Teaching-Learning Programs to Prevent and Control Infections Related to Long-Term Central Venous Access Device in Cancer Patients: A Systematic Review.

OBJECTIVES: To evaluate the effectiveness of teaching-learning programs for cancer patients and/or their caregivers or family in preventing and controlling infections associated with long-term central venous access devices. DATA SOURCES: This systematic review used the CINAHL, Cochrane Library, EMBASE, LILACS, and MEDLINE via PubMed portal, Scopus, and Web of Science. Google Scholar was used for the gray literature search. The included studies were analyzed, and the obtained data were qualitatively synthesized. The risk of bias was assessed using Cochrane tools: RoB 2 and ROBINS-I. The certainty of the evidence was evaluated using the GRADE. The review protocol was registered in PROSPERO (CRD42021267530). CONCLUSION: The teaching-learning programs were implemented through theoretical-practical and theoretical dimensions in five and two studies, respectively. The risk of bias in the studies was low, moderate, severe, and high in one, three, two, and one of them, respectively. The certainty was very low. Teaching-learning programs on central venous access devices care for cancer patients and/or their caregivers or families could be effective in reducing infection rates. IMPLICATIONS FOR NURSING PRACTICE: This systematic review addressed the teaching-learning programs for preventing and controlling infections associated with long-term central venous access devices. We identified that the most programs were effective in reducing the infection rates. The results may influence the clinical practice of oncology nurses, and consequently, the educational strategies and methods provided not only to these patients but for caregivers and families.

Prevalence of adverse events in pronated intubated adult COVID-19 patients: A systematic review with meta-analysis.

AIM: To present the pooled estimated prevalence of adverse events in pronated intubated adult COVID-19 patients. DESIGN: A systematic review and meta-analysis. DATA SOURCES: This study used the Cochrane Library, CINAHL, Embase, LILACS, Livivo, PubMed, Scopus, and Web of Science databases as data sources. METHODS: The studies were meta-analysed using JAMOVI 1.6.15 software. A random-effects model was used to identify the global prevalence of adverse events, confidence intervals and the heterogeneity data. Risk of bias was assessed using the Joanna Briggs Institute tool, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Of the 7904 studies identified, 169 were included for full reading, and 10 were included in the review. The most prevalent adverse events were pressure injuries (59%), haemodynamic instability (23%), death (17%) and device loss or traction (9%). CONCLUSION: The most prevalent adverse events in mechanically ventilated pronated patients with COVID-19 are pressure injuries, presence of haemodynamic instability, death and device loss or traction. IMPLICATIONS FOR THE PATIENT CARE: The evidence identified in this review can help improve the quality and safety of patient care by helping to design care protocols to avoid the development of adverse events that can cause permanent sequelae in these patients. IMPACT: This systematic review addressed the adverse events related to prone position in intubated adult COVID-19 patients. We identified that the most prevalent adverse events in these patients were pressure injuries, haemodynamic instability, device loss or traction and death. The results of this review may influence the clinical practice of nurses who work in intensive care units and, consequently, the nursing care provided not only to COVID-19 patients but for all intubated patients due to other reasons in intensive care units. REPORTING METHOD: This systematic review adhered to the PRISMA reporting guideline. PATIENT OR PUBLIC CONTRIBUTION: As this is a systematic review, we analysed data from primary studies conducted by many researchers. Thus, there was no patient or public contribution in this review.

Intervenção educativa para melhorar o manejo do dispositivo de acesso vascular totalmente implantado / Intervención educativa para mejorar el manejo del dispositivo de acceso vascular totalmente implantado / Educational intervention to improve management of totally implanted vascular access device

Resumo Objetivo Avaliar o efeito de uma intervenção educativa para enfermeiros para aumentar o conhecimento e as habilidades práticas de manejo de dispositivos de acesso vascular totalmente implantados. Métodos Estudo quase-experimental realizado em um hospital universitário. A intervenção incluiu exposição a um manual de procedimentos seguida de treinamento teórico-prático sete dias depois. Oitenta e um enfermeiros foram avaliados no início do estudo, após autoexposição ao manual e após receberem treinamento teórico-prático. Os participantes foram avaliados quanto ao seu conhecimento e habilidades práticas no gerenciamento de dispositivos de acesso vascular totalmente implantados. Estatísticas descritivas foram realizadas para todas as variáveis. O teste t pareado foi utilizado para examinar se a pontuação média mudou desde a linha de base até a primeira e segunda avaliações de conhecimento, acesso, desacesso e manutenção do cateter. O nível de significância foi definido como 0,05. Resultados Os aumentos médios nas pontuações após a exposição dos enfermeiros ao manual foram de 18,2 pontos para conhecimento, com 16,5 pontos para técnica de acesso, 15,5 para técnica de desacesso e 24,2 para técnica de manutenção do cateter. Após o treinamento teórico-prático, observamos aumento médio de 4,2 pontos para acesso, com 3,9 para desacesso e 4,2 para manutenção do cateter. Conclusão A intervenção educativa para enfermeiros aumentou os escores médios de conhecimentos e habilidades práticas. Ao final da intervenção, 75% dos enfermeiros atingiram pelo menos 33 pontos de 38 para conhecimento e 77%, 77% e 78% obtiveram escores perfeitos para acesso, desacesso e manutenção, respectivamente. A intervenção educativa foi eficaz na melhoria do conhecimento e das habilidades práticas para manejo de dispositivos de acesso vascular totalmente implantados.

