Inter-rater Reliability Testing of the Safety Protocol for Thirst Management.

PURPOSE: Thirst is one of the most common and yet undertreated symptoms in the postoperative period, mainly because of the lack of safety criteria to support indication for thirst management strategies. A Safety Protocol for Thirst Management was developed and validated, and the objective of this article was to evaluate the inter-rater reliability of the protocol. DESIGN: This is a methodological and applied study carried out in a teaching hospital in Brazil. METHODS: Safety criteria selected were the assessment of level of consciousness, presence of coughing and swallowing, and absence of nausea and vomiting. FINDINGS: Agreement between evaluators was almost perfect (Bachelors of Science in Nursing-Kappa of 0.968; nursing technicians-Kappa of 0.867). CONCLUSIONS: The protocol is presented as a viable and useful tool to evaluate safety criteria that allow administration of strategies to mitigate thirst of patients in the postoperative period.

Use of Chamomilla recutita in the Prevention and Treatment of Oral Mucositis in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Randomized, Controlled, Phase II Clinical Trial.

BACKGROUND: Oral mucositis is a common inflammatory complication among patients undergoing hematopoietic stem cell transplantation (HSCT). Among its therapeutic properties, Chamomilla recutita has anti-inflammatory effects. OBJECTIVE: The aim of this study was to identify the dosage of the liquid extract of C recutita in mouthwash that is needed to reduce the incidence and intensity of oral mucositis in adult patients undergoing allogenic HSCT. METHODS: In a randomized phase II clinical trial, 40 patients were randomized to receive routine care plus mouthwash containing a liquid extract of C recutita at 0.5%, 1%, or 2% (experimental groups) or standard care alone (control group). Daily evaluation was performed using the measurement scale for oral toxicity defined by the World Health Organization. Statistical analysis was performed, in which the incidence, intensity, and duration of oral mucositis were compared between each experimental group and the control group. RESULTS: The experimental group at the 1% dosage demonstrated reduced incidence, intensity, and duration of oral mucositis compared with the control group. The formulation was well tolerated by patients and was safe, as no moderate or severe adverse effects were identified. CONCLUSIONS: In this study, the use of mouthwash containing 1% C recutita extract can be associated with reduced incidence, intensity, and duration of mucositis in adults patients undergoing allogenic HSCT. IMPLICATIONS FOR PRACTICE: The results of this investigation will help nurses and other professionals in selecting the C recutita dosage used to manage oral mucositis in patients undergoing HSCT.

Validation of an instrument to assess factors associated with adherence to standard precautions among dentists in primary healthcare.

Accidents with biological material are a reality in dental practice. The use of preventive measures such as the adoption of Standard Precautions (SP) is essential, thus this study aims to validate an instrument to check factors associated with adherence to SP among dentists. The scales of psychosocial and organizational factors that influence adherence to SP were the starting point. These scales have already been nationally validated for doctors and nurses. The instrument consisted of 49 items divided into five dimensions. The process of instrument validation involved the following steps: its adaptation for situations that pose risks to dentists; content and semantic analysis by a committee of judges, and application to dentists. The adapted instrument was applied to 224 dentists who provided primary healthcare in the north region of Paraná State. After the application of scales, the psychometric properties were analyzed using the factor analysis technique and a reliability test. The factor analysis confirmed three domains: Obstacles to following standard precautions; Knowledge of occupational transmission of HIV and Safety climate. The reliability of the domains was considered adequate (Cronbach's alpha between 0.73 and 0.88.). The instrument demonstrated adequate psychometric properties to assess factors that influence adherence to SP among dentists.

Validation of an instrument to assess factors associated with adherence to standard precautions among dentists in primary healthcare

Accidents with biological material are a reality in dental practice.The use of preventive measures such as the adoption ofStandard Precautions (SP) is essential, thus this study aims tovalidate an instrument to check factors associated with adherenceto SP among dentists. The scales of psychosocial andorganizational factors that influence adherence to SP were thestarting point. These scales have already been nationally validatedfor doctors and nurses. The instrument consisted of 49items divided into five dimensions. The process of instrumentvalidation involved the following steps: its adaptation for situationsthat pose risks to dentists; content and semantic analysisby a committee of judges, and application to dentists. Theadapted instrument was applied to 224 dentists who providedprimary healthcare in the north region of Paraná State. Afterthe application of scales, the psychometric properties wereanalyzed using the factor analysis technique and a reliabilitytest. The factor analysis confirmed three domains: Obstaclesto following standard precautions; Knowledge of occupationaltransmission of HIV and Safety climate. The reliability of thedomains was considered adequate (Cronbach’s alpha between0.73 and 0.88.). The instrument demonstrated adequate psychometricproperties to assess factors that influence adherenceto SP among dentists...

