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Effectiveness of educational programs on reducing the burden of caregivers of elderly individuals with dementia: a systematic review.

OBJETIVO: o objetivo deste estudo foi analisar a efetividade de programas de educacao e suporte de cuidadores na reducao de sua sobrecarga. METODO: foi realizada uma revisao sistematica com consulta as bases Medline, Lilacs, Embase, Cochrane, Web of Science, SciELO e CINAHL. RESULTADOS: foram incluidos sete ensaios clinicos randomizados que comparavam o programa de educacao ao cuidado usual, avaliando a sobrecarga do cuidador atraves da escala Burden Interview de Zarit. Apos analise de sensibilidade, quatro estudos foram agrupados na metanalise, mostrando maior reducao na sobrecarga do cuidador entre participantes de programas de educacao e suporte, com significância estatistica. CONCLUSAO: as evidencias, neste estudo, mostram que programas de educacao e suporte sao favoraveis para a reducao da sobrecarga do cuidador quando comparados ao cuidado usual. Dessa forma, a inclusao desses programas em instituicoes voltadas para a assistencia de idosos e efetiva e deve ser estimulada. Pode-se inferir ainda que esses programas devam contemplar o compartilhamento de estrategias de manejo nao farmacologico dos sintomas psicologicos e comportamentais das demencias.OBJECTIVE This studys objective was to analyze the effectiveness of educational and support programs for caregivers on reducing their burden. METHOD The method used was a systematic review. The following were searched; MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. RESULTS Seven randomized clinical studies were included. These studies compared an educational program with standard care delivery, assessing the burden of caregivers through the Zarit Burden Interview. After the analysis of sensitivity, four studies were grouped in the meta-analysis showing a statistically significant reduction in caregiver burden among the participants of educational and support programs. CONCLUSION The evidence obtained in this study suggests that educational and support programs have a positive impact on the reduction of caregiver burden when compared to standard care. Therefore, the inclusion of these programs in institutions providing care to the elderly is effective and should be encouraged. These programs should also share non-pharmacological management strategies for the behavioral and psychological symptoms of dementia.

Screening and treatment for Staphylococcus aureus in patients undergoing hemodialysis: a systematic review and meta-analysis

BackgroundThis study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus.MethodsA systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were “Staphylococcus aureus”, “MRSA”, “MSSA”, “treatment”, “decolonization”, “nasal carrier”, “colonization”, “chronic kidney disease”, “dialysis”, and “haemodialysis” or “hemodialysis”. Five randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various treatments (various treatments group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). The outcomes were skin infection at the central venous catheter insertion site and bacteremia.ResultsIn total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in the control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05–0.34; p < 0.001). The risk of bacteremia was 82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08–0.42; p < 0.001). No statistically significant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and the control group (OR, 0.77; 95% CI, 0.51–1.15; p = 0.20).ConclusionsTwenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. Of all treatments evaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and bacteremia in patients undergoing chronic hemodialysis.

Cross-transmission of vancomycin-resistant Enterococcus in patients undergoing dialysis and kidney transplant

The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.

Screening for group B Streptococcus in pregnant women: a systematic review and meta-analysis

La infeccion por Streptococcus del grupo B (GBS) es considerada un importante problema de salud publica. Los estreptococos estan asociados a: sepsis neonatal, meningitis, neumonia, muerte neonatal, aborto septico, corioamnionitis, endometritis y otras infecciones perinatales. El objetico del estudio fue determinar la mejor estrategia de rastreo de GBS en gestantes. Se trata de una revision Sistematica con Metanalisis. Fue realizada en el Departamento de Enfermeria de la Universidad Federal de Sao Paulo, Centro Cochrane de Brasil. Se utilizaron las siguientes fuentes: EMBASE, LILACS, Medline, lista de referencias bibliograficas, comunicacion personal y Cochrane Library. Como criterio para la seleccion de los estudios, se escogieron los que analizaron algun tipo de rastreo para GBS en gestantes. Independientemente del comparador, todos los analisis fueron favorables al programa de screening universal para la reduccion de la incidencia de sepsis neonatal. Las evidencias obtenidas en el estudio sugieren que la estrategia de screening universal para las gestantes asociado al uso de antibioticos profilacticos es segura y efectiva.Infection with Group B Streptococcus (GBS) is considered an important public health problem. It is associated with: Neonatal sepsis, meningitis, pneumonia, neonatal death, septic abortion, chorioamnionitis, endometritis and other perinatal infections. The aim of this study was to determine the best screening strategy for GBS in pregnant women. For this a systematic review and meta-analysis were carried out in the Nursing Department of the Federal University of São Paulo, Cochrane Center, Brazil. Sources used were, EMBASE, LILACS, Medline, list of references, personal communication and the Cochrane library. The criterion for the selection of the studies was; studies which analyze some type of screening for GBS in pregnant women. Independent of the comparator, all analyses were in favor of a universal screening program for reducing the incidence of neonatal sepsis. The evidence obtained in this study suggests that the strategy of universal screening of pregnant women associated with the use of prophylactic antibiotics is safe and effective.