Resumen Objetivo Evaluar el efecto de una intervención educativa para enfermeros para aumentar los conocimientos y las habilidades prácticas de manejo de dispositivos de acceso vascular totalmente implantados. Métodos Estudio cuasi experimental realizado en un hospital universitario. La intervención incluyó la exposición a un manual de procedimientos, seguida de una capacitación teórico-práctica siete días después. Se evaluó a 81 enfermeros al comienzo del estudio, después de la autoexposición al manual y después de recibir la capacitación teórico-práctica. Los participantes fueron evaluados respecto a sus conocimientos y habilidades prácticas en la gestión de dispositivos de acceso vascular totalmente implantados. Se realizaron estadísticas descriptivas para todas las variables. Se utilizó el test-t pareado para examinar si el puntaje promedio cambió desde la línea basal hasta la primera y segunda evaluación de conocimientos, acceso, desacceso y mantenimiento del catéter. El nivel de significación fue definido como 0,05. Resultados El aumento promedio de los puntajes después de la exposición de los enfermeros al manual fue de 18,2 puntos en el conocimiento, con 16,5 puntos en la técnica de acceso, 15,5 en la técnica de desacceso y 24,2 en la técnica de mantenimiento del catéter. Después de la capacitación teórico-práctica, observamos un aumento promedio de 4,2 en el acceso, 3,9 en el desacceso y 4,2 en el mantenimiento del catéter. Conclusión La intervención educativa para enfermeros aumentó el puntaje promedio de conocimientos y habilidades prácticas. Al final de la intervención, el 75 % de los enfermeros alcanzó por lo menos 33 puntos de 38 en el conocimiento y el 77 % obtuvo puntaje perfecto en el acceso y en el desacceso y el 78 % en el mantenimiento. La intervención educativa fue eficaz en la mejora de los conocimientos y habilidades prácticas para el manejo de dispositivos de acceso vascular totalmente implantados.

Abstract Objective To evaluate the effect of an educational intervention for nurses to increase knowledge and practical skills of management of totally implanted vascular access devices. Methods A quasi-experimental study conducted in a teaching hospital. The intervention included exposure to a manual of procedures followed by a theoretical-practical training seven days later. Eighty-one nurses were evaluated at baseline, after self-exposure to the manual, and after receiving the theoretical-practical training. Participants were evaluated on their knowledge and practical skills of totally implanted vascular access device management. Descriptive statistics were performed for all variables. Paired t test was used to examine whether the mean score changed from the baseline to first and second assessments of knowledge, access, de-access and maintenance of catheter. Significance level was set to 0.05. Results Mean increases in scores after nurses were exposed to the manual were: 18.2 points for knowledge, 16.5 points for access technique, 15.5 for de-access technique, and 24.2 for catheter maintenance technique. After the theoretical-practical training, we observed a mean increase of 4.2 points for access, 3.9 for de-access and 4.2 for catheter maintenance. Conclusion The educational intervention for nurses increased mean scores of knowledge and practical skills. At the end of the intervention, 75% of the nurses reached at least 33 points out of 38 for knowledge, and 77%, 77%, and 78% had perfect scores for access, de-access, and maintenance, respectively. The educational intervention was effective in improving knowledge and practical skills for management of totally implanted vascular access devices.

Topical interventions for preventing hand-foot syndrome resulting from antineoplastic therapy: A scoping review.

OBJECTIVE: To map topical interventions used to prevent hand-foot syndrome in cancer patients undergoing antineoplastic therapy. METHOD: This is a scoping review reported in accordance with the recommendations of PRISMA-ScR (extension for scoping review) and the Joanna Briggs Institute Manual. The searches were carried out in the electronic databases CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; and gray literature (Google Scholar, Pro-Quest). RESULTS: The searches resulted in 12,016 references and the final sample consisted of 45 studies. A total of 42 topical interventions were identified, including: moisturizing creams, corticosteroids, acids, mapisal, silymarin, and henna. However, urea was the most cited intervention (62%). As for the presentations of the interventions, they varied among creams, ointments, gels, hydrocolloids, decoctions, patches, powders, oils, and soaps. CONCLUSION: The results allowed reviewing topical interventions, with emphasis on the use of urea and moisturizing creams. However, most of the interventions identified in this review require evaluation in future studies for better understanding of their benefits.

Topical interventions for preventing hand-foot syndrome resulting from antineoplastic therapy: A scoping review / Intervenciones tópicas para prevenir el síndrome mano-pie resultante de la terapia antineoplásica: revisión del alcance / Intervenções tópicas para prevenção de síndrome mão-pé decorrente de terapia antineoplásica: revisão de escopo

ABSTRACT Objective: To map topical interventions used to prevent hand-foot syndrome in cancer patients undergoing antineoplastic therapy. Method: This is a scoping review reported in accordance with the recommendations of PRISMA-ScR (extension for scoping review) and the Joanna Briggs Institute Manual. The searches were carried out in the electronic databases CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; and gray literature (Google Scholar, Pro-Quest). Results: The searches resulted in 12,016 references and the final sample consisted of 45 studies. A total of 42 topical interventions were identified, including: moisturizing creams, corticosteroids, acids, mapisal, silymarin, and henna. However, urea was the most cited intervention (62%). As for the presentations of the interventions, they varied among creams, ointments, gels, hydrocolloids, decoctions, patches, powders, oils, and soaps. Conclusion: The results allowed reviewing topical interventions, with emphasis on the use of urea and moisturizing creams. However, most of the interventions identified in this review require evaluation in future studies for better understanding of their benefits.

RESUMEN Objetivo: Mapear las intervenciones tópicas utilizadas para prevenir el síndrome mano-pie en pacientes con cáncer sometidos a terapia antineoplásica. Método: Esta es una revisión del alcance reportada de acuerdo con las recomendaciones de PRISMA-ScR (extensión para la revisión del alcance) y el Manual del Instituto Joanna Briggs. Las búsquedas se realizaron en las bases de datos electrónicas CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; y literatura gris (Google Scholar, Pro-Quest). Resultados: Las búsquedas resultaron en 12.016 referencias y la muestra final estuvo compuesta por 45 estudios. Se identificaron 42 intervenciones tópicas, entre ellas: cremas humectantes, corticoides, ácidos, mapisal, silimarina y henna. Sin embargo, la urea fue la intervención más citada (62%). En cuanto a las presentaciones de las intervenciones, variaron entre cremas, ungüentos, geles, hidrocoloides, decocciones, parches, polvos, aceites y jabones. Conclusión: Los resultados permitieron revisar las intervenciones tópicas, con énfasis en el uso de urea y cremas humectantes. Sin embargo, la mayoría de las intervenciones identificadas en esta revisión deben evaluarse en estudios futuros para mejor comprensión de sus beneficios.

