Manual educativo de cuidados à criança com gastrostomia: construção e validação / Child care educational manual with gastrostomy: construction and validation / Manual educativo sobre el cuidado de niños con gastrostomía: construccion y validación

Introdução: a gastrostomia é um procedimento no qual um cateter é inserido no estômago, através de uma abertura na parede abdominal anterior. Há escassez de trabalhos voltados para orientações e cuidados com do uso da gastrostomia e a influência para os familiares e cuidadores. Objetivo: desenvolver e validar um manual educativo sobre cuidados com gastrostomia em crianças. Método: realizado levantamento bibliográfico para desenvolvimento do conteúdo do manual e validação do mesmo realizada com 11 especialistas com base na técnica de Delphi e com cinco pais e cuidadores de crianças com gastrostomias mensurado por meio da escala de Likert. Resultados: o material elaborado foi validado por especialistas em dois ciclos por meio da técnica de Delphi, com a participação de 11 juízes no primeiro ciclo e seis juízes no segundo ciclo. A porcentagem de concordância absoluta de todo o manual alcançou valor de 97,91%. O menor valor encontrado no segundo ciclo foi de 83,3%, com sete de oito questões apresentando concordância de 100%. A validação com público-alvo apresentou taxa de concordância de 100% e todos os participantes pontuaram três na escala de Likert para todas as questões. O manual validado possui registro em ISBN de número: 978-85-924327-0-6, com 21 páginas, oito capítulos e 38 figuras de linguagem simples e acessível, abordando temas como o conceito e indicação da gastrostomia, o cuidado domiciliar e a prevenção de complicações. Conclusão: elaborado manual educativo de cuidado da criança com gastrostomia, validado por especialistas e por pais e cuidadores.(AU)

INTRODUCTION: the gastrostomy is a procedure in which a catheter is inserted into the stomach through an opening in the anterior abdominal wall. There is a shortage of work focused on guidelines and care with the use of gastrostomy and the influence for family members and caregivers. Goal: to develop and validate an educational manual regarding gastrostomy care with children. METHOD: it was carried out a bibliographical survey for the development of the content of the manual and validation of it, which was conducted with 11 experts based on the Delphi technique and with 5 parents and caregivers of children with gastrostomies, measured using the Likert scale. RESULTS: the elaborated material was validated by specialists in two cycles through the Delphi technique, with the participation of 11 judges in the first cycle and six judges in the second cycle. The absolute agreement percentage of the whole manual reached 97.91%. The lowest value found in the second cycle was 83.3%, with seven of eight questions showing agreement of 100%. The validation with target audience showed a 100% concordance rate and all participants scored three points on the Likert scale for all questions. The validated manual has ISBN (International Standard Book Number) registration number: 978-85-924327-0-6, with 21 pages, eight chapters and 38 simple and accessible figures of speech, addressing topics such as the concept and indication of gastrostomy, home care and the prevention of complications. CONCLUSION: elaborated educational manual of child care with gastrostomy, validated by specialists, by parents and caregivers.

Is it possible to repair diastasis recti and shorten the aponeurosis at the same time?

BACKGROUND: Abdominal wall deformity secondary to pregnancy is multidirectional. Plication of the anterior rectus sheath is the most widely used technique for correction of this condition. However, it would be desirable to simultaneously perform the transverse and longitudinal repair of this deformity. The aim of this study was to assess changes in the length of the musculoaponeurotic layer after diastasis recti repair using triangular mattress sutures. METHODS: Thirty-one women with Nahas' type III/A deformity were divided into two groups: the triangular mattress suture (TS) group and the continuous suture (CS) group. All patients underwent conventional abdominoplasty and diastasis recti repair with medial longitudinal plication performed between two metal clips. The two types of suture were used in both groups. In the TS group, after a CS was performed and removed, TSs were used and maintained in place. In the CS group, the order of suture placement was reversed. The distance between clips was measured before and immediately after suturing and at 3 weeks and 6 months postoperatively using plain abdominal radiographs. Statistical analysis was conducted using Friedman's analysis of variance and Wilcoxon's test. RESULTS: The use of TSs significantly reduced the length of the aponeurosis compared with both the intraoperative situation without suture (P<0.001) and the use of CS (intraoperatively and 6 months after surgery; P<0.001). CONCLUSION: The repair of diastasis recti using TSs resulted in vertical shortening of musculoaponeurotic layer immediately after the procedure and in the long term. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Health-related quality of life and self-esteem in patients with diabetic foot ulcers: results of a cross-sectional comparative study.

