[People with vascular ulcers in outpatient nursing care: a study of sociodemographic and clinical variables]

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.

Using AutoCAD software to measure venous leg ulcers: a reproducibility assessment study

OBJECTIVE

To assess the reproducibility of using AutoCAD software to measure the area of venous leg ulcers (VLUs).

METHOD

Data from patients with VLUs were collected between March and July 2015, using data collection forms and photographing the different ulcers. A researcher and five nurses collected the data. The wounds were measured using AutoCAD software. Data were analysed using intraclass correlation coefficient (ICC), concordance correlation coefficient (CCC) and Bland-Altman analysis.

RESULTS

A total of 21 patients with 36 VLUs were included in the study. A statistically significant difference (p<0.05) was observed between the areas of VLUs measured by the researcher and the evaluators. There was an excellent agreement when analysing the ICC [p=0.98; 95% CI (0.97-0.99); p <0.05] and the CCC [CCC=CI 0.97; 95% (0.95-0.98)]. There was no difference between the measurements of VLUs ≤10 cm² (p=0.49) and those with an area >10cm² (p=0.22).

CONCLUSION

The use of AutoCAD software is appropriate for measuring VLUs and appears to be more accurate when used to measure VLUs with an area >10cm².

Quality of life in patients with peripheral artery disease

Background

Vascular diseases have a direct influence on quality of life (QoL) and directly affect patients’ biopsychosocial aspects. Quality of life is therefore an important element for evaluation of vascular interventions.

Objective

To assess QoL in inpatients with peripheral arterial disease at a vascular surgery service in a charitable tertiary hospital.

Methods

This is an exploratory study, with a cross-sectional design, conducted at a vascular surgery service in a charitable tertiary hospital, assessing patients with peripheral arterial disease using two questionnaires, one on quality of life (the WHOQOL-Bref short form) and the other on sociodemographic conditions.

Results

It was observed that the physical domain, environment domain and total QoL scores were the lowest for the whole sample of 127 interviewees. Additionally, an intragroup analysis showed that men scored higher in all domains when compared with women, with the exception of the social relationships domain.

Conclusions

Women with peripheral arterial disease exhibited lower scores than men in all domains of the QoL questionnaire, except for social relationships.

Úlcera crônica tratada com gel de papaína 10% na Estratégia Saúde da Família: relato de experiência

As úlceras em membros inferiores são um problema de saúde pública em razão da significativa incidência, do elevado custo e de frequente recidiva. Frequentemente, a equipe da Estratégia Saúde da Família é o primeiro contato do portador de úlcera, necessitando estar atualizada acerca das opções terapêuticas. Um produto tópico utilizado no tratamento das úlceras cutâneas é o gel de papaína a 10%, devido às suas propriedades bactericida, bacteriostática e desbridante de tecidos necrosados, bem como acelerador de crescimento tecidual. Descreve-se a experiência da equipe da Estratégia Saúde da Família com a utilização de gel de papaína a 10% no tratamento de úlcera cutânea, que regrediu após o uso do gel, destacando-se o matriciamento pelo especialista para a resolutividade do caso.

Measurement of the area of venous ulcers using two software programs

Objective:

to compare the measurement area of venous ulcers using AutoCAD^(r) and Image Tool software.

Method:

this was an assessment of reproducibility tests conducted in a angiology clinic of a university hospital. Data were collected from 21 patients with venous ulcers, in the period from March to July of 2015, using a collection form and photograph of wounds. Five nurses (evaluators) of the hospital skin wound study group participated. The wounds were measured using both software programs. Data were analyzed using intraclass correlation coefficient, concordance correlation coefficient and Bland-Altman analysis. The study met the ethical aspects in accordance with current legislation.

Results:

the size of ulcers varied widely, however, without significant difference between the measurements; an excellent intraclass and concordance correlation was found between both software programs, which seem to be more accurate when measuring a wound area >10 cm².

Conclusion:

the use of both software programs is appropriate for measurement of venous ulcers, appearing to be more accurate when used to measure a wound area > 10 cm².

Validation of an instrument to assess nurses' level of knowledge on the prevention and treatment of individuals with venous ulcers

OBJECTIVES

Validating an instrument to assess nurse knowledge related to preventing and treating individuals with venous ulcer (VU).

METHODS

This is an exploratory study, conducted with 78 primary health care nurses. These professionals answered the questionnaire with twelve items pertaining to knowing and doing while addressing the person with VU. SPSS for Windows, version 21.0, with descriptive analyses and Pearson correlation was used for data analysis.

RESULTS

The measurement of questionnaire reliability, from Cronbach's alpha, revealed in the Theoretical Knowledge Domain (TKD), 0.88 alpha, and in the Practical Knowledge Domain (PKD), 0.70 alpha, indicators that guaranteed reliability of such a measurement for the extracted sample. With regard to the correlation between TKD and PKD and Nursing Care to the Person with VU, those were significant and strong in almost all items. The bi-factorial model, with theoretical and practical domains, is what best explains the nurse assistance for the person with VU. The nurse that knows one or both domains in treating wounds, probably, will allow for greater dominance over VU and in assisting the person with VU.

