Leila Blanes

Avaliação clínica e epidemiológica das úlceras por pressão em pacientes internados no Hospital São Paulo

BACKGROUND: To determine the profile of patients at the Hospital Sao Paulo with pressure ulcers (PU). METHODS: A prospective study was carried out. Seventy-eight patients with pressure ulcers were evaluated between May 1st and 31st of 2002. The questionnaire consisted of demographic and clinical data of the population, PU classification and Braden Scale. RESULTS: Concerning 78 patients with PU: 66.7% were over 61 years old (average: 64). The average period of hospitalization was 33 days. 68% (53) developed ulcers while hospitalized, of which 43.7% (34) were pre-ulcers. The most frequent causes of hospitalization were neurological diseases (29.5%) and cancer (29.5%). Regarding the classification of the pressure ulcers, all stages were found on the sacrum, being 24.4% (19) pre-ulcer, 38.5% (30) stage II, 11.5%(9) stage III and 12.8%(10) at stage IV. According to the Braden Scale, half of the patients hospitalized showed severe risk of PU development, while 20.5% (16) showed moderate risk and 19.3% (15) showed low risk. CONCLUSIONS: The study showed a high risk of PU development, indicating the importance of having knowledge about the main characteristics of the hospitalized patients who may develop pressure ulcers, and, thus, preventing them.

Health-related quality of life of primary caregivers of persons with paraplegia

Study Design:A cross-sectional descriptive study was performed with structured questionnaires and interviews conducted with 60 primary caregivers of persons with paraplegia (T1 to S2) owing to traumatic spinal cord injury (SCI).Objectives:The purpose of this study was the assessment of the health-related quality of life (HRQoL) of primary caregivers of persons with paraplegia owing to traumatic SCI.Setting:São Paulo, SP, Brazil.Methods:The HRQoL was assessed by the Short Form-36 (SF-36) health survey questionnaire and caregiver burden was evaluated by the Caregiver Burden Scale (CBS).Results:Among 60 caregivers evaluated, 49 (81.7%) were female, with mean age of 35.8 (SD=12.91) years, 16 (26.6%) being wives and 14 (23.4%) sisters of persons with paraplegia. It was found that the caregivers spend an average of 11.3 h/day caring for individuals with paraplegia. Twenty-three caregivers (38.3%) had a chronic disease and 32 (53.3%) were sole caregivers taking upon themselves the full responsibility of caring for the persons with paraplegia. The subjects reported lower scores on bodily pain and vitality than the other dimensions of the SF-36. The mean global CBS score was 1.71 (SD=0.50) and mean scores for each dimension ranged from 1.39 (SD=0.64) for emotional involvement to 2.44 (SD=0.79) for environment dimension.Conclusion:The primary caregivers of spinal cord-injured persons reported low scores on all of the SF-36 and CBS dimensions, bodily pain and vitality being the SF-36 dimensions that received the lowest scores.Sponsorship:Funding was provided by the Brazilian research agency CAPES.

Avaliação de sintomas depressivos em pessoas com diabetes mellitus e pé ulcerado

OBJECTIVE To evaluate the intensity of symptoms of depression in patients with diabetic foot ulcers. METHODS a exploratory, descriptive, analytical and cross-sectional study was held at the wound clinic of a public hospital in Sorocaba, São Paulo State, Brazil. Fifty patients with diabetes mellitus and foot ulcers were enrolled. To assess the intensity of the symptoms of depression, a Beck Depression inventory was used. RESULTS Of the 50 patients evaluated, 41 had some degree of depressive symptoms and 32 (64%) had moderate depression, with symptoms of self-loathing, grief, body image distortion and decreased libido. CONCLUSION Patients with diabetic foot ulcers showed varying degrees of depressive symptoms.

Prevalence of pressure ulcers among the elderly living in long-stay institutions in São Paulo

CONTEXT AND OBJECTIVE The prevalence of pressure ulcers varies according to geographic region and population group, such as the institutionalized elderly. The aim of this study was to identify the prevalence of pressure ulcers among elderly people living in long-stay institutions. DESIGN AND SETTING Cross-sectional study in six long-stay institutions for the elderly in São Paulo, Brazil. METHODS Demographic and clinical data were collected in six long-stay institutions on two visits to each institution between May and August 2007, during which all elderly patients with pressure ulcers were evaluated. The Braden scale was used to identify the risk of developing pressure ulcers and the National Pressure Ulcer Advisory Panel (NPUAP) stages for classifying the pressure ulcers. Statistical analysis was performed using the chi-square test, Students t-test and Fishers exact test. RESULTS There was no significant difference in the results between visits. The population was 181 elderly people in May and 184 in August: 23 had pressure ulcers in May (prevalence of 12.7%) and 17 in August (prevalence of 9.2%). The mean age at the two times was 84 years, and the average length of stay was 32 months. Pressure ulcers were found mainly in the sacral region (mean, 71.5%), and most commonly in stage II (mean, 41%). CONCLUSION The prevalence of pressure ulcers was 10.95%. These data provide background information that may aid in developing protocols for applying best practices for prevention and treatment of pressure ulcers, consequently reducing the prevalence.

