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PURPOSE: To compare a liposomal gel with and without chamomile extract for the prevention of radiation dermatitis in breast cancer patients undergoing radiotherapy. METHODS: This study was a double-blind randomized clinical trial. A total of 100 participants undergoing radiotherapy for breast cancer were recruited. The primary outcome was the occurrence of dry desquamation. Cumulative dose of ionizing radiation at the first occurrence of dry desquamation, occurrence of erythema, moist desquamation, global radiation dermatitis, and any signs and symptoms self-reported by participants were secondary outcomes. RESULTS: Dry desquamation occurred in 6.0% of the participants using chamomile liposomal gel and 12.2% of those using liposomal gel (p = 0.32). The mean cumulative dose of ionizing radiation for the first occurrence of dry desquamation was 45.1 Gy in the chamomile liposomal gel group and 43.7 Gy in the liposomal gel group. There were no differences between the two gels in the occurrence of erythema, dry desquamation, moist desquamation, and radiation dermatitis compared to liposomal gel. There was a lower proportion of reported symptoms in the chamomile liposomal gel group compared to liposomal gel group in the first 3 weeks of radiation, especially for itching (p = 0.05). CONCLUSION: No statistically significant differences between the two gels were found in radiation dermatitis occurrence and dose at first occurrence. Comparing to the literature, it seems that both interventions may be effective, which might explain the lack of statistical difference between the groups.

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BACKGROUND AND PURPOSE: Head and neck cancer patients frequently develop radiation dermatitis (RD) during radiotherapy. We compared liposomal gel with and without chamomile extract for the prevention and management of RD in head and neck cancer patients undergoing radiotherapy. MATERIALS AND METHODS: Sixty participants undergoing radiotherapy for the first time for head and neck cancer were recruited in a double-blind randomized clinical trial. Primary outcomes were the occurrence of dry desquamation and the cumulative dose of ionizing radiation at the first occurrence of dry desquamation. Secondary outcomes were the occurrence of erythema, moist desquamation, global RD, and participant self-reported symptoms. RESULTS: Dry desquamation occurred in 76.9 % (95 % CI: 57.9, 89.0) of participants in the chamomile liposomal gel group and in 88.9 % (95 % CI: 71.9, 96.1) in the liposomal gel group (p = 0.43). The median cumulative dose of ionizing radiation when dry desquamation occurred was 48.0 Gy in the chamomile liposomal gel group and 40.0 Gy in the liposomal gel group. Fewer symptoms were reported in the chamomile liposomal gel group. CONCLUSION: No statistically significant differences in outcomes were found between the two groups, though the chamomile liposomal gel group presented with lower grades of RD than the liposomal gel group. In addition, when compared to the literature on other topical interventions to manage RD, our results show that chamomile liposomal gel has potential for better management and prevention of RD in this population, which should be further tested. This study provides crucial information to design future studies. Clinical Trials Registration (REBEC): RBR-92cts3.

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Objetivo: analizar la respuesta emocional de pacientes conscientes en estado crítico durante la higiene diaria en una unidad de cuidados intensivos cardiológicos y compararla en función de experiencias previas o no. Método: estudio prospectivo y descriptivo. Encuesta ad hoc de 30 ítems realizada a 148 pacientes y basada en la higiene del primer día. Se formulan preguntas sobre los sentimientos durante la higiene y aspectos positivos y negativos de la experiencia. Se compara a los pacientes en función de si se los había higienizado con anterioridad. Resultados: el 67,6% fueron hombres y la media de edad fue de 67±15 años. El 45,9% presentó conformismo, el 27% sintió vergüenza y el 86,3% agradeció que le hablaran durante la higiene. Al 33,1% de los pacientes nunca les habían realizado higiene en la cama, eran significativamente más jóvenes y solteros, y tenían menor sensación de limpieza. El 32% expresó que le gustaría que un familiar colaborase en la higiene. Conclusión: los pacientes no sienten que se invade su intimidad cuando se los higieniza y aprecian la comunicación con el personal sanitario durante estos cuidados. Los pacientes a quienes no les habían realizado higiene en la cama previamente son más jóvenes, sienten mayor vergüenza y les molestan más las interrupciones, siendo más conscientes de ellas.

Objective: to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not. Method: a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not. Results: 67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures. Conclusion: the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Objetivo: analisar a resposta emocional de pacientes críticos conscientes durante a higiene diária em uma unidade de terapia intensiva cardíaca e compará-la considerando ou não as experiências prévias. Método: estudo prospectivo e descritivo. Foi aplicado questionário ad hoc de 30 itens a 148 pacientes, com base na higiene do primeiro dia. Foram feitas perguntas sobre sentimentos durante a higiene e aspectos positivos e negativos da experiência. Os pacientes foram comparados considerando o fato de terem sido higienizados anteriormente. Resultados: 67,6% eram homens e a idade média foi de 67±15 anos. 45,9% apresentavam conformismo, 27% se sentiram envergonhados e 86,3% estavam gratos por terem conversado com eles durante a higiene; 33,1% dos pacientes acamados nunca haviam recebido cuidados de higiene no leito, eram significativamente mais jovens e solteiros, e tinham um senso de limpeza mais baixo; 32% expressaram que gostariam que um membro da família ajudasse na higiene. Conclusão: os pacientes não se sentiram invadidos em sua intimidade quando receberam os cuidados de higiene e apreciaram a comunicação com o pessoal de saúde durante o procedimento. Os pacientes que não tinham recebido cuidados de higiene no leito anteriormente são mais jovens, sentem-se mais constrangidos e mais incomodados pelas interrupções, sendo mais conscientes delas.

