Vera Lúcia Conceição de Gouveia Santos

Estudo sobre a incidência de úlceras por pressão em um hospital universitário

Este estudo objetivou identificar a incidencia de ulceras de pressao (UP) no Hospital Universitario da USP e analisar as associacoes com as caracteristicas sociodemograficas e clinicas da clientela. Apos coleta de dados realizada durante 3 meses consecutivos, em que foram acompanhados 211 pacientes de risco, obteve-se indice de 39,8%. Correlacoes estatisticamente significativas (p<0,05) foram obtidas entre a incidencia e a idade e area das UP e entre a idade e umidade, tempo de internacao e nutricao, area das UP e nutricao. Os resultados indicam a urgente necessidade da implantacao de programa de prevencao e tratamento de UP na instituicao, bem como contribuem, metodologicamente, para que outros servicos possam estabelecer tal tipo de investigacao.

Adaptação transcultural do pressure ulcer scale for healing (PUSH) para a língua portuguesa

O objetivo do estudo foi realizar a adaptacao transcultural do Pressure Ulcer Scale for Healing (PUSH) para a lingua portuguesa, atraves da traducao do instrumento para a lingua portuguesa, feita por especialistas bilingues e comite de especialistas, e teste das propriedades de medida: confiabilidade interobservadores e validade convergente. Para tais analises foram utilizados o indice Kappa e os Testes de Fisher e Spearman. Apos aprovacao pelo Comite de Etica da Escola de Enfermagem da Universidade de Sao Paulo, 34 ulceras de pressao foram examinadas. Os resultados obtidos para os indices Kappa (0,90 a 1,0) entre as observacoes dos enfermeiros e estomaterapeutas (padrao-ouro) para todas as subescalas e escore total da escala, bem como a existencia de correlacao positiva e estatisticamente significativa (p<0,001) entre as observacoes relativas a classificacao das ulceras em estagios e escore total da escala, atestaram ambas as propriedades de medida, confirmando a futura utilizacao do PUSH, versao adaptada, em nosso meio.

Predictive validity of the Braden scale for pressure ulcer risk in critical care patients

Este estudo metodologico foi desenvolvido em quatro unidades de terapia intensiva de um hospital geral, com o objetivo de avaliar a validade preditiva da escala de Braden em pacientes criticos. Apos aprovacao do projeto pelo Comite de Etica em Pesquisa, da instituicao, durante seis meses, pacientes adultos com escore total de Braden <18 e sem ulceras por pressao (UP) foram avaliados na admissao e a cada 48 horas, enquanto permaneceram em risco ou ate o desenvolvimento de UP, alta, morte ou transferencia da UTI. Os escores de Braden 12, 13 e 13, respectivamente na primeira, segunda e terceira avaliacao apresentaram sensibilidade de 85,7, 71,4 e 71,4% e especifidade de 64,6, 81,5 e 83,1%. As areas sob a curva ROC (Receiver Operating Characteristics) revelaram acuracia muito boa para os escores de corte obtidos. O escore de corte da escala de Braden igual a 13, na terceira avaliacao, apresentou a melhor performance preditiva em pacientes criticos.

Risk factors for pressure ulcer development in institutionalized elderly

This study aimed to analyze the risk factors for the development of Pressure Ulcers (PU) in old people living in Long Staying Institutions. It is a prospective and cohort study carried out in four Institutions. A total of 94 old people composed the sample and were assessed during three consecutive months. The total scores of the Braden Scale were different between the groups with and without PU, at the first (p=0.030) and last assessments (p=0.001); humidity, nutrition and friction/shearing were significantly different between those with and without PU, and were always worst among the first. Female gender and previous PU were confirmed as predictive for the development of PU (r(2)=0.311).This study aimed to analyze the risk factors for the development of Pressure Ulcers (PU) in old people living in Long Staying Institutions. It is a prospective and cohort study carried out in four Institutions. A total of 94 old people composed the sample and were assessed during three consecutive months. The total scores of the Braden Scale were different between the groups with and without PU, at the first (p=0.030) and last assessments (p= 0,001); humidity, nutrition and friction/shearing were significantly different between those with and without PU, and were always worst among the first. Female gender and previous PU were confirmed as predictive for the development of PU (r²=0,311).This study aimed to analyze the risk factors for the development of Pressure Ulcers (PU) in old people living in Long Staying Institutions. It is a prospective and cohort study carried out in four Institutions. A total of 94 old people composed the sample and were assessed during three consecutive months. The total scores of the Braden Scale were different between the groups with and without PU, at the first (p=0.030) and last assessments (p= 0,001); humidity, nutrition and friction/shearing were significantly different between those with and without PU, and were always worst among the first. Female gender and previous PU were confirmed as predictive for the development of PU (r 2 =0,311).

