A multicentre comparison of tap water versus sterile saline for wound irrigation. Loures: Lusodidacta.2006; ISBN: 978-972-8930-03-5. Wash Your Hands Clean your hands using soap and water or hand sanitizer, then put on disposable gloves, if possible. Certainly we dont want cleansing to infect or damage the wound. It is well known that chronic and hard-to-heal wounds have created a global crisis. There is evidence that maggot therapy may help with wound healing. Last night I pressed on the wound to try to see if there is more liquid underneath, and since it had a bad smell I worried about infection. Nociception. Dextrose is a common type of added sugar that's made when corn is broken down with acids or enzymes before it's crystallized, according to the U.S. Food & Drug Administration (FDA). Visible wound. 21. Use a tissue forceps or probe to expose the wound tissue, and explore the entire depth and full extent of the wound to locate foreign bodies, particulate matter, bone fragments, and injuries to underlying structures. Tetanus vaccination and immune globulin may be needed depending on the wound type and patient's vaccination history (see table Tetanus Prophylaxis in Routine Wound Management Tetanus Prophylaxis in Routine Wound Management ). Intermountain Healthcare: Chronic Wounds., Mayo Clinic: Cuts and Scrapes: First Aid, Burns: First Aid., Familydoctor.org: First Aid: Cuts, Scrapes, and Stitches., Seattle Childrens Hospital: Skin Injury.. Gouveia J, Seco A, Ingls F. Limpeza da ferida: papel da polihexanida na preparao do leito da ferida. The controversy surrounding the use of antiseptics prompted the development of guidelines for the use of antiseptics by wound care experts. The Washington Post says an antiseptic . 5. Use OR to account for alternate terms One of the most typical uses is IV drips, for those who are dehydrated or suffering from diarrhea and serious vomiting. Santos EJF, Silva MANCGMM. Wounds involving deep structures (eg, nerves, blood vessels, ducts, joints, tendons, bones) and those covering large areas require specific repair techniques that may necessitate referral to a surgical specialist. Clostridium are gram-positive, spore-forming rods that are. We need to give dementia the attention it surely deserves. measuring cup. -a first aider can effectively clean a large wound-soaking wounds is an effective method of cleaning wounds out-applying antibiotic ointment reduces the risk of infection. Typically, a nonstick porous dressing is placed directly over the wound, followed sometimes by an absorbent dressing sufficient to absorb the wound's secretions, followed lastly by an occlusive dressing. Adjust the stretcher height so that you will be comfortable either sitting or standing at the bedside. reduce the number of microorganisms that form on the surface of the wound Continue irrigation until the wound is visibly clean. THE FACTS Most parents and school nurses have a time-honored approach to treating a small wound: clean it up, stop the bleeding and then let it get some air.. Elevate the area if possible, and, if needed, use other means (eg, inflated blood pressure cuff, brief application of a proximal tourniquet, injected or topical 1% epinephrine with lidocaine) to attain hemostasis. Dextrose solutions can be confusing to nursing students because they don't act like other IV fluids. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Go to the emergency room right away if you have any major burns. Check the quality of the water source. 3- Remove gloves, wash hands, apply new gloves. 1. Clean the wound: Use clean . 2009; 66(1):82-90. Am J Emerg Med.1998; 16: 379-381. 7. Wolters Kluwer Health Device Name: ProntosanTM Wound Irrigation Solution Indications For Use: Prontosan Wound Irrigation Solution is intended for cleaning wounds and for moistening and lubricating absorbent wound dressings for ulcers, burns, post-surgical wounds and abrasions. Water; sodium chloride; polihexanide; clean*; wound*; heal*; infect*; detergents; povidone-iodine; chlorhexidine; hydrotherapy; shower; bath; irrigate. Romanelli M, Dini V, Barbanera S, Bertone MS. Lump or nodule presence. These opposing forces loosen the particles and suspend them in the water. Apply firm pressure to the container to obtain the desired flow rate. No part of this website or publication may be reproduced, stored, or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the copyright holder, http://www.woundsource.com/product-category/wound-cleansers/wound-cleanser-products, http://woundcareadvisor.com/apple-bites-vol1-no4/, http://woundcareadvisor.com/debridement-options-beams-made-easy_vol2-no/, Silk wound dressing helps eliminate scar tissue formation, Predicting diabetic foot ulcer healing improves with thermal imaging, Biotech startup announces patent for regenerative tissue therapy, FDA approves wound retraction system that fights surgical