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In recent years, lycopene has been highlighted due to its antioxidant and anti-inflammatory properties, associated with a beneficial effect on human health. The aim of this study was to advance the studies of antioxidant and anti-inflammatory mechanisms on human keratinocytes cells (HaCaT) of a self-emulsifying drug delivery system (SEDDS) loaded with lycopene purified from red guava (nanoLPG). The characteristics of nanoLPG were a hydrodynamic diameter of 205 nm, a polydispersity index of 0.21 and a zeta potential of -20.57, providing physical stability for the nanosystem. NanoLPG demonstrated antioxidant capacity, as shown using the ORAC methodology, and prevented DNA degradation (DNA agarose). Proinflammatory activity was evaluated by quantifying the cytokines TNF-α, IL-6 and IL-8, with only IL-8 showing a significant increase (p < 0.0001). NanoLPG showed greater inhibition of the tyrosinase and elastase enzymes, involved in the skin aging process, compared to purified lycopene (LPG). In vitro treatment for 24 h with 5.0 µg/mL of nanoLPG did not affect the viability of HaCaT cells. The ultrastructure of HaCaT cells demonstrated the maintenance of morphology. This contrasts with endoplasmic reticulum stresses and autophagic vacuoles when treated with LPG after stimulation or not with LPS. Therefore, the use of lycopene in a nanoemulsion may be beneficial in strategies and products associated with skin health.

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ABSTRACT International health authorities recommend skin-to-skin care (SSC) at birth and that breastfeeding should be started as soon as possible, within the first hour after birth. This article aimed to review the benefits of breastfeeding initiation for mothers and newborns, the global status of breastfeeding initiation, the determinants of breastfeeding initiation and SSC, and interventions to improve breastfeeding initiation. The positive effects of breastfeeding initiation result from the contact between the baby and the mother and the components found in breast milk. Several factors related to the family, mother, child, and health institution affect the time of initiation of breastfeeding. It should be ensured that pregnant women have access to accurate and effective information about the benefits of breastfeeding initiation in healthcare facilities, com-munities, and different settings, including the media. Taking advantage of opportunities to counsel and support the mother in prenatal care and childbirth, and improving the rate of breastfeeding initiation can be achieved by implementing infant and young child feeding policies and programs with the Baby-Friendly Hospital Initiative.

RESUMEN Las autoridades sanitarias internacionales recomiendan el contacto piel a piel al nacer y el inicio temprano de la lactancia materna: dentro de la primera hora después del nacimiento. Este artículo revisa los beneficios de la lactancia materna temprana (LMT) para las madres y los recién nacidos, el estado global de la LMT, los determinantes de esta y el contacto piel a piel y las intervenciones para mejorar la LMT. Los efectos positivos de la LMT pueden predecirse tanto por el contacto entre el bebé y la madre como por los componentes que se encuentran en la leche materna. Alrededor de la mitad de los recién nacidos comienzan a amamantar dentro de la primera hora después del nacimiento. Algunas características de la familia, la madre, el niño y las instituciones de salud afectan el momento de inicio de la lactancia materna. Debe garantizarse que las mujeres embarazadas tengan acceso a información precisa y eficaz sobre los beneficios de la LMT en el centro de salud, en la comunidad y en diferentes entornos, incluidos los medios de comunicación. La implementación de políticas y programas de alimentación de lactantes y niños pequeños con la Iniciativa de Hospitales Amigos del Niño es clave para mejorar la tasa de LMT y aprovechar las oportunidades de asesoramiento y apoyo a la madre en la atención prenatal y el parto.

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INTRODUCTION: Compared to adults, newborns' skin has a thinner epidermis and stratum corneum with decreased hydration levels, higher transepidermal water loss, and a pH variation between 5.5 and 7.5. These characteristics can predispose to the occurrence of dryness, infections, and dermatological conditions. Water and liquid soap with adequate formulation have shown to be beneficial and safe for newborns' skin. However, studies evaluating the effect of bar soap, products widely used in Brazil and Latin America, are unknown. Therefore, the objective of this study was to compare the effects of liquid and bar soaps on the term newborns' skin. METHODS: This randomized controlled, parallel, single-blind clinical trial was conducted at a public university hospital in São Paulo, Brazil. 100 healthy term newborns with no congenital anomalies, acute diseases, or dermatological conditions were randomized to use liquid soap (experimental group) or bar soap (control group). Skin pH, transepidermal water loss, stratum corneum hydration, sebum content, and skin condition were assessed before and after the first bath, at 48 h, 14 days, and 28 days after birth. These evaluations were performed on the forearm, abdomen, buttocks, and thigh. In addition, the mother's perception of soap use was also evaluated. RESULTS: Data of 100 newborns were analyzed by intention to treat. The rate of retention was 53%. Newborns exposed to the liquid soap presented significantly better skin acidification (p < 0.001) and significantly better stratum corneum hydration (p < 0.001) than the skin of newborns exposed to the bar soap, regardless of the area evaluated. There were no significant differences in transepidermal water loss, sebum content, dryness, erythema, or skin breakdown and the mother's perceptions of the use of the soaps. CONCLUSION: Newborns in the experimental group presented better skin acidification and stratum corneum hydration when compared to newborns in the control group.

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SUMMARY OBJECTIVE: Inflammatory bowel diseases may have extra intestinal manifestations such as those affecting the skin. This study aimed to study skin manifestations in a cohort of Brazilian patients with inflammatory bowel diseases. METHODS: Epidemiological and clinical data were obtained through a cross-sectional study of 70 inflammatory bowel diseases patients and a control group comprising 50 healthy individuals. All patients were subjected to dermatological examination and photography of skin lesions. RESULTS: Out of the 70 inflammatory bowel diseases patients, 50 had ulcerative colitis and 20 had Crohn's disease. Skin lesions occurred in 95.7% of the inflammatory bowel diseases patients and in 88% of individuals in the control group (p=0.001). Alopecia (p<0.0001), xerosis (p=0.03), striae (p=0.02), and acne (p=0.04) were more common in inflammatory bowel diseases patients than in the control group. Alopecia was more frequent in females (p=0.01) than in males. Two male patients, one with ulcerative colitis and the other with Crohn's disease, had pyoderma gangrenosum. Erythema nodosum was not observed in both groups. CONCLUSION: There was a high prevalence of skin lesions in the Brazilian inflammatory bowel diseases patients. Additionally, alopecia, xerosis, striae, and acne were more common in patients with inflammatory bowel diseases than in those in the control group.