Os acidentes com presença de material biológico são umarealidade na prática odontológica. A utilização de medidaspreventivas como a adoção das Precauções Padrão (PP) éessencial, desta maneira este estudo tem como objetivo validarum instrumento para verificação de fatores associadosà adesão às PP, entre dentistas. Partiram-se das Escalas deFatores Psicossociais e Organizacionais que Influenciam aAdesão às Precauções-Padrão, já validadas nacionalmentepara enfermeiros e médicos. O instrumento compôs-se de49 itens distribuídos em 5 dimensões. O processo de validaçãodo instrumento seguiu as seguintes etapas: adaptaçãodo instrumento para as situações que envolvem riscos aosdentistas por meio da análise semântica e análise de conteúdo,as quais foram realizadas por um comitê de juízes. Oinstrumento adaptado foi para 224 dentistas que atuavamna Rede Básica de Saúde na região Norte do Estado doParaná. Após aplicação das escalas foram analisadas aspropriedades psicométricas através das técnicas de análisefatorial e teste de confiabilidade. A análise fatorial confirmoutrês domínios: Obstáculo para seguir às PrecauçõesPadrão; Conhecimento da transmissão ocupacional do HIVe Clima de segurança. A confiabilidade dos domínios foiconsiderada adequada (alfa de Cronbach entre 0,73 e 0,88).O instrumento demonstrou propriedades psicométricas adequadaspara avaliar fatores de influência na adesão as PP,entre dentistas...

Validation of an instrument to assess factors associated with adherence to standard precautions among dentists in primary healthcare. / Validation of an instrument to assess factors associated with adherence to standard precautions among dentists in primary healthcare.

Accidents with biological material are a reality in dental practice. The use of preventive measures such as the adoption of Standard Precautions (SP) is essential, thus this study aims to validate an instrument to check factors associated with adherence to SP among dentists. The scales of psychosocial and organizational factors that influence adherence to SP were the starting point. These scales have already been nationally validated for doctors and nurses. The instrument consisted of 49 items divided into five dimensions. The process of instrument validation involved the following steps: its adaptation for situations that pose risks to dentists; content and semantic analysis by a committee of judges, and application to dentists. The adapted instrument was applied to 224 dentists who provided primary healthcare in the north region of Paraná State. After the application of scales, the psychometric properties were analyzed using the factor analysis technique and a reliability test. The factor analysis confirmed three domains: Obstacles to following standard precautions; Knowledge of occupational transmission of HIV and Safety climate. The reliability of the domains was considered adequate (Cronbachs alpha between 0.73 and 0.88.). The instrument demonstrated adequate psychometric properties to assess factors that influence adherence to SP among dentists.

Cyclosporine level: difference between blood samples collected through peripheral and central venous access.

AIMS AND OBJECTIVES: To identify differences in cyclosporine levels between blood samples collected from a peripheral venous access, catheter line used for drug infusion and catheter line not used for drug infusion in adult patients receiving allogeneic haematopoietic stem cell transplantation. Background. Cyclosporine is an immunosuppressant that prevents graft-versus-host disease, has a narrow therapeutic window and causes nephrotoxicity. For cyclosporine infusion, a tunnelled central venous access device is used; however, because of the lipophilic properties of the drug, it can adsorb to the catheter surface and falsely raise cyclosporine concentrations in blood specimens. DESIGN: Prospective observational study. METHODS: The study collected 135 blood samples from 16 patients. In 13 subjects, samples were obtained from the three lines at three time points (1, 7 and 14 days after the start of cyclosporine infusion), and for three subjects, samples were only obtained at 1 and 7 days after the start of infusion. The 5-ml blood discard method was used for samples collected from the catheter. Using this procedure, the catheter line was washed with saline solution, 5 ml of blood and saline solution were aspirated from the catheter line and discarded, and then sample blood used for the test was collected. The paired t-test with the Bonferroni correction was used to analyse the differences in cyclosporine serum levels. RESULTS: Significant differences were observed when the drug serum levels obtained in the line used for drug infusion were compared with the levels obtained in the line not used for infusion or the peripheral venous line. No differences in drug levels were identified in blood collected from the peripheral venous line and the line not used for drug infusion. CONCLUSION: Drug adsorption occurs in the line used for infusion. Therefore, the blood sample collected from the line not used for cyclosporine infusion can be considered reliable for drug concentration determination. RELEVANCE TO CLINICAL PRACTICE: Nurses should standardise one line of the tunnelled central venous access device for cyclosporine infusion, which avoids the need for evasive procedures and provides patients with more comfort.

