Terapia tópica en el tratamiento de las heridas crónicas / Terapia tópica no tratamento de feridas crônicas / Topical therapy in the treatment of chronic wounds

El cuidado de la heridas retorna a la Antigüedad, cuando el hombre buscando mejores resultados en la cicatrización en menores intervalos de tiempo, hacía uso de diversos métodos y sustancias en el tratamiento de lesiones1,2. Actualmente, la terapéutica empleada en las heridas aún da lugar a discusiones, ya que debe atender a la herida y a su portador, con el fin de incluir la planificación y la realización de su cuidado. Se trata de un estudio descriptivo, exploratorio, con abordaje cuantitativo no probabilístico, cuyo objetivo central fue conocer la terapia tópica empleada para el tratamiento de heridas abiertas y crónicas por los usuarios de Unidades Básicas de Salud de la Familia (UBSFs) en el estado de Goiás, Brasil. Participaron en esta encuesta 19 personas de ambos sexos, con una edad media de 56,5 años, con heridas abiertas más de 3 meses. Para la recolección de datos se realizó la observación directa de la lesión con un instrumento dirigido semiestructurado, con preguntas sobre datos socioeconómicos del portador y relativos a la terapéutica de la herida. Los resultados mostraron que los productos tópicos más utilizados fueron antibióticos, antisépticos, siendo el principal la polivinilpirrolidona yodo (PVPI) y antifúngicos. También se verificó el empleo de sustancias impropias para la curación, como el producto creolina. Hubo desacuerdo entre los datos encontrados en la encuesta y lo sugerido por la literatura, ya que la mayoría de los productos tópicos utilizados en el tratamiento de heridas está en disonancia con lo indicado por la literatura investigada (AU)

O tratamento de feridas retoma a Antiguidade, quando o homem objetivando melhores resultados cicatriciais em menores intervalos de tempo fazia uso de diversos métodos e substâncias na terapêutica de lesões 1,2. Atualmente a terapêutica empregada em feridas ainda suscita discussões, pois esta deve atentar para a lesão e seu portador, de modo a contemplar o planejamento e efetivação do cuidado3. Trata-se de um estudo descritivo, exploratório com abordagem quantitativa não probalística, cujo objetivo central foi conhecer a terapia tópica empregada no tratamento de feridas abertas e crônicas por usuários das Unidades Básicas de Saúde da Família (UBSFs) em cidade do interior do Estado de Goiás, Brasil. Participaram da pesquisa 19 pessoas de ambos os sexos, com idade média de 56,5 anos, portadores de feridas abertas com tempo de existência superior a 3 meses. Para a coleta de dados foi realizada a observação direta da lesão e utilizado um instrumento dirigido semiestruturado, com perguntas sobre dados socioeconómicos do portador e relativos à terapêutica da ferida. Os resultados apontaram que os produtos tópicos mais utilizados foram antibióticos, os antissépticos, sendo o principal o polivinilpirrolidona iodo tópico (PVPI) e antifúngicos. Verificou-se também o emprego de substâncias impróprias a cicatrização, como o produto creolina. Houve divergência entre os dados encontrados pela pesquisa e o sugerido pela literatura, já que os produtos tópicos mais utilizados na terapia das feridas estarem em dissonância com o indicado pela literatura pesquisada

The treatment of wounds resumes antiquity when man aiming better results in scarring smaller time intervals was using various methods and substances in therapy injuries1-2. Currently employed in wound therapy is still debatable, as this should be aware of the injury and the patient, in order to include the planning and execution of care³. This is a descriptive, exploratory study with a quantitative approach is not probabilistic , whose main objective was to topical therapy used in the treatment of open wounds and chronic users of Basic Units for Family Health (UBSFs) in the city in the state of Goiás, Brazil. Participants were 19 people of both sexes, with a mean age of 56.5 years, with open wounds to their age more than 3 months . For data collection was carried out direct observation of the lesion and used an instrument directed semistructured questionnaire about socioeconomic data carrier and on the therapeutic wound. The results showed that the products were the topics most widely used antiseptic, being the main topic polyvinylpyrrolidone iodine (PVP), antibiotics and antifungals. It was also the employment of improper wound healing substances such as cresol product. There was disagreement between data found by the survey and suggested in the literature, since most topical products used in the therapy of wounds are at odds with the indicated by the literature (AU)

Adoption of a PDA-based home hospice care system for cancer patients.

This study describes a systematic and efficient point-of-care home hospice information system, which can effectively manage patient information and can easily be incorporated into a home hospice service using wired and/or wireless communications and mobile computing technology. To help with the design of a portable home hospice information system, we analyzed the services provided by visiting nurses and the opinions of users, based on the 2005 Guidelines for Cancer Patient Management Program of the Ministry of Health and Welfare of Korea. We performed a service trial with three experienced visiting nurses. A visiting nurse can use a PDA, implementing the hospice information system, to accomplish tasks that range from registering a new patient to performing nursing services based on the patient's condition, as well as accessing guidelines and searching past information for better nursing performance. The system resulted in a saving of 8.5 minutes in recoding time. We expect the findings of this study to help field workers in community nursing care by reducing unnecessary paperwork and by enabling improvements in the quality of point-of-care services.

