Dálete Delalibera Corrêa de Faria Mota

Self-report instruments for fatigue assessment: a systematic review.

This systematic review analyzed 18 self-reported fatigue instruments for adults. Five databases were searched combining fatigue with instrument, questionnaire, inventory, scale, or assessment. Eighteen fatigue instruments and six definitions of fatigue were found. Six instruments apply to physical or psychiatric disease; five are cancer-specific. Nine were unidimensional; others included intensity (n = 10), mental (n = 7), and physical (n = 7) dimensions. Eleven instruments had 15 or fewer items; the longest had 40 items. Four instruments were discriminative; 14 were evaluative. Fifteen assessed reliability using Cronbach’s alpha, which was greater than or equal to .90 seven times. Validity tests were convergent or divergent (n = 11), discriminant (n = 10), and factor analysis (n = 9). Because fatigue is a highly prevalent limiting symptom, this review is important for improving fatigue assessment.

Fadiga: uma análise do conceito

Background: Fatigue is one of the most commonly experienced phenomena by all human being. However, this concept is cause of great confusion in science. Objective: This study analyzed the concept of fatigue using the method of Walker and Avant (1995). Critical attributes, antecedents, consequents and empirical referents are identified. To illustrate the concept, model, contrary and illegitimate cases are presented. Results: The manifestation of tiredness or exhaustion associated with the impact on the development of every day activities and the absence of restorage of energy using habitual strategies are identified as the main empirical referents related to the concept of fatigue. Conclusions: This conceptual analysis offers support for the development of an operational definition and suggests new guidelines for future research.

Fatigue in colorectal cancer patients: prevalence and associated factors

This study identified the prevalence and predictors of fatigue in colorectal cancer (CRC) patients. Cross-sectional study with 157 adult CRC outpatients (age 60±11.7 years; 54% male; cancer stage IV 44.8%). The Piper Fatigue Scale-revised was used to assess fatigue scores. Socio-demographic, clinical, depression, performance status, pain and sleep disturbance data were assessed. Associations between fatigue and these data were analyzed through logistic regression models. Fatigue was reported by 26.8% patients. Logistic regression identified three predictors: depression (OR: 4.2; 95%CI 1.68-10.39), performance status (OR: 3.2; 95%CI 1.37-7.51) and sleep disturbance (OR: 3.2; 95%CI 1.30-8.09). When all predictors were present, the probability of fatigue occurrence was 80%; when none were present, the probability was 8%. The models specificity and sensitivity were 81.9% and 58.6%, respectively. Through the assessment of depression, performance status and sleep disturbance, the probability of fatigue occurrence can be estimated, and preventive and treatment strategies can be rapidly implemented in clinical practice.This study identified the prevalence and predictors of fatigue in colorectal cancer (CRC) patients. Cross-sectional study with 157 adult CRC outpatients (age 60±11.7 years; 54% male; cancer stage IV 44.8%). The Piper Fatigue Scale-revised was used to assess fatigue scores. Socio-demographic, clinical, depression, performance status, pain and sleep disturbance data were assessed. Associations between fatigue and these data were analyzed through logistic regression models. Fatigue was reported by 26.8% patients. Logistic regression identified three predictors: depression (OR: 4.2; 95%CI 1.68-10.39), performance status (OR: 3.2; 95%CI 1.37-7.51) and sleep disturbance (OR: 3.2; 95%CI 1.30-8.09). When all predictors were present, the probability of fatigue occurrence was 80%; when none were present, the probability was 8%. The models specificity and sensitivity were 81.9% and 58.6%, respectively. Through the assessment of depression, performance status and sleep disturbance, the probability of fatigue occurrence can be estimated, and preventive and treatment strategies can be rapidly implemented in clinical practice.

