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Motivos que llevan a las mujeres a optar por el parto domiciliario planificado

Objetivo principal: conocer los motivos que llevan a las mujeres a optar por el parto domiciliário planificado. Metodología: estudio descrip-tivo, exploratorio, con un enfoque cualitativo. Participaron en la investigaciõn nueve mujeres que han optado por tener su parto en casa. Recolección de datos se produjo a través de entrevistas semiestructuradas, realizadas individualmente. Se utilizó la técnica de análisis de contenido de tipo temático. Resultados principales: del análisis emergieron los temas: Motivos que llevaron al parto domiciliário; Percep-ción de las mujeres sobre el parto domiciliário; Conductas de los profesionales de la salud en el parto domiciliário; y El enfermero frente a la asistencia al parto domiciliário. Conclusión principal: Las mujeres que optan por el parto domiciliario buscan una atención más humana sobre el parto, evitando una serie de intervenciones innecesarias, comunes en los hospitales.

Prototype Development, Usability, and Preference of a Culturally-relevant Pictorial Aid to Facilitate Comprehension of Likert-type Levels of Agreement in Caregivers of Children Living With HIV in Ghana

imagePictorial illustrations of Likert-type scales are culturally useful and may reduce error associated with usage of Westernized self-report measures in low- and middle-income countries. Pictorial illustrations can be encounter-specific decision aids in populations with low literacy or English proficiency. In an unanticipated finding from the SANKOFA study, caregivers of children living with human immunodeficiency virus experienced challenges comprehending Likert-type scales. A cross-sectional, qualitative study was conducted with a SANKOFA participant subset (n = 30) in Ghana. Using an informatics-based formative design approach, we developed a culturally-relevant pictorial aid to assess usability and preference when compared to a Likert-type self-report measure. Ninety percent (n = 27) of substudy participants preferred the pictorial of a traditional Bolga basket over a shallow basket. Forty-three percent (n = 13) preferred the pictorial aid over the Likert-type measure. Fifty percent reported the pictorial aid was easy to use. Fifty-seven percent preferred the Likert-type measure, potentially because English proficiency is regarded in Ghana as a means of upward social and financial mobility. Such cultural norms may have contributed to the lack of consensus and must be considered for pictorial aids to be meaningful. Pictorial aids have been designed for use in clinical and research settings. They reduce barriers associated with lower textual literacy while facilitating comprehension and decision-making.

Contextualizing Instructional Technology to the Demands of Nursing Education

imageThis article reviews current technologies in nursing education and the impact of technology on learning. The integration of technology into nursing curricula is thought to improve efficiency and enhance student experiences through active learning and interactive learning designs. The following focused questions are explored: (1) What are the current technologies used by university students and faculty in nursing programs? (2) How does that technology influence student learning? The primary themes were student-centered technology, with five subthemes, and faculty-centered technology. Consumers of healthcare (patients) demand quality care and expect highly skilled, compassionate, ethical practitioners; to this end, training and education of future nurses by skilled, qualified nurse educators who are comfortable with technological demands of all aspects of healthcare are fundamental. While it is essential that nurses and nurse educators continue to publish as a mechanism for open discussion and transparency in our teaching and learning approaches, we need higher levels of evidence to strengthen the argument that technology improves the learning environment and student outcomes and has a positive impact on clinical settings and patient care.

Knowledge Discovery With Machine Learning for Hospital-Acquired Catheter-Associated Urinary Tract Infections

imageMassive generation of health-related data has been key in enabling the big data science initiative to gain new insights in healthcare. Nursing can benefit from this era of big data science, as there is a growing need for new discoveries from large quantities of nursing data to provide evidence-based care. However, there are few nursing studies using big data analytics. The purpose of this article is to explain a knowledge discovery and data mining approach that was employed to discover knowledge about hospital-acquired catheter-associated urinary tract infections from multiple data sources, including electronic health records and nurse staffing data. Three different machine learning techniques are described: decision trees, logistic regression, and support vector machines. The decision tree model created rules to interpret relationships among associated factors of hospital-acquired catheter-associated urinary tract infections. The logistic regression model showed what factors were related to a higher risk of hospital-acquired catheter-associated urinary tract infections. The support vector machines model was included to compare performance with the other two interpretable models. This article introduces the examples of cutting-edge machine learning approaches that will advance secondary use of electronic health records and integration of multiple data sources as well as provide evidence necessary to guide nursing professionals in practice.

Non‐healing wounds: Can it take different diagnosis?