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ABSTRACT Objective: To map topical interventions used to prevent hand-foot syndrome in cancer patients undergoing antineoplastic therapy. Method: This is a scoping review reported in accordance with the recommendations of PRISMA-ScR (extension for scoping review) and the Joanna Briggs Institute Manual. The searches were carried out in the electronic databases CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; and gray literature (Google Scholar, Pro-Quest). Results: The searches resulted in 12,016 references and the final sample consisted of 45 studies. A total of 42 topical interventions were identified, including: moisturizing creams, corticosteroids, acids, mapisal, silymarin, and henna. However, urea was the most cited intervention (62%). As for the presentations of the interventions, they varied among creams, ointments, gels, hydrocolloids, decoctions, patches, powders, oils, and soaps. Conclusion: The results allowed reviewing topical interventions, with emphasis on the use of urea and moisturizing creams. However, most of the interventions identified in this review require evaluation in future studies for better understanding of their benefits.

RESUMEN Objetivo: Mapear las intervenciones tópicas utilizadas para prevenir el síndrome mano-pie en pacientes con cáncer sometidos a terapia antineoplásica. Método: Esta es una revisión del alcance reportada de acuerdo con las recomendaciones de PRISMA-ScR (extensión para la revisión del alcance) y el Manual del Instituto Joanna Briggs. Las búsquedas se realizaron en las bases de datos electrónicas CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; y literatura gris (Google Scholar, Pro-Quest). Resultados: Las búsquedas resultaron en 12.016 referencias y la muestra final estuvo compuesta por 45 estudios. Se identificaron 42 intervenciones tópicas, entre ellas: cremas humectantes, corticoides, ácidos, mapisal, silimarina y henna. Sin embargo, la urea fue la intervención más citada (62%). En cuanto a las presentaciones de las intervenciones, variaron entre cremas, ungüentos, geles, hidrocoloides, decocciones, parches, polvos, aceites y jabones. Conclusión: Los resultados permitieron revisar las intervenciones tópicas, con énfasis en el uso de urea y cremas humectantes. Sin embargo, la mayoría de las intervenciones identificadas en esta revisión deben evaluarse en estudios futuros para mejor comprensión de sus beneficios.

RESUMO Objetivo: Mapear as intervenções tópicas utilizadas para a prevenção da síndrome mão-pé em pacientes com câncer em terapia antineoplásica. Método: Trata-se de uma revisão de escopo reportada de acordo com as recomendações do PRISMA-ScR (extensão para revisão de escopo) e o Manual do Instituto Joanna Briggs. As buscas foram realizadas nas bases eletrônicas CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; e literatura cinzenta (Google Scholar, Pro-Quest). Resultados: As buscas resultaram em 12.016 referências e a amostra final foi composta por 45 estudos. Um total de 42 intervenções tópicas foram identificadas, dentre elas: cremes hidratantes, corticosteroides, ácidos, mapisal, silimarina e henna. Entretanto, a ureia foi a intervenção mais citada (62%). Quanto às apresentações das intervenções, estas variaram entre cremes, pomadas, géis, hidrocoloides, decocções, adesivos, pós, óleos e sabões. Conclusão: Os resultados possibilitaram uma recensão das intervenções tópicas, com destaque ao uso da ureia e cremes hidratantes. Todavia, grande parte das intervenções identificadas nesta revisão necessitam ser avaliadas, em estudos futuros, para melhor compreensão dos seus benefícios.

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Introdução: A radioterapia desempenha um importante papel adjuvante ao tratamento cirúrgico do câncer de mama, pois diminui as taxas de recorrência local e aumenta a sobrevida global. Entretanto, até 95% das pacientes expostas à radiação ionizante desenvolverão algum grau de radiodermatite. O presente estudo revisa a literatura referente às terapias tópicas disponíveis para prevenção e tratamento da radiodermatite aguda das mamas, sintetizando as evidências disponíveis e auxiliando a tomada de decisão clínica. Métodos: Revisão integrativa da literatura publicada nos últimos 10 anos, utilizando as bases de dados LILACS, Medline e Biblioteca Cochrane. Foram utilizados os descritores neoplasias da mama, radiodermatite, higiene da pele e creme para a pele. Resultados: Dos 158 artigos encontrados, 48 foram incluídos nesta revisão. Foram identificadas 40 diferentes terapias tópicas que foram agrupadas em sete categorias para facilitar a análise e interpretação dos dados: fitoterápicos, hormônios/vitaminas/fatores de crescimento, corticoesteroides, barreira (filme ou creme), ácido hialurônico, curativos à base de prata e outros. Conclusões: Existe evidência científica proveniente de ensaios clínicos randomizados de boa qualidade embasando a indicação dos corticosteroides tópicos de alta (valerato de 17-betametasona) e média potência (furoato de mometasona 0,1%), assim como de filmes barreira como Mepitel®, Mepilex Lite® e Hydrofilm®, no manejo da radiodermatite aguda das mamas. As demais terapias não mostraram benefícios na prevenção e/ou tratamento da radiodermatite ou têm evidência científica limitada, contraindicando ou restringindo sua utilização na prática clínica.