Clinical and socio-demographic characteristics of persons with traumatic paraplegia living in São Paulo, Brazil

OBJECTIVE To evaluate the clinical profile of individuals with paraplegia living in São Paulo, Brazil. METHOD The sample consisted of 60 outpatients with traumatic paraplegia from whom clinical and demographic data were obtained. RESULTS The patients were predominately men (86.7%), single (61.7%), with mean age of 32.9 (SD=9.47) years, and complete or incomplete primary education (63.3%). Although 41.7% were born in different states, all patients were current residents of São Paulo, Brazil. The most frequent cause of paraplegia was firearm injury (63.3%) followed by car accident (20%). The most common complications observed in the patients were urinary (88.3%) and anal (45%) incontinence, muscle spasm (65%), and pressure ulcers (26.7%). CONCLUSION The data revealed that the sample consisted predominantly of young males with low education level, showing complications due to SCI, and who were victims of urban violence.

Capacidade funcional dos pacientes com diabetes mellitus e pé ulcerado

Objective: To evaluate and compare the functional capability of patients with diabetes with foot ulceration and patients with diabetes without foot ulceration. Methods: A cross sectional descriptive comparative study was conducted in a public hospital in the district of Sao Paulo. The sample consisted of 20 patients with foot ulceration and 20 patients without foot ulceration. Data were collected from June 2 to July 30, 2008. The heath assessment questionnaire-20 (HAQ-20) was used to collect the data. Results: There were no significant differences regarding demographic and clinical characteristics between the two groups. There were significant differences between the two groups on the total score of the HAQ-20 and items 1, 2, 3, 5, 6, 7, and 8, an in regard to physical functioning and functional capability. Conclusion: Findings suggest that patients with foot ulceration had worse physical functioning and functional capability than those without foot ulceration.Objective: To evaluate and compare the functional capability of patients with diabetes with foot ulceration and patients with diabetes without foot ulceration. Methods: A cross sectional descriptive comparative study was conducted in a public hospital in the district of Sao Paulo. The sample consisted of 20 patients with foot ulceration and 20 patients without foot ulceration. Data were collected from June 2 to July 30, 2008. The heath assessment questionnaire-20 (HAQ-20) was used to collect the data. Results: There were no significant differences regarding demographic and clinical characteristics between the two groups. There were significant differences between the two groups on the total score of the HAQ-20 and items 1, 2, 3, 5, 6, 7, and 8, an in regard to physical functioning and functional capability. Conclusion: Findings suggest that patients with foot ulceration had worse physical functioning and functional capability than those without foot ulceration.

Proliferation of fibroblasts cultured on a hemi-cellulose dressing

In recent times, hemi-cellulose dressing (HD) has been used clinically with satisfactory rates of success [Melandri D, De Angelis A, Orioli R, et-al. Use of a new hemicellulose dressing (Veloderm) for the treatment of split-thickness skin graft donor sites A within-patient controlled study. Burns 2006 Dec;32:964-72.]; however, the effect of cellulose dressings on the wound-healing process is unclear due to paucity of experimental data. This study aimed to determine the adhesion and proliferation of human skin fibroblasts, which were cultured in vitro using the explant technique, on HD. Cells were seeded onto HD discs and evaluated for cell adhesion and cell proliferation after 7, 14 and 21 days. Fibroblasts displayed 70% adhesion to HD after 24h. The HD discs seeded with a density of 5x10(4) cells per well showed a proliferation rate of 12% on day 7, 30% on day 14 and 75% on day 21. The results demonstrated that HD can sustain fibroblast proliferation--a highly desirable characteristic for an ideal skin substitute.

Functional capability of patients with diabetes with foot ulceration

Objective: To evaluate and compare the functional capability of patients with diabetes with foot ulceration and patients with diabetes without foot ulceration. Methods: A cross sectional descriptive comparative study was conducted in a public hospital in the district of Sao Paulo. The sample consisted of 20 patients with foot ulceration and 20 patients without foot ulceration. Data were collected from June 2 to July 30, 2008. The heath assessment questionnaire-20 (HAQ-20) was used to collect the data. Results: There were no significant differences regarding demographic and clinical characteristics between the two groups. There were significant differences between the two groups on the total score of the HAQ-20 and items 1, 2, 3, 5, 6, 7, and 8, an in regard to physical functioning and functional capability. Conclusion: Findings suggest that patients with foot ulceration had worse physical functioning and functional capability than those without foot ulceration.Objective: To evaluate and compare the functional capability of patients with diabetes with foot ulceration and patients with diabetes without foot ulceration. Methods: A cross sectional descriptive comparative study was conducted in a public hospital in the district of Sao Paulo. The sample consisted of 20 patients with foot ulceration and 20 patients without foot ulceration. Data were collected from June 2 to July 30, 2008. The heath assessment questionnaire-20 (HAQ-20) was used to collect the data. Results: There were no significant differences regarding demographic and clinical characteristics between the two groups. There were significant differences between the two groups on the total score of the HAQ-20 and items 1, 2, 3, 5, 6, 7, and 8, an in regard to physical functioning and functional capability. Conclusion: Findings suggest that patients with foot ulceration had worse physical functioning and functional capability than those without foot ulceration.