Wound healing is a complex cellular and biochemical process and can be affected by several systemic and local factors. In this study, we aimed to discuss the aetiologic factors of non‐healing wounds and the management of this complicated process with current information. The medical data of the patients who were admitted to our clinic due to non‐healing or chronic wounds were analysed retrospectively. A total of 27 patients were evaluated retrospectively during the 14 months of the study. The data of 6 patients who were followed up for chronic wound that developed after abdominal incisional hernia repair and pilonidal sinus surgery were not included in the study as their data could not be reached. A total of 21 patients were included in the study. Malignancy was diagnosed in two patients and granulomatous disease was found in four patients. The aetiology of the other cases included foreign body reaction, infection, and mechanical causes. Non‐healing wounds are a serious social and economic problem for patients. Further studies on the pathophysiology of various aetiologies in non‐healing wounds in both clinical settings and experimental animal models would be a useful step in treatment.

Nano‐hydrogel embedded with quercetin and oleic acid as a new formulation in the treatment of diabetic foot ulcer: A pilot study


Wound healing, especially diabetic ones, is a relevant clinical problem, so it is not surprising that surgical procedures are often needed. To overcome invasive procedures, several strategies with drugs or natural compound are used. Recently, in an experimental study, we described an increase in keratinocyte proliferation after their exposition to quercetin plus oleic acid. In the present clinical study, we evaluated both the clinical efficacy and the safety of nano‐hydrogel embedded with quercetin and oleic acid in the treatment of lower limb skin wound in patients with diabetes mellitus (DM). Fifty‐six DM patients (28 men and 28 women, mean age 61.7 ± 9.2 years) unsuccessfully treated with mechanical compression were enrolled and randomised to receive an add on treatment with hyaluronic acid (0.2%) or nano‐hydrogel embedded with quercetin and oleic acid. The treatment with nano‐hydrogel embedded with quercetin and oleic acid significantly (P < .01) reduced the wound healing time, in comparison to hyaluronic acid (0.2%) without developing of adverse drug reactions, suggesting that this formulation could be used in the management of wound healing even if other clinical trials must be performed in order to validate this observation.

Biological approaches for hypertrophic scars


Scar formation is usually the pathological consequence of skin trauma. And hypertrophic scars (HSs) frequently occur in people after being injured deeply. HSs are unusually considered as the result of tissue contraction and excessive extracellular matrix component deposition. Myofibroblasts, as the effector cells, mainly differentiated from fibroblasts, play the crucial role in the pathophysiology of HSs. A number of growth factors, inflammatory cytokines involved in the process of HS occurrence. Currently, with in‐depth exploration and clinical research of HSs, various creative and effective treatments budded. In here, we summarize the progress in the molecular mechanism of HSs, and review the available biotherapeutic methods for their pathophysiological characteristics. Additionally, we further prospected that the comprehensive therapy may be more suitable for HS treatment.

A randomised clinical trial to compare octyl cyanoacrylate with absorbable monofilament sutures for the closure of laparoscopic cholecystectomy port incisions


Tissue adhesives have gained increasing use as a possible method of wound closure. We compared the use of 2‐octyl cyanoacrylate (OCA) or subcuticular suture in incisions sutures for the closure of laparoscopic cholecystectomy port incisions. A prospective randomised controlled trial was performed. Patients were randomised to have closure of laparoscopic port sites using either OCA or sutures. Patients were reviewed at 24 hours and returned for follow‐up 1 week and 1 month after postoperatively. At these times, different wound characteristics were documented: Two tools were used to measure the cosmetic result using Hollander wound evaluation scale (HWES) and the patient and observer scar assessment scale (POSAS). A total of 70 patients, 35 in each group were enrolled. The wounds were closed significantly faster in the OCA group (mean 229.16 [±43.7] seconds versus 258.82 [±51.7] seconds, P = .01). Statistically significant difference in favour of using OCA was found for dehiscence (17.1% versus none in the suture group, P = .025) after 1 week. However, no difference was found for wound dehiscence after 1 month. OCA and suture groups did not differ significantly on patient satisfaction. There were no differences in the percentage of wounds achieving optimal scores on the HWES (suture 85.7% versus OCA 74.2%, P = .169). Nerveless, wound evolution was judged to be significantly better in the OCA group using POSAS. Patients' median POSAS was 9.45 (6–11) and 11.43 (10–13) in the OCA and suture groups, respectively (P = .005), and surgeon's median POSAS was 9.42 (6–11) and 11.48 (10–13) in the OCA and suture groups, respectively (P = .006). N‐butyl‐cyanoacrylate tissue adhesive is an acceptable technique for the closure of laparoscopic wounds with less operative time, and cosmetic results are comparable to suturing.