Co-morbidade fadiga e depressão em pacientes com câncer colo-retal

El estudio tuvo como objetivos caracterizar e identificar la relacion entre la fatiga y la depresion en pacientes con cancer colon-rectal. La muestra no probabilistica fue de 154 pacientes de ambulatorio (53% hombres; edad promedio 49,6±11,7 anos; escolaridad promedio 8,9±5,4 anos). La fatiga fue evaluada por la Escala de Fatiga de Piper Revisada y el humor por el Inventario de Depresion de Beck. La Fatiga fue relatada por 76 (49,4%) pacientes y fue intensa (puntaje total > 6) para 19,7% de ellos. Puntajes que sugieren depresion (IDB>20) fueron encontrados en 11 (7,1%) pacientes. La fatiga y la depresion estaban correlacionados (r= 0,395; p 0,001). La enfermedad concomitante fatiga moderada/intensa y disforia/depresion ocurrio en 12,3%. La Fatiga estaba presente en la totalidad de los enfermos deprimidos (100%), y la depresion ocurrio en 18% de los enfermos fatigados. Fatiga y depresion son fenomenos relacionados (concomitantes), y su accion puede ser muy deleterea para el enfermo; la depresion fue mas importante para la ocurrencia de fatiga que la fatiga para la depresion.The objective of this study was to identify and characterize the comorbidities of fatigue and depression in colorectal cancer patients. A non-probabilistic sample of 154 outpatients (53% men; mean age 49.6 +/- 11.7 years; mean education 8.9 +/- 5.4 years). Fatigue was evaluated using the Revised Piper Fatigue Scale (min:0; max:10) and depression was evaluated using the Beck Depression Inventory (BDI) (min:0; max: 63). Fatigue was identified by 76 (49.4%) patients, and was intense (total score > or =6) for 19.7%. Scores compatible with depression (BDI >20) were found in 11 (7.1%) patients. Fatigue and depression were correlated (r = 0.395, p < 0.001). Comorbidities of moderate/severe fatigue and dysphoria/depression occurred in 12.3%. Fatigue was present in all patients with depression (100%) and depression occurred in 18% of patients with fatigue. Fatigue and depression are related phenomena. Comorbidities can be deleterious to the patient. Depression had a stronger effect on the occurrence of fatigue than the effect of fatigue on depression.

Reflexões sobre o preparo para a docência na pós-graduação em enfermagem

It is noticeable the greater focus on scientific production in Graduate courses compared to the attention given to the preparation for teaching practices. This is a relevant issue considering the importance of having Masters and Doctors also prepared to form professionals in their area. This article discusses some aspects of the preparation of Graduate level students enrolled in the Teaching Improvement Program (Programa de Aperfeicoamento de Ensino, PAE), which the University of Sao Paulo offers. It also describes the experience of students who participate in the program, emphasizing its contribution to the development of competences for college teaching in Nursing.It is noticeable the greater focus on scientific production in Graduate courses compared to the attention given to the preparation for teaching practices. This is a relevant issue considering the importance of having Masters and Doctors also prepared to form professionals in their area. This article discusses some aspects of the preparation of Graduate level students enrolled in the Teaching Improvement Program (Programa de Aperfeiçoamento de Ensino, PAE), which the University of São Paulo offers. It also describes the experience of students who participate in the program, emphasizing its contribution to the development of competences for college teaching in Nursing.

Prevalência e comorbidade de dor e fadiga em mulheres com câncer de mama

Estudio analitico de analisis de prevalencia y comorbilidad de dolor y fatiga en mujeres con cancer de mama. Investigacion transversal, con muestra no probabilistica de 182 mujeres en tratamiento ambulatorio de cancer de mama, entrevistadas en periodo de julio 2006 a marzo 2007. Fatiga evaluada por Escala de Fatiga de Piper, fue dividida en dos categorias (puntaje 0,1-4,9 y >5-10). Dolor evaluado por escala de 0-10, categorizado del mismo modo que fatiga. Existio fatiga en 94 mujeres (51,6%), siendo >5 en 44 (46,8%) de ellas. Existio dolor en 86 mujeres (47,2%), siendo >5 en 50 (58,1%). Se correlacionaron dolor/fatiga (e=0,38, p=0,089) y la comorbilidad fatiga/dolor fue de 38,3%. El dolor intenso agudizo la fatiga (p=0,089) y la fatiga intensa acentuo el dolor (p=0,016). Datos ineditos en nuestro medio, confirman la existencia de un cluster de sintomas y los perjuicios derivados de la comorbilidad.This study analyzed the prevalence and comorbidity of pain and fatigue in women with breast cancer. This is a cross-sectional study using a non-probabilistic sample of 182 women following outpatient treatment for breast cancer, who were interviewed from July 2006 to March 2007. Fatigue was assessed using the Piper Fatigue Scale, and divided into two categories (scores 0.1-4.9 and >5-10). Pain was assessed by the 0-10 scale, and categorized the same way as fatigue. Fatigue occurred in 94 women (51.6%), and was >5 in 44 (46.8%) of the women. Pain occurred in 86 women (47.2%), with scores >5 in 50 (58.1%). Fatigue and pain were correlated (r=0.38, p=0.003) and the comorbidity fatigue and pain was 38.3%. Intense pain increased fatigue (p=0.089) and intense fatigue increased pain (p=0.016). Both data are new in our area, and confirm the existence of a cluster of symptoms and the harms resulting from that comorbidity.