Recording practices and satisfaction of hemophiliac patients using two different data entry systems.

Record keeping is integral to home treatment for hemophilia. Identified problems with paper diaries include suboptimal compliance and questionable data validity and quality. The effects of an electronic data recording system, Advoy, on data quality, patient adherence, and satisfaction were examined. An exploratory approach was used to examine the sequential use of paper diaries and e-diaries by 38 patients. Data were obtained from paper records for the 6 months preceding the introduction of the electronic record and from the first 6 months of use of Advoy. Completion of mandatory and additional treatment details was also compared. More mandatory information (27.57%) was recorded with the e-diary. As well, the amount of completed additional fields nearly doubled (19.9%-36.5%). Patients tended to complete a greater variety of additional fields with the e-diary than with paper records. Finally, a higher percentage of survey respondents (29.4%) indicated that they were "very satisfied" with Advoy compared with paper records (6.7%). Most survey respondents (94.4%) had a previous experience with electronic programs. The use of the e-diary significantly improved patient adherence in recording mandatory treatment information; the increase in additional data provided by the patients was also found to be an added benefit of this technology.

Infection prevention and control in home health care: the nurse's bag.

This study evaluates bacterial contamination rates of home health care nurses' bags and the patient care equipment found inside. Nurses' bags--a ubiquitous fomite in the home health care environment--may serve as a potential reservoir for multidrug-resistant organisms.

Implementing a home telemonitoring program.

In the current healthcare arena, it is imperative that home healthcare agencies seek to reduce costs and produce positive outcomes from the care they give. Telemonitoring offers the ability to monitor closely the daily status of the patients that home healthcare agencies serve, to provide best practice care, and to produce positive outcomes from that care. This article presents the experience of how 1 hospital-based agency implemented a home telemonitoring program and describes the lessons learned throughout the process. The current healthcare arena demands cost reduction and improved patient care outcomes from home healthcare agencies (HHAs). The direction that each HHA chooses to take to answer these demands will set the stage for their future. This article describes the steps needed to implement a telemonitoring program. The description is based on how 1 HHA chose its course of action and set it in motion and shows what was learned throughout the process.

Comparison of three single-person manual patient techniques for bed-to-wheelchair transfers.

The uniqueness of the home environment still requires home health clinicians to lift and transfer patients manually, tasks that are known to cause back injuries. Three manual patient transfers were evaluated to establish the technique with the least risk to the low back. Patient and worker perceptions as well as preferences, exposure duration, and a biomechanical low back evaluation are presented, together with transfer technique recommendations.

Educação para a saúde como estratégia de intervenção de enfermagem às pessoas portadoras de diabetes / Health education as a nursing intervention strategy for diabetes bearers

Estudo descritivo que objetivou analisar um processo de educação, enquanto estratégia de intervenção de enfermagem, junto às pessoas diabéticas, aproximando-se dos pressupostos da metodologia da problematização e do referencial teórico da educação libertadora de Paulo Freire. Participaram do estudo, durante 4 meses, 19 portadores de Diabetes do Município de Nova Aurora, Estado de Goiás, Brasil. A discussão evidenciou que a atividadeeducativa dialógica foi capaz de contribuir para o despertar do potencial reflexivo, crítico e criativo do grupo; apresentando-se como uma importante estratégia de intervenção para o enfermeiro que trabalha na perspectiva de emancipação de seus clientes

[Issues involved with supply of medical and hygienic materials to home care patients].

Questionnaires were mailed to doctors and nurses who are involved in home care to survey their observations on medical and hygienic materials and its supply to home care patients. Some of the survey items, such as problems encountered frequently, areas where an improvement was needed most and concerns that are often raised in suppling of medical and hygienic materials for home care patients, were analyzed by the Berelson's content analysis method to observe problems in suppling adequate medical and hygienic materials. As a result, 5 categories and 17 subcategories were formed. The recognized future issues were: policies concerning support extended to medical organizations and disseminate information of the system, which medical and hygienic materials supplied to home care patients.

Community nurse use of Doppler ultrasound in leg ulcer assessment.

Doppler ultrasound is used by community nurses to measure the ankle brachial pressure index (ABPI). This is required before applying compression therapy for patients with chronic venous insufficiency and venous leg ulcers.However, emphasis on the ABPI result has resulted in inappropriate referrals to the vascular department which led the author to survey current practice within one primary care trust. Results illustrated variations in how nurses obtain training and maintain their competency in using Doppler ultrasound. This has an impact on the accuracy of interpretation of the ABPImeasurement and subsequent management of the patient. Practical issues also explained the difficulties nurses encountered in using the correct procedure within the community, which may result in unreliable measurements. There is a need to standardize training for all community nurses, and to review the structure of current clinical guidelines to enable a wider analysis of arterial assessment, in order to reduce the emphasis purely on the ABPI measurement.