Introduction: Radiotherapy plays an important adjuvant role in the surgical treatment of breast cancer by reducing locoregional recurrence and improving overall survival. However, up to 95% of patients experience some degree of radiodermatitis. This study aims to review the literature regarding topical agent therapies in preventing and treating acute radiation dermatitis in breast cancer patients. Methods: Integrative review of LILACS, Medline and Cochrane Library databases. We searched for original articles published between 2010 and 2020, including the descriptors breast neoplasms, radiodermatitis, skincare, and skin cream. Results: The initial search returned 158 articles. After screening for eligibility, 48 articles were included. Forty different topical agent therapies were identified and grouped into seven categories to facilitate data analysis: herbal medicines, hormones/vitamins/growth factors, topical corticosteroids, barrier products (film or cream), hyaluronic acid, silver-based dressings and others. Conclusions: This review identifies that topical corticosteroids of high (betamethasone-17-valerate) and medium potency (mometasone furoate 0.1%), as well as barrier films such as Mepitel®, Mepilex Lite®, and Hydrofilm®, are effective in managing acute breast radiodermatitis. The other topical agent therapies did not show benefits in preventing and/or treating acute radiodermatitis or have limited evidence.

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BACKGROUND: The emollients are important ingredients used in skincare formulations that can act as moisturizing agents through their occlusive potential, preventing skin water loss. Consumer interest in natural and sustainable products has grown considerably in the last few years, requiring efforts from the cosmetic industry to design products with raw materials of natural, organic, and sustainable origin. Thus, it is essential to improve the knowledge about the behavior of cosmetic raw materials that can be used as sustainable alternatives to synthetic ingredients. AIM: This work aimed to evaluate the occlusive performance of different vegetable oils used as emollients in skincare cosmetics, through comparative analysis with petrolatum, a synthetic emollient with a high occlusive skin potential. METHOD: The study included 80 healthy female adult volunteers. TEWL measurements were performed before and after 15 min, 2 and 6 h of emollients application on the forearms of the research participants. All research participants provided written informed consent. RESULTS: The results obtained showed that the vegetable oils were effective in providing an occlusive effect on the skin. When compared to the petrolatum, the vegetable oils did not provide a high immediate skin occlusion effect. However, most of them showed a skin occlusion performance comparable to petrolatum throughout the 6 h time course. CONCLUSION: Vegetable oils can be used as a sustainable alternative to synthetic emollients, and they are promising in replacing petrolatum in skincare formulations with respect to the occlusion effect of the skin. The vegetable oils did not provide a high immediate skin occlusion effect (15 min post-application) as the petrolatum, which is known to have increased occlusion properties. However, most of them showed a skin occlusion performance comparable to petrolatum throughout the 6-hour time course.

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Dermatitis neglecta, a condition that results from inadequate skin cleansing, is still little reported in the literature and underreported. Although benign, it is aesthetically uncomfortable. It is associated with conditions that lead to fear of sanitizing a given region and may be related to psychiatric and neurological disorders. This observational study consisted of the case report of a patient followed up in a University Hospital in northeastern Brazil, with the objective of demonstrating the rare association between dermatitis neglecta and breast fibroadenoma. A young patient with a history of depressive disorder had crusted and hyperpigmented skin lesions covering the left breast and massive tumor in the same breast. The patient was oriented regarding the cleaning and removal of crusts, resulting in good clinical response. She underwent excision of the tumor, and the anatomopathological study was compatible with fibroadenoma. Interdisciplinary follow-up, including treatment for psychiatric disorder, was fundamental for the patient's recovery, considering the improvement of her mood after establishing the therapy and successful final breast reconstruction. Dermatitis neglecta can resemble other types of dermatitis, in such a way that it is essential to establish a differential diagnosis to avoid unnecessary evaluation procedures, interventions, and therapies. In this exuberant case of dermatitis neglecta, the importance of comprehensive health care is emphasized."

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ABSTRACT Objective: to identify the main nursing care procedures for performing bed bath in patients with COVID-19. Method: an integrative literature review. Five stages were followed for this research: research question elaboration (identification of the problem), search of studies in literature, study assessment, data analysis, and presentation of review. To search for primary studies, the VHL and SciELO databases were selected. Results: initially, 55 publications were found. After reading and analyzing the abstracts, the sample consisted of 15 studies. Conclusion: patients with the new coronavirus have specific care to perform a bed bath, oral, intimate and skin hygiene. It is important that professionals use adequate personal protective equipment, perform humanized care, continuously observing patients' vital signs to avoid occurrence of adverse events, promoting patient safety.

RESUMEN Objetivo: identificar los principales procedimientos asistenciales de enfermería para realizar un baño en cama en pacientes con COVID-19. Método: revisión integradora de la literatura. Se siguieron cinco etapas para esta investigación: elaboración de la pregunta de investigación (identificación del problema), búsqueda de estudios en la literatura, evaluación de estudios, análisis de datos y presentación de la revisión. Para la búsqueda de estudios primarios, se seleccionaron las bases de datos BVS y SciELO. Resultados: inicialmente se encontraron 55 publicaciones. Después de leer y analizar los resúmenes, la muestra estuvo formada por 15 estudios. Conclusión: los pacientes con el nuevo coronavirus tienen cuidados específicos para realizar un baño en la cama, higiene bucal, íntima y cutánea. Es importante que los profesionales utilicen equipos de protección personal adecuados, realicen cuidados humanizados, observando continuamente los signos vitales de los pacientes para evitar la ocurrencia de eventos adversos, promoviendo la seguridad del paciente.

RESUMO Objetivo: identificar os principais cuidados de enfermagem para a realização do banho no leito em pacientes com COVID-19. Método: revisão integrativa da literatura. Percorreram-se cinco etapas para esta pesquisa: elaboração da questão de pesquisa (identificação do problema), busca dos estudos na literatura, avaliação dos estudos, análise dos dados e apresentação da revisão. Para a busca dos estudos primários, selecionaram-se as bases de dados BVS e SciELO. Resultados: inicialmente, foram encontradas 55 publicações. Após leitura e análise dos resumos, a amostra foi composta por 15 estudos. Conclusão: pacientes com o novo coronavírus têm cuidados específicos para a realização do banho no leito, higiene bucal, íntima e com a pele. É importante que os profissionais utilizem Equipamento de Proteção Individual adequado, executem um cuidado humanizado, observando, continuamente, os sinais vitais dos pacientes para evitar a ocorrência de eventos adversos, promovendo a segurança do paciente.