Quality of life among Brazilian women living with HIV/AIDS.

The purpose of the present study was to assess quality of life (QoL) in Brazilian women living with HIV/AIDS, according to the World Health Organization Quality of Life HIV-BREF (WHOQoL-HIV-BREF) domains. A quantitative-based, cross-sectional, analytical study was carried out in healthcare centers specialized in assisting people living with HIV/AIDS, located in a municipality of the state of São Paulo, Brazil. One hundred and six women of age 18 years or more, users of the public healthcare system, participated in the study. Socio-demographic and clinical variables were collected using a specific questionnaire. Quality of life related variables were collected by means of the WHOQoL-HIV-BREF instrument. As per the QoL domains, study results show that the Spirituality domain reached a standardized mean score of 65.7, followed by the Physical (64.7), Psychological (60.6), Social Relationships (59.5), Independence (58.6), and Environment (54.5) domains. Results of the multiple regression analysis indicate that the women's employment or retirement, income greater than the minimum wage, and higher educational level were associated with a higher standardized mean score of QoL. However, recent HIV/AIDS diagnosis and exposure to antiretroviral agents for a period shorter than two years were negatively associated with QoL. It is critical that public policies favor an all-embracing social inclusion of these women, thus promoting better social conditions. Counseling, clinical follow-up immediately after the infection diagnosis, and initiation of antiretroviral treatment are crucial moments in the lives of these individuals.

Effect of a video on developing skills in undergraduate nursing students for the management of totally implantable central venous access ports.

BACKGROUND: Handling Totally Implantable Access Ports (TIAP) is a nursing procedure that requires skill and knowledge to avoid adverse events. No studies addressing this procedure with undergraduate students were identified prior to this study. Communication technologies, such as videos, have been increasingly adopted in the teaching of nursing and have contributed to the acquisition of competencies for clinical performance. OBJECTIVE: To evaluate the effect of a video on the puncture and heparinization of TIAP in the development of cognitive and technical competencies of undergraduate nursing students. METHOD: Quasi-experimental study with a pretest-posttest design. RESULTS: 24 individuals participated in the study. Anxiety scores were kept at levels 1 and 2 in the pretest and posttest. In relation to cognitive knowledge concerning the procedure, the proportion of correct answers in the pretest was 0.14 (SD=0.12) and 0.90 in the posttest (SD=0.05). After watching the video, the average score obtained by the participants in the mock session was 27.20. CONCLUSION: The use of an educational video with a simulation of puncture and heparinization of TIAP proved to be a strategy that increased both cognitive and technical knowledge. This strategy is viable in the teaching-learning process and is useful as a support tool for professors and for the development of undergraduate nursing students.

Validação do conteúdo de um instrumento para avaliação da prontidão do prematuro para início da alimentação oral / Content validation as a tool for evaluating oral feeding readiness in preterm babies

OBJETIVOS: elaborar e validar o conteúdo e a aparência de um instrumento de avaliação da prontidão do prematuro em iniciar a transição da alimentação gástrica para via oral. MÉTODOS: para validação do conteúdo do instrumento e seu respectivo guia instrucional, estabeleceu-se um percentual mínimo de concordância de 85 por cento entre os "juízes ", fonoaudiólogos com experiência na área de neonatologia. RESULTADOS: obteve-se concordância acima de 85 por cento nos itens avaliados. O instrumento e guia instrucional validados ficaram constituídos dos seguintes itens: idade corrigida, estado de organização comportamental (estado de consciência, postura e tônus global), postura oral (lábios e língua), reflexos orais (procura, sucção, mordida e vômito) e sucção não-nutritiva (movimentação e canolamento de língua, movimentação da mandíbula, força de sucção, sucções por pausa, manutenção do ritmo de sucção por pausa e do estado alerta e sinais de estresse). CONCLUSÕES: o instrumento e guia instrucional objetivam e sistematizam a avaliação do bebê prematuro iniciar a transição da alimentação gástrica para via oral. Para o uso em unidades neonatais, há necessidade de sua validação clínica.

