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Population-based otoscopic and audiometric assessment of a birth cohort recruited for a pneumococcal vaccine trial 15-18 years earlier: a protocol

Por: Chan · K. · Carosone-Link · P. · Bautista · M. T. G. · Sanvictores · D. · Uhler · K. · Tallo · V. · Lucero · M. G. · De Jesus · J. · Simoes · E. A. F.
Introduction

A cohort of 12 000 children in the Philippines who had enrolled in a 2000–2004 (current ages 16 to 20 years) Phase 3 11-valent pneumococcal conjugate vaccine for the prevention of radiographically confirmed pneumonia are now being asked to participate in a separate study (expected completion date September 2021) to assess the cohort’s current long-term audiometric and otologic status. This new study would allow assessments of the utility of the pneumococcal vaccine in conferring its protective effects on the long-term sequelae of otitis media (OM), if any. Lack of trained local healthcare providers in otolaryngology/audiology and testing equipment in Bohol, Philippines, necessitates the development of a distinct methodology that would lead to meaningful data analysis.

Methods and analysis

Reliable data collection and transfer are achieved by a US otolaryngologist/audiologist team training local nurses on all procedures in a didactic and hands-on process. An assortment of portable otolaryngologic and audiologic equipment suitable for field testing has been acquired, including an operating otoscope (Welch-Allyn), a video-otoscope (JedMed), a tympanometer with distortion product otoacoustic emission measurements (Path Sentiero) and a screening audiometer (HearScreen). Data will then be uploaded to a Research Electronic Data Capture database in the USA.

Tympanometric and audiologic data will be codified through separate conventional algorithms. A team of paediatric otolaryngology advanced practice providers (APPs) have been trained and validated in interpreting video otoscopy. The protocol for classification of diagnostic outcome variables based on video otoscopy and tympanometry has been developed and is being used by APPs to evaluate all otoscopy data.

Ethics and dissemination

The study was approved by the Research Institute of Tropical Medicine, Alabang, Manila, Philippines, and the institutional review board and the Colorado Multiple Institutional Review Board of the University of Colorado School of Medicine, Aurora, Colorado, USA.

Research results will be made available to children and their caregivers with abnormal audiologic outcomes, the funders and other researchers.

Trial registration number

ISRCTN 62323832; Post-results.

Nursing workload assessment in an intensive care unit: a 5‐year retrospective analysis

Abstract

Aims

To study the correlation between the workload of intensive care nursing teams and the sociodemographic, anthropometric and clinical characteristics of patients in critical condition in a Portuguese Intensive Care Unit (ICU) during a 5‐year period.

Background

Currently, indices of nursing workload quantification are one of the resources used for planning and evaluating ICUs. Evidence shows that there are several factors related to critical patients and their hospitalisation which potentially influence the nursing workload.

Design

Retrospective cohort analysis of a health record database from adult patients admitted to a Portuguese ICU between January 1, 2015, and December 31, 2019.

Methods

Simplified Therapeutic Intervention Scoring System (TISS‐28) scores of 730 adult patients. Three TISS‐28 assessments were considered: first assessment, last assessment and average. The STROBE guidelines were used in reporting this study.

Results

The TISS‐28 has an average of 34.2 ± 6.9 points at admission, which is considered a high nursing workload. A somewhat lower result was found for the discharge and average assessments. It shows that basic activities accounted for the highest percentage of time spent (38.0%), followed by the cardiovascular support category (26.5%). The TISS‐28 shows consistent results throughout the study period, despite a small trend reduction in the last 2 years.

Conclusions

Lower workloads were found for age ≤ 44 years and with a shorter length of stay. Higher workload was more probable in patients classified in Cullen Class IV (OR = 2.5) and with a normal to higher weight percentile (OR = 1.9 and 1.5, respectively).

Relevance to clinical practice

Knowledge of the factors influencing the nursing workload facilitates the implementation of rules to improve performance in nursing interventions, based on the redefinition of care priorities, increased productivity, human resources management and reduction of additional costs to the organisation, related to possible adverse events, among others.

Aplicação do cuidado baseado na teoria de Orem ao paciente ostomizado

Estomia intestinal é realizada para desviar o trânsito intestinal para o exterior do corpo, o autocuidado do sujeito é fundamental para o seu processo de bem-estar físico e psicossocial, visto que ocorre mudança na imagem corporal. Objetivo: relatar a experiência da prática da sistematização da assistência de enfermagem, com base nas demandas terapêuticas de autocuidado de acordo com a teoria de Orem. Método: Trata-se de um estudo descritivo, tipo relato de experiência das residentes do Programa de Residência Multiprofissional em Cuidados continuados integrados na área de concentração em atenção à saúde do idoso no estado de Mato Grosso do Sul (MS). Relato de Caso: Cliente 58 anos, branco, casado, profissão vendedor, com diagnóstico médico de choque séptico de foco abdominal. Discussão: A equipe multiprofissional nesse âmbito insere no contexto hospitalar uma nova visão do cuidado, tendo como uma das funções costurar o sujeito fragmentado pela medicina, e romper o modelo cartesiano ainda existente no imaginário dos profissionais. Considerações finais: O conhecimento da equipe multiprofissional acerca da legislação que regulamenta o atendimento das pessoas com estomias é de extrema importância, uma vez que, essa equipe deve desempenhar suas ações com eficiência e eficácia à luz do que a legislação preconiza.

