Exploring the effect of wound related pain on psychological stress, inflammatory response, and wound healing.

AIMS AND OBJECTIVES: The relationship between pain and poor healing is intricate, potentially mediated by psychological stress and aberrations in inflammatory response. The purpose of this study was to examine the biopsychosocial model of pain by assessing the relationships between pain, stress, inflammation and healing in people with chronic wounds. DESIGN: This was a 4-week prospective observational study to explore the relationship of pain, stress, inflammation and wound healing in a convenience sample of patients with chronic wounds in a chronic care hospital in Canada. METHODS: Only subjects over 18 with chronic wounds were recruited into the study. Chronic wounds were defined by the duration of wounds for more than 4 weeks of various aetiologies including wounds caused by pressure injuries, venous disease, arterial insufficiency, surgery or trauma and diabetic neuropathy. Participants were evaluated for pain by responding to the Brief Pain Inventory-Short Form, the McGill Pain Questionnaire-Short Form and the Leeds Assessment of Neuropathic Symptoms and Signs scale. Stress was measured by the Perceived Stress Scale (PSS). All wounds were assessed with the Pressure Ulcer Scale for Healing tool. The levels of matrix metalloproteinases were analysis by obtaining wound fluid from all participants. RESULTS: A total of 32 individuals with chronic wounds participated in the study. Correlation analysis indicated pain severity was positively and significantly related to pain interference, McGill Pain Questionnaire scores, neuropathic pain and matrix metalloproteinase levels. Logistic regression was used to determine the predictors for high or low perceived stress. The only significant variable that contributed to the stress levels was BPI-I. Results suggested that participants who experienced higher levels of pain interference also had an increased odds to report high level of stress by 1.6 times controlling for all other factor in the model. CONCLUSION: Pain is a complex biopsychosocial phenomenon affecting quality of life in people with chronic wounds. Results of this study identified a significant relationship between pain, stress and wound healing.

Perioperative interventions for the prevention of surgical wound infection in adult patients undergoing left ventricular assist devices implantation: A scoping review.

BACKGROUND: Surgical wound infection is the most frequent type of care health associated infection. Lack of knowledge about the prevention of surgical wound infection in patients undergoing left ventricular assist device implantation could significantly undermine the potential benefits of surgical intervention. OBJECTIVES: This study aimed to map the recommendations for adult patients undergoing left ventricular assist device implantation. DESIGN: This is a scoping review, being registered in the Open Science Framework under DOI https://doi.org/10.17605/OSF.IO/Q76B3 (https://osf.io/q76b3/). METHOD: Left ventricular assist device coordinators and nurse specialists in dermatology and stomatherapy conducted a scoping review in Scopus, The Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), limited to the period between 2015 and 2022. The results of this scoping review will be discussed and presented in separate articles. This paper will synthesize research evidence on the perioperative topic. RESULTS: The initial searches resulted in 771 studies. Sixty nine met the eligibility criteria and were included in the scoping review. Eight articles addressing the perioperative topic that answered the question of this article were included. CONCLUSION: Although this scoping review included heterogeneous, and scarce studies with left ventricular assist device patients. As such, there are many promising future research directions for this topic. IMPLICATIONS FOR CLINICAL PRACTICE: Infection surveillance should be an integral part of left ventricular assist device implantation programs in health care institutions. Velvet completely buried in subcutaneous tissues reduces transmission system infection. Triple tunnel method reduces transmission system infection risk.

Deficiencies in reporting inclusion/exclusion criteria and characteristics of patients in randomized controlled trials of therapeutic interventions in pressure injuries: a systematic methodological review.

Wound care is a complex procedure and the related research may include many variables. Deficiencies in the sample inclusion and exclusion criteria may limit the generalizability of randomized controlled trials (RCTs) for wound patients in the real world. This study aimed to evaluate deficiencies in reporting the inclusion and exclusion criteria and the characteristics of patients in RCTs of pressure injuries (PI) therapeutic interventions. We conducted a systematic methodological review in which 40 full text RCTs of PI treatment interventions published in English, from 2008 to 2020, were identified. Data on the general characteristics of the included RCTs and data about inclusion/exclusion criteria and characteristics of patients were collected. The inclusion/exclusion criteria were categorized into five domains (definition of disease, precision, safety, ethical/legal and administrative). Study duration (in weeks) was 8.0 (quartile 1: 2.0; quartile 3: 48.0); only 5.0% of the trials mentioned race, skin colour or ethnicity, and 37.5% reported the duration of the wound. Only 9 (22.5%) studies reported the drugs that the included patients were using and 10 (25.0%) RCTs reported adverse events. The presence of the five domains was observed only in 12.5% of RCTs and only 12 (30.0%) had the precision domain. Much more research is required in systematic assessments of the external validity of trials because there is substantial disparity between the information that is provided by RCTs and the information that is required by clinicians. We concluded that there are deficiencies in reporting of data related to inclusion/exclusion criteria and characteristics of patients of RCTs assessing PI therapeutic interventions.