RESUMO Objetivo: Mapear as intervenções tópicas utilizadas para a prevenção da síndrome mão-pé em pacientes com câncer em terapia antineoplásica. Método: Trata-se de uma revisão de escopo reportada de acordo com as recomendações do PRISMA-ScR (extensão para revisão de escopo) e o Manual do Instituto Joanna Briggs. As buscas foram realizadas nas bases eletrônicas CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; e literatura cinzenta (Google Scholar, Pro-Quest). Resultados: As buscas resultaram em 12.016 referências e a amostra final foi composta por 45 estudos. Um total de 42 intervenções tópicas foram identificadas, dentre elas: cremes hidratantes, corticosteroides, ácidos, mapisal, silimarina e henna. Entretanto, a ureia foi a intervenção mais citada (62%). Quanto às apresentações das intervenções, estas variaram entre cremes, pomadas, géis, hidrocoloides, decocções, adesivos, pós, óleos e sabões. Conclusão: Os resultados possibilitaram uma recensão das intervenções tópicas, com destaque ao uso da ureia e cremes hidratantes. Todavia, grande parte das intervenções identificadas nesta revisão necessitam ser avaliadas, em estudos futuros, para melhor compreensão dos seus benefícios.

Complementary therapies in the control of male lower urinary tract symptoms: A systematic review. / Terapias complementares no controle de sintomas do trato urinário inferior masculino: revisão sistemática.

OBJECTIVE: to evaluate diverse scientific evidence on the effectiveness of complementary therapies in the control of lower urinary tract symptoms in the adult and aged male population. METHOD: a systematic review developed according to the PRISMA checklist. The search was performed in the CINAHL, Embase, LILACS, PEDro, PubMed, Web of Science and Google Scholar databases. RESULTS: a total of 585 records were identified and 12 clinical trials were selected that met the inclusion criteria. The outcomes considered by the studies for analyzing effectiveness of the complementary therapies were validated questionnaires to assess the severity of the lower urinary tract symptoms (sensation of incomplete bladder emptying, frequent urination, intermittent flow, weak flow, pain or difficulty urinating, nocturia and urgency) and urodynamics parameters. The studies analyzed the complementary phytotherapy (n=8) and electroacupuncture (n=4) therapies. Six studies related to phytotherapy showed statistical significance. Electroacupuncture showed a significant improvement in the symptoms in two studies. CONCLUSION: pytotherapy was effective to control the simptoms related to frequency, urgency, nocturia, incomplete emptying, intermittence, weak flow and effort to initiate urination. To confirm the effectiveness of electroacupuncture, research studies with well-designed methodologies will also be necessary to resolve the divergences between the studies of this review.

Evaluación de una vena periférica para quimioterapia intravenosa: un estudio prospectivo observacional / Evaluation of a peripheral vein for intravenous chemotherapy: a prospective observational study

Este estudio tuvo como objetivo evaluar las alteraciones en el tiempo de una vena periférica utilizada para la infusión de quimioterapia en pacientes con cáncer de mama. Es un estudio observacional prospectivo que incluyó pacientes que estaban programados para recibir infusión periférica de quimioterapia. A estos pacientes se les evaluó la primera vena periférica utilizada para la infusión en cinco momentos: antes de la venopunción, después de la extracción del dispositivo al final de la primera infusión de quimioterapia y los días 21, 42 y 63 después de la primera infusión. El resultado primario fue el calibre de la vena, medido en milímetros con un transiluminador Veinlite LEDX® y una cinta métrica. Se inscribieron en el estudio 59 mujeres que recibieron doxorrubicina y docetaxel por primera vez. El tamaño del calibre varió de 2 a 4 milímetros en la línea de base y disminuyó con el tiempo. Durante el período de seguimiento, las venas periféricas de 35 mujeres (59,3%) se midieron a 0 mm el día 63. Las 24 mujeres restantes (40,7%) tuvieron cierta recuperación, pero para 15 de ellas (62,5%) la vena se convirtió en un cordón palpable. La viabilidad de utilizar una vena periférica para realizar quimioterapia disminuyó a medida que avanzaba el tratamiento.(AU)

This study aimed to assess over time alterations of a peripheral vein used for chemotherapy infusion in patients with breast cancer. It is a prospective observational study which included patients who were scheduled to receive peripheral infusion of chemotherapy. These patients had the first peripheral vein used for infusion evaluated in five moments: before the venipuncture, after device removal at the end of the first chemotherapy infusion, and on days 21, 42, and 63 after the first infusion. The primary outcome was the caliber of the vein, measured in millimeters with a Veinlite LEDX® transilluminator and a tape measure. Fifty-nine women receiving doxorubicin and docetaxel for the first time were enrolled to the study. The caliber size varied from 2 to 4 millimeters at baseline, and decreased overtime. During the follow-up period, peripheral veins of 35 women (59.3%) were measured at 0 mm at day 63. The remaining 24 women (40.7%) had some recovery, but for 15 of them (62.5%) the vein became a palpable cord. The feasibility of using a peripheral vein to perform chemotherapy decreased as the treatment progresses.(AU)

Terapias complementares no controle de sintomas do trato urinário inferior masculino: revisão sistemática / Complementary therapies in the control of male lower urinary tract symptoms: A systematic review / Terapias complementarias para el control de los síntomas del tracto urinario inferior masculino: revisión sistemática

Resumo Objetivo: avaliar as evidências científicas sobre a efetividade das terapias complementares no controle de sintomas do trato urinário inferior na população masculina adulta e idosa. Método: revisão sistemática desenvolvida de acordo com o checklist PRISMA. A busca foi realizada nas bases de dados CINAHL, Embase, LILACS, PEDro, PubMed, Web of Science e Google Scholar. Resultados: foram identificados 585 registros e selecionados 12 ensaios clínicos que atenderam aos critérios de inclusão. Os desfechos considerados pelos estudos para analisar a efetividade das terapias complementares foram questionários validados de avaliação da gravidade dos sintomas do trato urinário inferior (sensação de esvaziamento incompleto da bexiga, micções frequentes, fluxo intermitente, fluxo fraco, dor ou dificuldade na micção, noctúria e urgência) e parâmetros da urodinâmica. Os estudos analisaram as terapias complementares fitoterapia (n=8) e eletroacupuntura (n=4). Seis estudos relacionados à fitoterapia mostraram significância estatística. A eletroacupuntura mostrou melhora significativa dos sintomas em dois estudos. Conclusão: a fitoterapia foi efetiva para controle dos sintomas frequência, urgência, noctúria, esvaziamento incompleto, intermitência, fluxo fraco e esforço para iniciar a micção. Para confirmação da efetividade da eletroacupuntura ainda serão necessárias pesquisas com metodologias bem delineadas para sanar as divergências entre os estudos desta revisão.

