Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2014-12-19T17:29:14Z No. of bitstreams: 2 Tese - Suelen Gomes Malaquias - 2014.xps: 9309452 bytes, checksum: 6ae3a269518040bdf129b85b12f8d9d0 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-12-22T11:05:29Z (GMT) No. of bitstreams: 2 Tese - Suelen Gomes Malaquias - 2014.xps: 9309452 bytes, checksum: 6ae3a269518040bdf129b85b12f8d9d0 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-12-22T11:05:30Z (GMT). No. of bitstreams: 2 Tese - Suelen Gomes Malaquias - 2014.xps: 9309452 bytes, checksum: 6ae3a269518040bdf129b85b12f8d9d0 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-07-10 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Analyze the conditions of care to people with vascular ulcers and the evolution of venous ulcers and associated factors among users of the public healthcare system in an interior city. The research integrated a cross- sectional design with a cohort study, developed from July 2011 to October 2013, in an interior Brazilian Midwest city. It involved people with vascular ulcers, the wound dressing units where this population was cared for and nursing professionals who worked there. Data were collected using interviews, clinical examinations, the Pressure Ulcer Scale Healing (PUSH), planigraphy, photographic records of the lesions, samples collected from the lesions for microbiological analysis, and a script for observation of the units. The greatest ulcer was elected as the main lesion. Criteria were established to detect ulcers considered to be infected and to classify the risk for cross- contamination in the units. A questionnaire was used to approach the nursing professionals. Associations were analyzed using a marginal homogeneity test, McNemar and the chi-square test, with p<0.05. The research proposal was approved by the Research Ethics Committee of the Federal University of Goiás (protocol 026/2011). Initially,31 people with vascular ulcers undergoing treatment at the 13 wound dressing units of the studied city were included. All units presented conditions classified as highly susceptible to cross- contamination. Of the 31 assessed ulcers, 29 (93.5%) presented evidence of infection. Samples could be collected from 25 lesions, and a positive result in culture was found for 23 (92.0%), with presence of one to three microorganisms. Seven (20.0%) occurrences were found for oxacillin- resistant staphylococcus, four (11.4%) forampicillin-resistant enterococci, and two (5.7%) for beta-lactam-resistant pseudomonasaeruginosa. Of the 26 participants with venous ulcers, 22 were included in the cohort and presented a mean age of 57.9 years, ulcers of median duration of 24 months (SD±32.8), covering an area up to 12 cm 2 (63.5%). An 18.2% healing rate was found in the follow-up from 6 to 15 months, with improvement in the condition of the ulcers, as evidenced by decreased total scores in the PUSH (p=0.041). Aggravation in healing conditions was associated with clinical signs of infection in the lesions (p=0.019). Regarding self-care, there was a prevalence of reports of care with feeding and rest, which did not agree with the recommendations in literature, and the use of medications to control systemic diseases. Among the 53 nursing professionals who worked in the units, nursing technicians (56.6%) prevailed. Of the 411 activities referred in the care of people with vascular ulcers, 392 were mapped in theNursing Intervention Classification, with 53.3% corresponding to the “wound/skin control” class, demonstrating that care is focused on the topical treatment of the lesion. In a context of limitations in the care of users, the evolution of the healing of ulcers in follow-up was found favorable, however, the healing rate was significantly low. This context points to the need to reorganize public policies for the care of people with vascular ulcers, as well as the model of management of care to this population. / Analisar as condições de atendimento a pessoas com úlceras vasculares e a evolução de úlceras venosas e fatores associados entre os usuários do sistema público de saúde em um município interiorano. Trata-se de pesquisa que integra delineamento transversal e estudo de coorte, realizado entre julho de 2011 a outubro de 2013, em uma cidade do interior do Centro-Oeste brasileiro, envolvendo pessoas com úlceras vasculares, as salas de curativo onde era prestado atendimento a essa população e os profissionais de enfermagem que atuavam nessas salas. Para a coleta de dados utilizaram-se: entrevista, exame clínico, Pressure Ulcer Scale Healing (PUSH), planigrafia, registro fotográfico de lesões, coleta de espécime das lesões para análise microbiológica, roteiro de observação das salas de curativo. Elegeu-se a maior úlcera como a principal. Estabeleceram-se critérios para detecção de úlceras consideradas infectadas e para classificação de risco de contaminação cruzada nas salas. Na abordagem dos profissionais de enfermagem, utilizou-se questionário. Para análise de associações, utilizou-se teste de homegeneidade marginal, McNemar e qui- quadrado, com valor de p<0,05. Obteve-se aprovação do Comitê de Ética em Pesquisa da Universidade