.7 %, p = 0.007; odds ratio 4.222, 95 % confidence interval 1.443-12.355). The mean survival time was 37.9 ± 6.0 months for 19 survivors of the younger group and 22.6 ± 5.7 months for 9 survivors of the older group. Among the 28 surviving patients, 22 (78.6 %) were interviewed, and we found that age was a determining factor for functional outcome (Barthel indices of 65.7 ± 10.6 for younger patients vs 48.0 ± 9.3 for older patients, p < 0.001), but not for quality of life. The caregiver burden was significantly correlated (R = -0.53, p < 0.01) with the severity of disability and age (R = 0.544, p = 0.011) of the patients. CONCLUSION: Our findings show that the degree of impairment, as well as caregiver burden, is higher in patients older than 60 years than in younger patients.

Evaluating Educational Material from the Perspective of Informal Caregivers of Children with Hydrocephalus: A Qualitative Study.

OBJECTIVE: We evaluated whether educational material about hydrocephalus and its treatment previously developed by health professionals corresponded with the daily life of caregivers of children with hydrocephalus. METHODS: We conducted a qualitative study at a university hospital in Brazil, interviewing 32 informal caregivers of children with hydrocephalus. The methodological framework of Bardin content analysis was used to analyze the data. RESULTS: The educational material adequately represented caregivers' experience regarding daily life, surgery experiences, and care needed by children with hydrocephalus. In addition, the educational material may help to identify the signs and symptoms of ventriculoperitoneal shunt. However, the material did not address the limitations of children disabled with hydrocephalus in daily life. CONCLUSIONS: From the perspective of informal caregivers of children with hydrocephalus, the educational material corresponded with families' daily life and surgical experience and may be used by health professionals to reinforce important points for the care for children with hydrocephalus, facilitating the health education process.

Cirurgias realizadas em idosos em um hospital público do interior de São Paulo / Surgeries performed on elderly patients in a public hospital in the state of São Paulo / Cirugías realizadas en idosos en un hospital público del interior de São Paulo

Objetivo: Identificar a prevalência dos procedimentos cirúrgicos realizados em idosos em um centro cirúrgico de um hospital público do interior do estado de São Paulo e caracterizar tais procedimentos. Método: Estudo transversal, retrospectivo, quantitativo. A amostra constou de 7.483 procedimentos cirúrgicos em idosos, realizados entre 2013 e 2015. Os dados foram coletados a partir do sistema de cirurgia da instituição sede do estudo. Resultados: A faixa etária na qual prevaleceram os procedimentos foi entre 60 e 70 anos de idade; a maior média de tempo para recuperação da anestesia foi entre 71 e 80 anos. As especialidades que mais realizaram procedimentos foram: ortopedia, urologia e oftalmologia. As anestesias mais empregadas foram: geral inalatória, endovenosa, local com sedação e raquideana; 37,3% usaram o serviço de anestesia, porém não estava descrito em prontuário qual foi o tipo de anestesia realizada. Os óbitos decorrentes dos procedimentos ou complicações das cirurgias foram 1.140; três deles ocorreram no centro cirúrgico e os demais, em enfermarias ou unidades de cuidados intensivos. Conclusão: Os dados aqui apresentados reforçam a necessidade de novos modelos de assistência, com melhorias da assistência multidisciplinar geriátrica, no atendimento perioperatório aos pacientes idosos

Objective: To identify the prevalence of surgical procedures performed in the elderly in a surgical center of a public hospital in the state of São Paulo and to characterize such procedures. Method: Cross-sectional, retrospective, quantitative study. The sample consisted of 7,483 surgical procedures performed in the elderly, between 2013 and 2015. Data were collected from the surgical information system of the institution under study. Results: The age range was between 60 and 70 years of age; the highest average anesthesia recovery time was between 71 and 80 years. The specialties that performed the most procedures were: orthopedics, urology and ophthalmology. The most commonly used anesthesias were: general inhalation, intravenous, local with sedation and spinal; 37,3% used anesthesia, however the type was not described in the patient medical records. There were 1,140 deaths resulting from the procedures or complications; three of them occurred in the surgical center, while the others occured in the intensive care unit or ward. Conclusion: The data presented here reinforce the need for new models of care, with improvements in geriatric multidisciplinary care, in perioperative care for the elderly

Objetivo: Identificar la prevalencia de los procedimientos quirúrgicos realizados en ancianos en un centro quirúrgico de un hospital público del interior del estado de São Paulo y caracterizar tales procedimientos. Método: Estudio transversal, retrospectivo, cuantitativo. La muestra constató de 7.483 procedimientos quirúrgicos en ancianos, realizados entre 2013 y 2015. Los datos fueron recolectados a partir del sistema de cirugía de la institución sede del estudio. Resultados: El grupo de edad en el que prevalecieron los procedimientos fue entre 60 y 70 años de edad; la mayor media de tiempo para la recuperación de la anestesia fue entre 71 y 80 años. Las especialidades que más realizaron procedimientos fueron: ortopedia, urología y oftalmología. Las anestesias más empleadas fueron: general inhalatoria, endovenosa, local con sedación y raquídea; 37,3% usaron el servicio de anestesia, pero no estaba descrito en prontuario cuál fue el tipo de anestesia realizada. Las muertes derivadas de los procedimientos o complicaciones de las cirugías fueron 1.140; Y tres de ellos ocurrieron en el centro quirúrgico y los demás, en enfermerías o unidades de cuidados intensivos. Conclusión: Los datos aquí presentados refuerzan la necesidad de nuevos modelos de asistencia, con mejoras de la asistencia multidisciplinaria geriátrica, en la atención perioperatoria a los pacientes ancianos.

