Scientific production on the applicability of phenytoin in wound healing

Phenytoin is an anticonvulsant that has been used in wound healing. The objectives of this study were to describe how the scientific production presents the use ofphenytoinas a healing agent and to discuss its applicability in wounds. A literature review and hierarchy analysis of evidence-based practices was performed. Eighteen articles were analyzed that tested the intervention in wounds such as leprosy ulcers, leg ulcers, diabetic foot ulcers, pressure ulcers, trophic ulcers, war wounds, burns, preparation of recipient graft area, radiodermatitis and post-extraction of melanocytic nevi. Systemic use ofphenytoinin the treatment of fistulas and the hypothesis of topical use in the treatment of vitiligo were found. In conclusion, topical use ofphenytoinis scientifically evidenced. However robust research is needed that supports a protocol for the use ofphenytoinas another option of a healing agent in clinical practice.

Integrative Review: Concepts And Methods Used In Nursing


Integrative review (IR) has an international reputation in nursing research and evidence-based practice. This IR aimed at identifying and analyzing the concepts and methods recommended to undertaking IR in nursing. Nine information resources,including electronic databases and grey literature were searched. Seventeen studies were included. The results indicate that: primary studies were mostly from USA; it is possible to have several research questions or hypotheses and include primary studies in the review from different theoretical and methodological approaches; it is a type of review that can go beyond the analysis and synthesis of findings from primary studies allowing exploiting other research dimensions, and that presents potentialities for the development of new theories and new problems for research. Conclusion: IR is understood as a very complex type of review and it is expected to be developed using standardized and systematic methods to ensure the required rigor of scientific research and therefore the legitimacy of the established evidence.


Nursing intervention bundle for enteral nutrition in intensive care: a collective construction

Objective The collective construction of a nursing intervention bundle for patients in critical care in the hospital receiving enteral nutrition therapy, supported by evidence-based practice. Method A qualitative convergent-care study with 24 nursing professionals in an intensive care unit of a public hospital in Santa Catarina. Data collection was performed from May to August 2013, with semi-structured interviews and discussion groups. Results Four interventions emerged that constituted the bundle: bedside pH monitoring to confirm the position of the tube; stabilization of the tube; enteric position of the tube; and maintaining the head of the bed elevated at 30° to 45°.
 Conclusion The interventions chosen neither required additional professional workload nor extra charges to the institution, which are identified as improving the adoption of the bundle by nursing professionals at the ICU.

Informatics competencies essential to decision making in nursing management

Abstract OBJECTIVE To identify informatics abilities essential to decision making in nursing management. METHOD Survey study with specialist nurses in health informatics and management. An electronic questionnaire was built based on the competencies Information Literacy (five categories; 40 abilities) and Information Management (nine categories; 69 abilities) of the TIGER - Technology Informatics Guiding Education Reform - initiative, with the guiding question: Which informatics abilities are essential to decision making in management? Answers were sorted in a Likert scale, ranging from 1 to 5. Rasch analysis was conducted with the software WINSTEPS ®. Results were presented in logits, with cutoff value zero. RESULTS Thirty-two specialists participated, coming from all regions of Brazil. In the information literacy competency, 18 abilities were considered essential and in Information Management, 38; these were sorted according to their degree of essentiality. CONCLUSION It is believed that the incorporation of these abilities in teaching can support the education of nurse managers and contribute to evidence-based practice, incorporation of information and communication technologies in health and information management.

Cardiac magnetic resonance imaging in clinical practice

Objective To evaluate and describe indications, mainly diagnoses and cardiac magnetic resonance imaging findings observed in clinical practice. Materials and Methods Retrospective and descriptive study of cardiac magnetic resonance performed at a private hospital and clinic in the city of Niterói, RJ, Brazil, in the period from May 2007 to April 2011. Results The sample included a total of 1000 studies performed in patients with a mean age of 53.7 ± 16.2 years and predominance for male gender (57.2%). The majority of indications were related to assessment of myocardial perfusion at rest and under pharmacological stress (507/1000; 51%), with positive results in 36.2% of them. Suspected myocarditis was the second most frequent indication (140/1000; 14%), with positive results in 63.4% of cases. These two indications were followed by study of arrhythmias (116/1000; 12%), myocardial viability (69/1000; 7%) and evaluation of cardiomyopathies (47/1000; 5%). In a subanalysis, it was possible to identify that most patients were assessed on an outpatient basis (58.42%). Conclusion Cardiac magnetic resonance has been routinely performed in clinical practice, either on an outpatient or emergency/inpatient basis, and myocardial ischemia represented the main indication, followed by investigation of myocarditis, arrhythmogenic right ventricular dysplasia and myocardial viability.