OBJECTIVES: to produce and validate the content and appearance of a tool for evaluating the readiness of preterm infants to begin the transition from gastric to oral feeding. METHODS: for the validation of the tool and accompanying instructions, the authors established a minimum percentage agreement of 85 percent among the 15 peers who participated in the study, all of them speech therapists with broad experience in the area of neonatology. RESULTS: the validated tool and accompanying instructions contained the following items: corrected gestational age, state of behavioral organization (state of consciousness, overall posture and overall muscle tone), oral posture (lips and tongue), oral reflexes (rooting, sucking, biting and gagging) and non-nutritive sucking (tongue movements, cupped tongue configuration, jaw movements, sucking force, sucking pause, maintaining the rhythm sucking and pause, maintaining an alert state and signs of stress). CONCLUSIONS: the tool and accompanying instructions aim to systematize the evaluation of preterm infants, beginning with the transition from gastric to oral feeding. Clinical validation is necessary before they can be used in neonatal wards.

Influência dos hormônios esteróiodes sexuais no tempo de esqueletização de ratos wistar / Influence of steroid sexual hormones on skeletization time of wistar rats

A estimativa do tempo de morte é um dos problemas mais complicados e difíceis da Medicina Legal devido aos diversos fatores que interferem nesse processo (temperatura, umidade, condições aeróbica e anaeróbica, presença de microrganismos e condições do solo). Fatores intrínsecos ao corpo freqüentemente não são relacionados à decomposição corporal. Para investigar se o processo de esqueletização sofre interferência dos hormônios esteróides sexuais foi realizado um trabalho experimental com ratos Wistar (30 machos e 60 fêmeas divididos em subgrupos em diferentes fases hormonais). Os animais foram cuidados até atingirem o peso entre 350 e 450g, quando foram mortos em câmara de CO2 e sepultados. A análise dos fatores ambientais (temperatura, umidade do ar e chuvas) e corporais (peso e gordura corporal) mostrou que a variação destes não interferiu no processo de esqueletização. Após as exumações, apenas o grupo de machos controles para testosterona apresentou esqueletização completa. Os machos castrados sem reposição de testosterona e os machos castrados com reposição de testosterona apresentaram esqueletização mínima. Todos os grupos das fêmeas apresentaram esqueletização parcial. A análise dos resíduos de putrefação dos grupos com esqueletização mínima e parcial evidenciou a presença de ácidos graxos característicos da composição de adipocera. Considerando-se que os dois grupos de animais (machos e fêmeas) foram sepultados no mesmo local, sob as mesmas condições ambientais e corporais, durante o mesmo intervalo de tempo, é possível concluir que os hormônios esteróides sexuais são responsáveis pela diferença observada na decomposição corpórea, sendo a testosterona o principal interveniente neste processo. Além disso, o modelo experimental também evidenciou o potencial de utilização para ser utilizado futuramente em estudos do processo de formação de adipocera.

The establishment of the postmortem interval is one of the most complicated and difficult tasks in forensic investigation because of many factors that affect this process (temperature, humidity, aerobic and anaerobic conditions, presence of microorganisms and soil conditions). Body intrinsic factors frequently not are related to de body decomposition. To investigate if the skeletonization process is under interference of sexual steroid hormones an experimental investigation with Wistar rats was done (30 male and 60 females divided in sub-groups at different hormonal phases). The animals were raised until they reach body weight between 350 and 450g, when were killed in a CO2 chamber and buried. Analysis of the environmental (temperature, humidity and rain) and corporal factors (body weight and body fat) showed that variation in these factors did not interfere on the skeletonization process. After the exhumation, only the male control group for testosterone showed complete skeletonization. The castrated males with no testosterone reposition and the castrated males with testosterone reposition showed minimum skeletonization. All female groups showed partial skeletonization. Analysis of the putrefaction residues from the groups with partial and minimum skeletonization showed the presence of the characteristic fatty acids of adipocere composition. Considering that both animal groups (males and females) were buried at the same place, under the same environmental and body conditions, during the same time interval, it is possible to conclude that sexual steroid hormones are responsible for the observed difference in body decomposition, being testosterone the main intervenient factor in this process. Besides, the experimental model also evidenced its potential use for future studies in the process of adipocere formation.