Functional Independence of Children With Myelomeningocele: Is It Associated With the Informal Caregivers' Burden?

PURPOSE: This study aims to evaluate the association between the functional independence of children after postnatal spinal dysraphism correction and informal caregivers' burden. DESIGN AND METHODS: This is a cross-sectional study conducted in a child neurosurgery clinic at a University hospital. We included informal caregivers of children between six months and seven-and-a-half years old who were operated on for spinal dysraphism correction due to myelomeningocele. Functional independence was assessed using the Pediatric Evaluation of Disability Inventory (PEDI). Caregivers' burden was assessed through the Caregiver Burden Scale (CBS). RESULTS: Twenty-six caregivers were assessed, all mothers, aged 18-42years. Five provided child care and engaged in paid work. Regarding functional independence, 23.1% of the children were classified as needing supervision, 23.1% moderate assistance, 42.3% maximal assistance, and 11.5% total assistance. Median value for the overall CBS was 27.0 (22.0-53.0). The mean global CBS score was 1.42 and the mean PEDI score was 1.95. Correlations between PEDI and CBS scores were very close to zero. CONCLUSIONS: We found no association between the functional independence of children with myelomeningocele from 0 to 7years old and the burden of informal caregivers. PRACTICE IMPLICATIONS: The effect of functional independence of children with myelomeningocele may be balanced by the caregivers' resilience so that caregivers' burden is not dependent upon the child's independence.

[Time for cleaning and room preparation: connection between surgery size and professional perspectives]. / Tempo de limpeza e preparo de sala: relação com o porte cirúrgico e perspectivas profissionais.

The objective was to verify the association between time needed for room cleaning (TLPS) and the surgery size, and related advantages and difficulties faced by the circulator of the room asszgned to this task. A mixed method, with a transverse quantitative, retrospective approach, using a sample of 3095 surgeries performed,from January to June 2011, and a qualitative approach using a Thematic Content Analysis of statements from 11 circulators, was used. The average TLPS was smaller in size 1 surgeries, increasing in sizes 2, 3 and 4, with a significant difference. Advantages reported included organization and size of staff and difficulties reported related to sharp, bladed materials mixed with surgical instruments and a reduced number of cleaning professionals. The larger the size, the higher the TLPS. Surgical teams operating in the Surgical Center interfere directly in the process, facilitating or hindering the achievement of institutional goals related to quality and productivity.

[Safe surgery checklist: analysis of the safety and communication of teams from a teaching hospital]. / Checklist de cirurgia segura: análise da segurança e comunicação das equipes de um hospital escola.

This study aimed to apply the WHO surgical safety checklist in the surgical specialties of a university hospital and to evaluate the opinion of the team regarding the influence of its application on the safety of the surgical process and on the interpersonal communication of the team. It is a descriptive, analytical qualitative field study conducted in the surgical center of a university hospital Data were collected by applying the checklist in a total of 30 surgeries. The researcher conducted its application in three phases, and then members of the surgical team were invited to voluntarily participate in the study, signifying their agreement to participate by signing an informed consent form and answering guiding questions. Bardin's Content Analysis Method was used to organize and analyze the data. The subjects did not notice any changes in their interpersonal communication when using the checklist; however, they gave suggestions and reported that its use provided greater safety to the procedure.

[Telephone confirmation of a patient's intent to be present for elective surgery as a strategy to reduce absenteeism]. / Confirmação de presença de usuário à cirurgia eletiva por telefone como estratégia para reduzir absenteísmo.

The objective of this quasi-experimental study was to evaluate the impact of telephone confirmation of attendance on the reduction of absenteeism of patients scheduled for elective surgery. The study was conducted at the Surgical Department of the Botucatu School of Medicine for 30 days and included 89 patients. Results showed the effectiveness of the intervention, which reduced absenteeism by 30.0%. Telephone confirmation two days prior to surgery is recommended, thus allowing enough time to place new calls to find patients at home, or schedule another patient in the event the patient cannot be reached. The creation of a service center could provide a communication channel between the institution and patients, and would enable the confirmation of patients' attendance, provide them with the opportunity to ask questions concerning the procedure and provide information regarding impediments to the surgery or preparations needed. The center would require a professional skilled and knowledgeable regarding the service, as it involves providing patients with information about their upcoming surgery during the telephone contact.