A systematic review of the interventions for nipple trauma in breastfeeding mothers.

PURPOSE To identify the most effective interventions to treat nipple trauma in breastfeeding mothers. DESIGN AND METHODS Systematic literature review using the PICO strategy. The search was conducted on the electronic information systems Medline-PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), World Health Organization Library Information System (WHOLIS), Cochrane, ScienceDirect (Elsevier), Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), using standardized and unstandardized descriptors. Studies were selected if they were controlled or uncontrolled randomized clinical trials written in English, Portuguese, or Spanish. Two reviewers evaluated the studies independently using a guide, and in case there were disagreements, a third reviewer was called on to reach a consensus. Of the 496 studies located, five were included. FINDINGS The treatments investigated were lanolin, lanolin in association with breast protection shells, breast milk, hydrogel, adhesive polyethylene film dressings, a spray containing chlorhexidine with alcohol, and distilled water. All the groups in every study received breastfeeding education. The best outcomes for the treatment of nipple trauma used lanolin (recommendation B, evidence level 2) and breast milk (recommendation B, evidence level 2). Although one clinical study was found with positive outcomes resulting from treatment using a spray containing alcohol and chlorhexidine 0.2% (recommendation B, evidence level 2), this treatment modality should be further investigated since literature is not in favor of using antiseptic substances in skin wound treatment. CONCLUSIONS Considering the treatments investigated, the most favorable evidence indicates the use of lanolin alone or in association with breast protection shells and breast milk expressed and rubbed into the nipple and areola after each feeding session. However, the results obtained in this review are inconclusive, indicating the need for further studies in order to clarify the action of breast milk and lanolin on the damaged tissues, as well as studies involving samples representative of the number needed to treat. CLINICAL RELEVANCE This study provides evidence for nursing practice, thus contributing to the improvement of lactating mothers with nipple trauma care and, consequently, improving the rates of successful breastfeeding as well as the quality of life of breastfeeding mothers.

Prevalence and comorbidity of pain and fatigue in women with breast cancer

Estudio analitico de analisis de prevalencia y comorbilidad de dolor y fatiga en mujeres con cancer de mama. Investigacion transversal, con muestra no probabilistica de 182 mujeres en tratamiento ambulatorio de cancer de mama, entrevistadas en periodo de julio 2006 a marzo 2007. Fatiga evaluada por Escala de Fatiga de Piper, fue dividida en dos categorias (puntaje 0,1-4,9 y >5-10). Dolor evaluado por escala de 0-10, categorizado del mismo modo que fatiga. Existio fatiga en 94 mujeres (51,6%), siendo >5 en 44 (46,8%) de ellas. Existio dolor en 86 mujeres (47,2%), siendo >5 en 50 (58,1%). Se correlacionaron dolor/fatiga (e=0,38, p=0,089) y la comorbilidad fatiga/dolor fue de 38,3%. El dolor intenso agudizo la fatiga (p=0,089) y la fatiga intensa acentuo el dolor (p=0,016). Datos ineditos en nuestro medio, confirman la existencia de un cluster de sintomas y los perjuicios derivados de la comorbilidad.This study analyzed the prevalence and comorbidity of pain and fatigue in women with breast cancer. This is a cross-sectional study using a non-probabilistic sample of 182 women following outpatient treatment for breast cancer, who were interviewed from July 2006 to March 2007. Fatigue was assessed using the Piper Fatigue Scale, and divided into two categories (scores 0.1-4.9 and >5-10). Pain was assessed by the 0-10 scale, and categorized the same way as fatigue. Fatigue occurred in 94 women (51.6%), and was >5 in 44 (46.8%) of the women. Pain occurred in 86 women (47.2%), with scores >5 in 50 (58.1%). Fatigue and pain were correlated (r=0.38, p=0.003) and the comorbidity fatigue and pain was 38.3%. Intense pain increased fatigue (p=0.089) and intense fatigue increased pain (p=0.016). Both data are new in our area, and confirm the existence of a cluster of symptoms and the harms resulting from that comorbidity.