Federal de Goiás (protocolo 026/2011). Incluíram-se inicialmente 31 pessoas com úlceras vasculares que estavam em atendimento nas 13 salas de curativo do município estudado. Todas as salas apresentavam condições classificadas como altamente propensas a contaminação cruzada. Das 31 úlceras avaliadas, 29 (93,5%) apresentaram evidências de infecção. Foi possível coletar espécimes de 25 lesões, obtendo-se resultado positivo na cultura para 23 (92,0%) delas, com presença de um a três micro-organismos. Encontram-se sete (20,0%) ocorrências para estafilococos resistentes a oxacilina, quatro (11,4%) para enterococos resistentes a ampicilina, dois (5,7%) para P. aeruginosa resistentes a beta-lactâmicos. Dos 26 participantes que apresentavam úlceras venosas, 22 compuseram a coorte e apresentavam idade média de 57,9 anos, úlceras de duração mediana de 24 meses (DP±32,8), com área de até 12 cm 2 (63,5%). Verificou-se taxa de cicatrização de 18,2% no seguimento de seis a 15 meses e melhora nas condições das úlceras, evidenciado por diminuição dos escores totais da PUSH (p=0,041). Piora nas condições de cicatrização foi associada a sinais clínicos de infecção das lesões (p=0,019). Quanto às práticas de autocuidado, predominaram relatos de cuidados com alimentação, repouso, os quais não estavam em acordo às recomendações da literatura, e uso de medicamentos para controle de doenças sistêmicas. Entre os 53 profissionais de enfermagem que atuavam nas salas de curativo, predominaram técnicos de enfermagem (56,6%). Das 411 atividades referidas no atendimento à pessoas com úlceras vasculares mapearam-se 392 na Nursing Intervention Classification, sendo 53,3% correspondente à classe “controle de pele/feridas”, configurando um enfoque da assistência ao tratamento tópico da lesão. Num contexto de limitações no atendimento aos usuários, a evolução da cicatrização das úlceras no seguimento mostrou-se favorável, contudo, a taxa de cicatrização foi muito baixa. Esse contexto aponta para a necessidade de reorganização das políticas públicas para atendimento a pessoas com úlceras vasculares e do modelo de gestão do atendimento à essa população.

Objetivo: Determinar a influência do resultado imediato da angioplastia infrainguinal no sucesso clínico em 24 meses. Métodos: Foi realizado um estudo observacional prospectivo, que avaliou 40 angioplastias percutâneas infrainguinais, realizadas no período de abril de 2007 a fevereiro de 2011. Foram incluídos somente os casos com sucesso técnico e angiográfico intraoperatório. Todos os pacientes eram portadores de isquemia crítica de membro inferior decorrente unicamente de obstrução arterial crônica infrainguinal. Ultrassom com Doppler colorido (UDC) foi realizado um dia antes da cirurgia e no pós-operatório imediato. Foram registradas as velocidades de pico sistólico (VPS) nas artérias tibial anterior, tibial posterior e fibular na topografia do tornozelo. O gradiente de VPS pré e pós-operatório (GVPS) foi analisado e comparado prospectivamente quanto à melhora clínica em 2 anos, conforme os padrões recomendados pela SVS/ISCS. Foram utilizados os valores da artéria com a melhor variação perioperatória e da média das 3 artérias. Sucesso clínico foi definido como ausência de dor de repouso ou cicatrização de lesão. Resultados: Fizeram parte do estudo 19 mulheres e 20 homens, com média de idade de 68,5 ± 8,1 anos. Após 2 anos de seguimento, 26/40 lesões tiveram sucesso clínico sem novas intervenções cirúrgicas. Tempo de cicatrização variou de 4 a 111 semanas (mediana = 21,5 semanas). Lesões TASC II A/B tiveram sucesso clínico maior que TASC II C/D em 1 ano de seguimento (p<0,05), mas não em 2 anos (p=0,11). Entre os 14 casos de insucesso clínico, 6 foram submetidos a nova angioplastia e 4 a enxerto arterial. Três pacientes com angioplastia pérvia não tiveram cicatrização de lesão. Um paciente teve recorrência da úlcera no retorno de 24 meses. A perviedade primária foi de 62,5% ± 7,7% em 2 anos; e o salvamento de membro, de 92,5% ± 4,2% no mesmo período. Houve aumento de VPS, no leito distal, identificado pelo UDC. A variação de VPS foi de 44,4 cm/s, na melhor artéria, e de 21,9 cm/s, na média das artérias, para os casos de sucesso clínico. Para os casos de insucesso clínico, a variação foi de 45,3 cm/s, na melhor artéria, e de 24,7 na média das artérias. A comparação por UDC pré-operatória e pós-operatória imediata, através de VPS, não mostrou diferença estatística entre o grupos em 2 anos de seguimento. Conclusão: o aumento de fluxo pela avaliação por UDC, no pós-operatório imediato, não está relacionado com a resolução dos sintomas em 24 meses / Purpose: to evaluate the impact of the initial result of Percutaneous angioplasty (PA), objectively assessed with duplex-ultrasound, in the two-years clinical outcome. Methods: Between February 2007 and April 2011 thirty-nine patients with femoropopliteal atherosclerotic disease successfully treated by PA were included (40 limbs). One patient had both limbs treated in different occasions, and was considered as 2 cases for analysis. All patients had critical ischemia with rest pain and ischemic ulcers due to infrainguinal obstructions alone. The patients