Topical therapy for pain management in malignant fungating wounds: A scoping review.

AIMS AND OBJECTIVES: To map and synthesise the existing literature on topical therapies for malignant fungating wounds pain management and the gaps involved. BACKGROUND: Most cancer patients with malignant fungating wounds suffer from wound-related pain, affecting their quality of life. Unfortunately, even though pain is a relevant symptom in cancer and palliative care, little is currently known about topical treatments' availability and impact on pain management. DESIGN: A scoping review following JBI® methodology METHODS: Searches were performed in CINAHL, LILACS, Embase, Web of Science, PubMed, Cochrane, NICE, Scopus, JBISRIR and grey literature, in English, Portuguese and Spanish, with no time limit. Two authors independently reviewed all citations and a third was called in case of divergence, and studies in adults with malignant fungal wounds reporting topical pain interventions were included. In addition, a data extraction tool for synthesis and thematic analysis was developed. This study followed the PRISMA-ScR Checklist. RESULTS: Seventy publications were selected from 796 records retrieved from databases. The studies mainly included non-systematic reviews and case studies with only six clinical trials. According to the narrative synthesis, twenty therapies were identified, including the use of wound dressings (58.6%), analgesic drugs (55.7%), topical antimicrobials (25.7%), skin barriers (15.7%), cryotherapy (5.7%) and negative pressure wound therapy (4.3%). Therapies were recommended to be applied to the wound bed or the periwound skin. In 68.5% of the studies, a standardised assessment for pain was not described. CONCLUSIONS: Topical therapies applied to malignant fungating wounds or periwound areas had been examined for pain management. However, their effectiveness was analysed in a few interventional studies, indicating the need for further primary studies to inform evidence-based practice. IMPLICATION FOR PRACTICE: Highlighted topical therapies for clinical practice consideration are opioids, anaesthetics and antimicrobials, with positive results described in randomised clinical trials. This study did not include patients.

The prevalence of skin lesions and associated factors in hospitalised adult patients with cancer.

OBJECTIVE: To assess the prevalence of skin lesions and evaluate the clinical and sociodemographic factors associated with their presence in hospitalised patients. METHOD: This descriptive, cross-sectional, correlational study was performed in inpatient units and intensive care units of a cancer hospital in São Paulo, Brazil, after approval by the Institutional Research Ethics Committee. Data from hospitalised adult patients with cancer were collected during physical examinations and from medical records. A Chi-squared test, univariate analysis, a logistic regression model with results expressed as odds ratio (OR) and 95% confidence intervals (CI), and Classification and Regression Tree (CART) analysis were used to evaluate the data. RESULTS: Of 341 patients, 80 had skin lesions, equating to an overall prevalence of 23.5%. The skin lesions included pressure injuries (10%), incontinence-associated dermatitis (6.7%), skin tears (6.5%), malignant wounds (3.8%) and complicated surgical wounds (3.2%). The factors associated with skin lesions in cancer patients were the use of disposable nappies (OR: 4.436) and age (59.1±15.1 years), according to the CART analysis, and the wearing of nappies (OR: 4.466, p<0.001), presence of ecchymosis (OR: 2.532, p<0.001) and infection (OR: 6.449, p=0.040), according to multiple regression analysis. CONCLUSION: This study contributed to knowledge about prevalence and associated factors of skin lesions in hospitalised patients with cancer, allowing the implementation of preventive measures.

Skin tears in older adult residents of long-term care facilities: prevalence and associated factors.