Hemicellulose dressing versus rayon dressing in the re-epithelialization of split-thickness skin graft donor sites: a multicenter study

The aim of this study was to compare the effectiveness of a hemicellulose dressing with that of rayon dressing in the healing of split-thickness skin graft donor sites. Twenty-eight patients were selected from five different hospitals and randomized into two groups: hemicellulose dressing group and rayon dressing group. All patients underwent split-thickness skin grafting for various reasons, and the skin graft donor site wounds were covered with hemicellulose dressing (n=14) or rayon dressing (n=14). The donor site was assessed on postoperative days 1, 7, 14, 21, and 28 for hyperemia, pruritus, pain, exudate level, and adherence of the wound dressing. At the 60-day follow-up visit, the donor site was assessed again for pruritus and pain. Touch-pressure, thermal, and pain sensibility tests were performed preoperatively and on postoperative day 60 together with the assessment of color and texture of the re-epithelialized area. In all patients, re-epithelialization was completed between 14 and 21 days after surgery. There were no significant differences between the two groups with regard to pain, hyperemia, pruritus, exudate, and final appearance (color and texture) of the skin graft donor site. The rayon dressing provided significantly better adherence than the hemicellulose dressing, and both dressings showed similar results with regard to the parameters evaluated when used in the treatment of split-thickness skin graft donor sites.

Tradução para a língua portuguesa e validação da escala de Braden Q para avaliar o risco de úlcera por pressão em crianças

Objective: To translate and culturally adapt the Braden Q scale into a Portuguese version and to test its properties (reliability and validity). Methods: The Braden Q scale was translated and adapted according to internationally accepted methodology. The instrument was forward and back translated, and the translations were reviewed by a multidisciplinary committee. In the cultural adaptation process, three groups of ten nurses each interpreted the Brazilian version of the Braden Q scale until they fully understood the instrument. In order to evaluate the reliability of the Brazilian version, two other nurses administered the tool to pediatric ICU patients at different time points; the first nurse administered the instrument also in a second time. Statistical analysis was performed using Cronbach’s α to evaluate the internal consistency of the scale, and the Spearman and intra-class correlation coefficients were calculated as a measure of reliability. Results: There were no differences between scales translated by different translators during the forward and back translation process. All items of the scale culturally adapted by the 30 nurses were considered relevant. Cronbach’s α for internal consistency was 0.936; intra-class correlation coefficient for intra-rater reliability was 0.995 and for inter-rater reliability was 0.998, both indicating high reliability. Conclusions: The Braden Q scale was successfully translated and adapted, and demonstrated validity and reliability.OBJETIVO: Traduzir para a lingua portuguesa, adaptar ao contexto cultural brasileiro e testar as propriedades de medidas, reprodutibilidade e validade da escala de Braden Q. METODOS: A escala de Braden Q foi traduzida e adaptada de acordo com metodologia aceita internacionalmente. Realizou-se traducao e traducao reversa do instrumento, intercaladas de revisoes feitas por comite multisciplinar. Na fase de adaptacao cultural, tres grupos de dez enfermeiras avaliaram a versao brasileira da escala de Braden Q ate obter seu entendimento integral. Na validacao da reprodutividade, outras duas enfermeiras aplicaram a versao brasileira em criancas internadas na UTI em tempos diferentes, sendo que a primeira enfermeira avaliou tambem em um segundo momento. Na analise estatistica, para testar a consistencia interna da escala, foi calculado o α de Crombach e, para testar a reprodutividade, o teste intraclasse e a correlacao de Spearman. RESULTADOS: No processo de traducao e retrotraducao, nao houve diferenca nas escalas feitas pelos diferentes tradutores. Na adaptacao cultural realizada pelas 30 enfermeiras, todos os itens da escala foram considerados relevantes. A consistencia interna testada pelo α de Crombach foi de 0,936; a correlacao intraclasse da reprodutividade intraobservador foi de 0,995 e da reprodutividade interobservador foi de 0,998, ambas apontadas como excelentes. CONCLUSOES: A escala de Braden Q foi traduzida e adaptada com sucesso, demonstrando ser valida e reprodutivel.