were submitted to duplex-ultrasound examination on the day before and on the first or second day after the procedure. Peak systolic velocities (PSV) was recorded in the anterior tibial, posterior tibial and fibular arteries at the level of distal third of the leg. All patients were followed for 2 years. Comparison between good and bad groups were based on VPS, including the perioperative gradient (GPSV) of the artery with highest variation and the mean of the VPS in the 3 arteries. After 2-years good result were defined as good when the patient had no pain and complete healing of a previous ulcer or minor amputations. It was considered as bad result when a second intervention was required or when unhealed lesions were present at the end of the 2-year period. Results: Mean age was 68,5 ± 8,1 years-old. In 26 cases the long-term result was good. Healing time ranged from 4 to 111 weeks (median 21.5). Bad long-term results were observed in 14 cases. Three lesions had persisted unhealed despite patent angioplasty. One case has ulcer recurrence at 24 months appointment. In 10 cases a second procedure was carried out (redo angioplasty in 6 and bypass in 4). TASCII A/B registered better clinical success then TASCII C/D (p<0,05) at 1-year follow-up but not at 2-years (p=0,11). Two-year limb salvage was 92,5% ± 4,2%. Primary patency was 62,5% ± 7,7% in 2-years. GVPS was 44,4 cm/s (highest artery) and 21,9 cm/s (mean PSV) in success group. GVPS was 45,3 cm/s (highest artery), and 24,7cm/s (mean VPS). The quality of the initial result, as measured by GPSV, was not associated with a good or bad long-term success (p>0,05). Conclusion: once the procedure was successfully performed, the degree of increase in flow is not related to the long-term durability and ulcer healing

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-10-14T17:58:21Z No. of bitstreams: 1 Ana Luiza Soares Rodrigues.pdf: 1097029 bytes, checksum: 6d854fd13dfbf1dda2898d6f73d3ba62 (MD5) / Made available in DSpace on 2016-10-14T17:58:21Z (GMT). No. of bitstreams: 1 Ana Luiza Soares Rodrigues.pdf: 1097029 bytes, checksum: 6d854fd13dfbf1dda2898d6f73d3ba62 (MD5) Previous issue date: 2014 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / O estudo teve como objetivos avaliar a efetividade do gel de papaína a 2% comparado ao gel de carboximetilcelulose a 2% no tratamento de pacientes com úlceras venosas crônicas e analisar as características sociodemográficas, econômicas e clínicas destes pacientes, atendidos no Ambulatório de Reparo de Feridas do Hospital Universitário Antonio Pedro/UFF. Método: Ensaio clínico controlado e randomizado (ECCR) com tempo de seguimento de 12 semanas. A amostra consecutiva foi composta por 18 voluntários e um total de 28 úlceras venosas. A coleta de dados ocorreu de abril de 2013 a janeiro de 2014. O desfecho primário do estudo foi a redução da área da lesão e os desfechos secundários foram a redução de tecidos desvitalizados no leito da úlcera e a redução da quantidade de exsudato. A pesquisa foi submetida ao Comitê de Ética em Pesquisa da Faculdade de Medicina, do Hospital Universitário Antonio Pedro/UFF e aprovada com o número 196/98, CAAE nº 0154.0.258.000-08. Resultados: Os grupos foram homogêneos quanto às características sociodemográficas, econômicas e clínicas. A idade dos voluntários variou de 45 a 85 anos, com média de 61,94 anos. A maioria dos participantes se declarou casado (55,6%), com escolaridade até o ensino fundamental (66,7%), residente de São Gonçalo (44,4%) e aposentado (66,7%). Todos os voluntários possuíam insuficiência venosa crônica, 61,1% apresentava hipertensão arterial sistêmica e 11,1% diabetes mellitus. A maioria das úlceras venosas lesões teve início há mais de dez anos (53,6%) e a localização mais acometida foi a região maleolar (53,6%). Quanto à evolução das úlceras ao longo de 12 semanas de tratamento, o grupo papaína apresentou redução significativa da área das lesões, especialmente no período entre a 5ª e a 12ª semanas de tratamento, com duas úlceras cicatrizadas e aumento expressivo da quantidade de tecido de epitelização no leito das lesões. Nos dois grupos de tratamento houve redução significativa da quantidade de tecido desvitalizado e aumento de tecido de granulação da 1ª semana para a 12ª semana (p-valor <0,05). Conclusão: o gel de papaína a 2% apresentou maior efetividade quanto à redução da área das lesões, entretanto se mostrou similar ao gel de carboximetilcelulose a 2% quanto à redução da quantidade de exsudato e de tecido desvitalizado. A partir dos resultados da pesquisa foram destacados os principais cuidados de enfermagem que podem auxiliar a assistência e o tratamento de pacientes com úlceras venosas crônicas. / The study aimed to evaluate the effectiveness of papain gel at 2% compared to the carboxymethylcellulose gel at 2% in the treatment of patients with chronic venous ulcers and analyze sociodemographic, economic and clinical characteristics of these patients, treated at the Outpatient Wound Repair at Antonio Pedro University Hospital/UFF. Method: Randomized Controlled Trial (RCT) with 12 weeks of follow-up. The consecutive sample consisted of 18 volunteers and a total