OBJECTIVE: To determine the prevalence of skin tears, and demographic and clinical factors associated with their presence in older adult residents of long-term care facilities. METHOD: This observational, quantitative, cross-sectional, epidemiological study was conducted with older adult residents of three long-term care facilities in São Paulo, Brazil. For data collection, four instruments were used: a questionnaire assessing sociodemographic and clinical characteristics of the residents; and the Brazilian-Portuguese versions of the Mini-Mental State Examination, Skin Tear Audit Research (STAR) Skin Tear Classification System, and the Katz Index of Independence in Activities of Daily Living. RESULTS: A total of 69 residents took part in the study. The prevalence of skin tears was 11.6%. Skin tears were significantly associated with the presence of haematoma (odds ratio, OR=9.159; p=0.017) and actinic purpura (OR=6.265; p=0.033), which increased the odds of skin tear development nine-fold and six-fold, respectively. CONCLUSION: The findings agree with the international literature. Considering that this was the first epidemiological study on skin tears carried out in long-term care facilities for older adults in Brazil, its contribution lies in the systematisation of data collection and making data available on a field that has not yet been studied in this country.

Prevalence of surgical complicated wound and associated factors in adults treated at public hospitals / Prevalencia de herida operatoria complicada y factores asociados en adultos internados en hospitales públicos / Prevalência de Ferida Operatória Complicada e fatores associados em adultos internados em hospitais públicos

Objective: To estimate the prevalence of complicated surgical wounds and their associated factors in hospitalized adults. Method: Cross-sectional study, approved by the ethics committee. We analyzed information from 251 patients undergoing surgery, at risk of surgical site complications, and admitted to seven public hospitals in Manaus (Brazil); information was collected through interviews, physical examination, and review of medical records from March to June 2015. The prevalence rate was calculated as the ratio between individuals with complications and patients at risk. To explore associated variables, individuals with and without complications were compared using bivariate analyzes and logistic regression, with a significance level of 5%. Results: 15 patients (6%) had a complicated surgical wound. The presence of ecchymosis (p<0.001), adjusted for male sex (p=0.047), and admission to the general practice (p<0.003) increased the probability of developing the complication by 10.1; 8.2, and 13.9 times, respectively. Conclusion: Identifying the prevalence of complicated surgical wounds in adults and its associated factors contributes to its epidemiological understanding, highlighting prevention targets and providing data for scientific comparison.

Objetivo: Estimar la prevalencia de heridas operatórias complicadas y sus factores asociados, en adultos hospitalizados. Método: Estudio transversal, aprobado por comité de ética. Fueron analizadas informaciones de 251 pacientes sometidos a cirugía, con riesgo de complicación del sitio quirúrgico, internados en siete hospitales públicos en Manaus (Brasil); cuyos datos fueron recolectados por medio de entrevista, exame físico e revisión de historias clínicas en el período de marzo a junio de 2015. La tasa de prevalencia fue calculada como la raz´ón entre los individuos con complicación y los pacientes en riesgo. Para exploración de variábles asociadas, fueron comparados individuos con y sin complicación por meio de análisis bivariados y regresión logística, con significancia de 5%. Resultados: 15 pacientes (6%) presentaron heridas operatorias complicadas. La presencia de equimosis (p<0,001), ajustada por el sexo masculino (p=0,047), y la hospitalización en servicios generales (p<0,003) aumentaron la probabilidad de desarrollar la complicación en 10,1; 8,2 e 13,9 veces, respectivamente. Conclusión: la identificación de la prevalencia de la herida operatoria complicada en adultos y sus factores asociados contribuyen para a su comprensión epidemiológica, destacando blancos de prevención y disponibilizando datos para comparación científica.

Objetivo: Estimar a prevalência de ferida operatória complicada e seus fatores associados, em adultos hospitalizados. Método: Estudo transversal, aprovado por comitê de ética. Foram analisadas informações de 251 pacientes submetidos à cirurgia, com risco de complicação do sítio cirúrgico, internados em sete hospitais públicos em Manaus (Brasil); cujos dados foram coletados por meio de entrevista, exame físico e revisão de prontuários, no período de março a junho de 2015. A taxa de prevalência foi calculada como a razão entre os indivíduos com complicação e os pacientes em risco. Para exploração de variáveis associadas, foram comparados indivíduos com e sem complicação por meio de análises bivariadas e regressão logística, com significância de 5%. Resultados: 15 pacientes (6%) apresentaram ferida operatória complicada. A presença de equimose (p<0,001), ajustada pelo sexo masculino (p=0,047), e a internação na clínica geral (p<0,003) aumentaram a probabilidade de desenvolver a complicação em 10,1; 8,2 e 13,9 vezes, respectivamente. Conclusão: A identificação da prevalência da ferida operatória complicada em adultos e seus fatores associados contribuem para a sua compreensão epidemiológica, destacando alvos de prevenção e disponibilizando dados para comparação científica.

