Prevenção de recidiva de úlcera varicosa: um estudo de coorte

RESVECH 2.0: adaptação transcultural para o Brasil, confiabilidade e validade para avaliação de úlceras venosas

RESUMO Objetivos: adaptar transculturalmente a escala Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 para o português do Brasil; estimar sua consistência interna, validade de construto e de critério para utilização em úlceras venosas. Métodos: estudo metodológico, baseado em diretrizes internacionais para estudos dessa natureza. Realizou-se avaliação das feridas por meio da RESVECH 2.0 e da Pressure Ulcer Scale of Healing 3.0 (PUSH). Empregou-se análise descritiva, análise fatorial confirmatória, alfa de Cronbach e correlação de Spearman (p<0,05). Resultados: participaram 12 enfermeiros e 77 pessoas com 153 úlceras venosas. A tradução foi bem-sucedida, o modelo fatorial proposto foi validado, obteve-se alfa de Cronbach = 0,832 (IC95%=0,780-0,880) e coeficiente de correlação (RESVECH 2.0 e PUSH 3.0) = 0,74. Conclusões: a adaptação da RESVECH 2.0 para o português do Brasil é robusta. A confiabilidade e validade evidenciam compatibilidade para utilização no país e avaliação de úlceras venosas.

RESVECH 2.0: cross-cultural adaptation for Brazil, reliability and validity for the evaluation of venous ulcers

Objectives:

to cross-culturally adapt the scale Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 for Brazilian Portuguese; to estimate the internal consistency and construct and criterion validity of the scale in the evaluation of venous ulcers.

Methods:

methodological study, based on international guidelines for studies of this type. Wounds were evaluated using the RESVECH 2.0 and Pressure Ulcer Scale of Healing 3.0 (PUSH). Descriptive analysis, confirmatory factor analysis, Cronbach’s alpha and Spearman’s correlation (p<0.05) were used.

Results:

12 nurses and 77 people with 153 venous ulcers participated in the study. The translation was successful, the proposed factor model was validated, and Cronbach ‘s alpha = 0.832 (95%CI, 0.780-0.880) and correlation coefficient (RESVECH 2.0 and PUSH 3.0) = 0.74 were obtained.

Conclusions:

the adaptation of RESVECH 2.0 to Brazilian Portuguese is robust. Reliability and validity show compatibility for use in the country in the evaluation of venous ulcers.

SELF-ASSESSMENT OF PRIMARY CARE NURSES ABOUT CARE FOR PEOPLE WITH VENOUS ULCERS: A CROSS-CUTTING STUDY

Objective: To identify the self-knowledge of primary care nurses about care for people with venous ulcers. Method: This is a cross-sectional study with 40 nurses working in health units. Two data collection instruments were used: characterization, developed by the author, and self-assessment on venous ulcers. Results: All questions of the self-assessment instrument reached medians classified as little level of knowledge, except questions related to the application of elastic compression therapy, with the median = 3 (moderate), and the evaluation of lower limbs to investigate arterial involvement, with 3.50, between little and moderate. The item cleaning the lesion stood out, which obtained median = 4 (little) and the highest average found in the responses, 4.03 (little). Conclusion:The nurse’s self-assessment reached moderate and low scores of clinical practice in terms of knowing (theoretical knowledge) and doing (practical knowledge) in the care of people with venous ulcers. Venous ulcer is a complex wound and requires knowledge from nurses about the pathophysiology and appropriate treatment, interfering with the improvement of the person’s quality of life. It is believed that this study can encourage the reflection of this professional and education actions in the services.