of 28 venous ulcers. The data collection occurred from April 2013 to January 2014. The primary end point was the decrease of the lesion area and the secondary endpoints were devitalized tissue decrease in the ulcer bed and the reduction of the amount of exudate. The study was submitted to the Ethics Committee of the Faculty of Medicine, University Hospital Antonio Pedro/UFF and approved with the number 196/98, CAAE n. 0154.0.258.000-08. Results: The groups were homogenous regarding sociodemographic, economic and clinical characteristics. The volunteers ages ranged from 45 to 85 years old, with a mean of 61.94 years old. Most participants declared married (55.6%), with schooling up to elementary school (66.7%), resident of São Gonçalo (44.4%) and retired (66.7%). All volunteers had chronic venous insufficiency, 61.1% had hypertension and 11.1% diabetes mellitus. Most venous ulcers injuries began more than ten years ago (53.6%) and the most affected location was the malleolar area (53.6%). Regarding the ulcers evolution over the 12 weeks of treatment, the papain group showed a significant decrease in the lesions area, especially in the period between the 5th and the 12th weeks of treatment, with two healed ulcers and significant increase in the amount of epithelialization tissue. In both treatment groups, there was a significant decrease in the amount of devitalized tissue and an increase of the granulation tissue from 1st week to the 12th week (p <0.05). Conclusion: The papain gel at 2% was more effective in reducing of the lesions area, however it showed similar to the carboxymethylcellulose gel at 2% in reducing the amount of exudate and devitalized tissue. From the results of the research were highlighted the main nursing care that can help the assistance and treatment of patients with chronic venous ulcers.

L'angiodermite nécrotique ou "Hypertensive Leg Ulcer" (HLU) est un ulcère de jambe inflammatoire de traitement difficile, associé à une hypertension artérielle chronique. La douleur est très importante et nécessite l'utilisation de la morphine pour soulager les patients. Notre objectif était d'analyser les caractéristiques de l'inflammation et d'étudier son implication dans la physiopathologie de la nécrose cutanée. La peau inflammatoire est le siège d'un infiltrat composé de macrophages et de lymphocytes. L'épiderme et les cellules vasculaires lisses des microvaisseaux présentent des troubles de la différenciation et une importante prolifération. Nous observé une forte augmentation des transcrits de l'interleukine 1β (IL-1β), de l'IL-6 et de l'Oncostatin M (OSM), qui sont exprimées par les macrophages.Les kératinocytes humains in vitro et in vivo chez la souris montrent un phénotype semblable lorsqu'ils sont exposés à ces cytokines.Comparée à la peau inflammatoire et à la peau saine, la peau en périphérie de l'inflammation est douloureuse et présente des altérations histologiques intermédiaires. On observe une légère augmentation de l'expression des cytokines inflammatoires IL-1β et OSM. D'autre part, la consommation de morphine est associée au niveau d'expression de l'OSM et l'inflammation systémique reflète la douleur ressentie par le patient. Ces éléments sont en faveur d'une implication des cytokines inflammatoires IL-1β et OSM dans la physiopathologie de la douleur et de la nécrose dans l'HLU. Le cercle vicieux pourrait être bloqué par l'utilisation des biothérapies anticytokines, ce qui met en avant de nouvelles cibles thérapeutiques. / Hypertensive Leg Ulcer (HLU) is an inflammatory skin lesion associated to chronic high blood pressure. The ulcer is painful requiring morphine to relieve patients. Our objective was to analyze the characteristics of the inflammation and to study it’s implication in pathogenesis of skin necrosis. Inflammatory skin is infiltrated by macrophages and lymphocytes. Keratinocytes and vascular smooth muscle cells of microvessels display an alteration of differentiation and an important proliferation. We studied the expression of cytokines associated to skin inflammation and we observed a strong augmentation of the transcripts for the interleukin 1β (IL-1β), the IL-6 and the Oncostatin M (OSM); which are expressed by the macrophages. The reconstructed human epidermis in vitro exposed to these cytokines showed a similar phenotype of the histological studies in human. At least, injection of these cytokines to the mouse produces an inflammation and an alteration of the epidermis comparable to HLU.Compared to the inflammatory skin and to the healthy skin, the skin in periphery of the inflammation is painful and presents intermediate histological alterations. We observed a slight augmentation of the inflammatory cytokines IL-1β and OSM. On the other hand, the consumption of morphine is associated with the level of expression of the OSM and systemic inflammation reflects the pain felt by the patient.The present evidence indicates an involvement of inflammatory cytokines IL-1β and OSM in the pathogenesis of pain and skin necrosis in the HLU. The vicious circle may be blocked by the use of biotherapies against inflammatory cytokines, which highlights new therapeutic targets.

