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de Souza Fantin S, Scherer Dos Santos M, Ferro EB, Hirakata VN, Ferreira de Azeredo da Silva A, Rabelo-Silva ER. Peripherally Inserted Central Catheter Versus Centrally Inserted Central Catheter for In-Hospital Infusion Therapy: A Cost-Effectiveness Analysis. Value Health Reg Issues 2024; 41:123-130. [PMID: 38401289 DOI: 10.1016/j.vhri.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To evaluate the comparative effectiveness and cost-effectiveness of peripherally inserted central catheters (PICCs) compared with centrally inserted central catheters (CICCs). METHODS Prospective cohort study was followed by an economic analysis over a 30-day time horizon. Propensity score matching was used to select hospitalized adults with similar indications for PICC or CICC. The composite outcome was device removal or replacement because of complications before the end of treatment. The economic evaluation was based on a decision tree model for cost-effectiveness analysis, with calculation of the incremental cost-effectiveness ratio (ICER) per catheter removal avoided. All costs are presented in Brazilian reais (BRL) (1 BRL = 0.1870 US dollar). RESULTS A total of 217 patients were followed in each group; 172 (79.3%) of those receiving a PICC and 135 (62.2%) of those receiving a CICC had no device-related complication, respectively. When comparing the events leading to device removal, the risk of composite endpoint was significantly higher in the CICC group (hazard ratio 0.20; 95% CI 0.11-0.35). The cost of PICC placement was BRL 1290.98 versus BRL 467.16 for a CICC. In the base case, the ICER for placing a PICC instead of a CICC was BRL 3349.91 per removal or replacement avoided. On univariate sensitivity analyses, the model proved to be robust within an ICER range of 2500.00 to 4800.00 BRL. CONCLUSIONS PICC placement was associated with a lower risk of complications than CICC placement. Although the cost of a PICC is higher, its use avoided complications and need for catheter replacement before the end of treatment.
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Affiliation(s)
- Simone de Souza Fantin
- Cardiology and Cardiovascular Sciences Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Vascular Access Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Scherer Dos Santos
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduarda Bordini Ferro
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vania Naomi Hirakata
- Biostatistics Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Eneida Rejane Rabelo-Silva
- Cardiology and Cardiovascular Sciences Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Vascular Access Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
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Rohde LE, Rover MM, Hoffmann Filho CR, Rabelo-Silva ER, Silvestre OM, Martins SM, Passos LCS, de Figueiredo Neto JA, Danzmann LC, Silveira FS, Mesas CE, Hernandes ME, Moura LZ, Simões MV, Ritt LEF, Nishijuka FA, Bertoldi EG, Dall Orto FTC, Magedanz EH, Mourilhe-Rocha R, Fernandes-Silva MM, Ferraz AS, Schwartzmann P, de Castilho FM, Pereira Barretto AC, dos Santos Júnior EG, Nogueira PR, Canesin M, Beck-da-Silva L, de Carvalho Silva M, Adolfi Júnior MS, Santos RHN, Ferreira A, Pereira D, López Pedraza L, Kojima FCS, Campos V, de Barros e Silva PGM, Blacher M, Cavalcanti AB, Ramires F. Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission: The MESSAGE-HF Randomized Clinical Trial. JAMA Cardiol 2024; 9:105-113. [PMID: 38055237 PMCID: PMC10701668 DOI: 10.1001/jamacardio.2023.4501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/27/2023] [Indexed: 12/07/2023]
Abstract
Importance Readmissions after an index heart failure (HF) hospitalization are a major contemporary health care problem. Objective To evaluate the feasibility and efficacy of an intensive telemonitoring strategy in the vulnerable period after an HF hospitalization. Design, Setting, and Participants This randomized clinical trial was conducted in 30 HF clinics in Brazil. Patients with left ventricular ejection fraction less than 40% and access to mobile phones were enrolled up to 30 days after an HF admission. Data were collected from July 2019 to July 2022. Intervention Participants were randomly assigned to a telemonitoring strategy or standard care. The telemonitoring group received 4 daily short message service text messages to optimize self-care, active engagement, and early intervention. Red flags based on feedback messages triggered automatic diuretic adjustment and/or a telephone call from the health care team. Main Outcomes and Measures The primary end point was change in N-terminal pro-brain natriuretic peptide (NT-proBNP) from baseline to 180 days. A hierarchical win-ratio analysis incorporating blindly adjudicated clinical events (cardiovascular deaths and HF hospitalization) and variation in NT-proBNP was also performed. Results Of 699 included patients, 460 (65.8%) were male, and the mean (SD) age was 61.2 (14.5) years. A total of 352 patients were randomly assigned to the telemonitoring strategy and 347 to standard care. Satisfaction with the telemonitoring strategy was excellent (net promoting score at 180 days, 78.5). HF self-care increased significantly in the telemonitoring group compared with the standard care group (score difference at 30 days, -2.21; 95% CI, -3.67 to -0.74; P = .001; score difference at 180 days, -2.08; 95% CI, -3.59 to -0.57; P = .004). Variation of NT-proBNP was similar in the telemonitoring group compared with the standard care group (telemonitoring: baseline, 2593 pg/mL; 95% CI, 2314-2923; 180 days, 1313 pg/mL; 95% CI, 1117-1543; standard care: baseline, 2396 pg/mL; 95% CI, 2122-2721; 180 days, 1319 pg/mL; 95% CI, 1114-1564; ratio of change, 0.92; 95% CI, 0.77-1.11; P = .39). Hierarchical analysis of the composite outcome demonstrated a similar number of wins in both groups (telemonitoring, 49 883 of 122 144 comparisons [40.8%]; standard care, 48 034 of 122 144 comparisons [39.3%]; win ratio, 1.04; 95% CI, 0.86-1.26). Conclusions and Relevance An intensive telemonitoring strategy applied in the vulnerable period after an HF admission was feasible, well-accepted, and increased scores of HF self-care but did not translate to reductions in NT-proBNP levels nor improvement in a composite hierarchical clinical outcome. Trial Registration ClinicalTrials.gov Identifier: NCT04062461.
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Affiliation(s)
- Luis E. Rohde
- Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | - Luiz C. Danzmann
- Hospital Universitário de Canoas e Universidade Luterana do Brasil, Canoas, Brazil
| | | | | | | | | | - Marcus V. Simões
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Luiz E. F. Ritt
- Instituto D’Or de Pesquisa e Ensino, Hospital Cárdio Pulmonar, Salvador, Brazil
| | | | | | | | | | - Ricardo Mourilhe-Rocha
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Pedro Schwartzmann
- Centro Avançado de Pesquisa e Ensino e Hospital Unimed de Ribeirão Preto, Ribeirão Preto, Brazil
| | - Fábio M. de Castilho
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Manoel Canesin
- Hospital Universitário Regional do Norte do Paraná, Londrina, Brazil
| | - Luis Beck-da-Silva
- Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | | | - Amanda Ferreira
- Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Danielle Pereira
- Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | | | | | - Mariana Blacher
- Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
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Fraga IB, Caballero LG, Lago PD, de Oliveira JLC, Scherer M, Haeffner MP, Rabelo-Silva ER. Perceived dyspnea and experience of hospitalized patients with acute decompensated heart failure undergoing an early MObilization protocol with immersive Virtual rEality: MOVE study protocol for a parallel superiority randomized clinical trial. Trials 2023; 24:751. [PMID: 38001540 PMCID: PMC10675897 DOI: 10.1186/s13063-023-07786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Immersive virtual reality (VR) is an innovative strategy for inpatient rehabilitation programs. Using immersive VR in early mobilization protocols has not yet been investigated in the setting of hospitalized patients with acute decompensated heart failure (ADHF), especially to improve perceived dyspnea, a common symptom of heart failure (HF). METHODS This is a single-center parallel superiority randomized clinical trial. The study will be conducted at a public teaching hospital in Brazil from January 2023 to January 2024. The sample will include adult patients with ADHF hospitalized for at least 24 h, randomly assigned in a 1:1 ratio to the control (standard early mobilization protocol conducted in the intensive care unit (ICU)) or intervention group (the same standard early mobilization protocol but associated with immersive VR). The primary outcome will be assessing perceived dyspnea, and the secondary outcome will be assessing patient experience. DISCUSSION Using immersive VR in early mobilization protocols in the ICU is expected to improve perceived dyspnea in patients with ADHF as well as patient experience regarding care. This study has the potential to increase patient adherence to early mobilization protocols in the setting of ADHF as well as to promote a positive patient experience. Filling this gap could promote the rational incorporation of technologies in health care. TRIAL REGISTRATION This study protocol is in its first version. CLINICALTRIALS gov NCT05596292. Registered on 1 December 2022.
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Affiliation(s)
- Iasmin Borges Fraga
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Larissa Gussatschenko Caballero
- Graduate Program Program of the School of Nursing, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Cardiology Division and Heart Failure Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro Dal Lago
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Marina Scherer
- Cardiology Division and Heart Failure Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mauren Porto Haeffner
- Cardiology Division and Heart Failure Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
- Graduate Program Program of the School of Nursing, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
- Cardiology Division and Heart Failure Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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de Souza Hilário T, Mantovani VM, Aliti GB, de Fátima Lucena A, de Oliveira Lopes MV, Rabelo-Silva ER. Specific causal validation of nursing diagnosis Risk for thrombosis: A case-control study. Int J Nurs Knowl 2023. [PMID: 37990774 DOI: 10.1111/2047-3095.12451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/22/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE This study aims to perform specific causal validation of nursing diagnosis Risk for thrombosis (00291) of the NANDA International (NANDA-I) classification. METHODS This is a case-control study conducted in a university hospital from January to October 2020. A total of 516 adult patients were included-344 in the Case Group (with venous or arterial thrombosis evidenced by imaging) and 172 in the Control Group (without thrombosis). Statistical analysis was performed by univariate and multivariate logistic regression test, and odds ratios were calculated to measure the effect of exposure between groups. The study was approved by the Research Ethics Committee. FINDINGS The patients were predominantly female and aged 59 ± 16 years. In the univariate logistic analysis, five risk factors were significantly associated with thrombosis, two at-risk populations and 12 associated conditions. In the multivariate regression model, the following risk factors remained independently associated (p < 0.05): inadequate knowledge of modifiable factors (OR: 3.03; 95% CI: 1.25-8.56) and ineffective medication self-management (OR: 3.2; 95% CI:1.77-6.26); at-risk populations with history (OR: 2.16; 95% CI: 1.29-3.66) and family history of thrombosis (OR:2.60; 95% CI: 1.03-7.49); and the conditions associated with vascular diseases (OR:6.12; 95% CI:1.69-39.42), blood coagulation disorders (OR: 5.14; 95% CI:1.85-18.37), atherosclerosis (OR:2.07; 95% CI: 1.32-3.27), critical illness (OR: 2.28; 95% CI: 1.42-3.70), and immobility (OR: 2.09; 95% CI: 1.10-4.12). CONCLUSIONS The clinical validation allowed to establish strong evidence for the refinement of the diagnosis Risk for thrombosis and, consequently, to raise its level of evidence in the classification of NANDA-I. IMPLICATIONS FOR NURSING PRACTICE The evidence pointed out by this study favors the establishment of thrombosis diagnosis in an accurate way by nurses in clinical practice, directing preventive interventions to patients in this risk condition.