AUTOAVALIAÇÃO DE ENFERMEIROS DA ATENÇÃO PRIMÁRIA SOBRE ASSISTÊNCIA À PESSOA COM ÚLCERAS VENOSAS: UM ESTUDO DE CORTE TRANSVERSA

Objetivo:Identificar o autoconhecimento de enfermeiros da atenção primária sobre assistência à pessoa com úlceras venosas. Método: Trata-se de um estudo de corte transversal com 40 enfermeiros lotados em unidades de saúde. Utilizaram-se dois instrumentos de coleta de dados: caracterização, elaborada pelo autor, e autoavaliação sobre úlcera venosa. Resultados: Todas as questões do instrumento autoavaliativo alcançaram medianas classificadas como nível de conhecimento pouco, à exceção das questões relativas à aplicação de terapia compressiva elástica com mediana = 3 (moderado) e à avaliação de membros inferiores para investigar comprometimento arterial, 3,50, entre pouco e moderado. Destacou-se o item limpeza da lesão, o qual obteve a mediana = 4 (pouco) e a maior média encontrada das respostas, 4,03 (pouco). Conclusão: A autoavaliação do enfermeiro atingiu os escores moderado e pouco da prática clínica no que tange ao saber (conhecimento teórico) e ao fazer (conhecimento prático) no cuidado à pessoa com úlcera venosa. A úlcera venosa é uma ferida complexa e exige do enfermeiro conhecimento sobre a fisiopatologia e o tratamento adequado, interferindo na melhora da qualidade de vida dessa pessoa. Acredita-se que este estudo possa fomentar a reflexão desse profissional e ações de educação nos serviços.

Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient Clinic: Historical Cohort

The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.

Venous ulcer: characterization of outpatient care at a university hospital

Objective: To characterize the clinical and sociodemographic profile of people with venous ulcers followed up in a specialize outpatient clinic of a university hospital. Method: documentary study carried out in a general surgery outpatient clinic of a university hospital. 104 instruments applied in the first nursing consultation were reviewed. Results: there was a predominance of females, with a mean age of 54 years. The majority did not perform paid work, the wound being the reason for leaving work activities. Systemic arterial hypertension and obesity were the most prevalent comorbidities. The person with venous ulcer was the main person involved in direct care of the wound. Conclusion: the profile of the study population is compatible with other studies in different contexts in Brazil. The results allow a reflection on the assistance provided and the effectiveness of the implemented interventions.

Úlcera venosa: caracterização dos atendimentos em ambulatório de hospital universitário

Objetivo: caracterizar o perfil clínico e sociodemográfico de pessoas com úlceras venosas acompanhadas em ambulatório especializado de um hospital universitário. Método: estudo documental realizado em ambulatório de cirurgia geral de um hospital universitário. Realizou-se a revisão de 104 instrumentos aplicados na primeira consulta de enfermagem. Resultados: houve predominância do sexo feminino, com média de idade de 54 anos. A maioria não exercia atividade remunerada, sendo a ferida o motivo do afastamento das atividades laborais. A hipertensão arterial sistêmica e a obesidade foram as comorbidades mais prevalentes. A pessoa com úlcera venosa foi a principal envolvida no cuidado direto com a ferida. Conclusão: o perfil da população do estudo se mostra compatível com outros estudos em diferentes contextos do Brasil. Os resultados permitem uma reflexão acerca da assistência prestada e efetividade das intervenções implementadas.

Hyperelastic Properties of Platinum Cured Silicones and its Applications in Active Compression

This paper presents the fundamental research of design, development, and evaluation of an active compression system consisting of silicone based inflatable mini-bladders, which could be used in applying radial pressure for the treatment of venous disease. The use of mini-bladders will nullify the effect of radius of curvature and provide a higher resolution to the pressure distribution. They are designed with two elastomeric layers and inflation is limited only to one side. The mini-bladders apply a radial force onto the treated surface when inflated, and the pressure inside mini-bladders could be measured using the concept of back pressure, which provides the flexibility to inflate mini-bladders to a predefined pressure. The 3-D deformation profile of the mini-bladders was analysed using finite element method (FEM) and FEM simulations were validated with experimental data, which showed good agreement within pressure region required for the treatment of venous disease. Finally, the pressure transmission characteristics of mini-bladders were evaluated on a biofidellic lower leg surrogate and the results have shown that the mini-bladders could apply a uniform pressure irrespective of the location on the leg with a 60%–70% of inlet pressure successfully transmitted onto the leg surface, while 40%–50% was available after the fat layers.