Prevalência da incontinência urinária em adultos e idosos hospitalizados

Este estudo objetivou verificar a prevalencia da incontinencia urinaria em pacientes hospitalizados e identificar as associacoes estatisticas existentes entre os indices obtidos e algumas variaveis demograficas e clinicas da clientela. Os dados foram colhidos no Hospital Universitario da USP, junto a 77 pacientes internados em tres diferentes clinicas. Os resultados indicaram prevalencias total de 35% e parciais de 48%, 37% e 22% nas Clinicas Cirurgica, Obstetrica e Medica, respectivamente. Correlacoes estatisticamente significativas foram verificadas entre a prevalencia e disuria (r=0,19 e p=0,046), infeccoes urinarias (r=0,24 e p=0,019), tempo de internacao (r=-0,32 e p=0,002) e sexo masculino (r=-0,27 e p=0,008).

Fatores de risco para o desenvolvimento de úlceras por pressão em idosos institucionalizados

This study aimed to analyze the risk factors for the development of Pressure Ulcers (PU) in old people living in Long Staying Institutions. It is a prospective and cohort study carried out in four Institutions. A total of 94 old people composed the sample and were assessed during three consecutive months. The total scores of the Braden Scale were different between the groups with and without PU, at the first (p=0.030) and last assessments (p=0.001); humidity, nutrition and friction/shearing were significantly different between those with and without PU, and were always worst among the first. Female gender and previous PU were confirmed as predictive for the development of PU (r(2)=0.311).This study aimed to analyze the risk factors for the development of Pressure Ulcers (PU) in old people living in Long Staying Institutions. It is a prospective and cohort study carried out in four Institutions. A total of 94 old people composed the sample and were assessed during three consecutive months. The total scores of the Braden Scale were different between the groups with and without PU, at the first (p=0.030) and last assessments (p= 0,001); humidity, nutrition and friction/shearing were significantly different between those with and without PU, and were always worst among the first. Female gender and previous PU were confirmed as predictive for the development of PU (r²=0,311).This study aimed to analyze the risk factors for the development of Pressure Ulcers (PU) in old people living in Long Staying Institutions. It is a prospective and cohort study carried out in four Institutions. A total of 94 old people composed the sample and were assessed during three consecutive months. The total scores of the Braden Scale were different between the groups with and without PU, at the first (p=0.030) and last assessments (p= 0,001); humidity, nutrition and friction/shearing were significantly different between those with and without PU, and were always worst among the first. Female gender and previous PU were confirmed as predictive for the development of PU (r 2 =0,311).

Inter rater reliability of Pressure Ulcer Scale for Healing (PUSH) in patients with chronic leg ulcers

This study aimed to evaluate the inter rater reliability of the Pressure Ulcer Scale for Healing (PUSH), in its version adapted to the Portuguese language, in patients with chronic leg ulcers. Kappa index was used for the analysis. After accomplishing ethical issues, 41 patients with ulcers were examined. A total of 49% of the ulcers were located in the right leg and 36% of them were venous ulcers. The Kappa indices (0.97 to 1.00) obtained in the comparison between the observations of the clinical nurses and the stomal therapists for all sub-scales and for total score, confirmed the tool inter rater reliability, with statistical significance (p<0.001). The PUSH instrument, in its Portuguese adapted version, showed to be reliable to the use in patients with chronic leg ulcers. Further studies should be conducted to evaluate its prospective performance. El objetivo del estudio fue probar la confiabilidad inter-observadores del Pressure Ulcer Scale for Healing (PUSH), en su version adaptada al portugues, en pacientes con ulceras cronicas en la pierna. Para el analisis de concordancia se utilizo el Indice Kappa. Posterior a la aprobacion del Comite de Etica, 41 pacientes con ulcera fueron examinados, siendo que 49% de las ulceras se localizaron a la derecha y 36% eran de etiologia venosa. Los indices Kappa obtenidos (0,97 a 1,00), con un nivel significativo de p<0,001, confirmaron la confiabilidad de los inter-observadores, al obtenerse un nivel de concordancia muy bueno entre el total de las observaciones realizadas por enfermeros clinicos y especialistas en estomatologia (patron-oro), dichos valores obtenidos tanto para todas las sub escalas de PUSH como para el puntaje total. Los resultados permiten concluir que el PUSH, en su version adaptada para el portugues, mostro confiabilidad para ser utilizado en pacientes con ulceras cronicas en miembros inferiores, debiendo ampliarse el estudio para evaluar su desempeno prospectivo. Testar a confiabilidade interobservadores do Pressure Ulcer Scale for Healing (PUSH), em sua versao adaptada para o portugues, em pacientes com ulceras cronicas de perna foi o objetivo deste estudo. Para a analise de concordância, utilizou-se o indice Kappa. Apos aprovacao pelo Comite de Etica, pacientes com ulceras (41) ulceras foram examinados, sendo que 49% das ulceras localizavam-se a direita e 36% eram de etiologia venosa. Os indices Kappa obtidos (0,97 a 1,00), com significância estatistica (p<0,001), ratificaram a confiabilidade interobservadores, ao ser obtida concordância de muito boa a total entre as observacoes de enfermeiros clinicos e especialistas em estomaterapia (padrao-ouro), para todas as subescalas do PUSH, como para o escore total. Esses resultados permitem concluir que o PUSH, em sua versao adaptada para o portugues, mostrou confiabilidade para utilizacao em pacientes com ulceras cronicas de membros inferiores, devendo-se ampliar o estudo para avaliacao de seu desempenho prospectivo.This study aimed to evaluate the inter rater reliability of the Pressure Ulcer Scale for Healing (PUSH), in its version adapted to the Portuguese language, in patients with chronic leg ulcers. Kappa index was used for the analysis. After accomplishing ethical issues, 41 patients with ulcers were examined. A total of 49% of the ulcers were located in the right leg and 36% of them were venous ulcers. The Kappa indices (0.97 to 1.00) obtained in the comparison between the observations of the clinical nurses and the stomal therapists for all sub-scales and for total score, confirmed the tool inter rater reliability, with statistical significance (p<0.001). The PUSH instrument, in its Portuguese adapted version, showed to be reliable to the use in patients with chronic leg ulcers. Further studies should be conducted to evaluate its prospective performance.

