Karine Azevedo São Leão Ferreira

The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?

IntroductionPain is a major problem in the treatment of patients with cancer. This article reviews studies concerning evaluation of patients with cancer pain treated according to The World Health Organization (WHO) analgesic ladder.Materials and methodsSystematic search of PUBMED, MEDLINE, EMBASE, LILACS, BDENF, and OVID and a hand search of reference lists and textbooks from 1982 to 2004 were performed.ResultAnalgesia was considered adequate in 45 to 100% of patients analyzed in the studies.ConclusionHowever, the evidence that they provide is insufficient to grant the effectiveness of the WHO guidelines because a controlled clinical trial of this intervention has never been published.

Impact of Cancer-Related Symptom Synergisms on Health-Related Quality of Life and Performance Status

To identify the impact of multiple symptoms and their co-occurrence on health-related quality of life (HRQOL) dimensions and performance status (PS), 115 outpatients with cancer, who were not receiving active cancer treatment and were recruited from a university hospital in Sao Paulo, Brazil completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, the Beck Depression Inventory, and the Brief Pain Inventory. Karnofsky Performance Status scores also were completed. Application of TwoStep Cluster analysis resulted in two distinct patient subgroups based on 113 patient experiences with pain, depression, fatigue, insomnia, constipation, lack of appetite, dyspnea, nausea, vomiting, and diarrhea. One group had multiple and severe symptom subgroup and another had less symptoms and with lower severity. Multiple and severe symptoms had worse PS, role functioning, and physical, emotional, cognitive, social, and overall HRQOL. Multiple and severe symptom subgroup was also six times as likely as lower severity to have poor role functioning; five times more likely to have poor emotional; four times more likely to have poor PS, physical, and overall HRQOL; and three times as likely to have poor cognitive and social HRQOL, independent of gender, age, level of education, and economic condition. Classification and Regression Tree analyses were undertaken to identify which co-occurring symptoms would best determine reduction in HRQOL and PS. Pain and fatigue were identified as indicators of reduction on physical HRQOL and PS. Fatigue and insomnia were associated with reduction in cognitive; depression and pain in social; and fatigue and constipation in role functioning. Only depression was associated with reduction in overall HRQOL. These data demonstrate that there is a synergic effect among distinct cancer symptoms that result in reduction in HRQOL dimensions and PS.

Translation to Portuguese and Validation of the Douleur Neuropathique 4 Questionnaire

UNLABELLED The Douleur Neuropathique 4 (DN4) questionnaire was developed by the French Neuropathic Pain Group and is a simple and objective tool, with the ability to distinguish nociceptive from neuropathic pain. The purpose of this work was to validate the DN4 questionnaire in the Portuguese language in order to allow its use in clinical and research settings. A double-blind, accuracy study was conducted, consisting of translation, back-translation, literal evaluation, semantic equivalence, and communication with the target population. The Portuguese version of the questionnaire was applied in a sample of 101 patients with neuropathic (N = 42) or nociceptive pain (N = 59), ranked according to medical diagnosis. The reproducibility, reliability and validity of the instrument were analyzed, and showed a high diagnostic power for this version of the DN4 questionnaire. The Portuguese version of the DN4 questionnaire presented good validity and reliability, allowing it to identify neuropathic pain and neuropathic characteristics of mixed pain syndromes. PERSPECTIVE This article presents the first validated neuropathic pain questionnaire in the Portuguese language and represents a useful tool in the assessment of neuropathic pain both in the clinical setting and in population-based studies. The sensible and quick format of this instrument are key factors that will contribute to its widespread use, permitting a true recognition of patients with neuropathic pain.

Family members' needs at intensive care units: comparative analysis between a public and a private hospital

Se trata de un estudio transversal, con objeto de analizar y comparar las necesidades de los familiaresde pacientes adultos internados en UTIs de un hospital publico y un privado, respecto al grado de importanciay satisfaccion. Se les entrevistaron a 91 familiares, 47 de la institucion publica y 44 de la privada, utilizandoseel Inventario de Necesidades y Estresores de Familiares en Terapia Intensiva (INEFTI). No hubo diferenciasignificativa entre los grupos en la puntuacion total de importancia atribuida a las necesidades (p=0,410). Elgrado de satisfaccion fue mayor en el hospital privado con relacion al publico (p=0,002). El analisis de regresionlinear multipla permitio establecer una jerarquia de importancia y de satisfaccion de las necesidades de losfamiliares de cada grupo. Las diferencias observadas entre los grupos sugieren que el atendimiento de susnecesidades requiere intervenciones direccionadas a la especificidad de cada tipo de institucion.DESCRIPTORES: familia; enfermeria de la familia; evaluacion de necesidades; unidades de terapia intensiva

Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

The aim of this study was to develop and validate a short form of the Brazilian version of McGill Pain Questionnaire (SF-MPQ). Three hundred two patients with chronic pain filled out the validated Brazilian long form of the McGill Pain Questionnaire (LF-MPQ). Words chosen by ≥25% of the patients were selected to comprise the SF-MPQ. The Brazilian SF-MPQ consisted of 15 descriptors (8 sensory, 5 affective, and 2 evaluative) rated on a binary mode (present or absent). Four pain scores were derived by counting the words chosen by the patients for sensory, affective, evaluative, and total descriptors. The SF-MPQ showed poor internal consistency (KR-20 = 0.52) but possibly acceptable because it showed discriminant validity to discriminate patients presenting different levels and mechanisms of pain, and it was strongly correlated with the LF-MPQ. The low KR-20 coefficient could result from the small number of items. The Brazilian version of the SF-MPQ proved to be a useful instrument to evaluate the different qualities of pain. It is a reliable option to the long-form MPQ.

Necessidades de familiares de pacientes em unidades de terapia intensiva: análise comparativa entre hospital público e privado

Se trata de un estudio transversal, con objeto de analizar y comparar las necesidades de los familiaresde pacientes adultos internados en UTIs de un hospital publico y un privado, respecto al grado de importanciay satisfaccion. Se les entrevistaron a 91 familiares, 47 de la institucion publica y 44 de la privada, utilizandoseel Inventario de Necesidades y Estresores de Familiares en Terapia Intensiva (INEFTI). No hubo diferenciasignificativa entre los grupos en la puntuacion total de importancia atribuida a las necesidades (p=0,410). Elgrado de satisfaccion fue mayor en el hospital privado con relacion al publico (p=0,002). El analisis de regresionlinear multipla permitio establecer una jerarquia de importancia y de satisfaccion de las necesidades de losfamiliares de cada grupo. Las diferencias observadas entre los grupos sugieren que el atendimiento de susnecesidades requiere intervenciones direccionadas a la especificidad de cada tipo de institucion.DESCRIPTORES: familia; enfermeria de la familia; evaluacion de necesidades; unidades de terapia intensiva

Segurança do paciente em cirurgia oncológica: experiência do Instituto do Câncer do Estado de São Paulo

A preocupacao com a seguranca do paciente em centro cirurgico (CC) tem sido crescente, devido a elevada frequencia de erros e eventos adversos, que muitas vezes poderiam ser prevenidos. A Joint Commission on Accreditation of Healthcare Organizations (JCAHO) propos o Protocolo Universal (PU) para a prevencao do lado, procedimento e paciente errado. No Brasil foram poucas as instituicoes que o implantaram, sendo necessaria a divulgacao e avaliacao da sua efetividade. O objetivo foi relatar a experiencia do Instituto do Câncer do Estado de Sao Paulo (ICESP) na implantacao do PU-JCAHO. O protocolo inclui tres etapas: verificacao pre-operatoria, marcacao do sitio cirurgico (lateralidade) e TIME OUT. O CC do ICESP esta em funcionamento desde novembro de 2008. O PU-JCAHO e aplicado integralmente a todas as cirurgias. Ate junho de 2009 foram realizadas 1019 cirurgias, sem registro de erro ou evento adverso. A implantacao do PU-JCAHO e simples, sendo ferramenta util para prevenir erros e eventos adversos em CC.Patient safety concerns in surgery are increasing. The frequency of surgery-related adverse events and errors is high, and most could be avoided. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) proposed the Universal Protocol (UP-JCAHO) for preventing wrong site, wrong procedure, and wrong person surgery. In Brazil, very few health-care institutions have adopted this Protocol. Thus, there is a need to improve its dissemination and assess its effectiveness. The aim of the present study was to report the experiences of the Sao Paulo State Cancer Institute (ICESP, acronym in Portuguese) in implementing the UP-JCAHO. The Protocol comprises three steps: pre-operative verification process, marking the operative site and Time out immediately before starting the procedure. The ICESP surgical center (SC) has been functioning since November 2008. The UP-JCAHO is applied to all surgeries. A total 1019 surgeries were performed up to June 2009. No errors or adverse events were registered. The implementation of the UP-JCAHO is simple. It can be a useful tool to prevent error and adverse events in SC.