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INTRODUCCION. El paciente crítico presenta mayor riesgo de lesiones por presión, su incidencia en cuidados intensivos continúa elevada y variable, a pesar de su prevención. En Ecuador se desconoce la realidad de esta complicación. OBJETIVO. Realizar una caracterización demográfica y epidemiológica a los pacientes críticos con lesiones por presión. MATERIALES Y MÉTODOS. Estudio descriptivo, retrospectivo. De una población de 2 087 ingresados en la Unidad de Adultos Área de Cuidados Intensivos del Hospital de Especialidades Carlos Andrade Marín, se recolectaron datos demográficos y epidemiológicos de 147 registros de historias clínicas físicas y electrónicas de pacientes que presentaron lesiones por presión, en el periodo 01 de enero al 31 diciembre 2018. Los datos fueron analizados en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 22. RESULTADOS. La mediana de edad fue 66 años; sexo hombre 63,3%, pre obesidad 40,8%, hipertensos 37,6% y diabéticos 23,8%. Más del 60,0% recibieron ventilación mecánica invasiva, sedantes y drogas vasoactivas, la mediana del Acute Physiology and Chronic Health disease Classification System II fue 20 (IQ 14-27), mortalidad 34,0%. La prevalencia de lesiones por presión fue 7,0% y la incidencia 3,49%. En la localización de las lesiones por presión: en región sacra 62,6%, talón 24,0% y cara 7,5%; 59,2% estadío 2 y 5,4% estadío 3. Al comparar los grupos de lesiones por presión no adquiridas versus adquiridas hubo diferencia estadísticamente significativa en duración de hospitalización previa a la detección de lesiones por presión (p<0,001), duración de hospitalización (p=0,003), localización de lesiones por presión en sacro (p=0,02), cara (p=0,02) y estadío 3 de lesiones por presión (p=0,03), en el resto de variables no se encontró diferencias. CONCLUSIÓN. La prevalencia de lesiones por presión está en los estándares aceptados a nivel internacional, su frecuencia y estadíos son similares a otros reportes, gracias a las medidas de prevención y control adoptadas por la Unidad.

INTRODUCTION. A patient at a critical situation has a higher risk of pressure injuries, and their incidence in intensive care continues being high and variable, despite its prevention. In Ecuador the reality of this complication is unknown. OBJECTIVE. To perform a demographic and epidemiological characterization of critically ill patients with pressure injuries. MATERIALS AND METHODS. Descriptive, retrospective study. From a population of 2 087 admitted to the Adult Unit Intensive Care Area of the Carlos Andrade Marín Specialties Hospital, demographic and epidemiological data were collected from 147 records of physical and electronic Medical Records of patients who pressure injuries, in the period January 1 to December 31, 2018. The data were analyzed in the statistical program International Business Machines Statistical Package for the Social Sciences, version 22. RESULTS. Median age was 66 years; male sex 63,3%, pre-obese 40,8%, hypertensive 37,6% and diabetic 23,8%. More than 60,0% received invasive mechanical ventilation, sedatives and vasoactive drugs, the median of the Acute Physiology and Chronic Health disease Classification System II was 20 (IQ 14-27), mortality 34,0%. The prevalence of pressure injuries was 7,0% and incidence 3,49%. The location of pressure injuries were: the sacral region 62,6%, heel 24,0% and face 7,5%; 59,2% stage 2 and 5,4% stage 3. When comparing the groups of non-acquired versus acquired pressure lesions, there was a statistically significant difference in hospital-stay lengths prior to the detection of pressure lesions (p<0,001), hospital-stay lengths (p=0,003), location of pressure lesions in sacrum (p=0,02), face (p=0,02) and stage 3 of pressure lesions (p=0,03); no differences were found in the rest of the variables. CONCLUSION. The prevalence of pressure injuries remains within international accepted standards, their frequency and stages are similar to other reports.

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Introducción. El modelo de cuidado a pacientes en el Salvation Army Toronto Grace Health Centre Hospital está basado en los principios de cuidado centrado en el paciente y la familia como parte integral del equipo interprofesional. Dentro de este marco se diseñan y se implementan diferentes programas para que se mejore constantemente y se mantenga un buen nivel de cuidados y calidad de vida de los pacientes, dentro de las limitaciones que conlleva el estar hospitalizado, esto después de convertirse en Best Practice Spotlight. Objetivo. Presentar la experiencia de las rondas interprofesionales de heridas antes y después de Best Practice Spotlight.Síntesis. Antes de ser BPSO los documentos de pólizas y procedimientos que guiaban las prácticas alrededor de úlceras o heridas por presión, en el hospital se utilizaban como referencia las guías basadas en las evidencias de la Asociación de Enfermeras de Ontario (RNAO). Sin embargo, no estaba formalizada la ejecución o aplicación de estas prácticas al punto de cuidado directo al paciente. En este artículo se presenta la transición y los aspectos relevantes para que sea una realidad el cuidado centrado en el paciente y la familia como parte del equipo interprofesional en el componente de las rondas interprofesionales de heridas. Conclusiones. El éxito de la implementación efectiva de las guías ha sido el programa BPSO, que se ha convertido en una identidad colectiva de organizaciones que trabajan en pro de los mejores resultados en las organizaciones de salud en instituciones nacionales e internacionales

Introduction. The patient care model at the Salvation Army Toronto Grace Health Centre Hospital is based on principles of patient- and family-centered care provided by the interprofessional team. In this framework, different programs are designed and implemented to constantly improve and keep a good level of care and quality of life of the patients, within the limitations involved in hospitalization, once they have become a Best Practice Spotlight Objective. Present the experience of the interprofessional wound rounds before and after being recognized as a Best Practice Spotlight.Summary. Before becoming a BPSO, the policy and procedure documents guiding the hospital's practices on ulcers or pressure wounds used as reference the evidence-based guidelines of the Registered Nurses' Association of Ontario (RNAO). However, the implementation or application of these practices had not been formalized directly at the point of patient care. This article presents the transition and the relevant aspects for making patient- and family-centered care a reality for the interprofessional team in the component of interprofessional wound rounds. Conclusions. The success in the effective implementation of the guidelines of the BPSO program has become a collective identity for the organizations that work towards the best results in healthcare organizations in national and international institutions.

