Prevenção de quedas - capacitar para prevenir

Relatório de Estagio apresentado para a obtenção do grau de Mestre na Especialidade de Enfermagem Comunitária

Évaluation d’activités de transfert de connaissances auprès d’infirmières pour la détection du délirium post-chirurgie cardiaque

La détection du délirium à l’aide d’outils est importante pour pouvoir intervenir le plus rapidement et efficacement possible. Le but de ce projet de recherche est d’évaluer l’efficacité d’une intervention de transfert de connaissances (TC) sur mesure auprès d’infirmières sur le taux d’utilisation conforme d’un outil de détection du délirium (ODD). L’intervention auprès d’infirmières a été basée sur les barrières et facilitateurs à utiliser un tel ODD identifiés par un questionnaire (n=30) et deux groupes de discussion (n=4). Les barrières identifiées par le questionnaire reflétaient un besoin de connaissances et d’amélioration des compétences infirmières. L’une des barrières identifiée à partir des groupes de discussion était le manque de connaissances sur les causes possibles du délirium et les interventions infirmières à privilégier selon ces causes. Les activités de TC retenues étaient une capsule clinique sur les manifestations du délirium évaluées par un ODD et une carte aide-mémoire sur des interventions infirmières possibles. Les taux d’utilisation de l’ODD ont été évalués en pré et post implantation d’une intervention de TC (devis pré-post test) à partir d’une revue de 242 dossiers médicaux de patients (avant n=121 ; après n=121). Aucune différence significative n’a été notée entre les périodes pré et post intervention de TC (p > .99). Une explication réside dans le taux déjà élevé (> 85%) d’utilisation de l’ODD observé avant l’intervention de TC pour deux des trois quarts de travail. L’intervention de TC basée sur les barrières et les facilitateurs a été appréciée par les infirmières et elle pourrait avoir le potentiel de promouvoir une pratique basée sur les résultats probants.

Prevenção de quedas - capacitar para prevenir

Relatório de Estagio apresentado para a obtenção do grau de Mestre na Especialidade de Enfermagem Comunitária

Análisis de las barreras para la unificación de una Historia Clínica Electrónica -HCE- en Colombia

Objetivo: Identificar las barreras para la unificación de una Historia Clínica Electrónica –HCE- en Colombia. Materiales y Métodos: Se realizó un estudio cualitativo. Se realizaron entrevistas semiestructuradas a profesionales y expertos de 22 instituciones del sector salud, de Bogotá y de los departamentos de Cundinamarca, Santander, Antioquia, Caldas, Huila, Valle del Cauca. Resultados: Colombia se encuentra en una estructuración para la implementación de la Historia Clínica Electrónica Unificada -HCEU-. Actualmente, se encuentra en unificación en 42 IPSs públicas en el departamento de Cundinamarca, el desarrollo de la HCEU en el país es privado y de desarrollo propio debido a las necesidades particulares de cada IPS. Conclusiones: Se identificaron barreras humanas, financieras, legales, organizacionales, técnicas y profesionales en los departamentos entrevistados. Se identificó que la unificación de la HCE depende del acuerdo de voluntades entre las IPSs del sector público, privado, EPSs, y el Gobierno Nacional.

Patologías lumbares: determinación de los factores ocupacionales y carga prestacional en una entidad promotora de salud en Bogotá

Resumen: Introducción El dolor lumbar es un trastorno músculo esquelético que afecta la parte baja de la espalda, considerado como un problema de salud pública y catalogado como un desastre en el sitio de trabajo, se encuentra en las 10 primeras causas de enfermedad profesional reportadas por las entidades prestadoras de servicios de salud, generando ausentismo y discapacidad laboral en los países industrializados, con costos que oscilan de los 20 mil a los 98 millones de dólares en los Estados Unidos. Objetivo Determinar la prevalencia de patologías lumbares calificadas y sus factores ocupacionales asociados en una entidad promotora de salud de Bogotá Colombia durante 2013 al 2014. Metodología Se realizó un estudio de corte transversal con datos secundarios pertenecientes a 318 pacientes de una entidad promotora de salud en la ciudad de Bogotá que fueron diagnosticados con patologías lumbares (lumbalgia-lumbago, discopatía lumbar, trastorno de disco intervertebral, espondilolistesis, espondilólisis, hernia discal), y remitidos a medicina laboral o solicitaron calificación de origen en primera oportunidad, en el periodo comprendido entre el año 2013 al 2014. Las variables incluidas fueron sociodemográficas, ocupacionales y diagnósticos médicos, específicamente patologías lumbares. Se realizó distribuciones de frecuencias, medidas de tendencia central y dispersión, análisis de asociación mediante la prueba Chi cuadrado de Pearson y un análisis multivariado a través del modelo de regresión binaria logística y el análisis de concordancia usando el índice de Kappa. Para las pruebas se utilizó un nivel de significación de 0,05. Se digitó y depuró en SPSS versión 23. Resultado El total de usuarios diagnosticados con patologías lumbares fue de 318 de los cuales el 57,2% fueron de sexo masculino con edad promedio de 43 años (D.E 7,9 años). Se encontró asociación significativa entre lumbalgia y movimientos de columna lumbar y levantamiento de carga (p<0,05); discopatía lumbar y movimientos de columna lumbar y factores multicausales (p<0,05); trastorno de disco intervertebral y factores multicausales (p<0.05), hernia de disco y levantamiento de cargas (p<0,05). Respecto a espondilolistesis y espondilólisis no se encontró asociación con ningún factor de riesgo, pero si se encontró asociación significativa entre origen y movimientos de columna lumbar (p= 0.010), con postura mantenida (p= 0.014), con causas multifactoriales (p= 0.000). El grado de concordancia entre la entidad promotora de salud y la administradora de riesgos laborales arrojó un valor en el índice de kappa de 0.432 (p= 0.000) correspondiendo a un grado de acuerdo moderado; para la concordancia entre la entidad promotora de salud y la junta de calificación el índice de kappa fue de 0.680 (p= 0.000) grado de acuerdo alto. Conclusión Las patologías lumbares tienen un alta prevalencia en la población trabajadora como en la no trabajadora, encontrándose un gran número de factores condicionantes a estas enfermedades generando altos costos en días perdidos laborales y en días de incapacidad: Por lo tanto, es importante determinar si estas son catalogadas de origen común o de origen laboral, para establecer programas de vigilancia epidemiológica y programas preventivos.