Prevalence of constipation in the general adult population: an integrative review.

Constipation affects multiple aspects of a persons health, including health-related quality of life. It is one of the most frequently reported functional gastrointestinal disorders. The purpose of this integrative review of the literature was to identify research findings pertaining to the prevalence of constipation and factors are associated with constipation in the general population. Electronic databases were searched for articles published between 2005 and 2011. All retrieved studies were evaluated with respect to quality according to the guidelines for critical appraisal of health research literature on prevalence and incidence. Eleven studies were retrieved; they reveal a prevalence of constipation that varied from 2.6% to 26.9%. The most frequently cited associated factors were female gender and advanced age, which were cited in 11 and 7 of the studies, respectively. Prevalence rates reported by the selected studies were heterogeneous. This may be partially attributed to variability in methods used to measure prevalence, including differences in criteria for constipation.

Predictive Validity of the Braden Scale for Pressure Ulcer Risk in Elderly Residents of Long-Term Care Facilities

The aim of this study was to evaluate the predictive validity of the Braden Scale for Predicting Pressure Sore Risk in elderly residents of long-term care facilities (LTCFs) in Brazil. The determination of the cutoff score for the Brazilian population is important for the comparison between Brazilian and international studies and establishment of guidelines for prevention of pressure ulcers in our health care facilities. This is the first study of its kind in Brazil. This was a secondary analysis of a prospective cohort study conducted with 233 LTCF residents aged 60 and over who underwent complete skin examination and Braden Scale rating every 2 days for 3 months. Two groups of patients were considered: the total group (N = 233) and risk group (n = 94, total scores < or =18). Data from the first and last assessments were analyzed for sensitivity, specificity, and likelihood ratios. The best results were obtained for the total group, with cutoff scores of 18 and 17, sensitivity of 75.9% and 74.1%, specificity of 70.3% and 75.4%, and area under the receiver operating characteristic curve (AUC-ROC) of 0.79 and 0.81 at the first and last assessments, respectively. For the risk group, the cutoff scores of 16 (first assessment) and 13 (last assessment) were associated with a smaller AUC-ROC and, therefore, lower predictive accuracy. The Braden Scale showed good predictive validity in elderly LTCF residents.

(Handicapped) Caregiver: the social representations of family members about the caregiving process

La finalidad de este estudio fue evaluar los significados del cuidar para cuidadores/familiares que comparten el cuidado domiciliar de minusvalidos fisicos por lesion medular traumatica. Utilizando como referencial metodologico la teoria de las Representaciones Sociales (RS), el analisis de las entrevistas abiertas, realizadas a ocho cuidadores, apunto dos ejes conductores de los significados: el proceso de sufrimiento vivido por las personas en la practica del cuidar y el de las aguas turbulentas que atraviesan este sufrimiento. Estos ejes, caracterizados como Nucleo Central y Sistema Periferico de las RS, respectivamente, fueron compuestos de temas como la optica que se tiene de la minusvalia, la afectividad, la religiosidad, los cambios socio-economicos y (la falta de) soporte tecnico-institucional. Los resultados revelan un cuidador incapacitado volcado al cuidar de una persona tambien incapacitada, tenida como invalida, y este cuidar realizado con mucho sufrimiento y privaciones, fundamentado en la culpabilidad y en la religiosidad, sostenido por una ambiguedad afectiva y marcado por extenuantes cambios socio-economicos y falta de apoyo tecnico-institucional, para una practica que supone tantas especificidades. Las alternativas de transformacion del cotidiano de esos cuidadores senalan, principalmente, para una simbiosis de invalidez con el otro - el vivir por el minusvalido - o aun para unos pocos, un boceto de retomada de los proyectos personales de vida - el vivir con el minusvalido.