CONCLUSIONS

The validated version showed reliability, enabling thus the other professionals to tailor the same methodology to other topics, identifying the ramifications of knowing and doing and, thereby, strengthening gaps in the Nursing Education area.

Impacto de úlceras venosas na qualidade de vida de indivíduos atendidos na atenção primária

Objetivo: analisar o impacto das úlceras venosas (UV) na qualidade de vida (QV) das pessoas atendidas na atenção primária à saúde. Material e método: pesquisa quantitativa, descritiva e transversal, realizada com 101 usuários, atendidos em 42 serviços de saúde de Natal, Rio Grande do Norte, Brasil. Os dados foram coletados de fevereiro a setembro de 2014, por meio de um questionário sociodemográfico, clínico e de saúde, e do Charing Cross Venous Ulcer Questionnaire. Utilizou-se estatística descritiva e inferencial para a análise dos dados. Resultados: a QV esteve comprometida, principalmente, no estado emocional e estético, com pior média entre os indivíduos com mais de um ano de lesão. Identificou-se associação estatística significativa entre tempo de UV atual e estado emocional (p=0,008), com maior média (64,2) para aqueles com UV há mais de um ano. Conclusões: as pessoas com UV há mais de ano apresentam maior comprometimento da QV. Necessita-se de intervenções e ações de promoção à saúde dessa população.

Validação clínica de protocolo para úlceras venosas na alta complexidade

RESUMO Objetivo Realizar a validação clínica de um protocolo assistencial para pessoas com úlceras venosas em serviços de saúde de alta complexidade. Método Estudo metodológico, quantitativo, que incluiu quatro enfermeiros especialistas, que avaliaram 32 pacientes com úlceras venosas, no Hospital Universitário Onofre Lopes, em Natal/Rio Grande do Norte. A coleta de dados foi realizada entre julho e dezembro/2013 e a análise ocorreu por meio do teste Kappa (K), considerando K ≥ 0,61. Resultados Os itens com Kappa insatisfatórios foram excluídos, e os especialistas sugeriram modificações nas categorias: anamnese; exames; verificação da dor e pulsos; tratamento cirúrgico da doença venosa crônica; prevenção de recidiva; referência e contrarreferência. Conclusões O protocolo foi validado no contexto clínico, e sua composição, após os ajustes, foi de 15 categorias e 76 itens. A validação otimizou o instrumento quanto à aplicabilidade e à pertinência.

Combined therapy of Ulmo honey (Eucryphia cordifolia) and ascorbic acid to treat venous ulcers

OBJECTIVE

to assess the clinical effect of topical treatment using Ulmo honey associated with oral ascorbic acid in patients with venous ulcers.

METHOD

longitudinal and descriptive quantitative study. During one year, 18 patients were assessed who were clinically diagnosed with venous ulcer in different stages, male and female, adult, with a mean injury time of 13 months. Ulmo honey was topically applied daily. The dressing was applied in accordance with the technical standard for advanced dressings, combined with the daily oral consumptions of 500 mg of ascorbic acid. The monitoring instrument is the assessment table of venous ulcers.

RESULTS

full healing was achieved in 100% of the venous ulcers. No signs of complications were observed, such as allergies or infection.

CONCLUSION

the proposed treatment showed excellent clinical results for the healing of venous ulcers. The honey demonstrated debriding and non-adherent properties, was easy to apply and remove and was well accepted by the users. The described results generated a research line on chronic wound treatment.

Quality of life assessment of patients with and without venous ulcer

OBJECTIVES

to compare the quality of life of patients with chronic venous disease with and without ulcer and to identify the most affected aspects.

METHOD

cross-sectional study with a sample of 204 patients with chronic venous disease. The quality of life was assessed with the help of the SF-36 questionnaire. To compare the scores between the groups, the Mann-Whitney test was used, considering a statistically significant difference when p<0.05.

RESULTS

the quality of life score of patients with ulcer was lower when compared to that of patients without ulcer, in all domains and dimensions of the SF-36, particularly in the domains physical aspect and functional capacity, with very low scores.

CONCLUSION

all aspects of quality of life were more compromised in people with ulcers. These findings can contribute towards a better understanding of the effects of chronic venous disease on the quality of life and towards a better orientation of therapeutic interventions in this population.

The pernicious cycle of VLUs in Brazil: epidemiology, pathogeny and auxiliary healing methods

Venous leg ulcers (VLUs) represent the most advanced stage of chronic venous insufficiency. Despite the large body of knowledge available regarding the risk factors and aetiopathogeny of the condition, patients referred to public health care systems in developing countries often do not receive adequate diagnosis or early treatment, leading to clinical evolution and disease recurrence. This review collates updated information about the epidemiology, risk factors, aetiopathogeny, diagnosis, ulcer healing methods and determinant factors of the pernicious cycle of VLUs in developing countries, with a focus on the Brazilian setting.