Renata Cristina de Campos Pereira Silveira

Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem

Evidence based practice is an approach that encourages the development and/or use of research results in clinical practice. Due to the quantity and complexity of information in health care, literature review methods need to be produced. Among such methods, we highlight the integrative review. Hence, this study aimed to present the general concepts and steps for the elaboration of an integrative review, as well as relevant aspects about the applicability of this method for health and nursing research. The integrative review is a research method that allows for the search, critical assessment, and synthesis of available evidence about the research theme. Its end product is the current stage of knowledge about the investigated theme, the implementation of effective interventions in health care and cost reduction, as well as the identification of gaps that indicate developments for future research.

Integrative literature review: a research method to incorporate evidence in health care and nursing

Evidence based practice is an approach that encourages the development and/or use of research results in clinical practice. Due to the quantity and complexity of information in health care, literature review methods need to be produced. Among such methods, we highlight the integrative review. Hence, this study aimed to present the general concepts and steps for the elaboration of an integrative review, as well as relevant aspects about the applicability of this method for health and nursing research. The integrative review is a research method that allows for the search, critical assessment, and synthesis of available evidence about the research theme. Its end product is the current stage of knowledge about the investigated theme, the implementation of effective interventions in health care and cost reduction, as well as the identification of gaps that indicate developments for future research.

O cuidado de enfermagem e o cateter de Hickman: a busca de evidências

INTRODUCAO: Os pacientes submetidos ao transplante de medula ossea (TMO) necessitam de um acesso venoso seguro para a infusao da medula ossea. A implantacao de um cateter venoso central e parte da terapeutica, sendo o de Hickman o mais utilizado atualmente; entretanto, sua presenca impoe riscos, sendo a infeccao, o mais preocupante. OBJETIVO: Revisao integrativa da literatura, que teve como objetivo buscar e avaliar as evidencias sobre os cuidados de enfermagem relacionados ao cateter de Hickman. METODO: Para a selecao dos artigos utilizamos as bases de dados Lilacs, Medline, Cinahl e o periodico Bone Marrow Transplantation, e a amostra constituiu-se de 18 artigos. RESULTADOS: O curativo recomendado e o de poliuretano trocado a cada 7 dias. O metodo de coleta de sangue observado foi o de descarte, sendo que a dosagem de ciclosporina nao deve ser coletada da mesma via onde foi infundida. A reducao do numero de manipulacoes do cateter e considerada uma medida eficaz na prevencao e no controle de infeccao. CONSIDERACOES FINAIS: As evidencias extraidas dos estudos analisados podem auxiliar a implementacao de cuidados de enfermagem eficazes relacionados ao cateter de Hickman.

Idosos que foram vítimas de acidentes de trânsito no município de Ribeirão Preto-SP, em 1998

O aumento da populacao idosa mundial vem acarretando uma serie de estudos sobre os efeitos dos acidentes externos nessa populacao. Este estudo objetivou caracterizar os idosos, vitimas de acidentes de trânsito, atendidos em um hospital governamental de Ribeirao Preto, Sao Paulo. Realizou-se um estudo retrospectivo, utilizando os dados coletados pelo Servico de Vigilância Epidemiologica do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo. Analisaram-se os dados relativos a 112 vitimas, com idade entre 60 e 85 anos, de janeiro a dezembro de 1998. Assim sendo, pode-se entao observar que, entre elas, 56,3% das vitimas eram do sexo masculino e 42% com idade entre 60 e 64 anos de idade. A maior parte dos sujeitos era pedestre (41,4%), tendo sido a cabeca a area corporal mais lesada (36,7%). E importante salientar que 50,9% tiveram algum tipo de sequela decorrente do trauma sofrido. Este trabalho visou dar destaque ao tema, salientando a importância de estudos na area da gerontologia, associada aos acidentes de trânsito.The considerable increase in the elderly population is resulting in several studies on the effects of external accidents to the population included in this age band. This study aimed at characterizing the elderly people victimized by traffic accidents and assisted in a public hospital in the City of Ribeirao Preto-SP, Brazil. A retrospective study was conducted using the data collected by the Epidemiological Surveillance Services of the University of Sao Paulo at Ribeirao Preto Faculty of Medicine. The data referring to 112 victims aged 60 to 85 years were analyzed from January to December, 1998. In this way, it can be observed that, among them, 56,3% of the victims are males and 42% are aged 60 to 64 years. Most of the subjects were pedestrians (41,4%) and their most frequently injured body area was the head (36,7%). It is important to point out that 50,9% had some type of sequel resulting from the trauma. This work aimed at emphasizing such theme by pointing out the importance of studies in the area of gerontology associated with traffic accidents.