Desafíos en el cuidado de personas con Covid-19 en posición prono: apoyo al estudio internacional PRONEtect.

SINOPSIS: El siguiente editorial presenta los resultados de una encuesta a los líderes de las 13 asociaciones de la Confederación Multidisciplinar Latinoamericana de Heridas, Estomas e Incontinencias (COMLHEI). La encuesta buscó determinar, de manera general, la situación de los pacientes con Covid-19 en posición prono (PP) con desarrollo de lesiones por presión (LPP). Los resultados indican que, en América latina, las LPP en pacientes en PP son frecuentes. Se evidenciaron deficiencias en estudios epidemiológicos y de elementos de protección, prevención y educación, además de brechas entre los diferentes países e instituciones en cuanto a la disponibilidad de personal para poder cumplir con las recomendaciones de posicionamiento de los pacientes. Las autoras sugieren tener en cuenta los resultados del estudio internacional PRONEtect para identificar, revisar y evaluar las pautas internacionales de pronación y cuidado de la piel, y hacer un inventario de los equipos y recursos de capacitación de uso común.

Cultural Adaptation and Validation of the Ostomy Adjustment Inventory-23 for Brazil.

The Ostomy Adjustment Inventory-23 (OAI-23) was developed in English to measure the social and psychological adaptation of individuals who underwent ostomy surgeries. PURPOSE: The aim of the current study was to culturally adapt and test the measurement properties of a Brazilian Portuguese adapted version of the OAI-23. METHODS: The original version of the OAI-23 was composed of 23 questions distributed into the following 4 factors: acceptance, anxiety/preoccupation, social engagement, and anger. The OAI-23 was translated into Portuguese, reviewed by a committee of expert reviewers, pretested on a focus group, and back-translated. Using convenience sampling methods, patients who were treated at specialized health centers located in different parts of Brazil were invited to complete a demographic and health history questionnaire, the Janis and Field Self-Esteem Scale, and the adapted version of OAI-23 to assess its reliability, convergent construct validity, and discriminant construct validity. RESULTS: A total of 191 patients with a mean age of 58.9 years (SD = 14.7) (74.1% with colostomies, 19.6% with ileostomies, and 6.3% with urostomies) participated in the study. The Brazilian Portuguese adapted version of the OAI-23 had a Cronbach's alpha coefficient of 0.846 and an intra-class correlation coefficient of 0.903 (P < .001). Significant correlations between OAI-23 scores and self-esteem scale scores confirmed the convergent construct validity, and the instrument was able to discriminate patients' adjustment according to age. CONCLUSION: The adapted version of the OAI-23 proved to be reliable and valid for use in Brazil; this represents the first instrument capable of assessing psychosocial adaptation of patients with stomas in that country.

Complicated Surgical Wounds and Associated Factors in Oncology Patients.

The objective of this study was to identify the occurrence of complicated surgical wounds (CSWs) and to analyze the associated factors in hospitalized patients at an oncology institution. This was an epidemiological, observational, cross-sectional, descriptive, and correlational study conducted in the intensive care and hospitalization units forming part of a large cancer hospital. Sociodemographic and clinical data were collected from medical records and physical examinations of the skin. Associations between the dependent variable (presence of CSWs) and the independent variables were obtained by chi-square tests and odds ratio (OR) calculations with a 95% confidence interval. Logistic regression (LASSO) was used to verify the possible predictors of the outcome. The sample consisted of 341 patients, specifically individuals who are White (46.9%), married (53.4%), and men (58.1%) with an average age of 59.2 years. Complicated surgical wounds were present in 3.2% of patients, and the most frequent types of complications were dehiscence (40%), infection (26.7%), and fistula (20%) present in the abdominal (40%), cephalic (26.7%), and cervical (13.3%) regions. Senile purpura, diaper use, and infection were the clinical variables associated with the occurrence of CSWs (p = .044, p = .001, and p < .001, respectively). Based on the logistic regression, the presence of infection (p < .001; OR = 90.8; 95% CI [18.42, 538.79]) persisted as a predictor of the occurrence of CSWs. From these observations, recommendations regarding best practices for the prevention of CSWs are made, specifically for patients with cancer.