This dissertation covers the subject of how abstract concepts and complex situations can be concretized through research together with practitioners. The dissertation is based on four empirical studies. The researcher role, the practitioner participation and the methods for data collection and analysis have varied. In study I the concept ‘Närsjukvård’ was explored to understand how practitioners, managers and politicians in hospitals, primary health care and municipalities interpreted the concept. The researcher acted as consultant who collected data by interviews and questionnaires. Practitioners’ participation was limited. ‘Närsjukvård’ was interpreted as accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. Study II aimed to explore how people experienced leg ulcer care. The researcher acted as a consultant who performed the interviews and  analysed the data. Although the informants experienced their encounters with the nurses as satisfying, the study illuminated low participation in the care and low practitioner involvement in issues about daily living with the leg ulcer. The findings were brought back to the informants and the practitioners. The project did not proceed towards development and change. In study III the aim was to explore the Swedish concept ‘trygghet’ by using stories from daily life. Four older women were interviewed and the Story Dialogue method was used together with assistant nurses and registered nurses who participated in data collection and analysis. Two themes emerged: Sense of Security and factors strengthening the Sense of Security. Together with the assistant nurses, areas for improvements were identified. Study IV aimed to explore the discharge planning situation in order to     generate ideas for development. Members from a discharge planning network participated in the whole research process. Conditions for a successful coordinated discharge planning situation were a system including: the participation of the patient, the competence of the staff and the support from the organisation. The group arranged a workshop about communication and interdisciplinary   collaboration. The findings resulted in a form with self-evaluation questions. In conclusion, this thesis illustrates that it is possible to clarify abstract concepts and complex situations together with practitioners. To do this successfully, sense making activities and to start from practitioners’ experiences and their own context are key factors. The studies illuminate that building trust, relationship and sense of participation are essential in health and social care in general and specifically in the participatory action research process.

Bakgrund: Svårläkta bensår kan orsakas av en rad olika diagnoser. Sjuksköterskan har en viktig roll vid behandling av bensår, för optimal behandling behöver hela patientens situation beaktas. Tidigare forskning visar att patienter med svårläkta bensårs livskvalitet är påverkad genom nedsatt rörlighet, smärta, klåda, lukt, sömnrubbningar och social isolering. För att sjuksköterskan ska kunna förbättra hälsorelaterad livskvalité (HRQOL) hos patienter med bensår måste kunskap om vad som påverkar detta skapas. Syfte: Syftet med studien var att belysa skillnader i hälsorelaterad livskvalité med avseende på olika diagnosgrupper vid svårläkta bensår. Metod: En kvantitativ design har använts i studien som genomfördes med hälso-och livsstilsenkäten RAND36. Enkäterna fördes in i programmet SPSS och vid den statistiska analysen användes Kruskal-Wallis test och Chi-Square test för få fram signifikansvärden. Resultat: Mellan diagnosgrupperna fanns en signifikant skillnad inom domänerna fysisk funktion och generell hälsa och en påvisad signifikant skillnad mellan diagnosgrupperna och rörelseförmåga. Diskussion och konklusion: HRQOL var påverkat hos patienter med bensår inom domänerna fysisk funktion och generell hälsa och det behövs utvecklas metoder för att identifiera och förbättra HRQOL i omhändertagande av patienter med bensår. För att följa omvårdnadsresultat som är hälsofrämjande för patienten med bensår bör vårdresultat och hälsoeffekter mätas. / Background: Chronic leg ulcer may be caused by a variety of diagnoses, often interacted by several factors. The nurse has an important role in the treatment of leg ulcers, for optimal treatment you have to take the whole situation into account. Previous research shows that patients with chronic leg ulcers health related quality of life (HRQOL) is affected by reduced mobility, pain, itching, odor, sleep disorders and social isolation. To improve HRQOL for patients with leg ulcers the nurse need more knowledge about what causes it. Aim: To illustrate the differences in HRQOL with regard to different diagnostic groups for chronic leg ulcers. Method: A quantitative design has been used in the study and was performed with the health-related quality of life survey RAND36. The questionnaires were entered in program SPSS and in the statistical analysis, the Kruskal-Wallis test and chi-square test where used for obtaining significant values. Results: Between diagnostic groups is a significant difference in the domains of physical functioning and general health and a demonstrated significant differences between diagnostic groups and mobility. Discussion and conclusion: HRQOL was affected in patients with leg ulcers in the domains of physical functioning and general health. It is a need to develop methods for identifying and improving HRQOL in the care of patients with leg ulcers. To follow the care results that are improving health for patients with leg ulcers should care and health outcomes measured.

