FRAGILIDADES NO CONHECIMENTO DOS ENFERMEIROS SOBRE LESÃO POR PRESSÃO

O DESENVOLVIMENTO DE UMA LESÃO POR PRESSÃO É CONSIDERADO UM EVENTO ADVERSO QUE PROLONGA A RECUPERAÇÃO DO PACIENTE. A IDADE AVANÇADA CONSTITUI UM DOS FATORES DE RISCO INTRÍNSECOS AO SURGIMENTO DAS LP, ALÉM DA IMOBILIDADE, ALTERAÇÕES NA PERCEPÇÃO SENSORIAL E ESTADO NUTRICIONAL. ESTE ESTUDO TRATA-SE DE UMA REVISÃO INTEGRATIVA DA LITERATURA COM OBJETIVO DE REALIZAR UM LEVANTAMENTO SOBRE AS LACUNAS DO CONHECIMENTO DOS ENFERMEIROS RELACIONADAS A LP. FORAM SELECIONADOS 20 ARTIGOS NAS BASES DE DADOS BDENF, LILACS, MEDLINE, SCOPUS, GOOGLE SCHOLAR E WEB OF SCIENCE, UTILIZANDO A ESTRATÉGIA DE BUSCA EM PORTUGUÊS: (“LESÃO POR PRESSÃO” OR “ÚLCERA POR PRESSÃO” OR “ÚLCERA DE DECÚBITO” OR “ESCARA DE DECÚBITO”) AND ENFERMAGEM AND CONHECIMENTO, E, EM INGLÊS, (“PRESSURE ULCER” OR “BED SORE” OR “BED SORES” OR BEDSORE OR BEDSORES) AND NURSING AND KNOWLEDGE. VERIFICOU-SE QUE AS CLASSIFICAÇÕES DOS ESTÁGIOS 2 E 3 FORAM AS QUE APRESENTARAM MENOR NÚMERO DE ACERTOS NOS ESTUDOS. EVIDENCIOU-SE DEFICIÊNCIA DE CONHECIMENTO SOBRE DEFINIÇÃO DE CISALHAMENTO E A REDUÇÃO DE OFERTA DE OXIGÊNIO COMO FATOR DE RISCO PARA LP. AS MEDIDAS PREVENTIVAS QUE APRESENTARAM MAIOR FRAGILIDADE DO CONHECIMENTO REFEREM-SE AO ÂNGULO DA CABECEIRA DO LEITO E FREQUÊNCIA DE REPOSICIONAMENTO DE PACIENTES EM POSIÇÃO SENTADA. A IDENTIFICAÇÃO DAS LACUNAS DE CONHECIMENTO É UMA FERRAMENTA ESSENCIAL PARA O PLANEJAMENTO INSTITUCIONAL E MELHORIA NA QUALIDADE DA ASSISTÊNCIA.

Effect of preoperative feeding with germinated brown rice supplement on clinical outcome of orthopaedic and gastrointestinal surgery patients

Background: Malnutrition prior to surgery can lead to inflammation, increased length of hospital stay, bed sores, muscle weakness, poor quality of life and mortality post-surgery in patients. Therefore, preoperative drinks that have been enriched with vitamins, easily digestible carbohydrates and amino acids have been necessitated by ESPEN. Health benefits of brown rice, which is a good source of phytonutrients like GABA, Ferulic acid Oryzanol and B- complex, BCAA and maltodextrin, have been well researched.Methods: In the present study, a nutritious product was developed using germinated brown rice, salt and micronutrient mix (GBR Mix), analysed quantitatively (Proximate composition) and qualitatively (Phytochemicals). Major orthopaedic and gastrointestinal surgical patients in the age group of 40-65 years (n=124) were supplemented with GBR Mix in bouts of 3 meals (20gms x 3meals) namely lunch, mid-evening and bedtime time snack, 8 hrs prior to surgery unlike other patients who fasted for 12-16 hours prior to surgery. They were assessed for nutritional status, Serum Albumin, inflammatory markers (CRP and WBC), post-surgery complications and length of hospital stay.Results: Supplementation was found to improve blood sugar (p<0.05) in gastroenterology patients, reduce inflammatory markers like CRP(p=0.053) and WBC (p<0.001), reduced nausea and vomiting, improved food and fluid intake post-surgery in the patients. Additionally, length of hospital stay was also reduced (p=0.001).Conclusion: Thus, germinated brown rice could be recommended as an economical nutritious and anti-inflammatory pre surgery feed.Keywords: GBR, LOS, MUST, SGA, CRP, Micronutrient Mix

Enterocutaneous fistula; Management Challenges,Areterospective Review of 11 Patients Treated in our Institute

Enterocutaneous fistula is a local pathology and systemic disorder. OBJECTIVES: To analyze postoperative outcomes, morbidity, and mortality in patients treated for enterocutaneous fistula in our institute for past 18 months. DESIGN, SETINGS AND PATIENTS: Reterospective review of records of patients presented to Liaquat national university hospital Karachi, Pakistan between Jan 2010 to June 2011 with diagnosis of EC fistula. RESULTS: A total of eleven patients presented with diagnosis of enterocutaneous fistula in our institute in specified duration. Mean age at presentation was 33 years with amle to female ratio of 3:1.72.7 % had high output fistula and 27.2 % had low output fistula. Small bowel was involved in 72.7%, large bowel in 18.18% and 9.0% had both small and large bowel fistula.45.45% patients had single fistula while 54.55 had multiple fistula. Total length of stay varied between 22-150 days .6/11 (54.54%) had nosocomial infection, 3/11(27.27%) had bed sores.2/11(18.18%) had TPN related complications.Spontaneous closure occurred in 8/11(72.77) patients and definitive surgical closure was performed in one patient. Mortality rate was 18.8 %. CONCLUSION: Enterocutaneous fistula is a devastating outcome for both surgeons and patients, sytemetic timely multidisciplinary approach can save lives.