Introdução. O modelo de cuidados ao paciente no Salvation Army Toronto Grace Health Centre Hospital é baseado nos princípios de cuidados centrado no paciente e na família como parte integrante da equipe interprofissional. Dentro deste quadro, diferentes programas são concebidos e implementados para melhorar constantemente e manter um bom nível de cuidados e qualidade de vida para os pacientes, dentro das limitações de estarem hospitalizados, isto após se tornar um Best Practice Spotlight. Objetivo. Apresentar a experiência de rondas interprofissionais de feridas antes e depois do Best Practice Spotlight.Síntese. Antes de ser BPSO, a política e os documentos de procedimento que orientavam as práticas em relação às úlceras ou feridas de pressão, o hospital usava as diretrizes baseadas em evidências da Associação de Enfermeiros de Ontário (RNAO) como referência. No entanto, a execução ou aplicação dessas práticas até o atendimento direto ao paciente não estava formalizada. Este artigo apresenta a transição e aspectos relevantes para tornar uma realidade os cuidados centrados no paciente e na família como parte da equipe interprofissional no componente de rondas interprofissionais de feridas. Conclusões. O sucesso da implementação efetiva das diretrizes tem sido o programa BPSO, que se tornou uma identidade coletiva de organizações que trabalham em prol dos melhores resultados nas organizações de saúde em instituições nacionais e internacionais.

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ABSTRACT Objective: To build and validate the content of a good practice tool in the newborn bath. Method: Methodological study, developed from December 2018 to January 2019, in a Joint Neonatal Housing Unit of a teaching hospital, in three stages: bibliographic survey, construction of the instrument and content validation by nine judges. The content validity index was used above 80% and general analysis with ten requirements. Results: The instrument was organized in three domains: before bathing, during bathing and after bathing, with a total of 20 items. Two rounds of validation were carried out to adjust the suggestions; the second presented a percentage of agreement between the judges, equal to or above 0.82. Conclusion: The instrument "Good practices in the newborn's bath" was considered representative and valid in terms of content.

RESUMEN Objetivo: Construir y validar el contenido de un instrumento de buenas prácticas en el baño del recién nacido. Método: Estudio metodológico, desarrollado en el período de diciembre de 2018 a enero de 2019, en una Unidad de Alojamiento Conjunto Neonatal de un hospital de enseñanza, en tres etapas: levantamiento bibliográfico, construcción del instrumento y validez de contenido por nueve jueces. Se empleó el índice de validez de contenido arriba de 80% y análisis general con diez requisitos. Resultados: El instrumento ha sido organizado en tres dominios: cuidados antes del baño, durante el baño y después del baño, con el total de 20 ítems. Han sido realizadas dos rodadas de validez para adecuaciones de las sugestiones; la segunda presentó porcentual de concordancia entre los jueces igual o superior a 0,82. Conclusión: El instrumento "Buenas prácticas en el baño del recién nacido" ha sido considerado representativo y válido cuanto al contenido.

RESUMO Objetivo: Construir e validar o conteúdo de um instrumento de boas práticas no banho do recémnascido. Métodos: Estudo metodológico, desenvolvido no período de dezembro de 2018 a janeiro de 2019, em uma Unidade de Alojamento Conjunto Neonatal de um hospital de ensino, em três etapas: levantamento bibliográfico, construção do instrumento e validação de conteúdo por nove juízes. Empregou-se o índice de validade de conteúdo acima de 80% e análise geral com dez requisitos. Resultados: O instrumento foi organizado em três domínios: cuidados antes do banho, durante o banho e após o banho, com total de 20 itens. Foram realizadas duas rodadas de validação para adequações das sugestões; a segunda apresentou percentual de concordância entre os juízes igual ou superior a 0,82. Conclusão: O instrumento "Boas práticas no banho do recém-nascido" foi considerado representativo e válido quanto ao conteúdo.

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Ochronosis is a cutaneous disorder caused by the accumulation of phenols, either endogenously as homogentisic acid in patients with alkaptonuria (autosomal recessive disorder with deficiency of the enzyme homogentisic acid oxidase), or exogenously in patients using phenol products such as topical creams containing hydroquinone or the intramuscular application of antimalarial drugs. Exogenous ochronosis (EO) typically affects the face and was reported in patients with dark skin such as Black South Africans or Hispanics who use skin-lightening products containing hydroquinone for extended periods. Recently more cases have been reported worldwide even in patients with lighter skin tones, to include Eastern Indians, Asians, and Europeans. However, just 39 cases of EO have been reported in the US literature from 1983 to 2020. Here we present two cases; a 69 and a 45-year-old female who were seen for melasma, given hydroquinone 4% cream daily and tretinoin 0.05%. Both patients noticed brown spots on their cheeks, which progressively enlarged and darkened in color. The diagnosis of ochronosis was confirmed by characteristic histopathological features on the punch biopsy. Unfortunately, neither patient responded to multiple treatments (to include, tazarotene 0.1% gel and pimecrolimus ointment, topical corticosteroids, and avoidance of hydroquinone containing products). We also present a case of classic (endogenous) ochronosis in a patient with alkaptonuria to picture the histological similarities of these two entities. EO is an important clinical consideration because early diagnosis and treatment may offer the best outcome for this notoriously refractory clinical diagnosis.