Contributos da gestão de qualidade nas práticas em fisioterapia : o caso particular das percepções dos fisioterapeutas que trabalham junto de crianças e jovens com bronquiolite viral aguda

Durante os últimos anos tem sido preocupação dos fisioterapeutas conduzir a investigação para melhorar a eficácia, eficiência e efectividade dos tratamentos que prestam e que conduzam aos melhores resultados possíveis, com base na melhor evidência científica disponível. Esta investigação tinha como objectivo principal perceber qual o contributo que a Gestão da Qualidade dá às práticas em fisioterapia, investigar quais as barreiras e obstáculos, que os fisioterapeutas percepcionam na implementação da prática baseada na evidência na sua prática clínica e examinar as atitudes perante a investigação em fisioterapia. A amostra foi constituída por treze fisioterapeutas e a recolha dos dados feita através de uma entrevista semi-estruturada. Verificou-se que no geral, os fisioterapeutas, revelam atitudes e comportamentos positivos relativos à Prática Baseada na Evidência, tendo ainda dificuldade em usá-la a seu favor. Constatou-se que os principais obstáculos á implementação da Prática Baseada na Evidência são de ordem individual, institucional e organizacional. Sendo que o maior obstáculo se prende com a existência de recursos disponíveis para acesso à informação. /ABSTRACT: During the last years it’s been the physical therapists concern to lead the research to improve efficacy, efficiency e effectiveness of treatments which they provide and that they lead to the best achievable results, based in the best scientific evidence available. This research had as its main goal, understand what contribute does the quality management give to the physiotherapy practice, discover which barriers and obstacles are perceived, by the physical therapists, in the evidence-based practice implementation and analyze their attitudes and behavior towards physiotherapy research. The sample was formed by thirteen physical therapists and the data was collected by a semi- structured interview. The results showed that generally, the physical therapists demonstrated positive attitude and behavior regarding Evidence-Based Practice having, nevertheless, difficulties using it in their profit and benefit. The study revealed that the principle obstacles perceived, in the implementation of Evidence-Based Practice are of individual, institutional and organizational order. The biggest obstacle perceived is the availability of resources to achieve information.

Nursing Interventions in Prevention and Healing of Leg Ulcers: Systematic Review of the Literature

Aim: The purpose of this study was to define nursing interventions for patients with venous, arterial or mixed leg ulcers. Methodology: A survey was conducted in EBSCO (CINAHL Plus with Full Text, MEDLINE with Full Text), MedicLatina, Academic Search Complete, with full text articles, published between 2008/01/01 and 2015/01/31, with the following keywords: [(MM "leg ulcer") OR (wound care) OR (wound healing)] AND [(nursing) OR (nursing assessment) OR (nursing intervention)]. Results: The different leg ulcer etiologies require different therapeutic approach to prevention and treatment. Predictive factors were identified associated with healing: patient-centred care, interpersonal relationship, pain control, control of the exudate, education for health self-management, self-care, therapeutic compliance, implementation of guidelines, auditing and feedback on the practices. Conclusion: Evidence-based practice helps to improve efficiency, safety and quality of nursing care directed to people with leg ulcers or at risk of developing this type of wounds.