Supporting frail older people and their family carers at home using information and communication technology: cost analysis.

AIM: This paper describes a cost analysis of a home-based support service for frail older people and their family carers in two municipalities in West Sweden and using information and communication technology. BACKGROUND: A key challenge facing nurse managers across Europe is an increasingly aged population, combined with reduced numbers of young adults of working age. New solutions are needed to provide quality, cost-effective community care services to frail older people and their family carers. METHODS: A case study methodology involving five families was used, and included a detailed cost description of the technology-based service compared with usual services. Cost data were collected in June 2002. This work formed part of a larger project exploring the impact of a technology-based service known as, Assisting Carers using Telematics Interventions to meet Older Persons' Needs (ACTION). In addition to cost data, information was gathered on the quality of life of frail older people and their family carers, and the job satisfaction and work methods of nurses and other practitioners based in the community. The cost analysis comprised a description of the family and their caring situation, the perceived benefits of the telematic based support service and an assessment of its impact on the use of other care services. These analyses were carried out with the help of needs assessors who were known to the families, and nurses working in the ACTION call centre. All results were validated by the five participating families. RESULTS: Cost savings were achieved in all cases, and the benefits to older people and their carers were also considerable. As a result of the cost analysis and overall evaluation data, ACTION has been implemented as a mainstream service in the municipalities involved. CONCLUSION: Researchers, nurses, other practitioners and community care managers can work together with frail older people and their family carers to develop quality, cost-effective support services that reduce demands on staff whilst providing benefits to users.

Leg ulcer assessment techniques in a remote rural area.

Community-based leg ulcer clinics are a cost-effective and efficient way of managing patients with leg ulcers in the community (Blair et al, 1988; Moffatt and Oldroyd, 1994). According to the Scottish Clinical Standards for Vascular Services (NHS Quality Improvement Scotland, 2003): 'It is essential that all vascular patients are seen by a nurse with vascular expertise, who is able to provide information, support and health promotion advice'.

Stoma care accessories: an overview of a crowded market.

While many stomas do not develop any problems, up to 55% of them do. Stoma accessories are often used to either prevent stoma problems or resolve them, but there is a potentially baffling array of products available. This article provides an overview of the accessories currently available, to assist the community nurse in the care of patients with stomas.

Bag and supply transport tips.

Wearily glancing at the front entrance of the apartment building, about 100 yards away and up two flights of stairs, Chris thinks, "One more trip and I should have everything." Two boxes of supplies and a bag of assessment equipment are needed for this visit and Chris must transport everything alone. For the next visit, Chris will again be required to transport various boxes and bags. Because of increasing shoulder and neck pain, Chris resolves to stop using shoulder straps and start using bags with wheels and portable hand carts for the boxes and other bulky supplies these visits require.

Nutritional screening in the community: developing strategies.

Malnutrition is a significant clinical and public health problem in the community with the wider determinants of health including poverty, social isolation and deprivation all exacerbating its incidence. It is frequently undetected and untreated. Effective nutritional screening is needed to reduce the prevalence of malnutrition but barriers to implementation do exist. Working with staff to identify barriers that prevent the effective adoption of nutritional screening is key to ensuring that appropriate nutritional action always occurs in a timely manner. Profiling the local community helps to give a clearer overview of the high-risk population groups and provides robust evidence which helps the process of identifying priorities for action.

Assessing for depression and mood disturbance in later life.

Depression has been identified as a common mental disorder in old age but frequently remains undetected. The Geriatric Depression Scale is one of the most heavily promoted scales for the screening of older people. Short versions of the scale (GDS-15 and GDS-4) are recommended for use with community patients, though most of the validation studies have been with people attending GP surgeries and outpatient departments. Changing the threshold affects the sensitivity and specificity of the scale and it has been recommended that the cut-off points should be lower when the tool is used in clinical practice and higher when used for research purposes.

O Nebulizador contribuindo para a criação de uma tecnologia para a saúde da comunidade: um experiência / The nebulizer contributing to the creation of a technology for the community health: an experience / El vaporizador contribuyendo para la creación de una tecnología para la salud de la comunidad: una experiencia

Relato de experiência que tem por obejtivo apresentar um artefato tecnológico produzido a partir da aproximação de um artefato do procedimento técnico de enfermagem - nebulizador, com outras áreas de conhecimento especificamente a física, através de uma equação matemática. A concepção desse artefato surgiu quando uma das autoras passou a sentir os efeitos de noites insones que empediam a sua concentração diurna nos seus trabalhos acadêmicos. Esses efeitos eram causados pelo ruído de gotas d'água oriundas de aparelhos de ar condicionado instalados acima do seu apartamento incidentes sobre o seu próprio aparelho. O resultado obtido após a instalação do protótipo do artefato, produzido de forma artesanal, foi a anulação do ruído do gotejamento de água que incidia sobre os aparelhos instalados nos andares mais baixos, proporcionando a preservação do sono e, consequentemente, a saúde da comunidade envolvida no processo...