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We assessed safety and potential efficacy of a chamomile gel compared with urea cream to prevent acute radiation dermatitis in head and neck cancer patients. We assessed safety and potential efficacy of the chamomile gel in escalating concentrations of 2.50%, 5.00% and 8.35% of chamomile. Concentration of 8.35% was chosen for a randomized trial comparing chamomile gel (8.35%) with urea cream (n = 24 per group), for potential efficacy to delay or prevent radiation dermatitis in these patients. Preliminary results demonstrate a delayed onset of dermatitis, with onset of Grade 2 dermatitis at 5.1 (1.3) weeks in the chamomile group and 4.5 (1.3) weeks in the urea group (effect size of 0.46). Itching, burning and hyperpigmentation were more frequently reported in the urea group. Results indicates a potential efficacy of the chamomile gel. Further studies are needed to confirm the effect of the chamomile gel in reducing or delaying the occurrence of radiation dermatitis.

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Introdução: a rosácea é uma doença inflamatória de pele, de etiologia desconhecida. Apresenta-se na região centro-facial, com a presença de rubor, eritema, telangiectasias, pápulas e pústulas, periódicas ou persistentes. Objetivo: o objetivo deste trabalho é realizar uma revisão bibliográfica narrativa de estudos envolvendo os cuidados dermocosméticos no tratamento da rosácea. Metodologia: as buscas foram realizadas nas bases de dados: Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) e PubMed. A pesquisa envolveu artigos de revistas e periódicos, monografias e dissertações em português, inglês e francês, publicadas entre os anos de 2014 a 2020. Resultados: a pele dos pacientes com rosácea é suscetível a irritabilidade, logo, é necessário uma série de cuidados diários com a pele desde a limpeza, hidratação, proteção solar, que possibilitam efeitos calmantes que melhoram a qualidade da pele. Conclusão: devido à natureza multifatorial da doença não há tratamento padronizado. Logo, os profissionais envolvidos nos cuidados desses pacientes devem esclarecer aos pacientes sobre as ações e cuidados necessários para o uso das terapêuticas, incluindo os dermocosméticos.

Introduction: rosacea, erythema, telangiectasias, papules and pustules, periodic or persistent. Objective: the objective of this work is to carry out a narrative bibliographic review of studies involving dermocosmetic care in the treatment of rosacea. Methodology: Searches were carried out in the databases: Virtual Health Library (VHL), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS) and PubMed. The research involved magazine and periodical articles, monographs and dissertations in Portuguese, English and French, published between 2014 and 2020. Results: the skin of patients with rosacea is susceptible to irritability, therefore, a series of daily care is necessary with the skin from cleansing, hydration, sun protection, which enable calming effects that improve the quality of the skin. Conclusion: due to the multifactorial nature of the disease, there is no standardized treatment. Therefore, the professionals involved in the care of these patients must inform patients about the actions and care necessary for the use of therapies, including dermocosmetics.

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RESUMEN Introducción: el envejecimiento poblacional ocasiona en la actualidad un aumento de las afecciones vinculadas al deterioro de la integridad de la piel, siendo las dermatosis enfermedades frecuentes en el gerente. Objetivo: describir el comportamiento de las dermatosis en los adultos mayores. Métodos: estudio observacional, descriptivo de corte transversal, efectuado en el municipio de Pinar del Río durante 2018. Fue seleccionada de forma probabilística, aleatoria simple, una muestra 1164 pacientes geriátricos portadores de afecciones dermatológicas, empleándose las historias clínicas y el examen dermatológico para la obtención de información que dio salida a las variables estudiadas. Se respetó la ética médica. Resultados: predominaron las féminas (51,98 %) y el grupo etáreo 60-64 años (34,19 %), siendo el fototipo cutáneo III (23,11 %) el más frecuente mostrado por las afecciones dermatológicas. Dentro de ellas, las ectoparasitosis (16,15 %) y las virosis cutáneas (14,95 %) fueron las más representativas, mostrándose mayor representación en individuos de color de piel blanca, a excepción de la ectoparasitosis. Dentro de las patologías asociadas, la diabetes mellitus fuela más frecuente. Conclusiones: la oportuna identificación de la presencia de dermatosis en AM, y en especial en aquellos que reúnen factores de riesgo vinculados a su aparición, permitirá actuar tempranamente en el manejo de dichas afecciones, logrando reducir la aparición de complicaciones y secuelas asociadas a las mismas; a la vez que se logrará mejorar la calidad de vida de dicho paciente.

ABSTRACT Introduction: population aging currently causes an increase in conditions related to skin integrity disorder, with dermatoses being frequent diseases in the manager. Objective: to describe the behavior of dermatoses in older adults. Methods: an observational, descriptive cross-sectional study, carried out in the municipality of Pinar del Río during 2018. A sample of 1164 geriatric patients with dermatological conditions was selected in a probabilistic way, using random medical records and dermatological examination for the Obtaining information that output the variables studied. Medical ethics was respected. Results: predominantly females (51,98 %) and age group 60-64 years (34,19 %), skin phototype III (23,11 %) being the most frequent demonstrated by dermatological conditions. Among them, ectoparasitosis (16,15 %) and cutaneous virosis (14,95 %) were the most representative, showing greater representation in individuals with white skin color, an exception to ectoparasitosis. Within the associated pathologies, diabetes mellitus was the most frequent. Conclusions: the timely identification of the presence of dermatosis in AM, and especially in those that meet risk factors linked to its appearance, acting early in the management of various conditions, reducing the occurrence of complications and sequelae affected by themselves; while improving the quality of life of said patient.