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Affiliation(s)
- Thamires de Souza Hilário
- Postgraduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Nursing Research Group on the Care of Adults and the Elderly (GEPECADI-CNPq), Porto Alegre, Rio Grande do Sul, Brazil
| | - Vanessa Monteiro Mantovani
- Nursing Research Group on the Care of Adults and the Elderly (GEPECADI-CNPq), Porto Alegre, Rio Grande do Sul, Brazil
- Social Projects Leader at Department of Social Responsibility, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Graziella Badin Aliti
- Nursing Research Group on the Care of Adults and the Elderly (GEPECADI-CNPq), Porto Alegre, Rio Grande do Sul, Brazil
- School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre - Intensive Care Unit, Porto Alegre, Rio Grande do Sul, Brazil
- Member of the Lab of Health Measurement, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Amália de Fátima Lucena
- Nursing Research Group on the Care of Adults and the Elderly (GEPECADI-CNPq), Porto Alegre, Rio Grande do Sul, Brazil
- School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Nursing Process Committee, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Researcher at CNPq-level 1D, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcos Venícios de Oliveira Lopes
- Member of the Lab of Health Measurement, Universidade Federal do Ceará, Fortaleza, Brazil
- Department of Nursing, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Eneida Rejane Rabelo-Silva
- Nursing Research Group on the Care of Adults and the Elderly (GEPECADI-CNPq), Porto Alegre, Rio Grande do Sul, Brazil
- Researcher at CNPq-level 1D, Porto Alegre, Rio Grande do Sul, Brazil
- School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Vascular Access Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Head of the Clinical Research Service at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Bjorklund-Lima L, Müller-Staub M, Rejane Rabelo-Silva E. Knowledge translation for nursing care for patients with Risk of perioperative positioning injury: A case report. Int J Nurs Knowl 2023; 34:247-253. [PMID: 36151784 DOI: 10.1111/2047-3095.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim was to apply the Advanced Nursing Process and demonstrating procedures of surgical positioning, as well as to show the participating the Nursing Outcomes Classification findings in order to translate the knowledge on specific preventive perioperative positioning into practice, the review of clinical protocols and nursing care plan. METHODS The methods used include case report about knowledge translation by applying training modalities, review and adaptation of clinical protocols and examination of nursing care plans. FINDINGS One hundred and nine healthcare providers attended the training, including nurses and nursing technicians working in the surgical center and the outpatient surgical center of the hospital chosen for this study. The surgical positioning protocols were revised based on the evidence described in the literature and the main surgical guidelines. The review of care registered in the institution's electronic system for the nursing prescription stage of the diagnosis Risk of perioperative positioning injury was based on the review on evidence on risk factors, the main guidelines in the area and the interventions suggested by Nursing Intervention Classification. The electronic system had registered 14 cares for this diagnosis, and after the review, one care was excluded and eight new cares were included, totaling 21 cares. CONCLUSION Nursing teams play a prominent role in positioning patients for surgery, protecting them in a moment of extreme vulnerability, thus making knowledge about the fundamental elements of surgical positioning essential. This emphasizes the importance of training, and of reviewing protocols and records of procedures that promote safety to patients and care teams. IMPLICATION FOR NURSING PRACTICE The translation of knowledge about the Advanced Nursing Process in the perioperative area contributes to the refinement of classifications and standardization of language in this scenario, subsidizing an evidence-based clinical practice.
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Affiliation(s)
- Luciana Bjorklund-Lima
- Graduate Program of the Nursing School, the Universidade Federal do Rio Grande do Sul, (UFRGS), Porto Alegre, Brazil
- Surgical Center of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Committee for the Prevention and Treatment of Wounds
- Nursing Process Committee of the HCPA
| | - Maria Müller-Staub
- Nursing Diagnostics, Institute of Nursing, Hanze University, Groningen, The Netherlands
- Pflege PBS, Obere Hofbergstrasse, Switzerland
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Nursing, UFRGS, Porto Alegre, Brazil
- HCPA - Division of Cardiology, Vascular Access Program), Porto Alegre, Brazil
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Bernardes DDS, Santos MS, Mantovani VM, Almeida Neto OPD, Goldraich LA, Clausell N, Rabelo-Silva ER. Use of the ADHERE Risk Model as a Predictor of Risk of in-Hospital Worsening Heart Failure in a Cohort. Arq Bras Cardiol 2023; 120:e20220584. [PMID: 37672471 PMCID: PMC10519228 DOI: 10.36660/abc.20220584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/20/2023] [Accepted: 06/14/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Patients admitted with acute decompensated heart failure (HF) are subject to developing worsening episodes that require more complex interventions. The Acute Decompensated Heart Failure National Registry (ADHERE) risk model was developed in the United States to predict the risk of in-hospital worsening HF. OBJECTIVE To use the ADHERE risk model in the assessment of risk of in-hospital worsening HF and to determine its sensitivity and specificity in hospitalized patients. METHODS This cohort study was conducted at a Brazilian public university hospital, and data from 2013 to 2020 were retrospectively collected. P values < 0.05 were considered statistically significant. RESULTS A total of 890 patients with a mean age of 74 ± 8 years were included. The model showed that, in the group of 490 patients at risk, 254 (51.8%) developed in-hospital worsening HF. In the group of 400 patients not at risk, only 109 (27.2%) experienced worsening HF. The results demonstrated a statistically significant curve (area under the curve = 0.665; standard error = 0.018; P < 0.01; confidence interval = 0.609 to 0.701), indicating good accuracy. The model had a sensitivity of 69.9% and a specificity of 55.2%, with a positive predictive value of 52% and a negative predictive value of 72.7%. CONCLUSIONS In this cohort, we showed that the ADHERE risk model was able to discriminate patients who in fact developed worsening HF during the admission period, from those who did not.
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Affiliation(s)
- Daniela de Souza Bernardes
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Marina Scherer Santos
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | - Omar Pereira de Almeida Neto
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
- Departamento de Enfermagem, Universidade Federal de Uberlândia, Uberlândia, MG - Brasil
| | - Livia Adams Goldraich
- Divisão de Cardiologia, Grupo de Insuficiência Cardíaca e Transplante Cardíaco, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Nadine Clausell
- Divisão de Cardiologia, Grupo de Insuficiência Cardíaca e Transplante Cardíaco, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Eneida Rejane Rabelo-Silva
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
- Divisão de Cardiologia, Grupo de Insuficiência Cardíaca e Transplante Cardíaco, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
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Cardoso PC, Rabelo-Silva ER, Martins Bock P, Chopra V, Saffi MAL. Biomarkers Associated with Thrombosis in Patients with Peripherally Inserted Central Catheter: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4480. [PMID: 37445515 DOI: 10.3390/jcm12134480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The measurement and identification of plasma biomarkers can support the estimation of risk and diagnosis of deep vein thrombosis (DVT) associated with the use of a peripherally inserted central catheter (PICC). OBJECTIVES This systematic review and meta-analysis aimed to identify the association between the levels of potential biomarkers that reflect the activation of the blood system, long-term vascular complications, inflammatory system, and the occurrence of PICC-related DVT. METHODS Seven electronic databases (Embase, Web of Science, Medline, Scopus, Cinahl, Cochrane Central Register of Controlled Trials, and ERIC) were searched to identify literature published until December 2022. Studies were required to report: (I) adult and pediatric patients, outpatient or admitted to clinical, surgical, or ICU with PICC; (II) patients with PICC-related DVT and patients without PICC-related DVT as a comparator; and (III) at least one biomarker available. The Newcastle-Ottawa Scale was used to evaluate the quality of the studies. Study precision was evaluated by using a funnel plot for platelets level. We provided a narrative synthesis and meta-analysis of the findings on the biomarkers' outcomes of the studies. We pooled the results using random effects meta-analysis. The meta-analysis was conducted using Review Manager software v5.4. This systematic review is registered in PROSPERO (CRD42018108871). RESULTS Of the 3564 studies identified (after duplication removal), 28 were included. PICC-related DVT was associated with higher D-dimers (0.37 μg/mL, 95% CI 0.02, 0.72; p = 0.04, I2 = 92%; p for heterogeneity < 0.00001) and with higher platelets (8.76 × 109/L, 95% CI 1.62, 15.91; p = 0.02, I2 = 41%; p for heterogeneity = 0.06). CONCLUSIONS High levels of D-dimer and platelet were associated with DVT in patients with PICC. However, biomarkers such as APTT, fibrinogen, FDP, glucose, hemoglobin, glycated hemoglobin, INR, prothrombin time, prothrombin fragment 1.2, the thrombin-antithrombin complex, and WBC were not related to the development of DVT associated with PICC.
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Affiliation(s)
- Patrícia Cristina Cardoso
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
- School of Nursing, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90620-110, RS, Brazil
- Cardiology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Patricia Martins Bock
- Nursing Department, Faculdades Integradas de Taquara (FACCAT), Taquara 95612-150, RS, Brazil
| | - Vineet Chopra
- Department of Medicine, University of Colorado, Denver, CO 80045, USA
| | - Marco Aurélio Lumertz Saffi
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
- Cardiology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
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Hansel LA, Junges M, Santos MS, Hirakata VN, do Nascimento RC, Czerwinski GPV, Saffi MAL, Ferro EB, Jacobsen DV, Rabelo-Silva ER. UltraSound guided PEripheral Catheterization increases first-atTempt success RAte in hospitalized patients when compared with conventional technique: SPECTRA - Randomized Clinical Trial. J Vasc Access 2023:11297298231162132. [DOI: 10.1177/11297298231162132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: Peripheral intravenous catheter (PIVC) insertion is the most common invasive procedure in the hospital setting. Ultrasound guided PIVC insertion in specific populations and settings has shown patient care benefits. Objective: To compare the success rate of first attempts of ultrasound guided PIVC insertion performed by nurse specialists with conventional PIVC insertion performed by nurse assistants. Method: Randomized, controlled, single-center clinical trial registered on the ClinicalTrials.gov platform under registration NTC04853264, conducted at a public university hospital from June to September 2021. Adult patients hospitalized in clinical inpatient units with an indication for intravenous therapy compatible with a peripheral venous network were included. Participants in the intervention group (IG) received ultrasound guided PIVC performed by nurse specialists from the vascular access team, while those in the control group (CG) received conventional PIVC by nurse assistants. Results: The study included a total of 166 patients: IG ( n = 82) and CG ( n = 84), mean age 59.5 ± 16.5 years, mostly women ( n = 104, 62.7%) and white ( n = 136, 81.9%). Success rate on the first attempt of PIVC insertion in IG was 90.2% and in CG was 35.7% ( p < 0.001), with a relative risk of 2.5 (95% CI 1.88–3.40) for success in IG versus CG. Overall assertiveness rate was 100% in IG and 71.4% in CG. Regarding procedure performance time, the medians in IG and CG were 5 (4–7) and 10 (6–27.5) min respectively ( p < 0.001). As for the incidence of negative composite outcomes, IG had lower rates compared to CG, 39% versus 66.7% ( p < 0.001), generating a 42% lower probability of negative outcomes in IG, 0.58 (95% CI: 0.43–0.80). Conclusion(s): Successful first-try insertion was higher in the group receiving ultrasound-guided PIVC. Moreover, there were no insertion failures and IG presented lower insertion time rates and incidence of unfavorable outcomes.