Regenerated oxidised cellulose versus calcium alginate in controlling bleeding from malignant breast cancer wounds: randomised control trial study protocol.

OBJECTIVE: Malignant wounds due to breast cancer can present with recurrent episodes of bleeding in the tumour tissue. This study will compare the efficacy of a calcium alginate dressing (Biatain, Coloplast A/S, Denmark) and a regenerated oxidised cellulose dressing (Surgicel, Ethicon, LLC, Puerto Rico). PROTOCOL: A total of 24 patients with breast cancer and bleeding, malignant wounds will be enrolled in the randomised, controlled, open study, conducted at a hospital specialising in breast cancer treatment and at another hospital specialising in palliative care. Patients over 18 years old, with bleeding and willing to undergo venipuncture for blood collection will be included. All enrolled patients will be randomised for allocation to an experimental group (regenerated oxidised cellulose dressing) or a control group (calcium alginate dressing). The main intervention will consist of the application of the haemostatic product, assessment of digital pressure and estimation of the time required for haemostasis. OUTCOMES: Key outcome measures will be the percentage of patients with haemostasis within 20 minutes, observation of haemostasis after three, five and 10 minutes, in addition to recurrence of bleeding and the quantity of product used. DISCUSSION: To our knowledge, this is the first study to evaluate the effectiveness of haemostatic products in malignant wounds. This type of wound is poorly explored in the literature and, among its signs and symptoms, bleeding is poorly studied. The completion of this study will provide a more robust rationale for clinical decision-making related to the control of bleeding in malignant breast cancer wounds in the context of evidence-based nursing practices.

Incidence of Skin Tears and Risk Factors: A Systematic Literature Review.

Skin tears are traumatic wounds resulting from friction and shearing forces. Clinical practice strongly indicates that skin tears are a prevalent problem but their incidence is not well established in the literature. This systematic literature review identified and evaluated the available literature on the incidence and risk factors for skin tears in adults and the elderly. Inclusion criteria were epidemiological studies published in English, Spanish, or Portuguese languages from January 1990 through June 2014 and available in full text. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem. Five studies reporting incidence of skin tears met the selection criteria. Reported incidence rates of skin tears ranged from 2.23% to 92% in long-term care facilities and varied from 2.1% among men to 4.6% among women living in the community. The most prevalent risk factor for skin tears was old age, followed by impaired mobility, falls and accidental injuries, previous skin tears, cognitive deficit/dementia, dependence in transfers, and upper limbs. Further epidemiological studies on skin tears are necessary to elucidate the cause of these injuries and identify the profile of people at risk for skin tears, contributing to the development and implementation of appropriate preventive interventions.

Constipation: Prevalence and Associated Factors in Adults Living in Londrina, Southern Brazil.

The aims of this study were to estimate the prevalence of constipation and identify associated factors among adults living in an urban area in Londrina, Brazil. This was a secondary analysis of an epidemiological, population-based study on bowel habit performed in 2008 with 2,162 individuals selected through cluster sampling. Interviews were administered using a sociodemographic questionnaire and the adapted and validated Brazilian version of the "Bowel Function in the Community" tool. Variables from the original database were used to determine the prevalence of constipation (according to the Rome Criteria III) and associated factors. The chi-square test and multivariate logistic regression were used for data analysis. The overall prevalence of constipation (14.6%; n = 315) was higher among women than among men (21.9% vs. 5.3%), increased with age among men, and was inversely related to family income. Overall, female gender, low socioeconomic status, history of anal fissure, anorectal surgery, stroke, nervous system disease, fistulae, and hemorrhoids were factors significantly associated with constipation. The variables low social economic status, stroke, anal fissure history, and anorectal surgery were statistically significant in all three tested statistical models.

Incidence of pressure ulcers in the institutionalized elderly.