Pictograma de Fadiga: uma alternativa para avaliação da intensidade e impacto da fadiga

O objetivo foi validar o Fatigue Pictogram para uso no Brasil. Os dados foram coletados em quatro ambulatorios de oncologia de Sao Paulo (SP) e na Escola de Enfermagem da USP. A amostra de conveniencia envolveu 584 pacientes com câncer, 184 acompanhantes e 189 estudantes de graduacao enfermagem, que responderam ao Pictograma de Fadiga, ao Inventario de Depressao de Beck (IDB) e Escala de Karnofsky (KPS). Foram feitos testes de validade e confiabilidade. O Teste-reteste mostrou que o instrumento tem boa estabilidade. O primeiro item do Pictograma de Fadiga discriminou estudantes de cuidadores de pacientes, mas nao pacientes de cuidadores. O segundo item discriminou todos os grupos. Observou-se adequada validade convergente (fadiga e depressao) e divergente (fadiga e Karnofsky). O Pictograma de Fadiga e valido, confiavel e facil de usar para avaliar fadiga em câncer, mas necessita ajustes para uso em pessoas saudaveis.The purpose of this paper was to validate the Fatigue Pictogram for use in Brazil. Data was collected at four oncology ambulatory clinics in Sao Paulo (Brazil) and at the Nursing School of Sao Paulo University. A convenience sample of 584 cancer patients, 184 caregivers and 189 undergraduate nursing students completed the Karnofsky Scale, Fatigue Pictogram-Brazilian Version, and the Beck Depression Inventory (BDI). Validity and reliability tests were performed. Test-retest showed that the instrument has good stability. The first item of the Fatigue Pictogram discriminated students from caregivers and patients but not patients from caregivers. The second item discriminated among all groups. Adequate convergent (fatigue and depression) and divergent (fatigue and Karnofsky Scale) validity was observed. The Fatigue Pictogram is a valid, reliable, and easy-to-use tool for assessment of cancer-related fatigue but needs adjustments for use among healthy individuals.El objetivo fue validar el Pictograma de Fatiga para su uso en Brasil. Los datos fueron recolectados en cuatro clinicas de oncologia ambulatoria de Sao Paulo (SP) y la Escuela de Enfermeria de la USP. La muestra de conveniencia incluyo 584 pacientes con cancer, 184 acompanantes y 189 es tudiantes de posgrado en enfermeria, que respondieran a la Pictograma de Fatiga, el Inventario de Depresion de Beck (BDI) y la escala de Karnofsky (KPS). Realizadas pruebas de validez y fiabilidad. Test-retest mostro que el instrumento tiene una buena estabilidad. El primer item del Pictograma de Fatiga discrimino estudiantes de los cuidadores de los pacientes, pero no los pacientes de los cuidadores. El segun item discrimino todos los grupos. Hubo suficiente validez convergente (fatiga y depresion) y divergente(Karnofsky y fatiga). Pictograma de Fatiga es valida, fiable y facil de utilizar para evaluar la fatiga en el cancer, pero necesita ajustes para el uso en personas sanas.

Pressure Ulcers In Palliative home Care Patients: Prevalence And Characteristics

Persons in palliative care develop pressure ulcers (PU) as death approaches, but the extent of the problem is still unknown. The objectives were to identify the prevalence of pressure ulcers in people with cancer in palliative home care, compare the socio-demographic and clinical profile of patients with and without pressure ulcers, and analyze the characteristics of the ulcers. This descriptive, cross-sectional study included 64 people with advanced cancer in palliative home care. Twelve of them (18.8%) had PU, of whom 75.0% were men. The participants had one to three PU, amounting to 19 lesions, 89.4% of those developed at home and 47.4% at stage 3. The presence of PU was higher among those who had a history of previous wound. PU consisted of a significant event occurring in the studied population, indicating that preventive measures should be included in the home palliative care health team.Pessoas em cuidados paliativos desenvolvem ulceras por pressao (UPP) a medida que a morte se aproxima, contudo, pouco se sabe sobre a dimensao do problema. Realizou-se um estudo descritivo, transversal e quantitativo, cujos objetivos foram: identificar a prevalencia de ulceras por pressao em pessoas com câncer em cuidados paliativos domiciliares, comparar o perfil sociodemografico e clinico dos pacientes com e sem ulceras por pressao e analisar as caracteristicas das ulceras encontradas nessas pessoas. A amostra foi constituida por 64 pessoas com câncer avancado, em cuidados paliativos domiciliares, a maioria (75,0%) do sexo masculino. Doze (18,8%) apresentaram de uma a tres UPP, totalizando 19 lesoes, 89,4% desenvolvidas no domicilio e 47,4% de estagio 3. A presenca de UPP foi maior entre aqueles que tinham historia de lesao anterior. A UPP e um evento de ocorrencia expressiva na populacao estudada, indicando que medidas preventivas devem ser incluidas na atuacao das equipes de cuidados paliativos domiciliares.