Aplicação do cuidado baseado na teoria de Orem ao paciente ostomizado

Estomia intestinal é realizada para desviar o trânsito intestinal para o exterior do corpo, o autocuidado do sujeito é fundamental para o seu processo de bem-estar físico e psicossocial, visto que ocorre mudança na imagem corporal. Objetivo: relatar a experiência da prática da sistematização da assistência de enfermagem, com base nas demandas terapêuticas de autocuidado de acordo com a teoria de Orem.  Método: Trata-se de um estudo descritivo, tipo relato de experiência das residentes do Programa de Residência Multiprofissional em Cuidados continuados integrados na área de concentração em atenção à saúde do idoso no estado de Mato Grosso do Sul (MS). Relato de Caso: Cliente 58 anos, branco, casado, profissão vendedor, com diagnóstico médico de choque séptico de foco abdominal. Discussão: A equipe multiprofissional nesse âmbito insere no contexto hospitalar uma nova visão do cuidado, tendo como uma das funções costurar o sujeito fragmentado pela medicina, e romper o modelo cartesiano ainda existente no imaginário dos profissionais. Considerações finais: O conhecimento da equipe multiprofissional acerca da legislação que regulamenta o atendimento das pessoas com estomias é de extrema importância, uma vez que, essa equipe deve desempenhar suas ações com eficiência e eficácia à luz do que a legislação preconiza.

Aplicação do cuidado baseado na teoria de Orem ao paciente ostomizado

Nonpharmacological Clinical Effective Interventions in Constipation: A Systematic Review

Abstract

Purpose

To identify nonpharmacological clinically effective interventions for constipation in adults.

Methods

A systematic review of experimental studies of nonpharmacological interventions addressing participants’ management of constipation using samples of adults over 18 years of age was conducted. In evaluating the methodological quality of the eligible studies, we used the assumptions of the Cochrane Collaboration, and for the reporting of items in the systematic review we used the Model of Preferential Reporting Items for Systematic Reviews and Meta‐Analyses. The protocol of this review was recorded in the International Prospective Register of Systematic Reviews of the University of York under number 43693.

Results

This review included 12 randomized controlled trials. Nonpharmacological effective interventions for the resolution of constipation were identified: individualized intervention based on the participant’s modifiable risk factors of constipation promoting literacy in health; educational measures in dietary modification and lifestyle; and abdominal massage.

Conclusions

Specific nonpharmacological interventions are crucial for nurses’ clinical practice and of major importance for clients and families. Evidence on these interventions in resolving constipation is still scarce and fails to provide evidence‐based data to support nursing clinical practice.

Clinical Relevance

Personal lifestyles, comorbidities, medication, and sedentary habits are likely to be risk factors in constipation. Thus, it is important to invest in nonpharmacological interventions that promote changes in behavior regarding prevention or resolution of constipation. Moreover, nursing researchers worldwide should conduct research for clinical practice regarding the fundamentals of care.

Effectiveness of strategies for nutritional therapy for patients with type 2 diabetes and/or hypertension in primary care: protocol of a systematic review of randomised controlled trials

Introduction

Despite the increasing number of drugs available and various guidelines on the management of type 2 diabetes mellitus (T2DM) and hypertension, an expressive number of patients continue with these diseases uncontrolled. Nutrition therapy (NT) plays a fundamental role in the prevention and management of these comorbidities, as well as in the prevention of complications related to them. The objective of this review is to evaluate the effectiveness of NT strategies in the management of patients with T2DM and/or hypertension in primary care. The selected strategies did not substitute pharmaceutical treatment but instead focused on preventing a sedentary lifestyle and stimulating healthy nutrition.

Methods and analysis

We will perform a systematic review according to Cochrane methodology of randomised controlled trials, wherein patients with T2DM and/or hypertension were allocated into one of the two groups: NT strategy, which may be of dietary quality or energy restriction, and conventional treatment. The primary outcomes will be glycaemic and blood pressure (BP) control, measured by final glycosylated hemoglobin (HbA1c) (%) and BP (mm Hg), respectively. Four general and adaptive search strategies have been created for the Embase, Medline, Latin American and Caribbean Health Sciences Literature (LILACS) and Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases. Two reviewers will independently select eligible studies, assess the risk of bias and extract data from the included studies. Similar outcomes measured in at least two trials will be plotted in the meta-analysis using Review Manager V.5.3. The quality of evidence of the effect estimate of the intervention will be generated according to the Grading of Recommendations Assessment, Development, and Evaluation Working Group.

Ethics and dissemination

As no primary data collection will be undertaken, formal ethical assessment is not required. We plan to present the results of this systematic review in a peer-reviewed scientific journal, conferences and the popular press.

PROSPERO registration number

Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 20 December 2018 (Registration number CRD42018118117).

Carboxytherapy: Controls the inflammation and enhances the production of fibronectin on wound healing under venous insufficiency

To examine the influence of carboxytherapy on wound healing under venous insufficiency, full‐thickness excisional wounds were created on Wistar rats. We used three groups with 32 rats each: Group (I): daily cleaning with 0.9% saline solution; Group Sulfadiazine (II): 1% silver sulfadiazine; and Carboxytherapy (III): subcutaneous application of 0.3 mL of carbon dioxide. The predetermined periods of analysis were the 3rd, 7th, 14th, and 30th day. The slides were stained with haematoxylin and eosin and Picrosirius red and submitted for immunohistochemistry. Groups II and III presented a statistically significant decrease in relation to the presence of neutrophilic and lymphocytic infiltrates. The presence of collagen significant increased in groups II and III. However, group III presented better organisation. Only group I maintained the neovascularisation until the 30th day. The new epithelium statistically significantly increased in groups II and III. On immunohistochemistry, regarding fibronectin expression, only group III demonstrated a statistically significant increase since the beginning of the healing process. Thus, the use of carboxytherapy promotes the formation of a tissue better structured and that may be an important resource for the treatment of wounds under venous insufficiency, especially those of recurrent re‐openings.

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