Use of Chamomilla recutita in the Prevention and Treatment of Oral Mucositis in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Randomized, Controlled, Phase II Clinical Trial.

Background: Oral mucositis is a common inflammatory complication among patients undergoing hematopoietic stem cell transplantation (HSCT). Among its therapeutic properties, Chamomilla recutita has anti-inflammatory effects. Objective: The aim of this study was to identify the dosage of the liquid extract of C recutita in mouthwash that is needed to reduce the incidence and intensity of oral mucositis in adult patients undergoing allogenic HSCT. Methods: In a randomized phase II clinical trial, 40 patients were randomized to receive routine care plus mouthwash containing a liquid extract of C recutita at 0.5%, 1%, or 2% (experimental groups) or standard care alone (control group). Daily evaluation was performed using the measurement scale for oral toxicity defined by the World Health Organization. Statistical analysis was performed, in which the incidence, intensity, and duration of oral mucositis were compared between each experimental group and the control group. Results: The experimental group at the 1% dosage demonstrated reduced incidence, intensity, and duration of oral mucositis compared with the control group. The formulation was well tolerated by patients and was safe, as no moderate or severe adverse effects were identified. Conclusions: In this study, the use of mouthwash containing 1% C recutita extract can be associated with reduced incidence, intensity, and duration of mucositis in adults patients undergoing allogenic HSCT. Implications for Practice: The results of this investigation will help nurses and other professionals in selecting the C recutita dosage used to manage oral mucositis in patients undergoing HSCT.

The Use Of Polyurethane Transparent Film In Indwelling Central Venous Catheter

Dressing is an intervention aimed to prevent infection in central venous catheter. This study aimed to analyze the frequency of catheter-related infection and skin toxicity in the use of transparent film in Hickmans catheter in patients who underwent allogeneic hematopoietic stem cell transplantation. A case series with 10 cases was carried out. Due to the presence of exudate on the average for 12 days, sterile gauze dressing was used for 12.9 days (average). Transparent film was used, on average, for 15.1 days. Catheters were precociously removed due to infection in four cases. The highest degree of skin toxicity occurred in a case that used gauze dressing and in three cases with film. The transparent film permitted visualization of the exit site of the catheter and changes with longer intervals.O curativo e intervencao que visa a prevencao de infeccao no cateter venoso central. O estudo teve como objetivo analisar a frequencia de infeccao, relacionada ao cateter, e toxicidade cutânea, na utilizacao do curativo de poliuretano no cateter de Hickman, implantado em pacientes submetidos ao transplante de celulas-tronco hematopoeticas alogenico. Para tal, realizou-se uma serie de casos, constituida por 10 casos. O exsudato esteve presente em media por 12 dias, sendo necessario o uso do curativo de gaze esteril, com fita adesiva, por 12,9 dias (media). O curativo de poliuretano foi utilizado, em media, por 15,1 dias. A retirada precoce do cateter por infeccao ocorreu em quatro casos. O maior grau de toxicidade cutânea aconteceu em um caso que utilizou o curativo de gaze e em tres casos com filme. O filme transparente permitiu a visualizacao do sitio de saida do cateter e a troca com intervalos maiores.

Pharmacological interventions to treat phlebitis: systematic review.

This study presents a systematic review for evaluating effective pharmacological actions for the treatment of phlebitis stemming from infusion therapy. The studies reviewed were categorized according to the type of therapeutic approach proposed by the author and by the level of evidence presented. The review found that topical nitroglycerin and notoginseny were more effective in the reduction of the inflammatory process when compared with other proposed alternatives. Nevertheless, the development of research related to possible alternatives for the treatment of phlebitis is important.

Original research: telephone follow-up for patients after myocardial revascularization: a systematic review.