Prevenção de infecções de corrente sanguínea relacionadas a cateter em pacientes em hemodiálise

Objective: To conduct a systematic review of the literature on the prevention of catheter-related bloodstream infections in patients on hemodialysis. Methods: A literature search was performed in Medline, Embase, Scielo, Lilacs, and Cochrane databases for articles published from 1990 to 2008. Results: Two hundred ninety- three articles were retrieved. However, only 12 studies were included in this review. Conclusions: Findings suggest that health care providers use several infection control measures to prevent bloodstream infections in this patient population.OBJETIVO: Realizar uma revisao sistematica sobre medidas padronizadas para prevencao de infeccoes relacionadas a cateter em pacientes em hemodialise. METODOS: Foi realizada uma revisao sobre a prevencao de infeccoes em hemodialise nas bases de dados Medline, Embase, SciElo, Lilacs e Cochrane Library de estudos publicados entre os anos de 1990 e 2008. RESULTADOS: Foram encontrados 293 artigos e destes 12 foram incluidos no estudo. CONCLUSAO: Foi evidenciada a importância da aplicacao de um conjunto de medidas de controle de infeccoes pelos profissionais da saude para prevenir a infeccao nesta populacao de pacientes.

Microrganismos isolados de pacientes em hemodiálise por cateter venoso central e evolução clínica relacionada

OBJETIVO: Identificar os microrganismos isolados da pele pericateter, ponta do cateter e corrente sanguinea de pacientes em hemodialise por cateter venoso central, verificar o perfil de sensibilidade destes microrganismos aos antimicrobianos e avaliar a evolucao clinica e a mortalidade relacionada a estes microrganismos. METODOS: Estudo transversal. As cepas isoladas de pacientes em hemodialise por cateter venoso central que em estudo previo apresentaram infeccao na pele pericateter, ponta do cateter e corrente sanguinea foram analisadas quanto ao perfil microbiologico e letalidade relacionada. RESULTADOS: Foram isolados 128 microrganismos em corrente sanguinea nos 94 pacientes estudados. Ocorreram 35 casos de septicemia e 27 de endocardite. A letalidade nos casos de endocardite por Staphylococcus aureus resistente a meticilina foi 100%. CONCLUSAO: Infeccao em corrente sanguinea e endocardite por Staphylococcus aureus resistente a meticilina sao preditivas de alta mortalidade e letalidade.

Evaluation of the mortality of neonates and children related to the use of central venous catheters: a systematic review

Objective: To analyze mortality related to infections in the use of central venous catheters in newborns and hospitalized children. Methods: This was a systematic review, using studies that were identified in the databases of MEDLINE, EMBASE, Lilacs, CINAHL, SciELO and Cochrane, in bibliographical references of articles, and other reviews. Two reviewers independently identified relevant studies, analyzed the methodological quality, and subsequently, extracted data. Results: We encountered 1,000 articles, of which 16 were related to catheter infection and only two mentioned mortality. Findings of these two studies verified that sepsis was the principal complication related to the use of central venous catheters, and the most prevalent microorganisms in these infections were Candida sp. and Enterococcus sp., with significant impact on neonatal and child mortality. Conclusion: It was observed in this review that sepsis was most prevalent complication related to central catheters.