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Rabelo-Silva ER, Lourenço SA, Maestri RN, Candido da Luz C, Carlos Pupin V, Bauer Cechinel R, Bordini Ferro E, Aurélio Lumertz Saffi M, do Campo Silva TC, Martins de Andrade L, Sales Gomes LF, Alves da Gama L, Marques de Araújo M, Santo FRFDE, López Pedraza L, Hirakata VN, Santana Soares V, Sousa Montenegro W, Rocha Costa de Freitas G, Souza de Jesus T, Chopra V. Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters. BMJ Qual Saf 2022; 31:652-661. [PMID: 35086961 PMCID: PMC9411873 DOI: 10.1136/bmjqs-2021-013869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/28/2021] [Indexed: 02/05/2023]
Abstract
Background Little is known about peripherally inserted central catheter (PICC) use, appropriateness and device outcomes in Brazil. Methods We conducted an observational, prospective, cohort study spanning 16 Brazilian hospitals from October 2018 to August 2020. Patients ≥18 years receiving a PICC were included. PICC placement variables were abstracted from medical records. PICC-related major (deep vein thrombosis (DVT), central line-associated bloodstream infection (CLABSI) and catheter occlusion) and minor complications were collected. Appropriateness was evaluated using the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Devices were considered inappropriate if they were in place for <5 days, were multi-lumen, and/or were placed in patients with a creatinine >2.0 mg/dL. PICCs considered appropriate met none of these criteria. Mixed-effects logistic regression models adjusting for patient-level and hospital-level characteristics assessed the association between appropriateness and major complications. Results Data from 12 725 PICCs were included. Mean patient age was 66.4±19 years and 51.0% were female. The most common indications for PICCs were intravenous antibiotics (81.1%) and difficult access (62.7%). Most PICCs (72.2%) were placed under ultrasound guidance. The prevalence of complications was low: CLABSI (0.9%); catheter-related DVT (1.0%) and reversible occlusion (2.5%). Of the 12 725 devices included, a total of 7935 (62.3%) PICCs were inappropriate according to MAGIC. With respect to individual metrics for appropriateness, 17.0% were placed for <5 days, 60.8% were multi-lumen and 11.3% were in patients with creatinine >2.0 mg/dL. After adjusting for patient and hospital-level characteristics, multi-lumen PICCs considered inappropriate were associated with greater odds of major complications (OR 2.54, 95% CI 1.61 to 4.02). Conclusions Use of PICCs in Brazilian hospitals appears to be safe and comparable with North America. However, opportunities to improve appropriateness remain. Future studies examining barriers and facilitators to improving device use in Brazil would be welcomed.
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Affiliation(s)
| | | | | | | | | | | | - Eduarda Bordini Ferro
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marco Aurélio Lumertz Saffi
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | - Leticia López Pedraza
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vânia Naomi Hirakata
- Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | - Vineet Chopra
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
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10
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Rabelo-Silva ER, Mantovani VM, Saffi MAL. Knowledge translation and advances in health and nursing practices. Rev Gaucha Enferm 2022; 43:e20220165. [DOI: 10.1590/1983-1447.2022.20220165.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
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11
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Rabelo-Silva ER, Mantovani VM, Saffi MAL. Translação do conhecimento e avanços nas práticas de saúde e de enfermagem. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20220165.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
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12
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Rabelo-Silva ER, Mantovani VM, Saffi MAL. Translación del conocimiento y avances en las prácticas de salud y enfermería. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20220165.es] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
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13
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Cardoso ASF, Silva SMR, Rabelo-Silva ER, Umpierre D, Sostizzo LDRZ, Echer IC. Routine workflow in a reference clinical research center in face of COVID-19. Rev Gaucha Enferm 2021; 42:e20200389. [PMID: 34586333 DOI: 10.1590/1983-1447.2021.20200389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/19/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To develop and validate the content of workflows for trial participants care in a clinical research center during the Covid-19 pandemic. METHOD development study by consensus of experts carried out from March to July 2020 in southern Brazil. The flowcharts were developed following literature and validated by specialists considering comprehensiveness, clarity and pertinence, obtaining a 100% agreement index on each item of the developed instruments. The study was approved by the Ethics Committee of the institution. RESULTS two flowcharts of care were elaborated and validated: "Flow diagram to conduct protocols with research participant " and "Flow diagram in protocols with research participant with suspected or confirmed COVID-19 infection"; which describes activities to ensure continuity of care. FINAL CONSIDERATIONS a routine workflow can promote the continuity and safety of clinical research protocols. It is expected that the adopted flowcharts in this study can guide other institutions with a similar research profile.
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Affiliation(s)
| | - Stella Marys Rigatti Silva
- Hospital de Clínicas de Porto Alegre (HCPA), Centro de Pesquisa Clínica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Hospital de Clínicas de Porto Alegre (HCPA), Programa de Acesso Vascular. Porto Alegre, Rio Grande do Sul, Brasil
| | - Daniel Umpierre
- Hospital de Clínicas de Porto Alegre (HCPA), Centro de Pesquisa Clínica. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Saúde Coletiva. Porto Alegre, Rio Grande do Sul, Brasil
| | - Luciana da Rosa Zinn Sostizzo
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Enfermagem Ambulatorial. Porto Alegre, Rio Grande do Sul, Brasil
| | - Isabel Cristina Echer
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Assistência e Orientação Profissional, Porto Alegre, Rio Grande do Sul, Brasil
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14
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Rohde LE, Hoffmann Filho CR, Rover MM, Rabelo-Silva ER, Lopez L, Passos LCS, Silvestre OM, Martins SM, de Figueiredo Neto JA, Silveira FS, Canesin MF, Simões MV, Akio Nishijuka F, Bertoldi EG, Danzmann LC, Mourilhe-Rocha R, Magedanz EH, Esteves M, de Castilho FM, Fernandes-Silva MM, Ritt LEF, Blacher M, Soares RM, Cavalcanti AB, Ramirez F. Design of a multifaceted strategy based on automated text messaging in patients with recent heart failure admission. ESC Heart Fail 2021; 8:5523-5530. [PMID: 34535979 PMCID: PMC8712788 DOI: 10.1002/ehf2.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/30/2021] [Accepted: 07/05/2021] [Indexed: 11/20/2022] Open
Abstract
Aims To evaluate a telemonitoring strategy based on automated text messaging and telephone support after heart failure (HF) hospitalization. Methods and results The MESSAGE‐HF study is a prospective multicentre, randomized, nationwide trial enrolling patients from 30 clinics in all regions of Brazil. HF patients with reduced left ventricular ejection fraction (<40%) and access to mobile phones are eligible after an acute decompensated HF hospitalization. Patients meeting eligibility criteria undergo an initial feasibility text messaging assessment and are randomized to usual care or telemonitoring intervention. All patients receive a HF booklet with basic information and recommendations about self‐care. Patients in the intervention group receive four daily short text messages (educational and feedback) during the first 30 days of the protocol to optimize self‐care; the feedback text messages from patients could trigger diuretic adjustments or a telephone call from the healthcare team. After 30 days, the frequency of text messages can be adjusted. Patients are followed up after 30, 90, and 180 days, with final status ascertained at 365 days by telephone. Our primary endpoint is the change in N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels after 180 days. Secondary endpoints include changes in NT‐proBNP after 30 days; health‐related quality of life, HF self‐care, and knowledge scales after 30 and 180 days; and a composite outcome of HF hospitalization and cardiovascular death, adjudicated by a blinded and independent committee. Conclusions The MESSAGE‐HF trial is evaluating an educational and self‐care promotion strategy involving a simple, intensive, and tailored telemonitoring system. If proven effective, it could be applied to a broader population worldwide.
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Affiliation(s)
- Luis E Rohde
- Serviço de Cardiologia, Hospital Moinhos de Vento, R. Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, 90035-000, Brazil.,Heart Failure Clinic, Hospital de Clinicas de Porto Alegre and Nursing School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Marciane M Rover
- Instituto de Cardiologia/ Fundação Universitária de Cardiologia- Porto Alegre/RS., Porto Alegre, Brazil
| | - Eneida Rejane Rabelo-Silva
- Heart Failure Clinic, Hospital de Clinicas de Porto Alegre and Nursing School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Silvia M Martins
- Pronto-Socorro Cardiológico Universitário de Pernambuco - Prof. Luiz Tavares, Recife, Brazil
| | | | | | - Manoel F Canesin
- Hospital Universitário da Universidade Estadual de Londrina, Londrina, Brazil
| | - Marcus V Simões
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | - Luiz C Danzmann
- Hospital Universitário de Canoas da Universidade Luterana do Brasil, Canoas, Brazil
| | - Ricardo Mourilhe-Rocha
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Fábio M de Castilho
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Luiz E F Ritt
- Instituto D'or de Pesquisa e Ensino (IDOR) and Hospital Cárdio Pulmonar, Salvador, Brazil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Mariana Blacher
- Serviço de Cardiologia, Hospital Moinhos de Vento, R. Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, 90035-000, Brazil
| | - Rafael M Soares
- HCor Research Institute, R. Des. Eliseu Guilherme, 147 - Paraíso, São Paulo, 04004-030, Brazil
| | - Alexandre B Cavalcanti
- HCor Research Institute, R. Des. Eliseu Guilherme, 147 - Paraíso, São Paulo, 04004-030, Brazil
| | - Felix Ramirez
- HCor Research Institute, R. Des. Eliseu Guilherme, 147 - Paraíso, São Paulo, 04004-030, Brazil
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15
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Oliveira MC, Flores FDS, Barbosa FM, Fujii CDC, Rabelo-Silva ER, Lucena ADF. Evaluation of percutaneous renal biopsy complications based on outcomes and indicators of the Nursing Outcomes Classification. Rev Lat Am Enfermagem 2021; 29:e3415. [PMID: 34231785 PMCID: PMC8253370 DOI: 10.1590/1518-8345.3759.3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/19/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: to evaluate the complications of percutaneous renal biopsy based on outcomes
and clinical indicators of the Nursing Outcomes Classification. Method: a prospective longitudinal study. The sample consisted of 13 patients
submitted to percutaneous renal biopsy, with 65 evaluations. The patients
were evaluated in five moments in the 24 hours after the procedure, using an
instrument developed by the researchers based on five outcomes (Blood
coagulation, Circulation status, Blood loss severity, Pain level, Comfort
status: Physical) and 11 indicators. The Generalized Estimation Equation
Test was used to compare the scores of the indicators. The project was
approved by the institutional ethics committee. Results: in the 65 evaluations, a statistically significant difference was identified
in the reduction of the scores of the following nursing outcomes: Blood
coagulation, “hematuria” indicator; Circulation status, in the “systolic
blood pressure and diastolic blood pressure” indicators and Comfort status:
physical, in the “physical well-being” indicator. Conclusion: the evaluated patients did not show major complications. The clinical
indicators signaled changes in circulation status, with reduced blood
pressure, as well as in blood clotting observed by hematuria, but without
hemodynamic instability. The comfort status was affected by the rest time
after the procedure.