La Ulcera Venosa (UV) es una patología crónica, que afecta aproximadamente a un 1-2% de la población mayor y adulta en los países desarrollados y demanda, importantes costes, en atención a los tratamientos prolongados y variados, inversión de tiempos por parte de profesionales de la salud, consumo de grandes volúmenes de materiales. Se ha constatado que la calidad de vida relacionada con la salud (CVRS) de las personas con UV está afectada negativamente. La medición de CVRS permite, en gran medida, contribuir a mejorar la calidad del cuidado. En España no se dispone de instrumentos de medida específicos CVRS en personas con UV y de medida de la evolución hacia la cicatrización en pacientes con UV, que hayan sido validados mediante la investigación. Disponer de estas herramientas ayudaría a la toma de decisiones y a aumentar la calidad de los cuidados con este tipo de pacientes. / Objetivo General: Determinar CVRS de los pacientes con UV y analizar como la evolución clínica de la herida influye en las distintas dimensiones de la CVRS, mediante la aplicación de instrumentos específicos de medida para tal fin. / Material y Método: El estudio se realizó en tres fases: FASE 1: Revisión bibliográfica y sistemática en las principales bases de datos de ciencias de la salud MEDLINE (a través PubMed y Webspirs), PsycINFO, COCHRANE, CINAHL, LILACS, FECYT, EMBASE y CUIDEN entre 2003 y 2008. Se utilizaron las palabras clave: Leg ulcer, score, quality of life, instrument and tool, con sus correspondientes conectores booleanos. La calidad de las publicaciones fue evaluada mediante CASP Guide (Critical Appraissal Skill Programme y the JBI SUMARI (The Joanna Briggs Institute 2008) herramienta para la evaluación crítica de estudios cualitativos y cuantitativos. / FASE 2: La versión original del cuestionario CCVUQ, que incluye 21 preguntas, se ha adaptado al castellano siguiendo la metodología de traducción y retrotraducción y el establecimiento de equivalencias semánticas culturales. Se efectuaron ajustes considerados menores a partir de los aportes y las sugerencias de expertos y de los pacientes, que no afectó la esencia, de las preguntas originales, pero necesarios para la comprensión de la población local. / FASE 3: estudio de validación, observacional y de medidas repetidas, durante 6 semanas. Se estima una muestra de 105 pacientes. Se calcula consistencia interna mediante alfa de Cronbach, fiabilidad test-retest entre el inicio y la segunda semana, validez concurrente con el SF12.v2 y sensibilidad al cambio mediante ANOVA de medidas repetidas. Para la validez de constructo se realizó un análisis factorial confirmatorio. / Resultados: FASE 1: 22 estudios fueron incluidos, los cuales utilizaron métodos cuantitativos y cualitativos. El dolor se destacó como el hallazgo más prevalerte que afecta la CVRS en los estudios los instrumentos genéricos más utilizados: SF36 y sus adaptaciones, el Nottingham Health Profile y Euroqol-5. En cuanto a los instrumentos específicas de CVRS en UV se encontraron: Hyland, Cardiff Wound Impact Schedule and Charing Cross Venous Leg Ulcer Questionnaire. Dos nuevos instrumentos específicos para UV fueron encontrados Sheffield Preference-Based Venous Leg Ulcer 5D. Se confirma el impacto negativo de las UV en la CVRS, el cual es medido con una variedad de instrumentos específicos, sin embargo por sus valores psicométricos el más adecuado es el Charing Cross Venous Ulcer Questionnaire CCVUQ. / FASE 2: Se obtuvo una versión satisfactoria de la versión española del CCVUQ que es semántica y culturalmente equivalente a la versión original inglesa. En el proceso de adaptación participó un grupo de expertos en heridas crónicas y un grupo de pacientes con úlceras venosas, quienes a partir de los criterios de evaluación de ítems: precisión, claridad y comprensión asignaron resultados de aceptabilidad en el escenario de aplicación del 94% a la totalidad de los ítems como Índice de Validez de Contenido (IVC). / FASE 3: se incluyen 60 pacientes, en su mayoría mujeres (66,7%), con mediana de edad de 78 años. El 75% de las lesiones eran recurrentes con una antigüedad mediana de 2,14 años. La consistencia interna para el CCVUQ-e es alta (alfa>0,80), para el PUSH-e es baja. Ambos instrumentos tienen buena fiabilidad test-retest (CCVUQ-e ICC: 0,71, PUSH-e ICC: 0,97). Se confirma el modelo factorial de 4 dimensiones. Hay buena correlación entre el SF12.v2 y el CCVUQ-e. La sensibilidad al cambio es buena para los dos instrumentos de medida (diferencia de -44,3 puntos para el CCVUQ-e). / Conclusiones: queda confirmada la validez, fiabilidad y sensibilidad al cambio del CCVUQ-e. En el caso del PUSH-e solo se puede confirmar la sensibilidad al cambio a partir de la segunda semana de tratamiento. Además, se confirma que los pacientes con UV tienen mala CVRS cuando esta es medida con el CCVUQ-e y con el SF12 V2 pero que esta mejora cuando mejora el estado de la UV.