ObjectiveTo identify studies of telephone follow-up conducted with patients who had undergone myocardial revascularization, and to assess and synthesize the results. Design and methodsThis is a systematic review; the literature search was conducted in six electronic databases. Controlled descriptors were health education, teaching, myocardial revascularization, coronary artery bypass, angioplasty, telenursing, telephone, and hotlines; the noncontrolled descriptor was needs information. Of 170 identified studies, seven met the inclusion criteria and were selected for analysis. The Jadad scale, which ranges from 0 to 5, was used to assess the methodological quality of studies, with scores of 3 to 5 indicative of higher quality. FindingsFive of the seven studies found statistically significant positive changes in the outcome measures of health-related quality of life, pain, physical functioning, mood symptoms, anxiety, knowledge about self-care measures, medication compliance, and the lipid profile. Four of these five studies had a Jadad score of 3 and were of higher quality. ConclusionsThis review provides nurses and other clinicians with a synthesis of research on telephone follow-up in patients after myocardial revascularization. Of the seven studies analyzed, five showed evidence of some benefit from telephone follow-up. Their findings support the use of telephone follow-up to periodically assess patient knowledge, discuss patient concerns and offer ways to address them, monitor mood symptoms and anxiety levels, and encourage behavioral and lifestyle changes. Although any telephone follow-up intervention must be adapted according to each patients needs, the lack of similarity among and specific information about the interventions described in the analyzed studies made it difficult to evaluate specific elements. More research is needed to identify optimal content and frequency, number, and duration of calls.

Infection prevention measures used in hematopoietic stem cell transplantation: evidences for practice

This integrative review aimed to identify and assess evidence available about the use of high-efficiency air filters, protective isolation and masks for infection prevention in patients submitted to hematopoietic stem cell transplantation during hospitalization. LILACS, PUBMED, CINAHL, EMBASE and the Cochrane Library were used to select the articles. Of the 1023 identified publications, 15 were sampled. The use of HEPA filters is recommended for patients submitted to allogeneic transplantation during the neutropenia period. The level of evidence of protective isolation is weak (VI) and the studies evaluated did not recommend its use. No studies with strong evidence (I and II) were evaluated that justify the use of masks, while Centers for Disease Control and Prevention recommendations should be followed regarding the use of special respirators by immunocompromised patients. The evidenced data can support decision making with a view to nursing care.Esta revisao integrativa teve como objetivo identificar e avaliar as evidencias disponiveis em relacao ao uso de filtros de ar de alta eficiencia, isolamento protetor e mascaras para a prevencao de infeccao em pacientes submetidos ao transplante de celulas-tronco hematopoeticas, durante a internacao. Para a selecao dos artigos foram utilizadas as bases de dados LILACS, PubMed, CINAHL, EMBASE e a Biblioteca Cochrane. Das 1023 publicacoes identificadas, 15 foram incluidas na amostra. O uso dos filtros HEPA e recomendado para pacientes submetidos ao transplante alogenico, durante o periodo de neutropenia. O nivel das evidencias do isolamento protetor e fraco (VI) e os estudos avaliados nao recomendam o seu uso. Nao foram avaliados estudos com evidencias fortes (I e II) que justifiquem o uso de mascaras, sendo indicado que sejam seguidas as recomendacoes dos Centers for Disease Control and Prevention quanto ao uso de respiradores especiais pelos pacientes imunocomprometidos. Os dados evidenciados podem auxiliar na tomada de decisao para a assistencia de enfermagem.

Motivo de retirada do cateter de Hickman em pacientes submetidos ao transplante de células-tronco hematopoéticas

Objective: To identify rationale for removal of the first Hickman catheter implanted in patients undergoing allogeneic hematopoietic stem cell transplantation, the micro-organisms involved in the occurrence of infection, and the length of time the catheter was in situ. Methods: A cross sectional, retrospective study was conducted. The sample consisted of 57 transplant recipients. To conduct chart review, an instrument was developed containing variables related to patient identification, time of catheter use, reason for withdrawal, and isolated micro-organisms. Results: Among the reasons for catheter removal, frequent infection (49%) was the most common; the Stenotrophomonas maltophilia microorganism (25%) was the most frequently isolated. Conclusions: Due to the high incidence of infectious complications leading to Hickman catheter removal, it is essential to standardize catheter care for the health care team, patients and their caregivers.