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Affiliation(s)
- Magáli Costa Oliveira
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
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16
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Reich R, Rabelo-Silva ER, Swanson E, Moorhead S, Almeida MDA. Development of a nursing outcome for a percutaneous procedure. Int J Nurs Knowl 2021; 33:84-92. [PMID: 34105879 DOI: 10.1111/2047-3095.12329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To develop a nursing outcome, consistent with the standardized format of outcomes within the nursing Outcomes Classification (NOC). This outcome will include an outcome label, an outcome definition, and clinical indicators. The proposed use for this outcome is to evaluate the access site of a percutaneous procedure. METHODS Concept analysis with a scoping review. Initially, content experts were recruited to validate the indicators of the proposed outcome in order to complete a consensus validation. After consensus validation, a review of the proposed outcome and its indicators was completed by two of the editors of the NOC team to confirm that the outcome label, definition, and indicators were consistent with the NOC taxonomy. During this review, edits were made on the label name and definition. FINDINGS After a series of reviews, the initial outcome of Vascular Status: Percutaneous Procedure Access was changed to Tissue Injury Severity: Percutaneous Procedure. In addition, the original definition of the condition of an access site for percutaneous procedure by venous or arterial puncture and health of surrounding tissues was edited to: Severity of complications from a needle-puncture access through the skin and into deeper tissues. The outcome has 11 indicators to be used to formulate a target rating for use in the clinical setting. The indicators were not edited over the course of the reviews. CONCLUSION The proposed outcome will assist nurses in evaluating the access site of percutaneous procedures and in identifying possible complications. IMPLICATIONS FOR THE NURSING PRACTICE This research contributes to the refinement of the NOC taxonomy by having a new outcome that meets clinical practice needs.
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Affiliation(s)
- Rejane Reich
- School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eneida Rejane Rabelo-Silva
- School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Sue Moorhead
- College of Nursing, The University of Iowa, Iowa City, Iowa
| | - Miriam de Abreu Almeida
- School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Gomes do Carmo T, Ferreira Santana R, de Oliveira Lopes MV, Mendes Nunes M, Maciel Diniz C, Rabelo-Silva ER, Dantas Cavalcanti AC. Prognostic Indicators of Delayed Surgical Recovery in Patients Undergoing Cardiac Surgery. J Nurs Scholarsh 2021; 53:428-438. [PMID: 33885222 DOI: 10.1111/jnu.12662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to analyze the prognostic capacity of the clinical indicators of a delayed surgical recovery nursing diagnosis throughout the hospital stay of patients having cardiac surgery. DESIGN A prospective cohort design was adopted. A sample of inpatients undergoing elective cardiac surgery was followed during the immediate preoperative period and hospitalization. This research was conducted in the southeast region of Brazil at a national reference institution that treats highly complex diseases and performs cardiac surgeries. Data were collected from July 2017 to July 2018. METHODS At the end of 1 year of data collection, 181 patients were followed in this study. The Kaplan-Meier method was used to calculate the survival time related to delayed surgical recovery. In addition, an extended Cox model of time-dependent covariates was adjusted to identify the clinical signs that influenced the change in the nursing diagnosis status. RESULTS A delayed surgical recovery nursing diagnosis was present in 23.2% of the sample studied. With an expected length of stay of 8 to 10 days, most new cases of delayed surgical recovery were observed on the 10th postoperative day, and the survival rate after this day was decreased until the 29th postoperative day, when the nursing diagnosis no longer appeared. Interrupted healing of the surgical area, loss of appetite, and atrial flutter were indicators related to an increased risk for delayed surgical recovery. CONCLUSIONS Timely recognition of selected clinical indicators demonstrates a promising prognostic capacity for delayed surgical recovery. CLINICAL RELEVANCE Accurate identification of prognostic factors allows nurses to identify early signs of postoperative complications. Consequently, the professional can develop an individualized plan of care, aiming at the satisfactory clinical recovery of the patient.
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Affiliation(s)
- Thalita Gomes do Carmo
- Adjunct Professor, Undergraduate and Graduate Nursing Program, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Rosimere Ferreira Santana
- Associate Professor, Undergraduate and Graduate Nursing Programs, Federal Fluminense University, CNPq Researcher, Rio de Janeiro, Brazil
| | - Marcos Venicios de Oliveira Lopes
- Associate Professor, Undergraduate and Graduate Nursing Programs, Federal Ceara University, CNPq Researcher, Fortaleza, Ceara, Brazil
| | - Marília Mendes Nunes
- PhD student, Post-Graduate Program in Nursing at Federal Ceara University, Fortaleza, Ceara, Brazil
| | - Camila Maciel Diniz
- PhD student, Post-Graduate Program in Nursing at Federal Ceara University, Fortaleza, Ceara, Brazil
| | - Eneida Rejane Rabelo-Silva
- Associate Professor, Undergraduate and Graduate Nursing Programs - CNPq Researcher - Hospital de Clínicas de Porto Alegre - Cardiology Division, Vascular Access Program, Universidade Federal do Rio Grande do Sul CNPq, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ana Carla Dantas Cavalcanti
- Associate Professor, Undergraduate and Graduate Nursing Programs, Federal Fluminense University, CNPq Researcher, Rio de Janeiro, Brazil
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Reich R, Helal L, Mantovani VM, Rabelo-Silva ER. Hemostasis after percutaneous transfemoral access: A protocol for systematic review. Medicine (Baltimore) 2020; 99:e23731. [PMID: 33350755 PMCID: PMC7769327 DOI: 10.1097/md.0000000000023731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Access site hemostasis after percutaneous procedures done in the catheterization laboratory still needs to be better studied in relation to such aspects as the different results achieved with different hemostasis strategies, the impact of different introducer sheath sizes, and arterial versus venous access. The objective of this review is to synthesize the available scientific evidence regarding different techniques for hemostasis of femoral access sites after percutaneous diagnostic and therapeutic procedures. METHODS This review is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The primary outcomes will include the following vascular complications: hematoma, pseudoaneurysm, bleeding, minor, and major vascular complications. The secondary outcomes will include the following: time to hemostasis, repetition of manual compression, and device failure. A structured strategy will be used to search the PubMed/ MEDLINE, Embase, CINAHL, and CENTRAL databases. In addition, a handsearch of the reference lists of selected studies will be conducted. The ERIC research database will be queried for the gray literature and ClinicalTrials.gov, for potential results not yet published in indexed journals. Two reviewers will independently screen citations and abstracts, identify full-text articles for inclusion, extract data, and appraise the quality and risk of bias of included studies. If possible, a meta-analysis will be carried out. All estimations will be made using Review Manager 5.3. Statistical heterogeneity will be assessed by considering the I2 proxy, accompanied with qualitative indicators such as differences in procedures, interventions, and outcomes among the studies. If synthesis proves inappropriate, a narrative review will be undertaken. RESULTS This protocol adheres to the PRISMA-P guideline to ensure clarity and completeness of reporting at all phases of the systematic review. CONCLUSION This study will provide synthesized information on different methods used to achieve hemostasis after femoral access. ETHICS AND DISSEMINATION Ethical approval number CAAE 19713219700005327. The results of the systematic review will be disseminated via publication in a peer-reviewed journal and through conference presentations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019140794.
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Affiliation(s)
- Rejane Reich
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul
- Hospital de Clínicas de Porto Alegre
| | - Lucas Helal
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre
- Universidade Federal do Extremo Sul Catarinense, Criciúma
| | | | - Eneida Rejane Rabelo-Silva
- Hospital de Clínicas de Porto Alegre
- Graduate Program in Nursing and Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Pedraza LL, de Moraes JRW, Rabelo-Silva ER. Development and testing of a text messaging (SMS) monitoring software application for acute decompensated heart failure patients. Rev Lat Am Enfermagem 2020; 28:e3301. [PMID: 32901765 PMCID: PMC7478878 DOI: 10.1590/1518-8345.3519.3301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/14/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE to develop and test an SMS monitoring software application for patients with acute decompensated heart failure. METHOD the waterfall model was used for software development. All expected functionalities were defined, program modules were codified and tests were done so as to ensure good performance by the software application. Ten patients participated in the prototype test. RESULTS the system sends two types of messages: questions that should be answered by patients and unilateral educational reinforcements. In addition, the system generates alarms in case of no response or according to a flow chart to detect congestion in the patient previously created by the team. Of the 264 SMS texts sent, 247 were answered. The alarm was triggered seven times: three patients woke up with shortness of breath for two consecutive nights, and four patients felt more fatigued for two consecutive days. All patients took the prescribed medications during follow-up. The study nurse guided the patients who generated alarms in the system. CONCLUSION the SMS software application was successfully developed and a high response rate and preliminary evidence of improvements in self-management of HF were observed. With this regard, telehealth is a promising alternative in the treatment of chronic diseases.
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Affiliation(s)
| | | | - Eneida Rejane Rabelo-Silva
- Hospital de Clínicas de Porto Alegre, Serviço de Cardiologia, Grupo
de Insuficiência Cardíaca e Transplante Cardíaco, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem,
Departamento de Enfermagem Médico-Cirúrgica, Porto Alegre, RS, Brazil
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Rabelo-Silva ER, Monteiro Mantovani V, López Pedraza L, Cardoso PC, Takao Lopes C, Herdman TH. International Collaboration and New Research Evidence on Nanda International Terminology. Int J Nurs Knowl 2020; 32:103-107. [PMID: 32706525 DOI: 10.1111/2047-3095.12300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To discuss priorities and possibilities for promoting international collaboration and new research evidence on NANDA International, Inc. (NANDA-I). METHODS Theoretical reflection article based on the literature and the authors' opinions on the subject matter, carried out by six research nurses. CONCLUSIONS International research collaboration for NANDA-I allows the improvement of research production in an actual clinical setting, especially with multicenter and validation studies, conducted by researchers from different countries. This provides for improved understanding of patients' experiences and may help to produce robust scientific evidence. IMPLICATIONS FOR NURSING KNOWLEDGE The generation of new evidence may lead to an increase in NANDA-I visibility and in nurses' understanding of its meaning for clinical practice and for the formulation of diagnostic hypotheses.
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Affiliation(s)
- Eneida Rejane Rabelo-Silva
- Eneida Rejane Rabelo-Silva, RN, MSc, ScD, is an Associate Professor at School of Nursing, Universidade Federal do Rio Grande do Sul; Researcher of the Nursing Research Group on the Care of Adults and the Elderly (GEPECADI-CNPq), Researcher of CNPq, Nurse Coordinator of Vascular Access Program and Heart Failure Clinic at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vanessa Monteiro Mantovani
- Vanessa Monteiro Mantovani, RN, MSc, is a PhD Student at Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul and a Member of the GEPECADI-CNPq, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leticia López Pedraza
- Leticia López Pedraza, RN, SDc, Graduate Program on Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul and Member of the GEPECADI-CNPq, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patrícia Cristina Cardoso
- Patrícia Cristina Cardoso, RN, MSc, is a PhD Student at Graduate Program on Cardiology and Cardiovascular Sciences, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul and a Member of the GEPECADI-CNPq, Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Takao Lopes
- Camila Takao Lopes is a PhD in Science. Adjunct professor at Nursing Paulista School, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tracy Heather Herdman
- Tracy Heather Herdman, PhD, RN, FNI, is an Associate Lecturer at the University of Wisconsin-Green Bay, Green Bay, Wisconsin, Chief Executive Officer, NANDA International, Inc., Philadelphia, Pennsylvania
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Silveira LCJ, De Maria M, Dickson VV, Avila CW, Rabelo-Silva ER, Vellone E. Validity and reliability of the self-care of hypertension inventory (SC-HI) in a Brazilian population. Heart Lung 2020; 49:518-523. [PMID: 32192824 DOI: 10.1016/j.hrtlng.2020.02.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Poor self-care in patients with hypertension is associated with worse patient outcomes. The Self-Care of Hypertension Inventory (SC-HI) measures self-care in patients with hypertension and includes three scales: self-care maintenance, which measures adherence to prescribed treatments and behaviors; self-care management, which evaluates the responses to signs and symptoms of high blood pressure; and self-care confidence, which measures self-efficacy in dealing with the entire process. OBJECTIVE To test the psychometric characteristics of the Brazilian version of the SC-HI. METHODS We enrolled a sample of 360 patients with hypertension and performed confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) to test the factorial structure of the SC-HI and computed the factor score determinacy coefficient to evaluate the SC-HI internal consistency reliability. RESULTS The sample was predominantly female (65%), mean age of 65 years (SD = 10), white (70%). The self-care maintenance scale resulted in a unidimensional scale, with supportive fit indices (CFI = 0.901, RMSEA = 0.048); the self-care management did not reflect the original factorial structure and had unsupportive fit indices. EFA showed a different factorial solution in reference to the original study. Finally, the self-care confidence scale resulted in a unidimensional scale with supportive fit indices (CFI = 0.940, RMSEA = 0.093). The reliability of the self-care maintenance, management, and confidence scales resulted in factor score determinacy coefficients of 0.83, 0.78, and 0.97 respectively. CONCLUSION This study shows that the SC-HI is a valid and reliable tool to measure self-care in patients with hypertension among the Brazilian population.
