Effectiveness of combined virtual and clinical simulation compared with other active teaching strategies on health students' learning: a systematic review protocol.

OBJECTIVE: The objective of this review is to synthesize the available evidence on the effectiveness of combined virtual and clinical simulation compared with other active teaching strategies on health students' learning. INTRODUCTION: Current evidence indicates that both virtual simulation and clinical simulation are effective in assisting students to acquire clinical skills. However, there is a knowledge gap regarding the effectiveness of the combined use of both teaching strategies, which could enhance health students' learning. INCLUSION CRITERIA: This review will consider experimental, quasi-experimental, and observational studies that address the combined use of virtual simulation with clinical simulation compared with other active teaching strategies in learning, clinical reasoning, clinical decision-making, and/or clinical competencies of health students. Combining different hybrid simulators to form a new one will not be considered for inclusion in the review. METHODS: The databases to be searched will include Cochrane Library, MEDLINE (PubMed), CINAHL (EBSCOhost), Scopus, LILACS (VHL), Web of Science Core Collection, Embase, ERIC, and gray literature sources. Two independent reviewers will perform the study selection, critical appraisal, and data extraction using JBI tools. A narrative synthesis will be performed and, if possible, meta-analysis and risk assessment of publication bias. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach will be used to assess the certainty of the findings. REVIEW REGISTRATION: PROSPERO CRD42023422410.

Digital tools for post-discharge surveillance of surgical site infection.

AIMS: Conduct a scoping review on the development and use of digital tools for post-discharge surgical site infection surveillance. DESIGN: Scoping review. DATA SOURCES: Science Direct, PubMed, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde and Cumulative Index to Nursing and Allied Health Literature were searched from 2013 to May 2022. Six intellectual property registries were reviewed from 2013 to 2022. REVIEW METHODS: The review followed the Joanna Briggs Institute model, and included intellectual property records (applications, prototypes and software) and scientific articles published in any language on the development and/or testing of digital tools for post-discharge surveillance of surgical site infection among surgical patients aged 18 and over. RESULTS: One intellectual property record and 13 scientific articles were identified, covering 10 digital tools. The intellectual property record was developed and registered by a China educational institution in 2018. The majority of manuscripts were prospective cohort studies and randomized clinical trials, published between 2016 and 2022, and more than half were conducted in the United States. The population included adult patients undergoing cardiac, thoracic, vascular, abdominal, arthroplasty and caesarean surgery. The main functionalities of the digital tools were the previously prepared questionnaire, the attachment of a wound image, the integrated Web system and the evaluation of data by the health team, with post-discharge surgical site infection surveillance time between 14 and 30 days after surgery. CONCLUSION: Digital tools show promise for the surveillance of surgical site infection, collaborating with the early detection of wound infection. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Mobile technology was favourable for detecting surgical site infections, reducing unnecessary visits to the health service, and increasing patient satisfaction. IMPACT: Technological advances in the health area open new perspectives for post-discharge surveillance of surgical site infection. WHAT IS ALREADY KNOWN?: There is underreporting of surgical site infections due to difficulties related to traditional methods of post-discharge surveillance. The use of digital tools within surgical site infection surveillance is increasing. Benefits of using digital tools within surgical site infection surveillance have been reported. WHAT HAS THIS STUDY ADDED TO OUR KNOWLEDGE?: This scoping review is one of the first to analyse the development and use of digital tools for post-discharge surveillance of surgical site infection in different countries. The main functionalities of digital tools are: structured questionnaires; attachment of wound images; integrated web systems; and evaluation of data by professionals. The use of mobile technology is favourable for detecting surgical site infections with a reduction in costs from face-to-face consultations and increased patient satisfaction. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Healthcare providers can successfully use digital tools for surgical site infection post-discharge surveillance. Remote monitoring can reduce unnecessary patient visits to healthcare facilities. Policy makers can study how to implement digital platforms for remote patient monitoring. REPORTING METHOD: PRISMA statement for Scoping Reviews (PRISMA-ScR). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. TRIAL AND PROTOCOL REGISTRATION: The study protocol was registered in the OSF (https://doi.org/10.17605/OSF.IO/BA8D6).