Abstract Objective: to evaluate diverse scientific evidence on the effectiveness of complementary therapies in the control of lower urinary tract symptoms in the adult and aged male population. Method: a systematic review developed according to the PRISMA checklist. The search was performed in the CINAHL, Embase, LILACS, PEDro, PubMed, Web of Science and Google Scholar databases. Results: a total of 585 records were identified and 12 clinical trials were selected that met the inclusion criteria. The outcomes considered by the studies for analyzing effectiveness of the complementary therapies were validated questionnaires to assess the severity of the lower urinary tract symptoms (sensation of incomplete bladder emptying, frequent urination, intermittent flow, weak flow, pain or difficulty urinating, nocturia and urgency) and urodynamics parameters. The studies analyzed the complementary phytotherapy (n=8) and electroacupuncture (n=4) therapies. Six studies related to phytotherapy showed statistical significance. Electroacupuncture showed a significant improvement in the symptoms in two studies. Conclusion: pytotherapy was effective to control the simptoms related to frequency, urgency, nocturia, incomplete emptying, intermittence, weak flow and effort to initiate urination. To confirm the effectiveness of electroacupuncture, research studies with well-designed methodologies will also be necessary to resolve the divergences between the studies of this review.

Resumen Objetivo: evaluar la evidencia científica sobre la efectividad de las terapias complementarias para el control de los síntomas del tracto urinario inferior en la población masculina adulta y adulta mayor. Método: revisión sistemática desarrollada según la checklist PRISMA. La búsqueda se realizó en las bases de datos CINAHL, Embase, LILACS, PEDro, PubMed, Web of Science y Google Scholar. Resultados: se identificaron 585 registros y se seleccionaron 12 ensayos clínicos que cumplían con los criterios de inclusión. Los resultados que los estudios consideraron para analizar la efectividad de las terapias complementarias fueron cuestionarios validados que evaluaban la gravedad de los síntomas del tracto urinario inferior (sensación de vaciado incompleto de la vejiga, micción frecuente, flujo intermitente, flujo débil, dolor o dificultad para orinar, nicturia y urgencia) y parámetros urodinámicos. Los estudios analizaron las terapias complementarias fitoterapia (n=8) y electroacupuntura (n=4). Seis estudios relacionados con la fitoterapia demostraron significación estadística. La electroacupuntura demostró una mejoría significativa de los síntomas en dos estudios. Conclusión: la fitoterapia fue efectiva para controlar los síntomas de frecuencia, urgencia, nicturia, vaciado incompleto, intermitencia, flujo débil y esfuerzo para iniciar la micción. Para confirmar la efectividad de la electroacupuntura, aún es necesario que se realicen investigaciones con metodologías bien diseñadas para resolver las diferencias entre los estudios de esta revisión.

Atualização das recomendações da prática quanto ao cateter central de inserção periférica em recém-nascidos / Updated practical recommendations for the peripherally inserted central catheter in newborns / Actualización de las recomendaciones de la práctica sobre el catéter central de inserción periférica en neonatos

Objetivo: discorrer sobre as recomendações para prática de enfermagem mais atuais no manejo de cateter central de inserção periférica (PICC) em recém-nascidos (RNs). Conteúdo: a assistência ao RN com PICC vem sofrendo diversas alterações em relação às formas de mensuração do tamanho do cateter a ser inserido e de visualização da veia a ser puncionada, aos fatores que influenciam a escolha do sítio de inserção, ao acompanhamento da migração do cateter, à confirmação da ponta do PICC e a outros cuidados de manutenção e remoção do dispositivo. Conclusão: houve uma grande evolução do conhecimento referente ao manejo do PICC na população neonatal, mas ainda existem lacunas de conhecimento a serem exploradas. Espera-se uma melhoria da assistência ao RN que receberá um PICC.

Objective: to discuss the most current recommendations for nursing practice in the management of the peripherally inserted central catheter (PICC) in newborns (NBs). Content: care for NBs with PICCs has undergone several changes as regards measuring the size of the catheter to be inserted and visualizing the vein to be punctured, factors influencing choice of insertion site, monitoring for catheter migration, confirming PICC tip position, and other precautions for device maintenance and removal. Conclusion: knowledge of PICC management in newborns has advanced greatly, but still features gaps to be explored. Care for NBs who receive a PICC is expected to improve.

Objetivo: discutir las recomendaciones más actuales para la práctica de enfermería sobre el manejo de catéteres centrales de inserción periférica (PICC) en recién nacidos (RN). Contenido: la asistencia al RN con PICC ha sufrido varios cambios en relación con las formas de medir el tamaño del catéter a insertar y la visualización de la vena a puncionar, los factores que influyen en la elección del sitio de inserción, el seguimiento de la migración del catéter, la confirmación de la punta del PICC y otras precauciones de mantenimiento y extracción del dispositivo. Conclusión: ha habido una gran evolución del conocimiento sobre el manejo de PICC en la población neonatal, sin embargo, aún existen brechas de conocimiento por explorar. Se espera una mejora en la asistencia al RN que recibirá un PICC.