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Affiliation(s)
- Luana Claudia Jacoby Silveira
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Victoria Vaughan Dickson
- The Pless Center for Nursing Research, New York University, Rory Meyers College of Nursing, United States
| | - Christiane Wahast Avila
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul - School of Nursing and Hospital de Clínicas de Porto Alegre - Cardiology Division, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil; Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul - School of Nursing and Hospital de Clínicas de Porto Alegre - Cardiology Division, Brazil.
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
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Trojahn MM, Barilli SLS, Bernardes DDS, Pedraza LL, Aliti GB, Rabelo-Silva ER. B-type natriuretic peptide levels and diagnostic accuracy: excess fluid volume. Rev Gaucha Enferm 2020; 41:e20190095. [DOI: 10.1590/1983-1447.2020.20190095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/06/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Aim: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. Methods: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. Results: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. Conclusions: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.
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Silveira LCJ, Aliti GB, Da Silva EM, Pimentel RP, Gus M, Rabelo-Silva ER. Effect of motivational interviewing in hypertensive patients (MIdNIgHT): study protocol for a randomized controlled trial. Trials 2019; 20:414. [PMID: 31288854 PMCID: PMC6617897 DOI: 10.1186/s13063-019-3486-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/30/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Only one-third of hypertensive patients achieve and maintain blood-pressure control. This is attributed to low treatment adherence and has a negative impact on clinical outcomes. Adherence is multidimensional and involves aspects both related to patient characteristics and to the chronic nature of the disease. In this context, motivational interviewing has been proposed as an approach to foster patients' motivations to change their behavior for the benefit of their own health, thus providing more lasting behavioral changes. DESIGN AND METHODS Single-center, parallel, randomized controlled trial with outcome-assessor blinding. This study will select adult patients (n = 120) diagnosed with hypertension who receive regular follow-up in a specialized outpatient clinic. Patients will be randomly allocated across two groups: the intervention group will have appointments focused on motivational interviewing, while the control group will have traditional appointments. Patients will be monitored face-to-face, once monthly for six months. The primary outcomes will be a reduction of at least 8 mmHg in systolic blood pressure and changes in mean blood pressure measured by 24-h ambulatory blood pressure monitoring. Secondary outcomes include improvement of adherence to a low-sodium diet, adherence to self-care behaviors, regular use of antihypertensive medications, increase or maintenance of physical activity, weight reduction, evaluation of changes in daytime sleepiness, and cessation of smoking. DISCUSSION This study shows an intervention strategy that will be tested and, if effective, warrant replication in monitoring of other chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov, NCT02892929 . Registered on 24 August 2016.
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Affiliation(s)
- Luana Claudia Jacoby Silveira
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Graziella Badin Aliti
- Nursing School, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, Porto Alegre, RS, 90620-110, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Elisabeth Meyer Da Silva
- Graduate Program, Instituto de Cardiologia - Fundação Universitária de Cardiologia, Rua Princesa Isabel, 395, Porto Alegre, RS, 90620-001, Brazil
| | - Ravi Pereira Pimentel
- Nursing School, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, Porto Alegre, RS, 90620-110, Brazil
| | - Miguel Gus
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil. .,Nursing School, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, Porto Alegre, RS, 90620-110, Brazil. .,Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil.
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Romero PS, Costanzi AP, Hirakata VN, Beghetto MG, Sauer JM, Rabelo-Silva ER. Subsample analysis of the Vascular Complications Risk Score at two public referral centers for interventional cardiology. Rev Esc Enferm USP 2019; 53:e03438. [PMID: 31215613 DOI: 10.1590/s1980-220x2018005103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/20/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Evaluate the performance of the Vascular Complications Risk Score in two public referral centers for interventional cardiology. METHOD Subsample analysis of the Vascular Complications Risk Score, which was developed and validated in the catheterization laboratories of three cardiology referral centers (two public, one private) with a cutoff of <3 for no risk of developing vascular complications and ≥3 for risk. In this new analysis, we excluded data from the private facility, and only included participants from the original (validation) cohort of the two public hospitals. RESULTS Among the 629 patients studied, 11.8% had vascular complications; of these, 1.8% were major and 10% minor. Among the patients with a score <3, 310 (94.5%) presented no vascular complications; of those with a score ≥3, 50 (17%) developed complications. Of those who developed vascular complications, 18 scored <3; two of these had major complications. CONCLUSION This subanalysis confirms the ability of the Vascular Complications Risk core to predict low risk of vascular complications in patients with a score < 3.
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Affiliation(s)
- Paola Severo Romero
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Divisão de Cardiologia, Porto Alegre, RS, Brazil
| | - Angelita Paganin Costanzi
- Hospital Unimed, Caxias do Sul, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Vânia Naomi Hirakata
- Hospital de Clínicas de Porto Alegre, Divisão de Cardiologia, Porto Alegre, RS, Brazil
| | - Mariur Gomes Beghetto
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Jaquelini Messer Sauer
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Divisão de Cardiologia, Porto Alegre, RS, Brazil
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Cardoso ASF, Muller S, Echer IC, Rabelo-Silva ER, Boni FG, Ribeiro AS. Elaboration and validation of a drug administration checklist for patients in research protocols. ACTA ACUST UNITED AC 2019; 40:e20180311. [PMID: 31038601 DOI: 10.1590/1983-1447.2019.20180311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/01/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the elaboration and validation of a checklist as a strategy for safe drug administration. METHOD It is a Validation study by consensus of experts conducted from January to June 2018, in a Clinical Research Center of a university hospital. The checklist was validated by three nurses, two nursing technicians, a pharmacist, two nurse teachers and one medical teacher, all with extensive experience in drug administration and in clinical research. For the final version of the checklist, a consensus of 100% was considered. RESULTS A guide was prepared consisting of six items to be checked by the care team before, during and after administration of Clinical Research drugs. CONCLUSION The validation of the checklist provided guiding elements for the prevention of behaviors that could lead to the risk of adverse events and also allowed the care teams to seek safe strategies of care in drug administration.
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Affiliation(s)
| | - Suzana Muller
- Hospital de Clínicas de Porto Alegre (HCPA), Centro de Pesquisa Clínica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Isabel Cristina Echer
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Assistência e Orientação Profissional. Porto Alegre, Rio Grande do Sul, Brasil
| | - Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Fernanda Guarilha Boni
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Curso de Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Adriana Souza Ribeiro
- Hospital de Clínicas de Porto Alegre (HCPA). Serviço de Enfermagem em Emergência. Porto Alegre, Rio Grande do Sul, Brasil
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Monteiro Mantovani V, Moorhead S, de Abreu Almeida M, Rabelo-Silva ER. Adverse Reactions to Medications: Concept Analysis and Development of a New Risk Nursing Diagnosis. Int J Nurs Knowl 2019; 31:87-93. [PMID: 30900386 DOI: 10.1111/2047-3095.12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the concept of adverse reaction to medications and to develop the new nursing diagnosis Risk for Adverse Reactions to Medications. METHODS Concept analysis using Walker and Avant's eight step method. FINDINGS Thirty-three articles indexed in four databases were included. The components of the new nursing diagnosis were determined, including possible nursing outcomes and interventions. CONCLUSIONS The concept analysis supported the development of the new nursing diagnosis Risk for Adverse Reactions to Medications, which may help nurses to evaluate and identify patients susceptible to adverse reactions. IMPLICATIONS FOR NURSING PRACTICE The establishment of this nursing diagnosis will provide nurses an opportunity to implement interventions to anticipate and effectively intervene with patients at risk for this condition.
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Affiliation(s)
- Vanessa Monteiro Mantovani
- Vanessa Monteiro Mantovani, RN, MSc, is a PhD Student at the Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Brazil, is a Visiting Scholar at the College of Nursing, University of Iowa, Iowa, is a Member of the Nursing Research Group on the Care of Adults and the Elderly (GEPECADI-CNPq), Porto Alegre, Rio Grande do Sul, Brazil
| | - Sue Moorhead
- Sue Moorhead, RN, PhD, FAAN, is an Associate Professor at the College of Nursing, University of Iowa, Iowa, is the Director of the Center for Nursing Classification and Clinical Effectiveness, Iowa
| | - Miriam de Abreu Almeida
- Miriam de Abreu Almeida, RN, PhD, is an Associate Professor at the School of Nursing, is the Coordinator of the Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Brazil, is a Researcher at the GEPECADI, Porto Alegre, Rio Grande do Sul, Brazil, is a Researcher of CNPq, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eneida Rejane Rabelo-Silva
- Eneida Rejane Rabelo-Silva, RN, MSc, ScD, is an Associate Professor at the School of Nursing, Universidade Federal do Rio Grande do Sul, Nurse Coordinator of the PICC TEAM, Hospital de Clínicas de Porto Alegre, Brazil, is a Researcher at the GEPECADI, Porto Alegre, Rio Grande do Sul, Brazil, is a Researcher at CNPq, Porto Alegre, Rio Grande do Sul, Brazil
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d'Almeida KSM, Barilli SLS, Souza GC, Rabelo-Silva ER. Cut-Point for Satisfactory Adherence of the Dietary Sodium Restriction Questionnaire for Patients with Heart Failure. Arq Bras Cardiol 2019; 112:165-170. [PMID: 30785581 PMCID: PMC6371818 DOI: 10.5935/abc.20190011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/02/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The low or non-adherence to reduction of sodium intake has been identified as one of the main precipitating factors of heart failure (HF). The Dietary Sodium Restriction Questionnaire (DSRQ) identifies factors that can interfere with adherence to this recommendation. However, there is still no cut-point to define adherence for this questionnaire. OBJECTIVES To identify the cut-point for satisfactory adherence to the Brazilian version of the DSRQ, (the Questionário de Restrição de Sódio na Dieta, QRSD). METHODS Multicenter study. Patients with HF in outpatient treatment (compensated) and those treated in emergency departments due to acute HF (decompensated) were included. For the cut-point definition, the DSRQ scores were compared between groups. A ROC curve was constructed for each subscale to determine the best point of sensitivity and specificity regarding adherence. A 5% significance level was adopted. RESULTS A total of 206 compensated patients and 225 decompensated were included. Compensated patients exhibited scores that showed higher adhesion in all subscales (all p <0.05). Scores ≥ 40 points of a total of 45 for the subscale of Attitude and Subjective Norm; scores ≤ eight of a total of 20 for Perceived Behavioral Control; and ≤ three of a total of 15 for Dependent Behavior Control were indicative of satisfactory adherence. CONCLUSIONS Based on the evaluation of patients in these two scenarios, it was possible to determine the cut-point for satisfactory adherence to the reduction of sodium in the diet of patients with HF. Countries with similar culture could use this cut-point, as other researchers could also use the results as a reference for further studies.