Effects of Intensive Blood Glucose Control on Surgical Site Infection for Liver Transplant Recipients: A Randomized Controlled Trial.

BACKGROUND: The evidence supporting intensive blood glucose control to prevent surgical site infections (SSIs) among liver transplant recipients is insufficient. We aimed to assess the effects of postoperative intensive blood glucose control (IBGC) against standard blood glucose control (SBGC) on the incidence of SSIs among adult liver transplant recipients. METHODS: We performed a randomized controlled trial (ClinicalTrials.gov identifier NCT03474666). The IBGC target was 80 to 130 mg/dL, and the SBGC target was below 180 mg/dL. Analyses were made on an intention-to-treat basis. RESULTS: Of the 41 recipients enrolled onto the trial, 20 were randomly allocated to the IBGC group and 21 to the SBGC group. There were no significant differences in SSIs among recipients allocated to either group (relative risk [RR], 0.78; 95% confidence interval [CI], 0.21-2.88; P = .69). Mean (SD) blood glucose levels were significantly lower in the IBGC group in the 24-hour period after surgery (145.0 [20.7] mg/dL and 230.2 [51.6] mg/dL; P = .001). While there were fewer episodes of hypoglycemia in the IBGC group, this was not statistically significant. There were no episodes of severe hypoglycemia in either group. Hyperglycemia and severe hyperglycemia were significantly more frequent in the SBGC group (RR, 0.70; 95% CI, 0.52-0.93; P = .001 and RR, 0.07; 95% CI, 0.01-0.48; P = .001, respectively). Length of hospital stay was significantly shorter for recipients in the IBGC group (13.1 [5.5] days vs 19.3 [12.1] days; P = .04). CONCLUSIONS: Although this small trial did not find intensive control reduced SSI, it was associated with lower blood glucose levels, fewer episodes of hyperglycemia and severe hyperglycemia, and shorter length of hospital stay.

Essential oils for healing and/or preventing infection of surgical wounds: a systematic review.

OBJECTIVE: To analyze the evidence available in the literature on the use of essential oils for healing and/or preventing infection in surgical wounds. METHOD: Systematic review according to the JBI model and PRISMA statement. The search was carried out in November/2020 and updated in December/2021, using descriptors and keywords, in the CINAHL, LILACS, CENTRAL, EMBASE, PUBMED, Scopus, and Web of Science databases. The quality of the evidence was assessed using the JBI critical appraisal tool for randomized controlled trials. RESULTS: Five publications were included. Three studies evaluated healing and the presence of infection after episiotomy using the Redness-Edema-Ecchymosis-Discharge-Approximation (REEDA) scale; one study evaluated healing after periodontal surgery using the plaque index and Modified Gingival Index; the other four studies considered the presence of infection after episiotomy. Most studies used lavender oil, associated or not with other oils (80%). Two studies showed an improvement in healing. The infection outcome, although mentioned by 60% of studies, was not assessed as a primary outcome. CONCLUSION: The promising efficacy of essential oils, especially lavender, was verified in the healing of surgical wounds, especially in episiotomies.

Essential oils for healing and/or preventing infection of surgical wounds: a systematic review / Aceites esenciales para la cicatrización y/o prevención de infecciones de heridas quirúrgicas: una revisión sistemática / Óleos essenciais para a cicatrização e/ou prevenção de infecção de feridas cirúrgicas: revisão sistemática