PURPOSE: The aim of this study was to analyze the incidence of pressure ulcers (PUs) in elderly people living in long-term care facilities (LTCFs). DESIGN: We completed a prospective, comparison cohort study. SUBJECTS AND SETTING: Ninety-four persons, 60 years or older, participated in the study. Participants resided in 4 not-for-profit LTCFs in 3 cities in the southern region of the Brazilian state of Minas Gerais. METHODS: Participants underwent complete skin examination and Braden Scale rating every 2 days for 3 months. When a PU was detected, a careful examination was done to assess its stage, location, and size. From this moment on, the patient was included in the incidence rate and was excluded from the study. RESULTS: The incidence rate of PUs was 39.4%; 37 (77.1%) developed a single ulcer. The most common locations were the malleolus (27.1%) and the ischium (25.0%). Stage I PU were most frequent (66.7%). Females (62.8%) and whites (68.19%) prevailed, with an average age of 79.06 +/- 9.6 years. Body mass index was 20.93 +/- 4.9, with a predominance of urinary diseases (58.5%) and use of neuroleptics/psychotropics (52.1%); 28.7% had had a previous ulcer. Gender and the occurrence of a previous ulcer were found to predict the development of PU, based on logistic regression analysis (r = 0.311). CONCLUSIONS: The overall incidence of PU was significant, but the incidence of stage II and higher PUs was less than 12% and no elders had stage III or IV ulcers. Factors associated with PU development include female gender, regular use of neuroleptic or psychotropic medications, and a history of pressure ulceration.

Predictive validity of Waterlow Scale for pressure ulcer development risk in hospitalized patients.

AIM: We sought to evaluate the predictive validity of the Waterlow Scale in hospitalized patients. SUBJECTS AND SETTING: The study was conducted at a general private hospital with 220 beds and a mean time of hospitalization of 7.4 days and a mean occupation rate of approximately 80%. Adult patients with a Braden Scale score of 18 or less and a Waterlow Scale score of 16 or more were studied. The sample consisted of 98 patients with a mean age of 71.1 + or - 15.5 years. METHODS: Skin assessment and scoring by using the Waterlow and Braden scales were completed on alternate days. Patients were examined at least 3 times to be considered for analysis. The data were submitted to sensitivity and specificity analysis by using receiver operating characteristic (ROC) curves and positive (+LR) and negative (-LR) likelihood ratios. RESULTS: The cutoff scores were 17, 20, and 20 in the first, second, and third assessment, respectively. Sensitivity was 71.4%, 85.7%, and 85.7% and specificity was 67.0%, 40.7%, and 32.9%, respectively. Analysis of the area under the ROC curve revealed good accuracy (0.64, 95% confidence interval [CI]: 0.35-0.93) only for the cutoff score 17 in the first assessment. The results also showed probabilities of 14%, 10%, and 9% for the development of pressure ulcer when the test results were positive (+LR) and of 3% (-LR) when the test results were negative for the cutoff scores in the first, second, and third assessment, respectively. CONCLUSION: The Waterlow Scale achieved good predictive validity in predicting pressure ulcer in hospitalized patients when a cutoff score of 17 was used in the first assessment.

Prevalence of urinary incontinence in a community sample from the city of São Paulo.

PURPOSE: The aim of this study was to analyze the prevalence of urinary incontinence (UI) in a community sample from the city of São Paulo. METHODS: This epidemiological survey was conducted at a family health program in São Paulo, Brazil, using randomized sampling. Data were collected by interviewing residents and were analyzed by Pearson's correlation coefficients, chi-square tests, and logistic regression analysis. RESULTS: Seventy (10.7%) of the 657 subjects currently presented UI, including 50.7% with sporadic UI and 74.3% with UI upon moderate efforts. Ninety-three percent woke up during the night, 43.7% maintained continence until the bathroom, 63.4% had a sensation of wetness, and 77.5% reported no use of any continence aids. Female gender, advanced age, gynecologic or urologic surgery, dysuria, and urinary tract infection were correlated with UI (P < .001; r = 0.572). CONCLUSION: The overall prevalence of UI was found to be high and was comparable to results from multiple countries.

Cross-cultural adaptation and validation of the Portuguese version of the Bowel Function in the Community instrument.

PURPOSE: We sought to translate the Bowel Function in the Community instrument into the Portuguese language and to culturally adapt it to Brazilian society. We also aimed to test the validity and reliability (content validity, and interrater and test-retest reliability) of this adapted version. INSTRUMENT: The original instrument comprised 70 items grouped into 6 principal areas: general bowel habits, fecal incontinence, lower urinary tract symptoms, anorectal diseases and surgical history, medical care utilization, and potential contributing medical disorders. METHODS: The instrument was translated into Portuguese, and assessed by a committee of specialists. Content validity of the translated version was verified by testing and via feedback from a focus group. The adapted version incorporated both semantic and idiomatic alterations. The instrument then underwent testing for interrater and test-retest reliability. RESULTS: Interrater reliability testing revealed a 94% level of agreement between interviewers and researchers. Test-retest reliability testing revealed a slightly higher than 60% level of agreement when the same subjects completed the instrument twice, during a baseline measurement and a second time following a 1-week interval. CONCLUSIONS: The adapted version of the Bowel Function in the Community instrument demonstrates adequate validity and reliability for use in research in the Brazilian population.