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Affiliation(s)
- Karina Sanches Machado d'Almeida
- Programa de pós-graduação em Cardiologia e Ciências Cardiovasculares da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil.,Clínica de Insuficiência Cardíaca do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Curso de Nutrição da Universidade Federal do Pampa, Itaqui, RS - Brazil
| | - Sofia Louise Santin Barilli
- Clínica de Insuficiência Cardíaca do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Programa de pós-graduação da Escola de Enfermagem da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | - Gabriela Corrêa Souza
- Clínica de Insuficiência Cardíaca do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Departamento de Medicina Interna da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | - Eneida Rejane Rabelo-Silva
- Programa de pós-graduação em Cardiologia e Ciências Cardiovasculares da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil.,Clínica de Insuficiência Cardíaca do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Programa de pós-graduação da Escola de Enfermagem da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
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Ernandes CM, Bernardes DDS, Mantovani VM, Pedraza LL, Rabelo-Silva ER. Predição de risco e acurácia diagnóstica em pacientes internados com insuficiência cardíaca descompensada: estudo de coorte. Rev Gaucha Enferm 2019; 40:e20180032. [DOI: 10.1590/1983-1447.2019.20180032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo OBJETIVOS Analisar a acurácia diagnóstica de enfermagem em pacientes com predição de risco de piora clínica durante internação por insuficiência cardíaca agudamente descompensada. MÉTODO Estudo de coorte com coleta de dados em prontuário de acordo com o Acute Decompensated Heart Failure National Registry risk model. Após a definição dos pacientes em risco, aplicou-se a Escala de Acurácia de Diagnósticos de Enfermagem versão 2. A escala classifica a acurácia em nula, baixa, moderada ou alta. RESULTADOS Dos 43 pacientes com risco de piora, 22(51%) não pioraram e 21(49%) pioraram; em ambos, a acurácia diagnóstica apresentou-se na categoria Moderada/Alta em 22(89%) e 16(88%), respectivamente. Apenas Débito cardíaco diminuído e Volume de líquidos excessivo foram pontuados com 100% na categoria Alta. CONCLUSÕES Pacientes agudamente descompensados e com risco de piora clínica durante a internação foram identificados com acurácia diagnóstica Moderada ou Alta pelos enfermeiros.
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Affiliation(s)
| | | | | | | | - Eneida Rejane Rabelo-Silva
- Hospital de Clínicas de Porto Alegre (HCPA), Brasil; Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Brasil
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29
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Silva OMD, Proença MCDC, Vicari AR, Fengler KPM, Karohl C, Rabelo-Silva ER. Occupational hazards for nursing professionals related to the reuse and single use of the dialyzer. Rev Esc Enferm USP 2018; 52:e03389. [PMID: 30570080 DOI: 10.1590/s1980-220x2017045403389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 06/04/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the reports of occupational events recorded by nursing professionals during the periods of reuse and single use of the dialyzer. METHOD Retrospective longitudinal study with electronic medical records from nursing technicians of a hemodialysis service. Data were analyzed descriptively and Rate ratio. RESULTS During the reuse of the dialyzer, there were seven events from five professionals reporting musculoskeletal disorders, ocular allergies and dermatosis. During single use, two professionals reported low back pain. The rate ratio of medication use was 6.7 days for every 1000 professionals during the reuse period and 1.52 days in the single use period (RR=4.4; 95% CI 2.182-9.805). Anti-inflammatory drugs were the most prescribed, and sick leaves were similar in both periods. CONCLUSION Dialyzer reuse was associated with musculoskeletal disorders, ocular irritation, dermatosis and increased use of medications by professionals. Sick leaves were similar on the periods of dialyzer reuse and single use.
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Affiliation(s)
| | | | | | | | - Cristina Karohl
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, RS, Brasil
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Rabelo-Silva ER, Saffi MAL, Aliti GB, Feijó MK, Linch GFDC, Sauer JM, Martins SM. Precipitating factors of decompensation of heart failure related to treatment adherence: multicenter study-EMBRACE. Rev Gaucha Enferm 2018; 39:e20170292. [PMID: 30365756 DOI: 10.1590/1983-1447.2018.20170292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/02/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the precipitating factors of heart failure decompensation between adherent and non-adherent patients to treatment. METHODS Cross-sectional study of a multicenter cohort study. Patients over 18 years of age with decompensated heart failure (functional class III/IV) were eligible. The structured questionnaire was used to collect the data and evaluate the reasons for decompensation. The irregular use of medication prior to hospitalization and inadequate salt and fluid intake were considered as poor adherence to treatment. RESULTS A total of 556 patients were included, mean age 61 ± 14 years old, 362 (65%) male. The main factor of decompensation was poor adherence, representing 55% of the sample. Patients who reported irregular use of medications in the last week had a 22% greater risk of being hospitalized due to poor adherence than the patients who adhered to treatment. CONCLUSION The EMBRACE study showed that in patients with heart failure, poor adherence was the main factor of exacerbation.
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Affiliation(s)
- Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Graziella Badin Aliti
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
| | - Maria Karolina Feijó
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Jaquelini Messer Sauer
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Silvia Marinho Martins
- Hospital Universitário Osvaldo Cruz (HUOC). Recife, Pernambuco, Brasil.,Pronto-Socorro Cardiológico Universitário de Pernambuco (PROCAPE). Recife, Pernambuco, Brasil
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Paganin AC, Beghetto MG, Feijó MK, Matte R, Sauer JM, Rabelo-Silva ER. Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study. Rev Lat Am Enfermagem 2018; 26:e3060. [PMID: 30328978 PMCID: PMC6190486 DOI: 10.1590/1518-8345.2672.3060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE to analyze vascular complications among patients who underwent endovascular cardiac procedures in the hemodynamic laboratories of three referral centers. METHOD a multicenter cohort study was conducted in three referral facilities. The sample was composed of 2,696 adult patients who had undergone elective or urgent percutaneous cardiac procedures. The outcomes were vascular complications, such as: hematoma at the site of the arterial puncture; major or minor bleeding; surgical correction for retroperitoneal hemorrhage; pseudoaneurysm; and arteriovenous fistula. RESULTS 237 (8.8%) of the 2,696 patients presented a vascular complication at the site of the arterial puncture. The total number of vascular complications was 264: minor hematoma<10cm (n=135); stable bleeding (n=86); major hematoma ≥10cm (n=32); and unstable bleeding (n=11). There were no retroperitoneal hematoma events, pseudoaneurysm or arterial venous fistula. Most of the major and minor complications occurred in the first six hours after the procedure. CONCLUSION the results concerning the current context of interventional cardiology indicate that the complications predominantly occur in the first six hours after the procedure, considering a 48-hour follow-up. The staff should plan and implement preventive measures immediately after the procedures.
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Affiliation(s)
- Angelita Costanzi Paganin
- Unimed, Laboratório de Hemodinâmica, Caxias do Sul, RS, Brazil
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Mariur Gomes Beghetto
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Maria Karolina Feijó
- Prefeitura Municipal de Porto Alegre, Secretaria Municipal de Saúde, Porto Alegre, RS, Brazil
| | - Roselene Matte
- Hospital de Clínicas de Porto Alegre, Unidade de Hemodinâmica, Porto Alegre, RS, Brazil
| | | | - Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Unidade de Hemodinâmica, Porto Alegre, RS, Brazil
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Santos SMD, Rabelo-Silva ER, Aliti GB, Romero PS, Corrêa CL, Valle FH, Gonçalves SC, Wainstein MV, Wainstein RV. Two HEmostasis Methods After TransradIal Catheterization: THEMATIC - protocol for a randomized clinical trial. Rev Gaucha Enferm 2018; 39:e20170257. [PMID: 30088607 DOI: 10.1590/1983-1447.2018.2017-0257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/26/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Randomized clinical trial protocol to evaluate the incidence of radial artery occlusion with two different arterial compression devices after transradial procedures. METHODS Barbeau's test will be performed in adults scheduled to undergo transradial interventional procedures. Those with A, B, or C plethysmographic patterns will be selected. At the end of the procedure, patients will be randomly assigned (1:1) to receive patent haemostasis with TR Band™ device or conventional haemostasis with an elastic adhesive bandage. The primary outcome is the incidence of radial artery occlusion. Secondary outcomes are Barbeau's test curve change, additional time to achieve haemostasis, incidence of bleeding at the puncture site, pain severity, development of arteriovenous fistula, radial pseudo aneurysm, any access-site complication requiring vascular surgery intervention and costs between the two devices. DISCUSSION The results of this trial should provide valuable additional information on the best approach for haemostasis after transradial percutaneous cardiovascular interventions.
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Affiliation(s)
| | - Eneida Rejane Rabelo-Silva
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Graziella Badin Aliti
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Paola Severo Romero
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Felipe Homem Valle
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Marco Vugman Wainstein
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina. Porto Alegre, Rio Grande do Sul, Brasil
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Reich R, Rabelo-Silva ER, Santos SMD, Almeida MDA. Vascular access complications in patients undergoing percutaneous procedures in hemodynamics: a scoping review. Rev Gaucha Enferm 2018; 38:e68716. [PMID: 29933427 DOI: 10.1590/1983-1447.2017.04.68716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/28/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories. METHODS Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. RESULTS One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. CONCLUSION Vascular access site complications range according to the access route used. Knowledge of factors that permeate the occurrence of these events may contribute to early detection, planning, and monitoring of the care implemented.
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Affiliation(s)
- Rejane Reich
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Eneida Rejane Rabelo-Silva
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Simone Marques Dos Santos
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Miriam de Abreu Almeida
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
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Abstract
PURPOSE To select and refine the outcomes and indicators of Nursing Outcomes Classification for the diagnosis of risk for perioperative positioning injury. METHOD Validation study on expert consensus and refinement through pilot study. FINDINGS Eight outcomes and 35 indicators were selected in consensus. After clinical testing was performed, in which 10 patients were assessed at five different times. Eight outcomes and 33 indicators remained in the protocol. CONCLUSION This study made it possible to select the most relevant outcomes and indicators to be measured for this diagnosis in clinical practice. IMPLICATIONS FOR NURSING PRACTICE Validation studies by consensus and clinical testing are important to promote the accuracy, creating opportunities to legitimize, and improve the concepts of taxonomies.
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Affiliation(s)
- Luciana Bjorklund de Lima
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul-School of Nursing and Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Michelle Cardoso E Cardozo
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul-School of Nursing and Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniela de Souza Bernardes
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul-School of Nursing and Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul-School of Nursing and Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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da Silva AF, Cavalcanti ACD, Malta M, Arruda CS, Gandin T, da Fé A, Rabelo-Silva ER. Treatment adherence in heart failure patients followed up by nurses in two specialized clinics. Rev Lat Am Enfermagem 2017; 23:888-94. [PMID: 26487139 PMCID: PMC4660411 DOI: 10.1590/0104-1169.0268.2628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/22/2015] [Indexed: 11/23/2022] Open
Abstract
Objectives: to analyze treatment adherence in heart failure (HF) patients followed up by the
nursing staff at specialized clinics and its association with patients'
characteristics such as number of previous appointments, family structure, and
comorbidities. Methods: a cross-sectional study was conducted at two reference clinics for the treatment
of HF patients (center 1 and center 2). Data were obtained using a 10-item
questionnaire with scores ranging from 0 to 26 points; adherence was considered
adequate if the score was ≥ 18 points, or 70% of adherence. Results: a total of 340 patients were included. Mean adherence score was 16 (±4) points.