Prevalence of chronic pain in a metropolitan area of a developing country: a population-based study

Objective To estimate the prevalence of chronic pain (CP) in the adult population living in the city of São Paulo, Brazil, and to identify factors associated with CP in developing countries. Methods A cross-sectional study using a computer-assisted telephone interview in a two-stage stratified sample of adults living in households. Results 2,446 subjects were interviewed. The mean age was 39.8 years old. The majority was female and 42.7% had less than 10 years of education. The prevalence of CP was 28.1%. The independent factors associated with CP were female gender (OR = 2.0; p < 0.001), age older than 65 years (OR = 1.4; p = 0.019) and less than 15 years of education (OR = 1.3-1.6; p < 0.04). Conclusions The prevalence of CP was high and similar to that which has been reported in developed countries. These results raise awareness about CP and may potentially help clinicians and policy makers to design better health care programs for CP treatment in these populations.

Eficácia de três métodos de degermação das mãos utilizando gluconato de clorexidina degermante (GCH 2

The scrubbing of hands and forearms using antiseptic agents has been the standard pre-operative procedure to prevent surgical site infection. With the introduction of antiseptic agents, the need to use brushes for pre-operative disinfection has been questioned and it has been recommended that the procedure be abandoned due to the injuries it may cause to the skin. With the purpose to provide the foundations for the efficacy of pre-operative asepsis without using brushes or sponges, the objective of this study was to evaluate three methods of pre-operative asepsis using an antimicrobial agent containing chlorhexidine gluconate - CHG 2%; hand-scrubbing with brush (HSB), hand-scrubbing with sponge (HSS), and hand-rubbing with the antiseptic agent (HRA) only. A comparative crossover study was carried with 29 healthcare providers. Antimicrobial efficacy was measured using the glove-juice method before and after each tested method. Statistical analyses showed there were no significant differences regarding the number of colony-forming units when comparing HRA, HSB, and HSS techniques (p=0.148), which theoretically disregards the need to continue using brushes or sponges for hand asepsis.The scrubbing of hands and forearms using antiseptic agents has been the standard pre-operative procedure to prevent surgical site infection. With the introduction of antiseptic agents, the need to use brushes for pre-operative disinfection has been questioned and it has been recommended that the procedure be abandoned due to the injuries it may cause to the skin. With the purpose to provide the foundations for the efficacy of pre-operative asepsis without using brushes or sponges, the objective of this study was to evaluate three methods of pre-operative asepsis using an antimicrobial agent containing chlorhexidine gluconate - CHG 2%; hand-scrubbing with brush (HSB), hand-scrubbing with sponge (HSS), and hand-rubbing with the antiseptic agent (HRA) only. A comparative crossover study was carried with 29 healthcare providers. Antimicrobial efficacy was measured using the glove-juice method before and after each tested method. Statistical analyses showed there were no significant differences regarding the number of colony-forming units when comparing HRA, HSB, and HSS techniques (p=0.148), which theoretically disregards the need to continue using brushes or sponges for hand asepsis.

Patient safety in oncology surgery: experience of the São Paulo State Cancer Institute

A preocupacao com a seguranca do paciente em centro cirurgico (CC) tem sido crescente, devido a elevada frequencia de erros e eventos adversos, que muitas vezes poderiam ser prevenidos. A Joint Commission on Accreditation of Healthcare Organizations (JCAHO) propos o Protocolo Universal (PU) para a prevencao do lado, procedimento e paciente errado. No Brasil foram poucas as instituicoes que o implantaram, sendo necessaria a divulgacao e avaliacao da sua efetividade. O objetivo foi relatar a experiencia do Instituto do Câncer do Estado de Sao Paulo (ICESP) na implantacao do PU-JCAHO. O protocolo inclui tres etapas: verificacao pre-operatoria, marcacao do sitio cirurgico (lateralidade) e TIME OUT. O CC do ICESP esta em funcionamento desde novembro de 2008. O PU-JCAHO e aplicado integralmente a todas as cirurgias. Ate junho de 2009 foram realizadas 1019 cirurgias, sem registro de erro ou evento adverso. A implantacao do PU-JCAHO e simples, sendo ferramenta util para prevenir erros e eventos adversos em CC.Patient safety concerns in surgery are increasing. The frequency of surgery-related adverse events and errors is high, and most could be avoided. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) proposed the Universal Protocol (UP-JCAHO) for preventing wrong site, wrong procedure, and wrong person surgery. In Brazil, very few health-care institutions have adopted this Protocol. Thus, there is a need to improve its dissemination and assess its effectiveness. The aim of the present study was to report the experiences of the Sao Paulo State Cancer Institute (ICESP, acronym in Portuguese) in implementing the UP-JCAHO. The Protocol comprises three steps: pre-operative verification process, marking the operative site and Time out immediately before starting the procedure. The ICESP surgical center (SC) has been functioning since November 2008. The UP-JCAHO is applied to all surgeries. A total 1019 surgeries were performed up to June 2009. No errors or adverse events were registered. The implementation of the UP-JCAHO is simple. It can be a useful tool to prevent error and adverse events in SC.