Application of a glycaemic control optimization programme in patients with stress hyperglycaemia

Physician and Nurse Research in Multidisciplinary Intensive Care Units

BACKGROUND

Although clinical care is multidisciplinary, intensive care unit research commonly focuses on single-discipline themes. We sought to characterize intensive care unit research conducted by physicians and nurses.

METHODS

One hundred randomly selected reports of clinical studies published in critical care medical and nursing journals were reviewed.

RESULTS

Of the 100 articles reviewed, 50 were published in medical journals and 50 were published in nursing journals. Only 1 medical study (2%) used qualitative methods, compared with 9 nursing studies (18%) (P = .02). The distribution of quantitative study designs differed between medical and nursing journals (P < .001), with medical journals having a predominance of cohort studies (29 articles [58%]). Compared with medical journal articles, nursing journal articles had significantly fewer authors (median [interquartile range], 5 [3-6] vs 8 [6-10]; P < .001) and study participants (94 [51-237] vs 375 [86-4183]; P < .001) and a significantly lower proportion of male study participants (55% [26%-65%] vs 60% [51%-65%]; P = .02). Studies published in medical journals were much more likely than those published in nursing journals to exclusively involve patients as participants (47 [94%] vs 25 [50%]; P < .001). Coauthorship between physicians and nurses was evident in 14 articles (14%), with infrequent inclusion of authors from other health care disciplines.

CONCLUSIONS

Physician research and nurse research differ in several important aspects and tend to occur within silos. Increased interprofessional collaboration is possible and worthwhile.

Nursing interventions to reduce surgical site infection in potentially contaminated surgeries: an integrative review

Objective: Identify nursing interventions that contribute to the reduction of surgical site infections in potentially contaminated surgeries. Methods: Integrative review, carried out in four databases. There were 5,888 articles published in the period from January 2008 to July 2018, in English, Portuguese and Spanish, from which nine articles were selected after final analysis. Results: The nursing interventions appeared according to the perioperative periods: preoperative (55.55%), intraoperative (33.33%), postoperative (66.66%), being associated with: antibiotic therapy, trichotomy, alcoholic chlorhexidine bathing, hand hygiene, sterile glove/wear/ package change for fascia and skin closure, degermination, antisepsis, surgical classification, surgical time, care with dressings and drains, temperature and blood glucose control, patient education, discharge and post-hospital discharge orientation. Conclusions: Nursing interventions were identified in each perioperative period, proving to be essential for the qualification of nursing care and effective in reducing surgical site infection in potentially contaminated surgeries.

Intervenções de enfermagem para reduzir infecção do sítio cirúrgico em cirurgias potencialmente contaminadas: revisão integrativa

Objetivo: Identificar as intervenções de enfermagem que contribuem para a redução das infecções de sítio cirúrgico (ISCs) em cirurgias potencialmente contaminadas. Métodos: Revisão integrativa, realizada em quatro bases de dados. Foram encontrados 5.888 artigospublicados no período de janeiro de 2008 a julho de 2018, nos idiomas inglês, português e espanhol, sendo selecionados nove artigos após análise final. Resultados: As intervenções de enfermagem apareceram conforme os períodos perioperatórios: pré-operatório (55,55%), intraoperatório (33,33%) e pós-operatório (66,66%), estando associadas à: antibioticoterapia, tricotomia, banho de clorexidina alcoólica, higiene das mãos, troca de luva estéril/vestimenta/pacote para fechamento da fáscia e da pele, degermação, antissepsia, classificação cirúrgica, tempo cirúrgico, cuidados com curativos e drenos, controle de temperatura e glicemia, educação do paciente, orientações na alta e pós-alta hospitalar. Conclusões: As intervenções de enfermagem foram identificadas em cada período do perioperatório, mostrando-se essenciais para a qualificação da assistência de enfermagem e eficazes na redução da infecção do sítio cirúrgicos em cirurgias potencialmente contaminadas.

Hepatic and renal functions and blood cell counts in brain tumor patients during the perioperative period

We aimed to investigate the correlations between biochemical and hematological markers and the clinical conditions of brain tumor patients before and after craniotomy. A retrospective study was conducted in 90 brain tumor patients. Age, gender, underlying diseases, tumor size and intraoperative blood loss were recorded. Red blood cell counts and hepatic and renal markers were analyzed preoperatively and postoperatively. Albumin decreased by 5.6 g/L after surgery (p < 0.001). Older patients (>52 years) and females had lower albumin levels than younger patients and males did. Red blood cell counts and hemoglobin levels decreased significantly on the 1st and increased on the 3rd postoperative day. The blood glucose level increased on the 1st postoperative day and then decreased. Older patients had higher blood glucose levels than younger patients did (p < 0.05). The postoperative serum sodium, potassium and calcium levels were within the normal ranges; 37 patients had hypocalcemia (41.1%) and patients with hypokalemia and hyponatremia increased postoperatively. Albumin and hemoglobin levels were linearly correlated (correlation coefficient 0.559, p < 0.001). Intraoperative blood loss was correlated with tumor size (p < 0.05) but did not affect the decrease in hematological markers. In brain tumor patients, red blood cell counts and hemoglobin and serum albumin levels were significantly decreased after craniotomy; these effects were influenced by gender and age instead of intraoperative blood loss. The postoperative blood glucose level peaked and then decreased; it was affected by age and diabetes mellitus. Electrolytes remained relatively stable. These findings have implications for patient management and postoperative complication prevention.