Atualização das recomendações da prática quanto ao cateter central de inserção periférica em recém-nascidos / Actualización de las recomendaciones de la práctica sobre el catéter central de inserción periférica en neonatos / Updated practical recommendations for the peripherally inserted central catheter in newborns

RESUMO Objetivo discorrer sobre as recomendações para prática de enfermagem mais atuais no manejo de cateter central de inserção periférica (PICC) em recém-nascidos (RNs). Conteúdo a assistência ao RN com PICC vem sofrendo diversas alterações em relação às formas de mensuração do tamanho do cateter a ser inserido e de visualização da veia a ser puncionada, aos fatores que influenciam a escolha do sítio de inserção, ao acompanhamento da migração do cateter, à confirmação da ponta do PICC e a outros cuidados de manutenção e remoção do dispositivo. Conclusão houve uma grande evolução do conhecimento referente ao manejo do PICC na população neonatal, mas ainda existem lacunas de conhecimento a serem exploradas. Espera-se uma melhoria da assistência ao RN que receberá um PICC.

RESUMEN Objetivo discutir las recomendaciones más actuales para la práctica de enfermería sobre el manejo de catéteres centrales de inserción periférica (PICC) en recién nacidos (RN). Contenido la asistencia al RN con PICC ha sufrido varios cambios en relación con las formas de medir el tamaño del catéter a insertar y la visualización de la vena a puncionar, los factores que influyen en la elección del sitio de inserción, el seguimiento de la migración del catéter, la confirmación de la punta del PICC y otras precauciones de mantenimiento y extracción del dispositivo. Conclusión ha habido una gran evolución del conocimiento sobre el manejo de PICC en la población neonatal, sin embargo, aún existen brechas de conocimiento por explorar. Se espera una mejora en la asistencia al RN que recibirá un PICC.

ABSTRACT Objective to discuss the most current recommendations for nursing practice in the management of the peripherally inserted central catheter (PICC) in newborns (NBs). Content care for NBs with PICCs has undergone several changes as regards measuring the size of the catheter to be inserted and visualizing the vein to be punctured, factors influencing choice of insertion site, monitoring for catheter migration, confirming PICC tip position, and other precautions for device maintenance and removal. Conclusion knowledge of PICC management in newborns has advanced greatly, but still features gaps to be explored. Care for NBs who receive a PICC is expected to improve.

Exposure to endocrine disruptors and risk of breast cancer: A systematic review.

AIM: The aim of this study was to investigate the association between human exposure to endocrine disruptors (EDs) and the risk of breast cancer. METHODS: This was a systematic review conducted by searching Cochrane Library, LILACS, Livivo, PubMed, and Science Direct. Observational studies addressing the association between exposure to EDs and breast cancer risk in adults were included. Risk of bias was assessed using the National Toxicology Program's Office of Health Assessment Translation tool. RESULTS: a total of 37 studies were included. Most studies reported that exposure to organochlorine pesticides, phthalates, heavy metals, and polycyclic aromatic hydrocarbons was associated with increased breast cancer risk. CONCLUSION: qualitative analysis of observational studies indicates that human exposure to EDs is associated with increased breast cancer risk. Additional studies are needed to determine whether this association is causal.

Patients with lung cancer undergoing immune checkpoint inhibitors: A meta-analysis of dermatological toxicities.

Immune checkpoint inhibitors are affirming as standard care for advanced lung cancer treatment. Despite their proved efficacy, alone or in combination, they are capable to provoke several cutaneous immune-mediated adverse events. This systematic review aimed to determine the prevalence of cutaneous toxicity in patients with lung cancer undergoing immune checkpoint inhibitors alone, combined, or associated with chemotherapy and/or radiotherapy. The searches were performed in CINAHL, Cochrane CENTRAL, LILACS, LILIVO, PubMed, Scopus, and Web of Science. We included both clinical trials and observational studies that described cutaneous toxicities presented by patients during treatment with immunological checkpoint inhibitors. The final sample consisted of 24 studies in which 9127 patients were evaluated. In included studies, the drug under consideration were ipilimumab, pembrolizumab nivolumab, and atezolizumab, at different dosages. The most prevalent dermatological toxicities were alopecia (27%), pruritus, and rash (10%). Remarkably, the prevalent severity was graded 1-2 for both alopecia, pruritus and rash.

Interventions for Occluded Central Venous Catheters: A Meta-analysis.

CONTEXT: Thrombotic occlusion is 1 of the most frequent complications in catheters implanted in children. OBJECTIVE: To identify the interventions used to treat thrombotic events in long-term central venous catheters in pediatric patients with cancer. DATA SOURCES: Electronic searches were performed in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, LIVIVO, PubMed, Scopus, Web of Science, Google Scholar, OpenGrey, and ProQuest databases. There were no restrictions on language or publication period. STUDY SELECTION: This systematic review was performed in 2 phases and included clinical trials and observational studies on drugs used to treat thrombotic catheter events in pediatric patients with cancer. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist, and the protocol was registered at PROSPERO (identifier CRD42018083555). DATA EXTRACTION: The authors evaluated the quality of included studies using the Methodological Index for Nonrandomized Studies and Grading of Recommendations Assessment, Development and Evaluation methods. The meta-analysis was performed by using Stata software. RESULTS: Ten studies were included. The drugs used to restore catheter function were alteplase, urokinase, and streptokinase. A meta-analysis of 6 studies revealed an overall restoration rate of 88% for alteplase. LIMITATIONS: Reference studies were excluded when it was not possible to reliably extract data that met the inclusion criteria of this review. Sampling issues (absence of randomization, blinding, or a control group) were the main methodologic concerns for the included articles. CONCLUSIONS: On the basis of the evidence obtained, thrombolysis is effective and potentially safe in this population.

Interventions to obstructive long-term central venous catheter in cancer patients: a meta-analysis.