Noninvasive measures of venous ulcer recurrence prevention: integrative review

Objective: This study aimed to identify, in the literature, noninvasive measures for prevention of venous ulcer recurrence (VUs). Methods: An integrative review was carried out in the databases of the Biblioteca Virtual em Saúde (BVS), Public Medline (PubMed), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Excerpta Medica Database (Embase) in the period from 2015 to 2017. the search was performed using the controlled descriptors «varicose ulcer» and «recurrence» and the Boolean operator AND between them in all databases described, in Portuguese, English, and Spanish. After the searches, two reviewers carried out the pre-selection by titles and summary of the articles followed by the full reading of the pre-selected studies. Results: 210 studies were identified, of which 188 were excluded because they did not attend to the guiding question. Two reviewers read in full the 22 pre-selected articles and included in this review nine that were part of the discussion of this paper. Conclusion: Studies in this review suggest that adherence and correct use of compressive therapy with socks associated with education and self-care measures are effective in preventing recurrence of VU. The association of acetylsalicylic acid with standard measures of treatment still lacks conclusive results and new studies to prove efficacy are suggested.

Medidas não invasivas de prevenção da recidiva de úlcera venosa: revisão integrativa

Objetivo: Este estudo teve como objetivo identificar, na literatura, as medidas não invasivas de prevenção da recidiva de úlceras venosas (UVs). Método: Realizou-se revisão integrativa nas bases de dados da Biblioteca Virtual em Saúde (BVS), Public Medline (PubMed), Cumulative Index of Nursing and Allied Health Literature (CINAHL) e Excerpta Medica dataBASE (Embase) no período de 2015 a 2017. A busca bibliográfica foi realizada utilizando-se os descritores controlados “varicose ulcer” e “recurrence” e o operador booleano AND entre eles em todas as bases de dados descritas, em português, inglês e espanhol. Após as buscas, dois revisores realizaram a pré-seleção por títulos e resumo dos artigos seguida da leitura na íntegra dos estudos pré-selecionados. Resultado: Identificaram-se 210 estudos, sendo que 188 foram excluídos por não atenderem à questão norteadora. Dois revisores leram na íntegra os 22 artigos pré-selecionados e incluíram nesta revisão nove que fizeram parte da discussão deste trabalho. Conclusão: Os estudos desta revisão sugerem que a adesão e o uso correto da terapia compressiva com meias associados a medidas de educação e autocuidado são efetivos para prevenção de recidiva da UV. A associação de ácido acetilsalicílico com as medidas padrão de tratamento ainda carece de resultados conclusivos e sugerem-se novos estudos para comprovação da eficácia.

Compression therapy: Unna boot applied to venous injuries: an integrative review of the literature

OBJECTIVE

To analyze the literature related to the types of therapies for venous injuries with emphasis on use of the Unna boot, and to investigate and discuss the main aspects related to its use compared to other techniques.

METHOD

Integrative review of the literature of the last five years through searches in the following databases: VHL, LILACS, BDENF, SciELO, MEDLINE/PubMed.

RESULTS

Twenty-two publications were identified, with 15,931 cases among adult or elderly individuals, whose mean age was 60 (35-78) years or greater with no sex differences. The Unna boot presented a shorter healing time than the single and two-layer elastic bandage.

CONCLUSION

Although other compression techniques may prove to be more efficient than the Unna boot by adding more technology, the boot stands out as a traditional low-cost dressing. Multilayer bandage is a gold standard technique. This review demonstrated the best option may not be the Unna boot, because it requires a higher healing time compared to the multilayer bandage, but it meets the expectation with a high rate of treatment efficiency, also when compared to simple dressing, single or two-layer bandage.