Additionally, 124 (36.5%) patients showed an adherence rate ≥ 70%. It was
demonstrated that patients who lived with their family had higher adherence
scores, that three or more previous nursing appointments was significantly
associated with higher adherence (p<0.001), and that hypertension was
associated with low adherence (p=0.023). Conclusions: treatment adherence was considered satisfactory in less than a half of the
patients followed up at the two clinics specialized in HF. Living with the family
and attending to a great number of nursing appointments improved adherence, while
the presence of hypertension led to worse adherence.
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Affiliation(s)
| | | | - Mauricio Malta
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Thamires Gandin
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Adriana da Fé
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Oliveira FDS, Freitas LDOD, Rabelo-Silva ER, Costa LMD, Kalil RAK, Moraes MAPD. Predictors of Mediastinitis Risk after Coronary Artery Bypass Surgery: Applicability of Score in 1.322 Cases. Arq Bras Cardiol 2017; 109:207-212. [PMID: 28832745 PMCID: PMC5586227 DOI: 10.5935/abc.20170119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/30/2017] [Indexed: 11/20/2022] Open
Abstract
Background Mediastinitis is a severe surgical complication of low incidence, but high
lethality. Scores used in the preoperative period to stratify the risk of
postoperative mediastinitis may contribute to improve the results. Objective To test the applicability of the MagedanzSCORE in predicting the risk factors
for mediastinitis in patients undergoing coronary artery bypass grafting at
a cardiology reference hospital. Methods Historical cohort study with adult patients who underwent coronary artery
bypass grafting. The analyzed variables were contemplated in the
MagedanzSCORE: reoperation, chronic obstructive pulmonary disease (COPD),
obesity, class IV unstable angina, polytransfusion therapy, mediastinitis
and death as outcome variables. Results Of the 1.322 patients examined, 56 (4.2%) developed mediastinitis. Of these,
26 (46.4%) were classified as high risk for mediastinitis and 15 (26.8%) at
very high risk for mediastinitis. Three of the five variables of the
Magendanz Score showed statistically significant differences: reoperation,
COPD and obesity. Class IV unstable angina and postoperative polytransfusion
were not associated with mediastinitis after coronary artery by-pass
grafting. The area under the ROC curve was 0.80 (CI 95% 0.73 - 0.86),
indicating the model's satisfactory ability to predict the occurrence of
mediastinitis. Conclusion The tool was useful in the preoperative assessment demonstrating the risk for
mediastinitis in this population of intensive care patients.
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Affiliation(s)
| | | | | | - Laura Maggi da Costa
- Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | - Renato Abdala Karam Kalil
- Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
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Mantovani VM, Silveira CB, Lima LL, Orlandin L, Rabelo-Silva ER, Moraes MA. Comparison of quality of life between patients on the waiting list and heart transplant recipients. Rev Gaucha Enferm 2017; 37:e53280. [PMID: 28198941 DOI: 10.1590/1983-1447.2016.04.53280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 10/14/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives To compare the quality of life (QOL) between wait-listed patients and heart transplant recipients. Methods Cross-sectional study of 56 adult patients at two institutions in Southern Brazil, 9(16%) wait-listed patients and 47(84%) transplant recipients. Data were collected from August to December 2012. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), with scores ranging from zero to 100. Results There was statistically significant difference between the two groups in the overall QOL score (p=0.010) and in four dimensions. The mean rank was 16.9 in wait-listed patients and 30.7 in transplant recipients. Wait-listed patients presented the lowest for general health (9.1) and the highest scores for role-emotional (24.8). Transplant recipients obtained the highest scores for general health (32.2) and the lowest scores for bodily pain (29.1). Conclusions Undergoing a transplant has a positive impact on the QOL of recipients compared to that of patients awaiting transplantation.
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Affiliation(s)
- Vanessa Monteiro Mantovani
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Lidia Lucas Lima
- Instituto de Cardiologia (IC-FUC). Porto Alegre, Rio Grande do Sul, Brasil
| | - Letícia Orlandin
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
| | - Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
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Azzolin KDO, Lemos DM, Lucena ADF, Rabelo-Silva ER. Home-based nursing interventions improve knowledge of disease and management in patients with heart failure. Rev Lat Am Enfermagem 2017; 23:44-50. [PMID: 25806630 PMCID: PMC4376030 DOI: 10.1590/0104-1169.0144.2523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 09/11/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire. METHODS in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered. RESULTS overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4. CONCLUSION the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument.
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Hilário TDS, Santos SMD, Kruger J, Goes MG, Casco MF, Rabelo-Silva ER. Pain assessment and management in patients undergoing endovascular procedures in the catheterization laboratory. Rev Esc Enferm USP 2017; 51:e03229. [DOI: 10.1590/s1980-220x2016018003229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 02/14/2017] [Indexed: 11/21/2022] Open
Abstract
Abstract OBJECTIVE To describe how pain is assessed (characteristic, location, and intensity) and managed in clinical practice in patients undergoing endovascular procedures in the catheterization laboratory setting. METHOD Cross-sectional study with retrospective data collection. RESULTS Overall, 345 patients were included; 116 (34%) experienced post-procedural pain; in 107 (92%), pain characteristics were not recorded; the location of pain was reported in 100% of patients, and its intensity in 111 (96%); management was largely pharmacologic; of the patients who received some type of management (n=71), 42 (59%) underwent reassessment of pain. CONCLUSION The location and intensity of pain are well reported in clinical practice. Pharmacologic pain management is still prevalent. Additional efforts are needed to ensure recording of the characteristics of pain and its reassessment after interventions.
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Affiliation(s)
| | | | | | - Martha Georgina Goes
- Universidade Federal do Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Brazil
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Paganin AC, Beghetto MG, Hirakata VN, Hilário TS, Matte R, Sauer JM, Rabelo-Silva ER. A Vascular Complications Risk (VASCOR) score for patients undergoing invasive cardiac procedures in the catheterization laboratory setting: A prospective cohort study. Eur J Cardiovasc Nurs 2016; 16:409-417. [DOI: 10.1177/1474515116684250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- AC Paganin
- Graduate Program in Nursing, Federal University of Rio Grande do Sul, Brazil
- Unimed Hospital, Caxias do Sul, Brazil
| | - MG Beghetto
- Graduate Program in Nursing, Federal University of Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Brazil
| | - VN Hirakata
- Hospital de Clínicas de Porto Alegre, Brazil
| | - TS Hilário
- Graduate Program in Nursing, Federal University of Rio Grande do Sul, Brazil
| | - R Matte
- Hospital de Clínicas de Porto Alegre, Brazil
| | - JM Sauer
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Brazil
| | - ER Rabelo-Silva
- Graduate Program in Nursing, Federal University of Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Brazil
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Rabelo-Silva ER, Dantas Cavalcanti AC, Ramos Goulart Caldas MC, Lucena ADF, Almeida MDA, Linch GFDC, da Silva MB, Müller-Staub M. Advanced Nursing Process quality: Comparing the International Classification for Nursing Practice (ICNP) with the NANDA-International (NANDA-I) and Nursing Interventions Classification (NIC). J Clin Nurs 2016; 26:379-387. [PMID: 27192041 DOI: 10.1111/jocn.13387] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To assess the quality of the advanced nursing process in nursing documentation in two hospitals. BACKGROUND Various standardised terminologies are employed by nurses worldwide, whether for teaching, research or patient care. These systems can improve the quality of nursing records, enable care continuity, consistency in written communication and enhance safety for patients and providers alike. DESIGN Cross-sectional study. METHODS A total of 138 records from two facilities (69 records from each facility) were analysed, one using the NANDA-International and Nursing Interventions Classification terminology (Centre 1) and one the International Classification for Nursing Practice (Centre 2), by means of the Quality of Diagnoses, Interventions, and Outcomes instrument. Quality of Diagnoses, Interventions, and Outcomes scores range from 0-58 points. Nursing records were dated 2012-2013 for Centre 1 and 2010-2011 for Centre 2. RESULTS Centre 1 had a Quality of Diagnoses, Interventions, and Outcomes score of 35·46 (±6·45), whereas Centre 2 had a Quality of Diagnoses, Interventions, and Outcomes score of 31·72 (±4·62) (p < 0·001). Centre 2 had higher scores in the 'Nursing Diagnoses as Process' dimension, whereas in the 'Nursing Diagnoses as Product', 'Nursing Interventions' and 'Nursing Outcomes' dimensions, Centre 1 exhibited superior performance; acceptable reliability values were obtained for both centres, except for the 'Nursing Interventions' domain in Centre 1 and the 'Nursing Diagnoses as Process' and 'Nursing Diagnoses as Product' domains in Centre 2. CONCLUSION The quality of nursing documentation was superior at Centre 1, although both facilities demonstrated moderate scores considering the maximum potential score of 58 points. Reliability analyses showed satisfactory results for both standardised terminologies. RELEVANCE TO CLINICAL PRACTICE Nursing leaders should use a validated instrument to investigate the quality of nursing records after implementation of standardised terminologies.
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Affiliation(s)
- Eneida Rejane Rabelo-Silva
- Graduate Program in Nursing at Federal University of Rio Grande do Sul and Hospital de Clínicas de Porto Alegre and Grupo de Estudo e Pesquisa em Enfermagem no Cuidado ao Adulto e Idoso (GEPECADI), Porto Alegre, RS, Brazil
| | | | | | - Amália de Fátima Lucena
- Graduate Program in Nursing at Federal University of Rio Grande do Sul and Hospital de Clínicas de Porto Alegre and Grupo de Estudo e Pesquisa em Enfermagem no Cuidado ao Adulto e Idoso (GEPECADI), Porto Alegre, RS, Brazil
| | - Miriam de Abreu Almeida
- Graduate Program in Nursing at Federal University of Rio Grande do Sul and Hospital de Clínicas de Porto Alegre and Grupo de Estudo e Pesquisa em Enfermagem no Cuidado ao Adulto e Idoso (GEPECADI), Porto Alegre, RS, Brazil
| | | | - Marcos Barragan da Silva
- Graduate Program in Nursing at Federal University of Rio Grande do Sul and Hospital de Clínicas de Porto Alegre and Grupo de Estudo e Pesquisa em Enfermagem no Cuidado ao Adulto e Idoso (GEPECADI), Porto Alegre, RS, Brazil
| | - Maria Müller-Staub
- Nursing Projects, Research and Innovation (Switzerland) & Hanze University, Groningen, the Netherlands
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Pezzi MV, Rabelo-Silva ER, Paganin A, de Souza EN. Nursing Interventions and Outcomes for the Diagnosis of Impaired Tissue Integrity in Patients After Cardiac Catheterization: Survey. Int J Nurs Knowl 2016; 27:215-219. [PMID: 27324174 DOI: 10.1111/2047-3095.12140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Determine the outcomes and interventions for patients undergoing cardiac catheterization with nursing diagnosis of impaired tissue integrity. METHODS Survey with e-questionnaires sent for expert nurses in two rounds. FINDINGS Only one nursing outcome was approved: tissue integrity-skin and mucosa and five related interventions, namely, pressure control, topical drug administration, care of incision site, care of injuries, and infection control. CONCLUSIONS The expected outcomes and the most significant interventions for the implementation of nursing care during the immediate recovery of patients with impaired tissue integrity following invasive hemodynamic procedures were defined. IMPLICATIONS FOR NURSING PRACTICE The study findings support selection of appropriate nursing outcomes and interventions for this patient profile.