ABSTRACT Objective: To analyze the evidence available in the literature on the use of essential oils for healing and/or preventing infection in surgical wounds. Method: Systematic review according to the JBI model and PRISMA statement. The search was carried out in November/2020 and updated in December/2021, using descriptors and keywords, in the CINAHL, LILACS, CENTRAL, EMBASE, PUBMED, Scopus, and Web of Science databases. The quality of the evidence was assessed using the JBI critical appraisal tool for randomized controlled trials. Results: Five publications were included. Three studies evaluated healing and the presence of infection after episiotomy using the Redness-Edema-Ecchymosis-Discharge-Approximation (REEDA) scale; one study evaluated healing after periodontal surgery using the plaque index and Modified Gingival Index; the other four studies considered the presence of infection after episiotomy. Most studies used lavender oil, associated or not with other oils (80%). Two studies showed an improvement in healing. The infection outcome, although mentioned by 60% of studies, was not assessed as a primary outcome. Conclusion: The promising efficacy of essential oils, especially lavender, was verified in the healing of surgical wounds, especially in episiotomies.

RESUMEN Objetivo: Analizar la evidencia en la literatura sobre el uso de aceites esenciales para la cicatrización y/o prevención de infecciones en heridas quirúrgicas. Método: Revisión sistemática de acuerdo con el modelo JBI y el PRISMA. Se realizó una búsqueda en las bases de datos CINAHL, LILACS, CENTRAL, EMBASE, PUBMED, Scopus y Web of Science, en el periodo de noviembre/2020, con actualizaciones en diciembre/2021, utilizando descriptores y palabras clave. La calidad de la evidencia se evaluó por la herramienta JBI critical appraisal para ensayos controlados aleatorizados. Resultados: Se incluyeron cinco publicaciones. Tres estudios evaluaron la curación y la presencia de infección tras episiotomía mediante la escala REEDA (Redness-Edema-Ecchimosis-Discharge-Approximation); uno evaluó la curación después de cirugía periodontal utilizando el índice de placa y el índice gingival modificado; y los demás consideraron la presencia de infección posterior a la episiotomía. La mayoría de los estudios utilizaron aceite de lavanda, asociado a otros aceites o no (80%). Dos estudios demostraron mejorar la cicatrización. El resultado infección, aunque mencionado por el 60% de los estudios, no se evaluó como resultado primario. Conclusión: Se verificó la prometedora eficacia de los aceites esenciales, especialmente el de lavanda, en la cicatrización de heridas quirúrgicas, especialmente en episiotomías.

RESUMO Objetivo: Analisar as evidências disponíveis na literatura sobre o uso de óleos essenciais para a cicatrização e/ou prevenção de infecção em feridas cirúrgicas. Método: Revisão sistemática segundo modelo JBI e declaração PRISMA. Busca realizada em novembro/2020 e atualizada em dezembro/2021, utilizando-se descritores e palavras-chave, nas bases CINAHL, LILACS, CENTRAL, EMBASE, PUBMED, Scopus e Web of Science. A qualidade das evidências foi avaliada usando a ferramenta JBI critical appraisal para ensaios clínicos randomizados. Resultados: Cinco publicações foram incluídas. Três estudos avaliaram a cicatrização e presença de infecção após episiotomia por meio da escala REEDA (Redness-Edema-Ecchymosis-Discharge-Approximation); um avaliou cicatrização após cirurgia periodontal por meio do índice de placa e Índice Gengival Modificado; o restante considerou a presença de infecção após episiotomia. A maioria dos estudos utilizou o óleo de lavanda, associado ou não a outros óleos (80%). Em dois estudos houve melhora da cicatrização. O desfecho infecção, embora mencionado por 60% estudos, não foi avaliado como primário. Conclusão: Verificou-se a eficácia promissora de óleos essenciais, sobretudo do de lavanda, na cicatrização de feridas cirúrgicas, especialmente em episiotomias.

Nasogastric/nasoenteric catheter in the adult ICU: best practices implementation project.