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-07T14:06:03Z No. of bitstreams: 1 Luciana Miranda Rodrigues.pdf: 2906831 bytes, checksum: c63fff07e6a85a3c8689b9aadbab96a2 (MD5) / Made available in DSpace on 2015-12-07T14:06:03Z (GMT). No. of bitstreams: 1 Luciana Miranda Rodrigues.pdf: 2906831 bytes, checksum: c63fff07e6a85a3c8689b9aadbab96a2 (MD5) Previous issue date: 2010 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Este estudo teve como objetivos avaliar a efetividade do hidrogel 2% em pacientes com úlceras de perna; estimar o custo médio do uso do hidrogel 2% num período de 90 dias e comparar o custo do uso do hidrogel 2% em pacientes com úlceras de perna com hidrogéis industrializados disponíveis no mercado nacional. Trata-se de um estudo de intervenção terapêutica, prospectivo, do tipo ensaio clínico não controlado sobre a avaliação do uso do hidrogel 2% produzido na farmácia universitária para o tratamento de feridas em pacientes com úlceras de perna. A amostra constou de 20 voluntários, de ambos os sexos, para 90 dias de tratamento com o hidrogel a 2%, totalizando 250 consultas durante o período de fevereiro a outubro de 2010. Este estudo foi encaminhado ao Comitê de Ética em Pesquisa do Hospital Universitário Antônio Pedro sob o parecer CAAE n0 0154.0.258.000-08 e os termos de consentimento livre e esclarecido e de fotografia encontram-se de acordo com as Resoluções n0 196/96 e 251/97 do Conselho Nacional de Saúde. Do grupo amostral, pôde-se identificar que 62,5% dos voluntários eram predominantemente do sexo feminino. A idade média variou de 60,5 anos ± 11,4 e que 52,25% residiam no município de Niterói. Em relação à análise da evolução clínica das úlceras de perna, pôde-se observar que surgiram dois grupos distintos com relação ao tamanho da área da lesão, sendo estas classificadas no estudo como, área 1 – para lesões com tamanho acima de 100 cm 2 e área 2 – para lesões com tamanho abaixo de 100 cm 2. O tecido de maior prevalência na avaliação inicial foi o tecido de esfacelo que apresentou uma média de 3,75 ± 1,2 de presença no leito da lesão dos voluntários do estudo. Destaca-se ainda, que após 90 dias de tratamento com o hidrogel a 2%, foram observadas alterações teciduais importantes para a cicatrização e/ou redução da área lesional (p=0,0416). A presença do tecido de granulação passa a prevalecer com uma média de 3,12 ± 1,0 e 25% dos voluntários obtiveram cicatrização total (100% de tecido de epitelização). Em relação à análise dos custos do tratamento com o hidrogel a 2% destacou-se inicialmente que o tratamento das úlceras pertencentes à área 1 foi maior que a das úlceras da área 2, sendo esta variação de R$114,40 a R$393,23 (M= R$227,55 e Dp=72). Ao comparar o tratamento das úlceras de perna com hidrogel 2% 100 gramas com outros hidrogéis disponíveis no mercado nos valores proporcionais a 100 gramas observou-se uma diferença significativa (p= 0,0003) para os valores referentes às áreas 1 e 2 em todas as perspectivas estudadas. Os valores variaram de acordo com o tamanho das áreas da lesão. A área 1 teve uma variação de preço de R$ 112,85 a R$ 912,11 nas três esferas estudas e a área 2 variou de R$ 70,75 a R$ 558,88 nas três perspectivas do estudo. Ao analisar os custos e a efetividade do uso dessa terapêutica, verificou-se que o hidrogel a 2% apresenta uma efetividade significante assim como os seus custos, não sendo justificável a sua não utilização nos serviços de saúde. O hidrogel a 2% manipulado magistralmente numa farmácia universitária representa uma alternativa para essa situação, uma vez que promove melhora das taxas de cicatrização, com diminuição do tempo de tratamento dessas úlceras, além de ser um tratamento de baixo custo, se comparado a outros hidrogéis industrializados disponíveis no mercado nacional, trazendo menores gastos para os serviços de saúde e órgãos de financiamento. / This study aimed to evaluate the effectiveness of hydrogel 2% in patients with leg ulcers, estimate the average cost of using the hydrogel 2% within 90 days and compare the cost of the use of hydrogel 2% with others hydrogels