PURPOSE: The aim of this systematic review was to identify the interventions used to treat obstructive events, whether thrombotic or non-thrombotic, in long-term central venous catheters (LT-CVC) in cancer patients. METHODS: This review included clinical trials and observational studies reporting the drugs used to treat obstructive catheter events in cancer patients. The authors developed specific search strategies for CINAHL, Cochrane CENTRAL, LILACS, PubMed, Scopus, Web of Science, Google Scholar, Open Grey, and ProQuest. The authors evaluated methodological quality of included studies using criteria from Cochrane's Collaboration Tool and the Methodological Index for non-randomized studies (MINORS). The quality of evidence was analyzed by using GRADE's software. RESULTS: More than 9000 articles were found across the databases. After duplicates removed, the studies were selected in 2 phases. After that, only 15 studies were included. The drugs used to restoration of catheter function were urokinase (53.3%), alteplase (20%), tenecteplase (13.3%), reteplase (6.7%), recombinant urokinase (6.7%), and staphylokinase (6.7%). The results of meta-analysis of 14 studies showed an overall restoration rate of ~ 84%. The drug type meta-analysis demonstrates a success rate of ~ 84%, ~ 92%, and ~ 84% for urokinase, alteplase, and tenecteplase groups, respectively. The main methodological problem in included articles concerns the sample. The quality of evidence ranged from very low to high. CONCLUSION: The most common interventions used to treat thrombotic catheter occlusion in cancer patients were urokinase and alteplase. No evidence was found about the treatment for non-thrombotic occlusion, thus elucidating an important gap to be investigated.

Face validation of an educative manual for head and neck cancer patients submitted to radiotherapy / Validação de aparência de manual educativo para pacientes com câncer de cabeça e pescoço submetidos à radioterapia

execute the face validation of the educative manual for head and neck cancer patients submitted to radiotherapy. Methodological and descriptive research. The sample consisted of 11 patients, divided in four groups according to the instruction level. An Agreement Rate of at least 80% was considered to guarantee the validation of the material with regard to its semantic analysis. The items addressed in the evaluation tool of the educative manual were divided in five blocks: objectives, organization, writing style, appearance and motivation. Only one item, related to the cover of the material, obtained an Agreement Rate < 80% and was reformulated based on the participants' suggestions. All other items were considered appropriate and/or totally appropriate in the five blocks proposed: objectives - 100%, structure and presentation ­ 93.93%, writing style ­ 95.45%, appearance ­ 97.72%, and motivation ­ 93.50%. The analysis of the face validation of the educative manual proposed demonstrated that it is apt for use as a guide during the nursing consultation, in order to support nursing care for head and neck cancer patients submitted to radiotherapy.

validar a aparência de manual educativo direcionado aos pacientes com câncer de cabeça e pescoço submetidos à radioterapia. Pesquisa metodológica, de caráter descritivo. A amostra foi composta por 11 pacientes, divididos em quatro grupos de acordo com o nível de instrução de cada um deles. Foi considerado o Índice de Concordância de, no mínimo, 80% para se garantir a validação do material em relação a sua análise semântica. Os itens abordados no instrumento de avaliação do manual educativo foram divididos em cinco blocos: objetivos, organização, estilo da escrita, aparência e motivação. Apenas um item, relacionado à capa do material, obteve Índice de Concordância < 80%, a qual foi reformulada com base nas sugestões dos participantes. Todos os outros itens foram considerados adequados e/ou totalmente adequados nos cinco blocos propostos: objetivos - 100%, estrutura e apresentação - 93,93%, estilo da escrita - 95,45%, aparência - 97,72%, e motivação - 93,50%. O manual educativo proposto foi considerado válido quanto à aparência, estando apto a ser utilizado enquanto guia de orientações para subsidiar a assistência de enfermagem prestada ao paciente com câncer de cabeça e pescoço submetido à radioterapia durante a consulta de enfermagem.

Preferência de via de parto e experiência prévia de dores em puérperas atendidas em uma maternidade / Preference of delivery paths and previous pain experience of new mothers attended at a maternity

Introdução: Vários fatores pessoais, culturais e sociais atuam como determinantes na escolha do parto, assim como infl uenciam na dor.Nas tomadas de decisão devem ser respeitados os sentimentos e desejos da mulher. Objetivo: Verifi car a preferência de via de partoe a experiência prévia de dores de puérperas atendidas em uma maternidade. Método: Estudo descritivo com abordagem quantitativarealizado com 55 puérperas com idade igual ou superior a 18 anos. A pesquisa ocorreu por meio de levantamento de prontuários eentrevistas. Utilizou-se a estatística descritiva para análise dos dados de perfi l sociográfi co, procura pelo atendimento, experiências dedores, antecedentes reprodutivos e de perfi l obstétrico. Resultados: Acerca da preferência de parto, aproximadamente 89% (n=49) daspuérperas preferiram a via vaginal. À entrevista, 81,8% (n=45) afi rmaram que a dor associada ao trabalho de parto foi a experiência maisintensa já sentida. Conclusão: Embora a dor associada ao trabalho de parto tenha sido a experiência mais intensa relatada pela maioria,a preferência pelo parto vaginal foi prevalente entre as entrevistadas.

Introduction: Several personal, cultural and social factors play a role as determinants in the choice of childbirth, as well as infl uence pain.In decision-making, woman feelings and desires must be respected. Objective: To verify the preference of delivery path and the previouspain experience of new mothers attended at a maternity. Method: It is a descriptive study with quantitative approach, performed with 55new mothers aged 18 years or older. The research was carried out through the collection of medical records and interviews. Descriptivestatistics were used to analyze data about sociographic profi le, search for care, pain experiences, reproductive history and obstetricprofi le. Results: Regarding the preference of delivery path, approximately 89% (n = 49) new mothers preferred the vaginal route. At theinterview 81.8% (n = 45) stated that pain associated with labor was the most intense experience ever felt. Conclusion: Although thepain associated with labor was the most intense experience reported by the majority, the preference for vaginal delivery was prevalentamong the interviewees.