[Nursing diagnosis in the perioperative period of cardiac surgery]. / Diagnósticos de enfermagem no perioperatório de cirurgia cardíaca.

This study identified the nursing diagnoses of patients in the perioperative period of cardiac surgeries and verified the existence or not of agreement between the first author and other nurses in the identification of these diagnoses. Seventeen patients admitted for cardiac surgery were submitted to evaluation using instruments for the perioperative period. In the preoperative, out of the 9 diagnosis categories identified by the first author, three agreed with the nurses (example: Activity intolerance). In the trans-operative, seven categories showed agreement among the nurses and the first author (example: Risk for infection). In the post-operative, 11 categories showed agreement among the nurses and the first author (example: Risk for peripheral neurovascular dysfunction).

Diagnósticos de enfermagem no perioperatório de cirurgia cardíaca / Nursing diagnosis in the perioperative of cardiac surgery

Foram identificados os diagnósticos de enfermagem de pacientes no período perioperatório de cirurgia cardíaca e verificada a concordância ou não entre a primeira autora e outros enfermeiros na identificação desses diagnósticos. Dezessete pacientes admitidos para cirurgia cardíaca foram avaliados utilizando-se instrumentos para o período perioperatório. No pré-operatório, das nove categorias diagnósticas identificadas pela primeira autora, três apresentaram concordância com os enfermeiros (exemplo: Intolerância à atividade). No trans-operatório, sete categorias apresentaram concordância entre enfermeiros e primeira autora (exemplo: Risco para infecção). No pós-operatório imediato, 11 categorias apresentaram concordância entre enfermeiros e primeira autora (exemplo: Risco para disfunção neurovascular periférica).

This study identified the nursing diagnoses of patients in the perioperative period of cardiac surgeries and verified the existence or not of agreement between the first author and other nurses in the identification of these diagnoses. Seventeen patients admitted for cardiac surgery were submitted to evaluation using instruments for the perioperative period. In the pre-operative, out of the 9 diagnosis categories identified by the first author, three agreed with the nurses (example: Activity intolerance). In the trans-operative, seven categories showed agreement among the nurses and the first author (example: Risk for infection). In the post-operative, 11 categories showed agreement among the nurses and the first author (example: Risk for peripheral neurovascular dysfunction).

Fueron identificados los diagnósticos de enfermería de pacientes en el periodo peri-operatorio de cirugía cardiaca y verificada la existencia o no de concordancia entre la primera investigadora y otros enfermeros en la identificación de esos diagnósticos. Diecisiete pacientes admitidos para cirugía cardiaca fueron sometidos a evaluación, utilizando un instrumento para cada momento del periodo peri operatorio. En el peri-operatorio, de los diagnósticos identificados por la primera investigadora, tres coincidieron con los enfermeros (ejemplo Intolerancia a la actividad). En el trans-operatorio, siete categorías coincidieron entre los enfermeros y la primera investigadora (ejemplo: Riesgo de infección). En el post-operatorio inmediato, 11 categorías coincidieron entre los enfermeros y la primera investigadora (ejemplo: Riesgo para disfunción neuro-vascular periférica).

First isolation and molecular characterization of Toxoplasma gondii from finishing pigs from São Paulo State, Brazil.