Inter rater reliability of Pressure Ulcer Scale for Healing (PUSH) in patients with chronic leg ulcers.

This study aimed to evaluate the inter rater reliability of the Pressure Ulcer Scale for Healing (PUSH), in its version adapted to the Portuguese language, in patients with chronic leg ulcers. Kappa index was used for the analysis. After accomplishing ethical issues, 41 patients with ulcers were examined. A total of 49% of the ulcers were located in the right leg and 36% of them were venous ulcers. The Kappa indices (0.97 to 1.00) obtained in the comparison between the observations of the clinical nurses and the stomal therapists for all sub-scales and for total score, confirmed the tool inter rater reliability, with statistical significance (p<0.001). The PUSH instrument, in its Portuguese adapted version, showed to be reliable to the use in patients with chronic leg ulcers. Further studies should be conducted to evaluate its prospective performance.

Quality of life and coping of persons with temporary and permanent stomas.

PURPOSE: To evaluate and compare the use of coping strategies and quality of life (QoL) among individuals with temporary and permanent stomas. DESIGN: Descriptive, cross-sectional. METHODS: After consideration of ethical issues, 42 subjects with temporary stomas and 72 subjects with permanent stomas were interviewed. The Coping Strategies Inventory of Folkman and Lazarus, and Ferrans and Powers QoL Index, both validated for the Brazilian culture, were administered. RESULTS: Subjects from both groups used all coping strategies queried in the Coping Strategies Index and QoL index, but significant differences (P<0.05) were found in use of confrontive, escape-avoidance, and positive reappraisal factors, which were more frequently employed by patients with temporary stoma. QoL scores did not differ between the groups. Significant correlations (P<.001) among subjects with temporary stomas were observed between the family QoL subscale and (a) distancing, (b) self-control, (c) accepting responsibility, (d) escape-avoidance, and (e) positive reappraisal coping factors. Significant correlations were also found between the psychological/spiritual QoL subscale and positive reappraisal factor; between the health/functioning QoL subscale and planful problem solving and positive reappraisal for patients with temporary stomas. Among subjects with permanent stomas, only significant correlations existed between the psychological/spiritual QoL subscale and self-control and social support coping factors. CONCLUSION: Individuals with stomas tend to show positive QoL scores. However, different coping strategies were used by persons with temporary versus permanent stomas.

Pain in chronic leg ulcers.

OBJECTIVES: Describe the characteristics of pain in patients with chronic leg ulcers, correlate these descriptions with the characteristics of the ulcers and with patients' sociodemographic data, and determine the measures used for pain management. DESIGN: Descriptive and cross-sectional study with quantitative approach. SETTING AND SUBJECTS: The convenience sample was composed of 90 patients with chronic leg ulcers drawn from 4 outpatient departments in Sao Paulo and Curitiba. INSTRUMENTS: Intensity and quality of patients' pain were determined using a 0-10 numeric pain intensity rating scale and a short version of the McGill Pain Questionnaire. METHODS: After gaining ethics committee approval, patients were selected during their ambulatory visits and interviewed by researchers. Data obtained were analyzed using the Kolmogorov-Smirnov Normality test, Mann-Whitney test, Chi-Square test, and Spearman's Correlation coefficient. RESULTS: Seventy-three (81.11%) patients had venous ulcers. The mean pain intensity reported was 3.10 (SD = 3.15), the mean intensity of the "worst pain of the week" was 7.56 (SD = 2.96), and the mean intensity of the "best pain of the week" was 2.05 (SD = 2.37). The McGill Questionnaire showed that sensitive descriptors were most frequently used to describe the pain. Statistically significant correlations (P < .05) were observed. The most intense pain was reported in subjects from the lowest income bracket studied and female gender and was correlated with alterations in sleep, movement, walking, and mood. Nonsteroidal antiinflammatory drugs were most commonly used (70%) for pain management. CONCLUSIONS: This study indicates the need for more attention and understanding on the part of healthcare workers regarding leg ulcer pain and its characteristics and the need for specific and effective procedures designed to contribute to the improvement in quality of life of these individuals.