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Affiliation(s)
| | - Eneida Rejane Rabelo-Silva
- Professor at Cardiovascular Division, Hospital de Clínicas de Porto Alegre, and Nursing School at the Federal University of Rio Grande do Sul, Brasil
| | - Angelita Paganin
- Nurse at Cath Lab at Hospital Unimed Nordeste, Caxias do Sul - RS, Brasil
| | - Emiliane Nogueira de Souza
- Professor at Nursing Department of Federal University of Health Sciences of Porto Alegre, Cardiology Institute of Rio Grande do Sul, Brasil.
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Barilli SLS, D'Almeida KSM, Trojahn MM, Souza GC, Aliti GB, Rabelo-Silva ER. Knowledge, Barriers and Attitudes Related to Dietary Sodium in Decompesated Heart Failure Patients. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Matte R, Hilário TDS, Reich R, Aliti GB, Rabelo-Silva ER. Reducing bed rest time from five to three hours does not increase complications after cardiac catheterization: the THREE CATH Trial. Rev Lat Am Enfermagem 2016; 24:e2796. [PMID: 27463113 PMCID: PMC4982447 DOI: 10.1590/1518-8345.0725.2796] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/25/2015] [Indexed: 11/30/2022] Open
Abstract
Objective: to compare the incidence of vascular complications in patients undergoing
transfemoral cardiac catheterization with a 6F introducer sheath followed by
3-hour versus 5-hour rest. Methods: randomized clinical trial. Subjects in the intervention group (IG) ambulated 3
hours after sheath removal, versus 5 hours in the control group (CG). All patients
remained in the catheterization laboratory for 5 hours and were assessed hourly,
and were contacted 24, 48, and 72 h after hospital discharge. Results: the sample comprised 367 patients in the IG and 363 in the GC. During cath lab
stay, hematoma was the most common complication in both groups, occurring in 12
(3%) IG and 13 (4%) CG subjects (P=0.87). Bleeding occurred in 4 (1%) IG and 6
(2%) CG subjects (P=0.51), and vasovagal reaction in 5 (1.4%) IG and 4 (1.1%) CG
subjects (P=0.75). At 24-h, 48-h, and 72-h bruising was the most commonly reported
complication in both groups. None of the comparisons revealed any significant
between-group differences. Conclusion: the results of this trial show that reducing bed rest time to 3 hours after
elective cardiac catheterization is safe and does not increase complications as
compared with a 5-hour rest. ClinicalTrials.gov Identifier: NCT-01740856
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Affiliation(s)
- Roselene Matte
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Rejane Reich
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Graziella Badin Aliti
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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da Silva OM, Rigon E, Corradi Dalazen JV, Bissoloti A, Rabelo-Silva ER. Pain during Arteriovenous Fistula Cannulation in Chronic Renal Patients on Hemodialysis. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.612098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Linhares JCC, Orlandin L, Aliti GB, Rabelo-Silva ER. Aplicabilidade dos resultados de enfermagem em pacientes com insuficiência cardíaca e volume de líquidos excessivo. Rev Gaucha Enferm 2016; 37:e61554. [DOI: 10.1590/1983-1447.2016.02.61554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/04/2016] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Testar a aplicabilidade clínica da Nursing Outcomes Classification em pacientes com insuficiência cardíaca descompensada e Diagnóstico de Enfermagem Volume de Líquidos Excessivo. Métodos Estudo longitudinal conduzido em duas etapas em um hospital universitário no ano de 2013. Na primeira etapa, utilizou-se a validação por consenso de especialistas para selecionar os resultados de enfermagem e os indicadores relacionados ao diagnóstico de enfermagem; na segunda, foi realizado um estudo longitudinal para avaliação clínica dos pacientes, utilizando-se o instrumento contendo os resultados e indicadores produzidos no consenso. Resultados Foram realizadas avaliações em 17 pacientes. Na avaliação clínica, mensuraram-se os resultados de enfermagem através da avaliação de seus indicadores. Seis resultados apresentaram aumento nos escores, quando comparados às médias da primeira e da última avaliação. A utilização da Nursing Outcomes Classification na prática clínica demonstrou melhora dos pacientes internados por insuficiência cardíaca descompensada. Conclusão A Nursing Outcomes Classification foi sensível às alterações no quadro clínico dos pacientes.
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Affiliation(s)
| | - Letícia Orlandin
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
| | - Graziella Badin Aliti
- Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal do Rio Grande do Sul, Brasil
| | - Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal do Rio Grande do Sul, Brasil
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Reich R, Vieira DFVB, Lima LBD, Rabelo-Silva ER. Nursing workload in a coronary unit according to the Nursing Activities Score. Rev Gaucha Enferm 2015; 36:28-35. [DOI: 10.1590/1983-1447.2015.03.51367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 06/24/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: this study aimed to using the Nursing Activities Score to assess nursing workload in a coronary care unit, to assess the distribution of workload between shifts, and to compare the current staff of the care unit with that recommended by the instrument.Method: this was a longitudinal study, conducted in a teaching hospital in Southern Brazil, between April to June 2012.Results: A total of 604 NAS measures were obtained from the 61 patients included. The mean workload per shift was 47% (±12), with the greatest workload being reported in the afternoon shifts.Conclusion: according to the NAS, a mean of two and a maximum of 2.4 nursing professionals would be required per shift to meet all patient demands, suggesting that the current staff size in the CCU is adequate. The NAS was successful in assessing nursing workload and changes in patient demands over time.
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Affiliation(s)
- Rejane Reich
- Universidade Federal do Rio Grande do Sul, Brasil
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Feijó MKEF, Biolo A, Ruschel KB, Orlandin L, Aliti GB, Rabelo-Silva ER. Effect of a diuretic adjustment algorithm and nonpharmacologic management in patients with heart failure: study protocol for a randomized controlled trial. Trials 2015; 16:44. [PMID: 25885424 PMCID: PMC4340682 DOI: 10.1186/s13063-015-0559-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/08/2015] [Indexed: 01/11/2023] Open
Abstract
Background One of the challenges in treating patients with heart failure (HF) is achieving clinical stability and reducing the hospital readmission rate. A diuretic dose adjustment algorithm developed in the United States (Diuretic Treatment Algorithm, DTA) and later validated for use in Brazil (as the Algoritmo de Ajuste de Diurético, AAD) has proved feasible and readily applicable, but its effect on clinical outcomes has yet to be assessed. This report aims to describe a randomized clinical trial protocol designed to assess the effectiveness of the AAD and of nonpharmacologic management in improving clinical stability and reducing the readmission rate at 90 days in patients with HF. Methods/Design A PROBE (prospective randomized open blinded endpoint) parallel-group design will be used. Adult patients with a diagnosis of reduced ejection fraction HF, who are being treated at a specialized HF clinic are being recruited. Those with indications for loop diuretic dose adjustment during routine clinic visits will be randomized to take part in the trial. Participants in the intervention group (IG) shall have their diuretic doses adjusted in accordance with the AAD and receive four telephone calls (one per week) over 30 days to reinforce guidance on nonpharmacological management (fluid and sodium restriction). Participants in the control group (CG) shall have their diuretic doses adjusted by a physician during the first trial visit and shall not receive any telephone calls. Patients in both groups shall return at 1 month for face-to-face reassessment. The study endpoints shall comprise readmission and/or emergency department visits due to HF decompensation within 90 days and clinical instability. All participants shall be required to have a scale at home (or easy access to one), a telephone number, agree to telephone-based follow-up, and be available to return for a 1-month trial visit. Overall, 135 patients are expected to be enrolled in each group. Discussion This trial shall assess the effectiveness of the AAD algorithm and non-pharmacologic management by early identification of clinical deterioration and establishment of a combined intervention to reduce emergency department visits, readmission rate, or a composite endpoint thereof. Trial registration number ClinicalTrials.gov Identifier, NCT02068937 (23 February 2014).
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Affiliation(s)
- Maria Karolina Echer Ferreira Feijó
- School of Nursing, Graduate Program Federal University of Rio Grande do Sul, São Manoel, 963 - Rio Branco, Porto Alegre, RS, 90620-110, Brazil.
| | - Andreia Biolo
- Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. .,Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Karen Brasil Ruschel
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Letícia Orlandin
- Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. .,Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Graziella Badin Aliti
- School of Nursing, Graduate Program Federal University of Rio Grande do Sul, São Manoel, 963 - Rio Branco, Porto Alegre, RS, 90620-110, Brazil. .,Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. .,Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Eneida Rejane Rabelo-Silva
- School of Nursing, Graduate Program Federal University of Rio Grande do Sul, São Manoel, 963 - Rio Branco, Porto Alegre, RS, 90620-110, Brazil. .,Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. .,Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Mantovani VM, Ruschel KB, Souza END, Mussi C, Rabelo-Silva ER. Adesão ao tratamento de pacientes com insuficiência cardíaca em acompanhamento domiciliar por enfermeiros. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivo Verificar a adesão ao tratamento de pacientes com insuficiência cardíaca em acompanhamento domiciliar por enfermeiras após alta hospitalar. Método Estudo tipo antes-depois realizado com pacientes recentemente internados por insuficiência cardíaca descompensada. Três visitas domiciliares foram realizadas após alta em um intervalo de 45 dias. Avaliou-se a adesão na primeira e terceira visitas através de um questionário validado (10 questões, ponto de corte 18 pontos=70%=adesão satisfatória). Durante a primeira e segunda visitas, os pacientes receberam educação quanto à doença, adesão e autocuidado. Resultados Foram incluídos 32 pacientes, idade média 65±16 anos, 18(58%) masculinos. Os 32 pacientes receberam um total de 96 visitas domiciliares. Os escores de adesão foram 16±2.6 vs 20.4±2.7 na primeira e terceira visitas, respectivamente (p=0,001). Questões como peso e restrição hídrica aumentaram significativamente após a intervenção. Conclusão A intervenção de educação no domicílio melhorou significativamente a adesão ao tratamento de pacientes com insuficiência cardíaca e internação recente.
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Saffi MAL, Furtado MV, Polanczyk CA, Montenegro MM, Ribeiro IWJ, Kampits C, Haas AN, Rösing CK, Rabelo-Silva ER. Relationship between vascular endothelium and periodontal disease in atherosclerotic lesions: Review article. World J Cardiol 2015; 7:26-30. [PMID: 25632316 PMCID: PMC4306203 DOI: 10.4330/wjc.v7.i1.26] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/26/2014] [Accepted: 12/19/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammation and endothelial dysfunction are linked to the pathogenesis of atherosclerotic disease. Recent studies suggest that periodontal infection and the ensuing increase in the levels of inflammatory markers may be associated with myocardial infarction, peripheral vascular disease and cerebrovascular disease. The present article aimed at reviewing contemporary data on the pathophysiology of vascular endothelium and its association with periodontitis in the scenario of cardiovascular disease.
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