BACKGROUND: Good-quality nursing care is usually associated with decreased risk of harms or adverse events and improved nutritional status in patients. It is important to prevent an increased risk of infection, mortality, and hospital costs in patients, along with a rework for the nursing team. OBJECTIVE: To implement best evidence-based practices in the management of the nasogastric catheter in patients admitted to adult clinical intensive care. METHOD: The methodology used for this study was based on that of the Joanna Briggs Institute, using the audit and feedback tools JBI Practice Application of Clinical Evidence System and Getting Research into Practice. A base audit was performed, which screened for the education of the nursing team aimed at the knowledge of the best practices, approaching the barriers related to nonadherence to the best practices and a follow-up audit. RESULTS: The results of the base and follow-up audit showed positive variation in the percentage of adherence to the best practices proposed after the education of the nursing team. The implemented criteria that showed the greatest impact in practice (P < 0.001) were related to insertion and checking of the catheter and maintenance of the device with adequate lavage technique. CONCLUSION: The results obtained from adherence to the best practices contributed to the enhancement of care related to catheter insertion, its maintenance, and withdrawal. Changes were made to the local care protocol, with care being taken to measure the exteriorized portion and to increase the frequency of catheter lavage. It is necessary to invest in the record in the chart of the care related to the management of the catheter to confirm the care provided and to assist in the clinical audit process. The results obtained can also be compared with the nutritional indicators.

Melaleuca alternifolia essential oil soap: a potential alternative for hand hygiene.

This study aimed to compare the antimicrobial action of three soaps for hand hygiene (HH): 2.0% Tea Tree Oil (TTO); 0.5% triclosan; 2.0% chlorhexidine, and to explore the perception of healthcare professionals about TTO. Two-step study: a quantitative, to determine the logarithmic reduction of Escherichia coli K12 colony-forming units before and after HH of 15 volunteers and quali-quantitative, through interviews with 23 health professionals. All the three products demonstrated antimicrobial action (a log10 reduction factor of 4.18 for TTO, 4.31 for triclosan, 3.89 for chlorhexidine, and 3.17 for reference soap). Professionals remarked the pleasant aroma and non-dryness of skin when using soap containing TTO.

Evaluation of Nursing Actions in Anesthesia Guided by the Patient Safety Checklist: Nursing in Anesthetic Procedure (PSC/NAP): A Cross-Sectional Study.

PURPOSE: This study aimed to evaluate the implementation of nursing actions in anesthesia guided by the Patient Safety Checklist: Nursing Anesthetic Procedure and the difficulties in performing patient care. DESIGN: A cross-sectional study. METHODS: Nursing actions were evaluated in 282 anesthetic procedures of adult patients undergoing general anesthesia in three periods of anesthesia in a private hospital operating room in Brazil, from January to July 2018. The evaluated outcomes were the number of items performed by nurses during anesthesia periods and limitations for applying the Patient Safety Checklist: Nursing Anesthetic Procedure instrument. FINDINGS: Execution of the nursing actions presented a mean percentage of 85.6, highlighting the anesthetic induction stage and differences between the periods before induction and reversal. The main items not performed in evaluating the nursing care in anesthesia were as follows: the anesthesia equipment test (84; 29.78%) in the preinduction period; the evaluation of adequate ventilation (132; 46.81%) in the induction period; and the tracheal aspiration assistance (62; 21.98%) during reversal. Receiving a call from another room with care interruption was highlighted among the nurses' justifications for not performing the activities and difficulty in continuing care because of shift change. CONCLUSIONS: The execution of nursing care actions in anesthesia mainly occurred during the period related to induction, with limitations because of dimensioning of operating rooms and simultaneous procedures.

Immunosuppressive adherence after kidney transplantation in adult patients treated at an outpatient clinic: a better practice implementation project.