Varios factores de personales, culturales y sociales actúan como determinantes en la elección del parto, así como infl uyenen el dolor. En las tomas de decisión deben respetarse los sentimentos y deseos de la mujer. Objetivo: Verifi car la preferencia de viade parto y la experiencia previa de dolor de puérperas atendidas em una maternidad. Método: Estudio descriptivo con un enfoquecuantitativo realizado con 55 madres mayores de 18 años. La investigación se llevó a través de levantamiento de registros y entrevistas.Se utilizó estadística descriptiva para el análisis de los datos de perfi l sociográfi cos, la demanda de atención, experiencias de dolor, historiareproductiva y el perfi l obstétrico. Resultados: Sobre la preferencia de parto, aproximadamente 89% (n = 49) de las puérperas preferíanla via vaginal. En la entrevista el 81,8% (n = 45), declaró que el dolor associado con el trabajo de parto fue la experiencia más intensareportada por la mayoría. Conclusión: A pesar de que el dolor associada con el trabajo de parto fue la experiencia más intensa reportadapor la mayoría, la preferencia por el parto vaginal fue frecuente entre las entrevistadas.

Topical interventions to prevent acute radiation dermatitis in head and neck cancer patients: a systematic review.

PURPOSE: The purpose of the study is to evaluate the effects of pharmacological and non-pharmacological topical controls in the prevention of radiation dermatitis. METHODS: Relevant clinical trials were identified through electronic searching databases CINAHL, CENTRAL, LILACS, PubMed, Scopus, and Web of Science. Handsearching and gray literature searches were also performed to find additional references. Primary outcomes of interest were the development of radiation dermatitis and the time of occurrence of radiation dermatitis. RESULTS: Thirteen randomized clinical trials were included in this review. The trials were published in Chinese, English, or French, from 1980 to 2015. Pharmacological interventions used in the trials were trolamine, aloe vera, allantoin, Lianbai liquid, sucralfate, Na-sucrose octasulfate, olive oil, hialuronic acid, and dexpanthenol. Non-pharmacological topical controls were usual care/institution routine, aqueous cream, mild soap, water thermal gel, placebo, and no intervention. CONCLUSIONS: There was no strong evidence that indicates differences between topical pharmacological interventions or non-pharmacological topical controls in the prevention of acute radiation dermatitis among patients with head and neck cancer undergoing radiotherapy.

Adesão de pacientes ao tratamento com antineoplásicos orais: fatores influentes / Adhesión de pacientes al tratamiento con antineoplásicos orales: factores influyentes / Adherence of patients to oral antineoplastic therapy: influential factors

Objetivo avaliar a adesão de pacientes aos tratamentos antineoplásicos orais e identificar os fatores que a influenciam. Método estudo quantitativo, prospectivo, de delineamento não experimental, realizado entre julho de 2013 e janeiro de 2014, em um hospital oncológico no interior do estado de Minas Gerais, Brasil. Os instrumentos utilizados foram: questionário sociodemográfico e clínico, escala Medida de Adesão ao Tratamento e Questionário dos Fatores que podem Influenciar a Adesão ao Tratamento. Os dados foram submetidos a estatística descritiva e testes de correlação entre variáveis. Resultados a média de adesão foi de 6,02 ± 0,8 pontos, e seis (4,9%) pacientes se mostraram não aderentes ao tratamento. Os fatores que mais dificultaram a adesão foram: dificuldade para a aquisição do antineoplásico (36,1%) e utilização de muitos medicamentos (14,8%). Conclusão a taxa de adesão ao uso de antineoplásicos orais é alta, entretanto ainda há muitos fatores que dificultam a adesão e a continuidade do tratamento.

Objetivo evaluar la adhesión de pacientes a los tratamientos antineoplásicos orales e identificar los factores que la influyen. Método estudio cuantitativo, prospectivo, de delineado no experimental, realizado entre julio de 2013 y enero de 2014 en hospital oncológico del interior de Minas Gerais, Brasil. Se utilizaron cuestionario sociodemográfico y clínico, escala Medida de Adhesión al Tratamiento y Cuestionario de Factores que pueden influir en la Adhesión al tratamiento. Los datos fueron sometidos a estadística descriptiva y tests de correlación entre variables. Resultados la media de adhesión fue de 6,02 ± 0,8 puntos, y seis (4,9%) pacientes no adhirieron al tratamiento. Los factores que más dificultaron la adhesión fueron: dificultado para adquirir el antineoplásico (36,1%) y utilización de muchos medicamentos (14,8%). Conclusión la tasa de adhesión al uso de antineoplásicos orales es alta, aunque aún existen numerosos factores que dificultan la adhesión y la continuidad del tratamiento.

Objective to evaluate the adherence of patients to oral antineoplastic therapy and identify the factors influencing it. Method quantitative and prospective study with non-experimental design carried out between July 2013 and January 2014 in an oncology hospital in the state of Minas Gerais, Brazil. The instruments used were: questionnaire for socio-demographic and clinical variables, the Therapy Adherence Measurement scale and the Questionnaire on Factors Influencing Medication Adherence. Data were submitted to descriptive statistics and to correlation tests. Results the mean adherence was 6.02 ± 0.8 points and six (4.9%) patients showed to be non-adherent to treatment. The most frequent factors hindering adherence were: difficulty in acquiring the antineoplastic drug (36.1%) and use of many drugs (14.8%). Conclusion the rate of adherence to oral antineoplastic therapy is high, but there are still many factors that hinder adherence and the continuity of care.

Validation of an educative manual for patients with head and neck cancer submitted to radiation therapy.