Revisão sistemática: uma revisão narrativa

OBJETIVO: realizar uma revisão narrativa sobre revisão sistemática. FONTE DOS DADOS: foi realizada busca no Cochrane Methodology Register, na Medline, na LILACS, no Google Scholar e na Cochrane Library, no período de 2000 a janeiro de 2007. Foram utilizados a busca manual das listas de referências e os contatos pessoais. SELEÇÃO DOS ESTUDOS: a estratégia de busca empregou, na Medline, as seguintes combinações dos termos MeSH: "Meta-Analysis" [Publication Type] AND "Evidence-Based Medicine"[MeSH] Limits: Publication Date from 2000 to 2007, Humans, Systematic Reviews. Na LILACS: (metanalise) or "metanalise" [Descritor de assunto] and [ medicina baseada em evidências] or "medicina baseada em evidências" [Descritor de assunto]. No Cochrane Methodology Register e no Google Scholar: "revisão sistemática e metanálise" e "medicina baseada em evidências". Após uma revisão independente por dois revisores, dez artigos que se referiam ao objetivo proposto foram selecionados. SÍNTESE DOS DADOS: os temas mencionados nos estudos foram agrupados em duas categorias: aqueles que se reportavam à história da revisão sistemática e aqueles que definiam Medicina Baseada em Evidência, revisão sistemática e metanálise. CONCLUSÃO: os autores concluem com a necessidade de mais discussões sobre revisão sistemática entre os cirurgiões.

Pancreatite aguda sem etiologia aparente: a microlitíase deve ser pesquisada?

In a large number of patients, with episodes of acute pancreatitis the etiology is not identified, even after initial clinical history, detailed physical examination, laboratory tests and biochemical exams and an transabdominal ultrasound. This patient are considered with a unexplained acute pancreatitis. In this cases the treatment is restricted to improvement of symptoms. These patients after treated tend to have new episodes with the risk of raising the rates of morbidity and mortality. Therefore, the identification of a cause and its prompt treatment prevent at recurrent episodes of pancreatitis. This review aims to draw attention to how best diagnostic approach when the light of evidence-based medicine, to search for causes of difficult identification with microlithiasis, occult stones, the anatomical variations of biliary and pancreatic duct and in addition to sphincter of Oddi dysfunction.

Revisão sistemática da acurácia dos testes diagnósticos: uma revisão narrativa

Este artigo tem o objetivo de realizar uma revisão narrativa sobre revisão sistemática da acurácia dos testes diagnósticos. Foi realizada busca na Cochrane Methodology Reviews (Cochrane Reviews of Diagnostic Test Accuracy), Medline e LILACS, bem como busca manual das listas de referências dos artigos incluídos na revisão. As estratégias de busca empregadas foram as seguintes, empregando-se títulos de assuntos e termos livres: 1. na Cochrane Methodology Reviews: accuracy study "Methodology" 2. Na Pubmed "Meta-Analysis "[Publication Type] AND "Evidence-Based Medicine"[Mesh]) AND "Sensitivity and Specificity"[Mesh]; 3. Na LILACS: (revisao sistematica) or "literatura de REVISAO como assunto" [Descritor de assunto] and (sistematica) or "SISTEMATICA" [Descritor de assunto] and (acuracia) or "SENSIBILIDADE e especificidade" [Descritor de assunto]. Em suma, a preparação e o planejamento metodológicos das revisões sistemáticas de testes diagnósticos é ulterior àqueles empregados nas revisões sistemáticas das intervenções terapêuticas. Há muitas fontes de heterogeneidade nos desenhos dos estudos de teste diagnóstico, o que dificulta muito a síntese - metanálise - dos seus resultados. Para contornar esse problema, existem atualmente normas, exigidas pelas principais revistas biomédicas, para a submissão de um manuscrito sobre testes diagnósticos.

Management of stab wounds to the anterior abdominal wall

The meeting of the Publication "Evidence Based Telemedicine - Trauma and Emergency Surgery" (TBE-CiTE), through literature review, selected three recent articles on the treatment of victims stab wounds to the abdominal wall. The first study looked at the role of computed tomography (CT) in the treatment of patients with stab wounds to the abdominal wall. The second examined the use of laparoscopy over serial physical examinations to evaluate patients in need of laparotomy. The third did a review of surgical exploration of the abdominal wound, use of diagnostic peritoneal lavage and CT for the early identification of significant lesions and the best time for intervention. There was consensus to laparotomy in the presence of hemodynamic instability or signs of peritonitis, or evisceration. The wound should be explored under local anesthesia and if there is no injury to the aponeurosis the patient can be discharged. In the presence of penetration into the abdominal cavity, serial abdominal examinations are safe without CT. Laparoscopy is well indicated when there is doubt about any intracavitary lesion, in centers experienced in this method.