Instillation negative pressure wound therapy: An effective approach for hardware salvage


Wound infection involving hardware can be notoriously difficult to treat, often requiring the removal of the infected implant. The goal of this study was to determine the utility of instillation negative pressure wound therapy to help eradicate infection and allow for definitive wound closure in patients without removing the infected hardware. A retrospective review was performed on the outcomes of 28 patients who presented with open wounds with exposed or infected hardware and who were treated with a combination of surgical debridement and negative pressure wound therapy with instillation (NPWTi). Eleven patients were treated for infected spinal hardware, 12 for extremity, and 5 for sternal hardware. Twenty‐five of 28 (89%) patients had successful retention or replacement of hardware, with clearance of infection and healed wounds. Original hardware was maintained in 17 of 28 (61%) patients. In 11 patients, original hardware was removed, with subsequent replacement in eight of those patients after a clean wound was achieved. Average time to definitive closure was 12.6 days. Average follow‐up was 135 days. This series supports NPWTi as an effective adjunct therapy to help expeditiously eradicate hardware infection, allowing for hardware retention.

Incidence and risk factors for medical device‐related pressure ulcers: The first report in this regard in Iran


Few studies, especially among developing countries such as Iran, have been conducted on the incidence and risk factors for medical device‐related pressure ulcers (MDRPUs). Given the importance of this issue and the lack of previous studies, the present study aimed to investigate the incidence and risk factors for MDRPUs in Iran. The present descriptive‐analytical study was conducted at three hospitals in Qazvin, Iran, from June 1, 2019, to September 1, 2019. Data collection took approximately 3 months from July to September 2019. Sampling was carried out through a convenience sampling method, and the samples consisted of 404 patients. For data collection, a checklist for demographic variables, a checklist for patient‐connected medical devices, Braden Scale, Glasgow Coma Scale, National Pressure Ulcer Advisory Panel Pressure Grading Scale, and Nutrition Risk Screening 2002 were used. Of the 404 patients studied, 20.54% (n = 83) developed some degree of MDRPUs. From those, 61 (70.11%) were in stage I, 17 (19.5%) were in stage II, and 9 (10.34%) were in stage III. Among the nine medical devices that caused pressure ulcers, the most commonly reported ones were nasal oxygen tubes (31 cases), oxygen face masks (23 cases), and endotracheal tubes (17 cases). The mean score of Braden Scale (P = .004), the mean score of NRS 2002 (P = .037), older age (P = .007), male gender (P = .002), the average length of stay in hospitals (P = .001), and having pressure ulcers in body (P = .025) significantly increased the possibility of occurring MDRPUs. In the present study, the incidence of MDRPUs was high. Taking the necessary measures into consideration in order to prevent the MDRPUs is essential in Iranian hospitals. Further studies in this regard are strongly recommended.

Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis


Pressure injuries (PIs) are a common quality indicator for hospital care, and preventing PIs often requires patient engagement; as such, Australian consensus research has recommended that high‐quality education materials be made to patients for PIs via hospital networks. The purpose of the present study was to assess the availability and accuracy of patient education materials on PIs in publicly available hospital websites in Victoria, Australia. Two independent coders assessed 212 websites for content on PI prevention and management, analysing availability and accuracy of PI definitions, risk factors, preventive strategies, referral, visual tools, consumer endorsement, information for family/carers, and translation on community languages. A greater proportion of hospitals did not have any patient education materials on PI prevention publicly available, with private hospitals (compared with public) and metropolitan hospitals (compared to rural) more likely to have materials available on their sites. The available materials contained accurate messages on PI defining characteristics and risk factors for PIs, although there was considerable variability on the availability of other information. Our findings suggest a significant deficit in the availability of educational materials for acute care patients and their families. There is a need for evidence‐based, consumer‐endorsed, uniform materials on all hospital websites to prevent PIs in acute care.

In vitro evaluation of the hyaluronic acid/alginate composite powder for topical haemostasis and wound healing


The use of haemostatic agents can provide life‐saving treatment for patients who suffer from massive bleeding in both prehospital and intraoperative conditions. However, there are still urgent demands for novel haemostatic materials that exhibit better haemostatic activity, biocompatibility, and biodegradability than existing products. In the present study, we aim to evaluate the feasibility of new wound dressing, RapidClot, for treating uncontrolled haemorrhage through a series of in vitro assessments to determine the swelling ratio, clotting time, enzymatic degradation, haemolytic activity, cytotoxicity, cell proliferation, and migration. The results indicated that the RapidClot revealed better water adsorption capacity and shorter blood clotting time (132.7 seconds) than two commercially available haemostatic agents Celox (378.7 seconds) and WoundSeal (705.3 seconds). Additionally, the RapidClot dressing exhibited a similar level of degradability in the presence of hyaluronidase and lysozyme as that of Celox, whereas negligible degradation of WoundSeal was obtained. Although both Celox and RapidClot revealed a similar level in cell viability (above than 90%) against NIH/3 T3 fibroblasts, improved cell proliferation and migration could be obtained in RapidClot. Taking together, our results demonstrated that RapidClot could possess a great potential for serving as an efficient healing dressing with haemorrhage control ability.