Toxoplasma gondii infection is widely prevalent in humans in Brazil. Among the food animals, pigs are considered the most important meat source of T. gondii for infection in humans. In the present study, we report the first isolation of viable T. gondii from finishing pigs in Brazil. Antibodies to T. gondii were found in 49 (17%) of 286 pigs prior slaughter using the modified agglutination test (MAT) at a serum dilution of 1:25. Attempts were made to isolate T. gondii from 28 seropositive pigs. Samples of heart, brain, and tongue from each pig were pooled, digested in acid pepsin, and bioassayed in five mice per pig. Viable T. gondii was isolated from seven pigs; all isolates were lethal for mice. Restriction fragment length polymorphism on products of SAG2 locus amplified by PCR revealed that two isolates were Type I and five were Type III. The results indicate that phenotypically and genetically T. gondii isolates from pigs from Brazil are distinct from isolates of T. gondii from pigs in the USA.

Tradução e validação do Eating Attitudes Test em adolescentes do sexo feminino de Ribeirão Preto, São Paulo / Translation and validation of the Eating Attitudes Test in female adolescents in Ribeirão Preto, SP, Brazil

O objetivo desta pesquisa foi realizar a tradução e validação semântica do ating Attitudes test (EAT-26) para a língua portuguesa. Foram utilizadas a tradução e a retrotradução do instrumento e a análise estatística para avaliar a consistência interna dos itens do teste e sua confiabilidade. O EAT-26 foi aplicado em 365 adolescentes do sexo feminino com idades entre 12 e 18 anos. A idade média das meninas foi de 14,2 anos e a maioria era eutrófica. A pontuação média total do EAT-26 foi de 19,8 pontos. A consistência interna do teste representada pelo alfa de Cronbach foi de 0,82,considerado estatisticamente bastante satisfatório. Concluímos, assim, que o EAT-26 encontra-se em boas condições de ser utilizado nesse grupo de risco, possibilitando indicativos para o prognóstico de transtornos alimentares como a anorexia e a bulimia nervosas

Fatores de risco e medidas preventivas para úlcera de pressäo no lesado medular. Experiência da equipe de enfermagem do HCFMRP-USP / Risk factors and prevention of pressure ulcer in spine cord injury patients. Experience of members of nursing team at FMRP-USP Hospital

As úlceras de pressäo (UP) säo freqüentes no lesado medular, podendo trazer sérias complicações, como osteomielite, septicemia, amputações, e mesmo levar o paciente a óbito. Interferem na qualidade de vida do paciente e família, impedindo ou dificultando o acesso a programas de reabilitaçäo. Assim, a prevençäo e o tratamento no estágio inicial devem ser a meta da assistência que vise à qualidade. Este estudo teve como objetivo identificar as causas de UP em pacientes com traumatismos da medula espinhal, atendidos em uma instituiçäo hospitalar, e descrever as medidas identificadas como mais importantes para a prevençäo do problema, segundo a opiniäo de enfermeiros, auxiliares e técnicos de enfermagem. Através de um inquérito, os dados foram coletados, utilizando-se um instrumento composto de 35 frases com descritores dos fatores de risco e 18 frases com descritores de medidas preventivas, construído a partir de dados da literatura e validado anteriormente. A análise de estatística inferencial foi realizada através da análise de variância. Os resultados da análise descritiva e os testes de estatística inferencial evidenciaram que a equipe de enfermagem identificou, como importantes para a causalidade da UP, fatores de risco referentes tanto ao paciente quanto à estrutura institucional e ao processo de cuidar. Segundo a percepçäo da equipe, o paciente com traumatismos da medula espinhal apresenta diminuiçäo ou perda da mobilidade e sensibilidade, tornando-se dependente de outra pessoa para mobilizar-se. A estrutura institucional e o processo de cuidar näo atendem às necessidades do paciente, assim, näo se faz a rigorosa mudança de decúbito como deveria ser feita, os colchões utilizados näo säo adequados, levando o paciente a uma permanência prolongada no leito, em uma só posiçäo, o que causa excesso de pressäo nas proeminências ósseas. Após a alta, o problema persiste, pois, segundo a percepçäo dos participantes da pesquisa, a família näo tem conhecimento a respeito da prevençäo e näo presta cuidados adequados em casa. Quanto às medidas preventivas, houve diferença entre a percepçäo dos auxiliares/técnicos e a dos enfermeiros; estes últimos consideraram todos os descritores do questionário importantes para a prevençäo, enquanto os auxiliares/técnicos näo consideraram. Houve uma discrepância no que diz respeito aos fatores de risco, que os auxiliares/técnicos consideraram importantes e o que apontaram como intervenções para prevenir o problema