To evaluate health-related quality of life (HRQoL) and self-esteem in patients with diabetic foot ulcers (DFUs), a cross-sectional, comparative study was conducted among 35 consecutive patients with diabetes mellitus (DM) attending outpatient clinics in Pouso Alegre, Brazil. Fifteen (15) patients with and 20 without a DFU participated in the study. Demographic variables were obtained and HRQoL and self-esteem were assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Rosenberg Self-Esteem Scale. In both groups, 80% of patients were women. Average age did not differ significantly between the DFU and control groups (average 56 [SD 8.42] and 52 years [SD 6.68], respectively) but disease duration was significantly longer (P < 0.001) in the DFU (mean 12 years, range 3 to 24 years) than in the control group (mean 8 years, range 1 to 21 years). Mean HRQoL scores in all domains were lower in the DFU than in the control group with significant differences in the following domains: physical functioning (P = 0.043), role physical (P = 0.003), social functioning (P = 0.022), and role emotional (P = 0.001). Self-esteem scores were similar in both groups. The results of this study confirm that patient HRQoL is negatively affected by the presence of a DFU. Wound prevention programs for patients with DM may help reduce the scope of this problem while DFU treatment programs that include psychological support may improve patient QoL.

Experimental model to study the effect of nicotine in a random skin flap, in the rat

Presentation of an experimental model to study the effect of nicotine in a random skin flap, in the rat. Adult rats of the same lineage are exposed to nicotine for seven days in the preoperative period. After the preoperative period, the animals are anesthetized and a dorsal random pattern skin flap, cranially based is elevated. On the seventh postoperative day, the rats are anesthetized and the percentages of distal necrosis in the flaps are determined. After that, excision of skin fragments for biochemical analysis is possible. Blood samples may be collected by decapitation.

Apresentação de um modelo experimental para estudar o efeito da nicotina em um retalho cutâneo randômico, no rato. Ratos adultos da mesma linhagem são expostos à nicotina por sete dias no período pré-operatório. Após este período os animais são anestesiados e um retalho cutâneo randômico dorsal, de base cranial é elevado. No sétimo dia de pós-operatório, os ratos são anestesiados e as porcentagens de necrose distal são determinadas. Isto feito, é possível colher fragmentos de pele para análise bioquímica. Amostras de sangue podem ser colhidas por decapitação.

Experimental model to study the effect of nicotine in a random skin flap, in the rat

Presentation of an experimental model to study the effect of nicotine in a random skin flap, in the rat. Adult rats of the same lineage are exposed to nicotine for seven days in the preoperative period. After the preoperative period, the animals are anesthetized and a dorsal random pattern skin flap, cranially based is elevated. On the seventh postoperative day, the rats are anesthetized and the percentages of distal necrosis in the flaps are determined. After that, excision of skin fragments for biochemical analysis is possible. Blood samples may be collected by decapitation.

Apresentação de um modelo experimental para estudar o efeito da nicotina em um retalho cutâneo randômico, no rato. Ratos adultos da mesma linhagem são expostos à nicotina por sete dias no período pré-operatório. Após este período os animais são anestesiados e um retalho cutâneo randômico dorsal, de base cranial é elevado. No sétimo dia de pós-operatório, os ratos são anestesiados e as porcentagens de necrose distal são determinadas. Isto feito, é possível colher fragmentos de pele para análise bioquímica. Amostras de sangue podem ser colhidas por decapitação.

Uric acid as a monitor of oxidative stress in a random skin flap in rats

PURPOSE: To verify the possible role of uric acid as a monitor of oxidative stress in a random skin flap, in the rat. METHODS: This study utilized 21 adult male Wistar-EPM rats divided, at random, in three groups of seven animals, to evaluate the behavior of uric acid levels during oxidative stress zero, 5 and 15 minutes after elevation of the flap. According to the time schedule, skin samples were collected in order to allow determination of uric acid and malondialdehyde (MDA) levels. RESULTS: Uric acid levels in the skin samples did not change with time, but the values in normal skin were higher since the beginning. Malondialdehyde (MDA) levels in the skin samples remained stable throughout. CONCLUSION: Uric acid levels in the flap skin were lower than those in the normal skin, denoting local oxidative stress.

OBJETIVO: Verificar o possível papel do ácido úrico como monitor do estresse oxidativo em um retalho cutâneo randômico, no rato. MÉTODOS: Este estudo utilizou 21 ratos adultos Wistar-EPM, divididos, ao acaso, em três grupos de sete animais, para avaliar o comportamento dos níveis de ácido úrico durante o estresse oxidativo, aos zero, 5 e 15 minutos após a elevação do retalho. De acordo com os períodos de tempo estabelecidos, amostras de pele foram coletadas de modo a permitir a determinação dos níveis de ácido úrico e malondialdeído (MDA). RESULTADOS: Os níveis de ácido úrico nas amostras de pele não variaram com o tempo, mas os valores na pele normal foram maiores desde o início. Os níveis de malondialdeído (MDA) nas amostras de pele permaneceram estáveis. CONCLUSÃO: Os níveis de ácido úrico na pele do retalho foram menores que aqueles da pele normal, denotando estresse oxidativo local.