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Introducción. Se reconoce que uno de los aportes de la enfermería basada en la evidencia (EBE) es el mejoramiento de la calidad de la atención y existen organizaciones como la Asociación de Enfermeras Registradas de Ontario (RNAO) que han desarrollado guías de práctica clínica y estrategias metodológicas para su implementación. El objetivo de este artículo es describir la experiencia y reflexiones sobre el proceso de implementación de guías de EBE de la RNAO, haciendo énfasis en los resultados de adherencia y sostenibilidad de tres guías en una institución de tercer nivel. Temas de reflexión. La organización RNAO ha elaborado una herramienta de implementación según el modelo de Proceso de Conocimiento para la Acción que implica seis fases: identificación del problema, adaptación al contexto local, evaluación de los facilitadores y barreras para el uso del conocimiento, adaptación, implantación de intervenciones / estrategias de implementación, monitorización, evaluación y sostenibilidad. Todas estas se adelantaron para implementar inicialmente tres guías ("Valoración y manejo del dolor", "Prevención de caídas y lesiones derivadas de las caídas" y "Valoración del riesgo de lesiones de piel por presión"), en una institución de tercer nivel. Conclusiones. La auditoría y verificación periódica de las estrategias implementadas promueve la adherencia del personal de los servicios en el cumplimiento de las metas institucionales y la sostenibilidad del cambio logrado. Cómo citar: Granados-Oliveros LM, Esparza-Bohorquez M. Implementación y sostenibilidad de las guías de enfermería basadas en la evidencia: modelo de la RNAO. MedUNAB. 2020;23(1):85-94. doi:10.29375/01237047.3725

Introducción. Se reconoce que uno de los aportes de la enfermería basada en la evidencia (EBE) es el mejoramiento de la calidad de la atención y existen organizaciones como la Asociación de Enfermeras Registradas de Ontario (RNAO) que han desarrollado guías de práctica clínica y estrategias metodológicas para su implementación. El objetivo de este artículo es describir la experiencia y reflexiones sobre el proceso de implementación de guías de EBE de la RNAO, haciendo énfasis en los resultados de adherencia y sostenibilidad de tres guías en una institución de tercer nivel. Temas de reflexión. La organización RNAO ha elaborado una herramienta de implementación según el modelo de Proceso de Conocimiento para la Acción que implica seis fases: identificación del problema, adaptación al contexto local, evaluación de los facilitadores y barreras para el uso del conocimiento, adaptación, implantación de intervenciones / estrategias de implementación, monitorización, evaluación y sostenibilidad. Todas estas se adelantaron para implementar inicialmente tres guías ("Valoración y manejo del dolor", "Prevención de caídas y lesiones derivadas de las caídas" y "Valoración del riesgo de lesiones de piel por presión"), en una institución de tercer nivel. Conclusiones. La auditoría y verificación periódica de las estrategias implementadas promueve la adherencia del personal de los servicios en el cumplimiento de las metas institucionales y la sostenibilidad del cambio logrado. Cómo citar: Granados-Oliveros LM, Esparza-Bohorquez M. Implementación y sostenibilidad de las guías de enfermería basadas en la evidencia: modelo de la RNAO. MedUNAB. 2020;23(1):85-94. doi:10.29375/01237047.3725

Introduction. It is recognized that the evidence-based nursing (EBN) contributed to enhancing the quality of care and that there are organizations such as the Registered Nurses' Association of Ontario (RNAO) that have developed guides on clinical practice and methodological strategies for their implementation. This article describes the experience and reflections on the implementation process of RNAO's EBN guides, focusing on the sustainability and adhesion results of three guides implemented in a tertiary institution. Reflection topics. RNAO has created an implementation tool according to the knowledge-to-action process model which consists of six phases: problem identification, local context adaptation, assessment of facilitating agents and of obstacles for the use of knowledge, adjustment, deployment of interventions / implementation strategies, monitoring, evaluation and sustainability. All these phases were advanced to initially implement three guides ("Assessing and managing pain", "Preventing falls and injuries from falls" and "Assessing skin lesions risk due to pressure") at a tertiary institution. Conclusions. The periodic audit and verification of the strategies implemented promotes compliance by the service personnel as regards institutional goals and the sustainability of the change achieved. Cómo citar: Granados-Oliveros LM, Esparza-Bohorquez M. Implementación y sostenibilidad de las guías de enfermería basadas en la evidencia: modelo de la RNAO. MedUNAB. 2020;23(1):85-94. doi:10.29375/01237047.3725

Introdução. Reconhece-se que uma das contribuições da enfermagem baseada em evidencias (EBE) é a melhoria da qualidade do atendimento, e existem organizações como a Associação de Enfermeiras Registradas de Ontário (RNAO) que tem desenvolvido diretrizes de prática clínica e estratégias metodológicas para sua implementação. Objetivo. Descrever a experiencia e as reflexões sobre o processo de implementação dos guias de EBE do RNAO, enfatizando os resultados da adesão e sustentabilidade de três guias em uma instituição de terceiro nível. Refleção. A organização RNAO desenvolveu uma ferramenta de implementação de acordo com o modelo Processo de Conhecimento para a Ação que envolve seis fases: identificação do problema, adaptação ao contexto local, avaliação de facilitadores e limitações ao uso do conhecimento, adaptação, implementação de intervenções/estratégias de implementação, monitoramento, avaliação e sustentabilidade. Todas estas foram organizadas para implementar inicialmente três guias ("Avaliação e tratamento da dor", "Prevenção de quedas e lesões resultantes de quedas" e "Avaliação do risco de lesões na pele devido à pressão"), em uma instituição de terceiro nível. Conclusões. A auditoria e a verificação periódica das estratégias implementadas promovem a adesão do pessoal de serviço no cumprimento dos objetivos institucionais e a sustentabilidade da mudança alcançada. Cómo citar: Granados-Oliveros LM, Esparza-Bohorquez M. Implementación y sostenibilidad de las guías de enfermería basadas en la evidencia: modelo de la RNAO. MedUNAB. 2020;23(1):85-94. doi:10.29375/01237047.3725

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