Smart Diaper System Using Bluetooth and Smartphone to Detect Urination and Volume of Voiding Automatically: A Prospective Observational Pilot Study in an Acute Care Hospital (Preprint)

BACKGROUND Caregivers of patients who wear conventional diapers are required to check voiding every hour because prolonged wearing of wet diaper causes health problems including diaper dermatitis and urinary tract infection. However, frequent checking is labor-intensive and disturbs patients’ or caregivers’ sleep. Furthermore, assessing urine output of the patients with diapers in an acute care setting is difficult. Recently, a smart diaper system with wetness-detection technologies has been developed to solve these issues. OBJECTIVE We aimed to evaluate the applicability of the smart diaper system for urinary detection, its accuracy for measuring voiding volume, and incontinence-associated dermatitis (IAD) occurrence in an acute care hospital. METHODS This prospective, observational, single-arm pilot study was conducted at a single tertiary hospital. We recruited 35 participants aged ≥50 years who were wearing diapers due to incontinence between August and November 2020. When the smart diaper was wet, the smart diaper system notified the caregiver to change the diaper and measured voiding volume automatically. Caregivers were instructed to record the weight of wet diapers on the frequency-volume charts (FVCs). We determined the voiding detection rate of the smart diaper system and compared the automatically calculated urine volume by the smart diaper system with the recorded volume on FVCs. Agreement between the two measurements was estimated using the Bland-Altman plot. We also checked the occurrence or aggravation of IAD and bed sores. RESULTS A total of 30 participants completed the protocol. Three hundred and ninety episodes of urination were recorded. There were 108 records (27.7%) on the FVCs and the smart diaper system concurrently, 258 (66.2%) on the FVCs alone, 18 (4.6%) on the smart diaper system alone, and six (1.5%) on the FVCs with sensing device lost. The detection rate of the smart diaper system was 32.8% (126/384). In analysis of records concurrently listed in both the FVCs and the smart diaper system, linear regression showed a strong correlation between the two measurements (R2=0.88, P<.001). The Bland-Altman assessment showed good agreement between the two measurements with a mean difference of –4.2 ml and 95% limits of agreement between –96.7 and 88.3 ml. New occurrence or aggravation of IAD and bed sores was not observed. Bed sore was improved in one participant. CONCLUSIONS The smart diaper system showed acceptable accuracy for measuring urine volume, and it could replace the conventional FVCs in acute setting hospitals. Furthermore, the smart diaper system showed its potential advantage to prevent IAD development and bed sore worsening. However, the detection rate of the smart diaper system was below than the researchers’ expectation. Detection rate polarization among participants was observed, and improvements in user interface and convenience are needed for aged individuals who are unfamiliar to the smart diaper system.

Physical Therapy’s Management for the Complex Treatment of Patients Having Had a Cerebral Vascular Accident - Case Study

Worldwide, cerebral vascular accident is one of the leading causes of morbidity and mortality. According to the World Health Organization, 6,5 million cerebrovascular accident- induced deaths were recorded in 2011. In Romania, the cerebrovascular accident is the third mortality cause, after cancer and cardiovascular diseases. The number of cerebral vasculo-circulatory diseases continues to grow, due to atherosclerosis and high blood pressure frequency. Physical therapy aims to help patients gradually recover the range of motion in their lower and upper limbs, reduce oedema, prevent bed sores, prevent or reduce joint stiffness, as well as recover the ability to perform day to day activities. The purpose of this paper was to highlight physical therapy’s beneficial outcome when applied individualised to a patient having had a cerebral vascular accident with a view to improving the psycho- motor and sensory imbalances accompanying this diagnosis.

Design of Automated Bed for Prevention of Pressure Ulcer for Patient with Moving Disability

In this paper, a design of mattress for patients suffering from pressure ulcer has been proposed. When patients are lying in the bed due to their disability or disorder, the body cells do not function properly and leads to decaying because the body is pressurized and there is no circulation of air. This design helps in lifting the patient body in a periodic manner in order to prevent decay and hence the formation of ulcers is prevented. The most important is that patient does not feel any discomfort in the body when the movement is made. The proposed system helps the patient with moving disability by preventing them from becoming victims of bed sores.

Mechanism design and analysis of a proposed wheelchair-exoskeleton hybrid robot for assisting human movement

As a conventional mobile assistance device, a wheelchair makes people suffer from skin injuries such as bed sores and ulcer, owing to sitting on a wheelchair for a long period. And the wheelchair is barely able to adapt to complex terrains, such as stairs. With the development of robotic technology, the rise of lower-limb exoskeleton robotics provides a new means of motion assistance, and provides training of motor ability. However, it can't support a user to compete long-distance movement because a user need consume much energy to keep balance. Considering the merits and demerits of wheelchairs and exoskeletons, we propose a novel hybrid motion assistant robot that combines both. The biggest challenge is the design of a mechanism that can transform the robot from a wheelchair into an exoskeleton, as well as the reverse transformation. To achieve this goal, the mechanism must be able to achieve three configurations: the wheelchair configuration, the support configuration, and the exoskeleton configuration. To reduce the weight of the robot and make it more compact, the linkages and actuators in the mechanism are designed to be reusable when the configuration changes. The mechanism is designed based on the analysis of functional requirements, and distributed synthesis of the mechanism is adopted. The kinematics and statics of every configuration are discussed in detail, to obtain the most reasonable dimensions using the particle swarm optimization algorithm. The mechanism performance is simulated and verified using ADAMS software. Finally, an experimental prototype is constructed for preliminary tests.