OBJECTIVE: develop the content and face validation of an educative manual for patients with head and neck cancer submitted to radiation therapy. METHOD: descriptive methodological research. The Theory of Psychometrics was used for the validation process, developed by 15 experts in the theme area of the educative manual and by two language and publicity professionals. A minimum agreement level of 80% was considered to guarantee the validity of the material. RESULTS: the items addressed in the assessment tool of the educative manual were divided in three blocks: objectives, structure and format, and relevance. Only one item, related to the sociocultural level of the target public, obtained an agreement rate <80%, and was reformulated based on the participants' suggestions. All other items were considered appropriate and/or complete appropriate in the three blocks proposed: objectives - 92.38%, structure and form - 89.74%, and relevance - 94.44%. CONCLUSION: the face and content validation of the educative manual proposed were attended to. This can contribute to the understanding of the therapeutic process the head and neck cancer patient is submitted to during the radiation therapy, besides supporting clinical practice through the nursing consultation. OBJETIVO: validar o conteúdo e a aparência de manual educativo direcionado aos pacientes com câncer de cabeça e pescoço, submetidos à radioterapia. MÉTODO: pesquisa metodológica, de caráter descritivo. Utilizou-se a Teoria da Psicometria para o processo de validação, o qual foi realizado por 15 peritos na área temática do manual educativo e por dois profissionais de letras e publicidade. Foi considerado o índice de concordância de, no mínimo, 80% para se garantir a validação do material. RESULTADOS: os itens abordados no instrumento de avaliação do manual educativo foram divididos em três blocos: objetivos, estrutura e apresentação, e relevância. Apenas um item, relacionado ao nível sociocultural do público-alvo, obteve índice de concordância <80%, tendo sido reformulado com base nas sugestões dos participantes. Todos os outros itens foram considerados adequados e/ou totalmente adequados nos três blocos propostos: objetivos - 92,38%, estrutura e apresentação - 89,74%, e relevância - 94,44%. CONCLUSÃO: o manual educativo proposto foi considerado válido quanto ao conteúdo e à aparência. Sugere-se que possa contribuir para a compreensão do processo terapêutico ao qual o paciente com câncer de cabeça e pescoço é submetido ao realizar a radioterapia, além de subsidiar a prática clínica por meio da consulta de enfermagem. OBJETIVO: validar el contenido y la apariencia de manual educativo dirigido a los pacientes con cáncer de cabeza y cuello, sometidos a radioterapia. MÉTODO: investigación metodológica de carácter descriptivo. Se utilizó la Teoría de la Psicometría para el proceso de validación, el cual fue realizado por 15 peritos en el área temática del manual educativo y por dos profesionales de letras y publicidad. Fue considerado un índice de concordancia que fuese, por lo menos, de 80%, para garantizar la validación del material. RESULTADOS: los ítems abordados en el instrumento de evaluación del manual educativo fueron divididos en tres bloques: objetivos, estructura y presentación, y relevancia. Apenas un ítem, relacionado al nivel sociocultural del público-objetivo, obtuvo un índice de concordancia <80%, habiendo sido reformulado con base en las sugestiones de los participantes. Todos los otros ítems fueron considerados adecuados y/o totalmente adecuados en los tres bloques propuestos: objetivos (92,38%), estructura y presentación (89,74%), y relevancia (94,44%). CONCLUSIÓN: el manual educativo propuesto fue considerado válido en lo que se refiere al contenido y a la apariencia. Se sugiere que puede contribuir para la comprensión del proceso terapéutico, al cual el paciente con cáncer de cabeza y cuello es sometido al realizar la radioterapia, además de auxiliar la práctica clínica por medio de la consulta de enfermería.

Medidas de biossegurança na administração de quimioterapia antineoplásica: conhecimento dos enfermeiros / Biosafety measures in chemotherapy administration: nurses' knowledge / Medidas de bioseguridad en administración de quimioterapia: conocimiento de los enfermeiros

Introdução: A exposição ocupacional às propriedades citotóxicas da quimioterapia implica em riscos à saúde desses profissionais, podendo causar alterações agudas ou crônicas oriundas do manuseio dos agentes antineoplásicos em longo prazo. Objetivo: Identificar o conhecimento de enfermeiros a respeito das medidas de biossegurança para administração de quimioterapia. Método: Estudo descritivo transversal com enfermeiros de um hospital geral. A coleta de dados ocorreu por meio de questionário autoaplicado e os dados foram analisados através de medidas de tendência central, dispersão e correlações. Resultados: Trinta enfermeiros participaram do estudo e 23 deles informaram nunca ter recebido capacitação para trabalhar com quimioterápicos. O escore médio de conhecimento dos participantes foi 27,6 de um total possível de 37 pontos. Conclusão: Os enfermeiros da instituição pesquisada apresentam conhecimento parcialmente adequado às recomendações de biossegurança. A identificação de lacunas no conhecimento pode orientar o desenvolvimento de protocolos e programas de capacitação, aspecto fundamental atualmente, haja vista o elevado número de pacientes com câncer internados em unidades de clínica médica em hospitais gerais.

Introduction: Occupational exposure to the cytotoxic properties of chemotherapy entails risks to professionals' health and may cause acute or chronic changes arising from the long-term handling of antineoplastic agents. Objective: To identify the nurses' knowledge of the biosecurity measures for administering chemotherapy. Method: Cross-sectional descriptive study with nurses at a general hospital. The data were collected through a self-applied questionnaire and the data were analyzed using measures of central tendency, dispersion, and correlation. Results: Thirty nurses were enrolled in this study and 23 reported they had never received training on working with chemotherapy drugs. The average score of the subjects was 27.6 out of a possible 37 points. Conclusion: The nurses of the institution investigated have partially adequate knowledge of biosafety recommendations. Identifying gaps in knowledge can guide the development of protocols and training programs, a fundamental aspect, given the high number of cancer patients admitted to medical units in general hospitals.

Introducción: La exposición ocupacional a las propiedades citotóxicas de la quimioterapia implica riesgos para la salud de estos profesionales, puede causar cambios agudos o crónicos derivados de la manipulación de agentes antineoplásicos a largo plazo. Objetivo: Identificar los conocimientos de los enfermeros acerca de las medidas de bioseguridad para administración de la quimioterapia. Método: Estudio descriptivo transversal, con enfermeros de un hospital general. Los datos fueron recolectados a través cuestionario autoadministrado y se analizaron los datos utilizando medidas de tendencia central, dispersión y correlación. Resultados: Treinta enfermeros participaron en el estudio, 23 de ellos informaron que nunca recibieron capacitación para trabajar con agentes quimioterapéuticos. La puntuación media de los participantes fue de 27,6 de un máximo de 37 puntos. Conclusión: Los enfermeros de la institución investigada tienen conocimiento parcialmente adecuado a las recomendaciones de bioseguridad. La identificación de lagunas en el conocimiento puede guiar el desarrollo de protocolos y programas de formación, un aspecto fundamental en la actualidad visto teniendo en cuenta elevado número de pacientes con cáncer ingresados en unidades médicas en los hospitales generales.