industrialized. This is a study of therapeutic intervention, prospective clinical trial, uncontrolled on evaluating use of hydrogel 2% produced in the pharmacy college in the treatment of wounds in patients with leg ulcers. The sample consisted of 20 volunteers of both sexes, during 90 days of treatment with the hydrogel to 2% to 250 consultations during the period from February to October 2010. This study was submitted to Committee on Research Ethics at University Hospital on advice CAAE number 0154.0.258.000-08 and terms of consent and photography are in accordance with Resolutions 196/96 and 251/97 of the National Health Council. Of this sample group, could be identified that 62.5% of the volunteers were predominantly female. The mean age ranged from 11.4 ± 60.5 years and 52.25% lived in Niterói. On the analysis of clinical outcome of leg ulcers, it was observed that emerged two distinct groups with respect to the size of the lesion area, which are classified in this study: area1 - for lesions with a size greater than 100 cm2 and area 2 - for lesions with size below 100 cm2. About these group it was noted that the tissue with the highest prevalence at baseline was the desvitalization tissue that showed presence an average 3.75 ± 1.2 of the wound bed. After 90 days by treatment with hydrogel 2%, it has obtained tissue with an important changes to healing and / or reduction area lesion (p = 0.0416). The granulation tissue presence begins to prevail with an average 3.12 ± 1.0 and 25% these volunteers had total healing (100% epithelization tissue). On the costs analysis with hydrogel 2% treatment it has initially the ulcers belonging area 1 was higher than the second area of ulcers, and this variation was the R$ 114.40 to R$ 393, 23 (mean = R$ 227.55 and dv = 72). When comparing the treatment of leg ulcers with hydrogel 2% 100 grams with other commercially available hydrogels in proportionate amounts to 100 grams there was a significant difference (p = 0.0003) for the values related to areas 1 and 2 in all perspectives studied. The values ranged with the size of the lesion areas. The area 1 had a variation in price from R$ 112.85 to R$ 912.11 and the area 2 ranged from R$ 70.75 to R$ 558.88 on the three perspectives of the study. Analyzed the costs and effectiveness using this therapy, it was found that hydrogel 2% shows a significant efficacy as well as their costs are not justified in not using health services. The hydrogel 2% manipulated in a pharmacy college represents an alternative to this situation, since it promotes improved healing rates, decreased treatment time of these ulcers, as well as being a low-cost treatment, as compared to other hydrogels industrialized in the national sale, bringing lower costs to health services.

No / To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.

No / Increasing pressure on health care budgets highlights the need for clinicians to understand the true costs of wound care, in order to be able to defend services against indiscriminate cost cutting. Our aim was to develop and test a straightforward method of measuring treatment costs, which is feasible in routine practice. The method was tested in a prospective study of leg ulcer patients attending three specialist clinics in the UK. A set of ulcer-related health state descriptors were defined on the basis that they represented distinct and clinically relevant descriptions of wound condition ['healed', 'progressing'; 'static''deteriorating; 'severe' (ulcer with serious complications)]. A standardised data-collection instrument was used to record information for all patients attending the clinic during the study period regarding (i) the health state of the ulcer; (ii) treatment received during the clinic visit and (iii) treatment planned between clinic visits. Information on resource use was used to estimate weekly treatment costs by ulcer state. Information was collected at 827 independent weekly observations from the three study centres. Treatment costs increased markedly with ulcer severity: an ulcer which was 'deteriorating' or 'severe' cost between twice and six times as much per week as an ulcer which was progressing normally towards healing. Higher costs were driven primarily by more frequent clinic visits and by the costs of hospitalisation for ulcers with severe complications. This exercise has demonstrated that the proposed methodology is easy to apply, and produces information which is of value in monitoring healing and in potentially reducing treatment costs.