Worldwide Wound Healing - Innovation in Natural and Conventional Methods

The book Worldwide Wound Healing - Innovation in Natural and Conventional Methods develops a set of themes on the healing and treatment of complex wounds through evidence-based practice with innovations in the use of natural and conventional methods. It is an innovative way that promotes the integration of conventional and natural perspectives in wound healing, with a unique focus on the quality of life of the patient.

Promoting physical activity to older adults: a preliminary evaluation of three general practice-based strategies

The aim of this study was to explore the feasibility of an exercise scientist (ES) working in general practice to promote physical activity (PA) to 55 to 70 year old adults. Participants were randomised into one of three groups: either brief verbal and written advice from a general practitioner (GP) (G1, N=9); or individualised counselling and follow-up telephone calls from an ES, either with (G3, N=8) or without a pedometer (G2, N=11). PA levels were assessed at week 1, after the 12-wk intervention and again at 24 weeks. After the 12-wk intervention, the average increase in PA was 116 (SD=237) min/wk; N=28, p < 0.001. Although there were no statistically significant between-group differences, the average increases in PA among G2 and G3 participants were 195 (SD=207) and 138 (SD=315) min/wk respectively, compared with no change (0.36, SD=157) in G1. After 24 weeks, average PA levels remained 56 (SD=129) min/wk higher than in week 1. The small numbers of participants in this feasibility study limit the power to detect significant differences between groups, but it would appear that individualised counselling and follow-up contact from an ES, with or without a pedometer, can result in substantial changes in PA levels. A larger study is now planned to confirm these findings.

Adult starvation and disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee

Background & aims: Multiple definitions for malnutrition syndromes are found in the literature resulting in confusion. Recent evidence suggests that varying degrees of acute or chronic inflammation are key contributing factors in the pathophysiology of malnutrition that is associated with disease or injury. Methods: An International Guideline Committee was constituted to develop a consensus approach to defining malnutrition syndromes for adults in the clinical setting. Consensus was achieved through a series of meetings held at the ASPEN and ESPEN Congresses. Results: It was agreed that an etiology-based approach that incorporates a current understanding of inflammatory response would be most appropriate. The Committee proposes the following nomenclature for nutrition diagnosis in adults in the clinical practice setting. ""Starvation-related malnutrition"", when there is chronic starvation without inflammation, ""chronic disease-related malnutrition"", when inflammation is chronic and of mild to moderate degree, and ""acute disease or injury-related malnutrition"", when inflammation is acute and of severe degree. Conclusions: This commentary is intended to present a simple etiology-based construct for the diagnosis of adult malnutrition in the clinical setting. Development of associated laboratory, functional, food intake, and body weight criteria and their application to routine clinical practice will require validation. (C) 2009 European Society for Clinical Nutrition and Metabolism and ASPEN American Society for Parenteral and Enteral Nutrition. Published by Elsevier Ltd. All rights reserved.

Adult Starvation and Disease-Related Malnutrition: A Proposal for Etiology-Based Diagnosis in the Clinical Practice Setting From the International Consensus Guideline Committee

Background & Aims: Multiple definitions for malnutrition syndromes are found in the literature resulting in confusion. Recent evidence suggests that varying degrees of acute or chronic inflammation are key contributing factors in the pathophysiology of malnutrition that is associated with disease or injury. Methods: An International Guideline Committee was constituted to develop a consensus approach to defining malnutrition syndromes for adults in the clinical setting. Consensus was achieved through a series of meetings held at the ASPEN. and ESPEN Congresses. Results: It was agreed that an etiology-based approach that incorporates a current understanding of inflammatory response would be most appropriate. The Committee proposes the following nomenclature for nutrition diagnosis in adults in the clinical practice setting. ""Starvation-related malnutrition,"" when there is chronic starvation without inflammation, ""chronic disease-related malnutrition"", when inflammation is chronic and of mild to moderate degree, and ""acute disease or injury-related malnutrition"", when inflammation is acute and of severe degree. Conclusions: This commentary is intended to present a simple etiology-based construct for the diagnosis of adult malnutrition in the clinical setting. Development of associated laboratory, functional, food intake, and body weight criteria and their application to routine clinical practice will require validation. (JPEN J Parenter Enteral Mar. 2010;34:156-159)

Ways of using evidence-based medicine in general practice

General practitioners wanting to practise evidence-based medicine (EBM) are constrained by time factors and the great diversity of clinical problems they deal with. They need experience in knowing what questions to ask, in locating and evaluating the evidence, and in applying it. Conventional searching for the best evidence can be achieved in daily general practice. Sometimes the search can be performed during the consultation, but more often it can be done later and the patient can return for the result. Case-based journal clubs provide a supportive environment for GPs to work together to find the best evidence at regular meetings. An evidence-based literature search service is being piloted to enhance decision-making for individual patients. A central facility provides the search and interprets the evidence in relation to individual cases. A request form and a results format make the service akin to pathology testing or imaging. Using EBM in general practice appears feasible. Major difficulties still exist before it can be practised by all GPs, but it has the potential to change the way doctors update their knowledge.