OBJECTIVE: To evaluate the compliance of the practice with the evidence-based criteria in relation to interventions developed to improve the immunosuppressive adherence of adults in postkidney transplantation. METHOD: A best practice implementation project, based on the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in health practice, was conducted. A baseline and a follow-up audit were conducted in a kidney transplant clinic, including a sample of kidney transplant patients with a maximum of 30 days postoperatively, and health professionals working in the post-transplant period. RESULTS: The basic audit revealed that the parameters related to the professionals' knowledge did not reach adequate compliance; the involvement of patients in strategies to overcome barriers that interfere with nonadherence; guidelines for specific therapeutic regimens for patients and the prescription of immunosuppressants according to the patient's routine. To solve the identified weaknesses, training strategies were implemented with the professionals, follow-up by telephone contact with the patients and the elaboration and distribution of an educational booklet with guidance on the use of immunosuppressants, leading to an increase from 50 to 87.5% of conformity in the evaluated service. CONCLUSION: The evidence implementation project provided improvements in clinical practice behaviors. It demonstrated that there are strategies that facilitate the implementation of evidence regarding the promotion of interventions to improve immunosuppressive adherence. Additional audits are still needed to improve and assess the quality of interventions promoted by professionals regarding drug adherence in the post-transplant period, as well as to verify the behavior of patients, ensuring that the project will be maintained and supported.

Adverse Events in Anesthesia: An Integrative Review.

PURPOSE: This study conducted an integrative review of the literature in a search for scientific evidence related to the occurrence of perioperative adverse events resulting from anesthesia. DESIGN: Integrative review. METHODS: The search was performed in the PubMed/MEDLINE, Virtual Health Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases and portals, including studies published in Portuguese, English, or Spanish, from 1997 to 2017. The studies were supposed to assess adverse events associated exclusively with anesthesia care. FINDINGS: We selected 21 studies. The main adverse events in anesthesia were respiratory, drug error, cardiology, and neurology. Most of the events were related to human errors, slips, and lapses that resulted in damage to the patient, such as permanent injuries or death. CONCLUSIONS: Care planning, efficient communication, and teamwork are critical to prevent adverse events in anesthesia.

Exposição da equipe de Enfermagem à radiação em centro cirúrgico: um estudo descritivo / La exposición del personal de Enfermería a la radiación en la sala de operaciones: un estudio descriptivo / Exposure of Nursing staff to radiation in the operating room: a descriptive study

Objetivo: Verificar a exposição à radiação da equipe de Enfermagem nos Centros Cirúrgicos de sete hospitais de seis cidades do interior do Estado de São Paulo. Método: Realizou-se um estudo quantitativo e descritivo, por meio de entrevista dos profissionais de Enfermagem, atuantes há mais de um ano em sete unidades dos Centros Cirúrgicos pertencentes a seis cidades diferentes. Resultados: Foram entrevistados 30 funcionários, sendo que todos pertenciam ao sexo feminino, oito (26,7%) tinham mais de 40 anos, 25 (83,3%) eram técnicos de Enfermagem e 14 (46,7%) atuavam em Centro Cirúrgico entre um e cinco anos. Destes, 28 (93,3%) relataram contato com radiação e apenas 11 (39,3%) utilizavam algum tipo de proteção; apenas dois (7,1%) faziam uso do dosímetro e 25 (89,3%) não possuíam remuneração diferenciada devido ao grau de periculosidade de suas atividades. Conclusão: As normas de proteção radiológica não são rigorosamente cumpridas pelas instituições incluídas neste estudo.

Objetivo: Determinar la exposición a la radiación del personal de Enfermería de quirófano en siete hospitales en seis ciudades del interior del estado de San Pablo, en Brasil. Método: Estudio cuantitativo y descriptivo, a través de entrevistas a enfermeras que trabajan durante más de un año en el quirófano en siete unidades pertenecientes a seis ciudades diferentes. Resultados: Se entrevistaron a 30 empleados, todos los cuales eran mujeres, ocho (26,7%) tenían más de 40 años, 25 (83,3%) eran técnicas de Enfermería y 14 (46,7%) trabajaban en el Centro de Cirugía entre uno y cinco años. De ellos, 28 (93,3%) informaron contacto con la radiación y sólo 11 (39,3%) utilizaban algún tipo de protección, sólo dos (7,1%) estaban usando un dosímetro y 25 (89,3%) no tenían salarios diferentes por el grado de peligrosidad de sus actividades. Conclusión: Las normas de protección radiológica no son estrictamente cumplidas por las instituciones incluidas en el estudio.