Evaluating complications in below‐knee skin cancer surgery after introduction of preoperative appointments: A 2‐year retrospective cohort study


Below‐knee dermatological surgery has a high risk of complications such as wound infection, bleeding, and necrosis. In this study, we evaluated the impact of preoperative appointments on complication risks. We searched the medical records of the Helsinki University Central Hospital (HUS) Dermatosurgery unit for all below‐knee surgeries during 2016, when no preoperative nurse appointments were carried out, and compared it with 2018, when preoperative appointments for risk patients were introduced. The study included 187 patients in 2016 and 179 patients in 2018, of whom 68 (about one third) attended preoperative appointments. At the appointments, risk factors were evaluated, and compression therapy was introduced when possible. The results show complication rates of 13.4% in 2016 vs 10.1% in 2018 (P = .33), despite significantly higher risks in the 2018 patient group. The odds ratio for complications in appointment attendees vs non‐attendees was reduced after adjustments to 0.58; however, this was insignificant (P = .47). The odds of complications for skin grafts were considerably higher: 11.33 vs other surgery techniques (P = .00). In conclusion, the introduction of preoperative appointments appeared to reduce complications in below‐knee surgery. For graft reconstructions, complication risk is high, even with carefully planned pre‐ and postoperative care. Further studies are needed to evaluate preventable risk factors of below‐knee graft reconstructions.

Over-confidence in cardiac devices can create a barrier in engaging patients in advance care planning and discussions around device deactivation

Por: Elliott · K.

Commentary on: Hadler RA, Goldstein NE, Bekelman DB, et al. "Why Would I Choose Death?": A Qualitative Study of Patient Understanding of the Role and Limitations of Cardiac Devices. J Cardiovasc Nurs 2019;34:275–82. doi: 10.1097/JCN.0000000000000565.

Implications for practice and research

  • Stage II-IV heart failure patients with cardiac devices may overestimate their device’s ability to prevent further deterioration and death. This may become a barrier to engaging in advance care planning.

  • Further research is required to evaluate best methods of engaging these patients in discussions around advance care planning and device deactivation.

  • Context

    Guidelines for managing patients with heart failure indicate that discussions about the condition, treatment options and advance care planning should be discussed at an early stage of the disease.1 Prior to implanting a cardiac device, clinicians should be discussing when device deactivation might become appropriate.2–4...

    Development and psychometric evaluation of the patient knowledge of, and attitudes and behaviours towards pressure ulcer prevention instrument (KPUP)


    The Patient Knowledge of, and Attitude and Behaviour towards Pressure Ulcer Prevention Instrument (KPUP) was developed and validated using a two‐stage prospective psychometric instrument validation study design. In Stage 1, the instrument was designed, and it is psychometrically evaluated in Stage 2. To establish content validity, two expert panels independently reviewed each item for appropriateness and relevance. Psychometric evaluation included construct validity and stability testing of the instrument. The questionnaire was administered to a convenience sample of 200 people aged more than 65 years, living independently in the community; reliability and stability were assessed by test/retest procedures, with a 1‐week interval. Mean knowledge scores at ‘test’ were 11.54/20 (95% CI = 11.10‐11.99, SD: 3.07), and ‘retest’ was 12.24 (95% CI = 11.81‐12.66, SD: 2.93). For knowledge, correlation between the test/retest score was positive (r=. 60), attitude section‐inter‐item correlations ranged from r = −.31 to r = .57 (mean intraclass correlation coefficient of r = .42), and internal consistency for the retest was the same as the test (α = .41 for the eight items). For health behaviours, individual inter‐item correlations for test items ranged from r = −.21 to r = .41 for the 13 standardised items. Psychometric testing of the KPUP in a sample of older persons in the community provided moderate internal consistency and general high test‐retest stability.

    Violencia obstétrica desde la perspectiva de las madres en un hospital de Serra Gaucha

    Objetivo principal: identificar posibles situaciones de violencia obstétrica durante el ciclo embarazo-puerperal en la perspectiva de mujeres puerperales en un hospital de la Serra Gaúcha. Metodología: estudio descriptivo, exploratorio con enfoque cualitativo. Once mujeres postparto participaron en el estudio. La recolección de datos se realizó a través de entrevistas semiestructuradas, realizadas de forma individual. Para el análisis de la información se utilizó la técnica de Análisis de Contenido de tipo Temático. Resultados principales: los siguientes temas surgieron del análisis: Percepciones de las mujeres puérperas sobre su experiencia en la atención del parto; y Prácticas inadecuadas durante la atención en el período de embarazo-puerperal. Conclusión principal: el estudio permitió conocer situaciones de violencia obstétrica que a veces no son reconocidas por las mujeres. La educación continua puede ser una estrategia para combatir la violencia obstétrica, a través de actualizaciones profesionales que permiten mejores prácticas de salud en el cuidado del parto y el parto.