Prevention of Catheter-Related Bloodstream Infections in Patients on Hemodialysis

Objective: To conduct a systematic review of the literature on the prevention of catheter-related bloodstream infections in patients on hemodialysis. Methods: A literature search was performed in Medline, Embase, Scielo, Lilacs, and Cochrane databases for articles published from 1990 to 2008. Results: Two hundred ninety- three articles were retrieved. However, only 12 studies were included in this review. Conclusions: Findings suggest that health care providers use several infection control measures to prevent bloodstream infections in this patient population.OBJETIVO: Realizar uma revisao sistematica sobre medidas padronizadas para prevencao de infeccoes relacionadas a cateter em pacientes em hemodialise. METODOS: Foi realizada uma revisao sobre a prevencao de infeccoes em hemodialise nas bases de dados Medline, Embase, SciElo, Lilacs e Cochrane Library de estudos publicados entre os anos de 1990 e 2008. RESULTADOS: Foram encontrados 293 artigos e destes 12 foram incluidos no estudo. CONCLUSAO: Foi evidenciada a importância da aplicacao de um conjunto de medidas de controle de infeccoes pelos profissionais da saude para prevenir a infeccao nesta populacao de pacientes.

Avaliação da mortalidade de neonatos e crianças relacionada ao uso do cateter venoso central: revisão sistemática

Objective: To analyze mortality related to infections in the use of central venous catheters in newborns and hospitalized children. Methods: This was a systematic review, using studies that were identified in the databases of MEDLINE, EMBASE, Lilacs, CINAHL, SciELO and Cochrane, in bibliographical references of articles, and other reviews. Two reviewers independently identified relevant studies, analyzed the methodological quality, and subsequently, extracted data. Results: We encountered 1,000 articles, of which 16 were related to catheter infection and only two mentioned mortality. Findings of these two studies verified that sepsis was the principal complication related to the use of central venous catheters, and the most prevalent microorganisms in these infections were Candida sp. and Enterococcus sp., with significant impact on neonatal and child mortality. Conclusion: It was observed in this review that sepsis was most prevalent complication related to central catheters.

Efetividade de programas de educação e suporte na redução da sobrecarga de cuidadores de idosos com demência: revisão sistemática

OBJETIVO: o objetivo deste estudo foi analisar a efetividade de programas de educacao e suporte de cuidadores na reducao de sua sobrecarga. METODO: foi realizada uma revisao sistematica com consulta as bases Medline, Lilacs, Embase, Cochrane, Web of Science, SciELO e CINAHL. RESULTADOS: foram incluidos sete ensaios clinicos randomizados que comparavam o programa de educacao ao cuidado usual, avaliando a sobrecarga do cuidador atraves da escala Burden Interview de Zarit. Apos analise de sensibilidade, quatro estudos foram agrupados na metanalise, mostrando maior reducao na sobrecarga do cuidador entre participantes de programas de educacao e suporte, com significância estatistica. CONCLUSAO: as evidencias, neste estudo, mostram que programas de educacao e suporte sao favoraveis para a reducao da sobrecarga do cuidador quando comparados ao cuidado usual. Dessa forma, a inclusao desses programas em instituicoes voltadas para a assistencia de idosos e efetiva e deve ser estimulada. Pode-se inferir ainda que esses programas devam contemplar o compartilhamento de estrategias de manejo nao farmacologico dos sintomas psicologicos e comportamentais das demencias.OBJECTIVE This studys objective was to analyze the effectiveness of educational and support programs for caregivers on reducing their burden. METHOD The method used was a systematic review. The following were searched; MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. RESULTS Seven randomized clinical studies were included. These studies compared an educational program with standard care delivery, assessing the burden of caregivers through the Zarit Burden Interview. After the analysis of sensitivity, four studies were grouped in the meta-analysis showing a statistically significant reduction in caregiver burden among the participants of educational and support programs. CONCLUSION The evidence obtained in this study suggests that educational and support programs have a positive impact on the reduction of caregiver burden when compared to standard care. Therefore, the inclusion of these programs in institutions providing care to the elderly is effective and should be encouraged. These programs should also share non-pharmacological management strategies for the behavioral and psychological symptoms of dementia.