Objective: To determine radiation exposure of the nursing staff in the Surgical Centers of seven hospitals in six countryside cities of São Paulo State, Brazil. Method: We conducted a quantitative and descriptive study through interviews with nurses working for over a year in operating rooms of seven units belonging to six cities. Results: Thirty employees were interviewed, all of whom were women; 8 (26.7%) were older than 40 years, 25 (83.3%) were nursing technicians, and 14 (46.7%) had been working in the Surgical Center from 1 to 5 years. Of these, 28 (93.3%) reported contact with radiation and only 11 (39.3%) used some type of protection, only 2 (7.1%) were using a dosimeter, and 25 (89.3%) did not have different salaries because of dangerousness degree of their activities. Conclusion: The radiological protection standards are not strictly enforced by the institutions included in the study.

A systematic review on the effectiveness of prewarming to prevent perioperative hypothermia.

AIMS AND OBJECTIVES: To analyse available research on the effectiveness of prewarming to prevent perioperative hypothermia and identify knowledge gaps for future research. BACKGROUND: Perioperative hypothermia is common and causes complications, such as coagulation and platelet function abnormalities; increased cardiac morbidity, surgical site infection, and pressure ulcer incidence levels. In this context, several methods have been investigated to prevent perioperative hypothermia, including prewarming. Prewarming is defined as the warming of peripheral tissues or the skin surface before anaesthetic induction and may consist of an active cutaneous warming system or the preoperative administration of vasodilation drugs. DESIGN: Systematic review. METHODS: We searched CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline (January 1990-November 2011) for randomised controlled trials on the effectiveness of prewarming for prevention of perioperative hypothermia, published in English, Spanish and Portuguese, and involving elective surgery patients aged 18 years or older. RESULTS: Of 730 identified studies, only 13 met the inclusion criteria. After hand-searching the reference lists of included studies, an additional study was identified for a total sample of 14 studies. The results suggest that forced-air warming system is effective to reduce hypothermia when applied for the prewarming of surgical patients. CONCLUSION: Prewarming patients with the forced-air warming system might be effective to reduce perioperative hypothermia, and new studies are needed to examine the use of carbon fibre technology. RELEVANCE TO CLINICAL PRACTICE: Nurses can use this review to inform decision-making on a prewarming programme in the perioperative period. They can also develop research on strategies to put in practice prewarming in the surgical context.

[Construction and evaluation of educational software on urinary indwelling catheters]. / Construção e avaliação de software educacional sobre cateterismo urinário de demora.

Since this is an era in which information is open concerning the benefits it brings, the field of nursing informatics earns its moment. The objective of this study was to design educational software for teaching and learning the technique of urinary indwelling catheterization and compare the acquisition of knowledge regarding the technique before and after the implementation of the educational software. This is a descriptive study using a quantitative approach. The pedagogical foundations for designing the software were the theories of Piaget and Vygotsky. The teaching-learning process was evaluated through a questionnaire consisting of 10 multiple choice questions which the 60 participants completed before and after using the software. The results showed the software made significant contributions after its application, thus being very useful in the teaching-learning process.

Factors associated to the development of hypothermia in the intraoperative period.

This study aimed to assess factors associated to body temperature changes intraoperatively in patients undergoing elective surgery. A prospective study including 70 patients was carried out in a charity hospital. A data collection instrument was developed and its face and content validity was established. The variables measured were operating room temperature and humidity and patient body temperature at different times. In the multivariate linear regression, the variables type of anesthesia, duration of anesthesia, body mass index, and operating room temperature were directly associated to mean body temperature. Nurses are responsible for planning and implementing effective interventions that can contribute to minimize costs and most importantly reduce hypothermia complications.