site infections. Dr. Arturo Gonzalez and Dr. Alton R. Johnson, Cathy Thomas Hess, BSN, RN, CWOCN and Dr. Lisa Gould, MD, PhD, FACS, How to Choose an Antimicrobial Wound Dressing: Questions to Ask and Factors to Consider, Cellular and/or Tissue-Based Products: Helping to Close Chronic Wounds, Recommendations for Wounds After Flaps and Grafts, How to Leverage Technology to Improve Patient Education and Outreach, From Chronic to Closure: An Innovative Approach to Manage Challenging Wounds, Working Smarter, Not Harder: Strategies for Wound Management Success, How to Advance Complex Wounds Toward Healing, Implementing Wound Hygiene: A Stepwise Approach, Transforming Cleansing Practice: Following the Science & Consensus Guidelines. You dont need hydrogen peroxide or iodine products to thoroughly clean a simple cut or scrape. Use a new 44 gauze pad for each circle. Advantages of tap water for wound cleansing are efficiency, cost effectiveness, and accessibility. Dont pick at any scabs -- theyre part of the healing process. Puncture wounds should be irrigated and debrided at the surface, particularly if secondary to cat bites given their high likelihood of infection. These symptoms are unpleasant for patients and often interfere with read more should be used as needed for wounds that are difficult to anesthetize using local anesthesia (eg, very painful or large wounds) and for agitated or uncooperative patients. 10. Your message has been successfully sent to your colleague. Although the two most commonly cited concerns regarding tap water are possible infection risk and the fact that it is not an isotonic solution. Can I change the ratio of the saline solution? Ingredients in commercial cleansers may include surfactants, wetting agents, moisturizers, and/or antimicrobials. Even though they are wearing gloves, this increases risk of infection. Place all equipment on a tray within yourbut not the patient'sreach. You should clean a wound every time you change a dressing, unless its contraindicated. The dedicated team at Cogent Purchasing are here to help. Towler J. Cleansing traumatic wounds with swabs, water or saline. Why should they be used? Tap water is also recommended and has the advantages of being efficient, cost effective and accessible.5,16 There is now increasing recognition of the safe use of tap water for wound irrigation, especially in chronic wounds15 and it is worth considering as an acceptable alternative to other products. It can also be used in other ways including dealing with sore throats, razor burn, acne, cuts, nasal congestion and burns. 1 If the wound is not dirty, don't clean it. 4- Clean wound with prescribed cleanser Smith RG. your express consent. The wound cleanser should also: be effective in the presence of organic material, such as blood, slough, or necrotic tissue Lactated Ringers solution. 3. 1. Keep Your Wound Clean & Covered Make sure your wound stays clean, covered, and dry at all times. Potable tap water can be used if there is no other alternative. A critical discussion of the use of antiseptics in acute traumatic wounds.J Am Podiatr Med Assoc.2005; 95: 148-53. Wounds with possible retained foreign bodies, joint penetration, or damage to underlying structures such as tendons require full wound exploration and observation through the range of motion of adjoining joints. What is the most common bacteria found in postopeative wound infections. It can take up to 40 minutes after cleaning for a wound to regain its original temperature, and up to 3 hours for miotic cell division and leukocytic activity to return to normal. If only there were a multifunctional smart-dressing that could be used on every wound etiology. Cleansing wounds is, therefore, not recommended unless the wound shows signs of infection, presents with slough or is visibly contaminated with faecal material or debris. Position the patient comfortably reclined or supine. Effect of povidone-iodine on wound healing: a review. Do this before you touch your. 20. This step applies only if the wound is bleeding. Yet amongst scientific literature, several studies have recommended various cleansing agents for their supposed therapeutic value. Then inject the anesthetic, minimizing the pressure of injection while slowly withdrawing the needle. All traumatic wounds are assumed to be contaminated. 9. In addition to use of antiseptics to reduce bacterial load of a wound, several other approaches have been developed, including debridement, cleansing and pulsating jet lavage for removal of the devitalized tissue, and application of topical antibiotics. However, cleaning a wound is important to make sure it heals correctly. If the wound has been closed with sutures, many operators apply topical antibiotic to keep the sutures from adhering to the dressing. 6. Provide tissue care as needed. ORESTAL ORANGE FLAVOUR Liquid 200ml. Relatively straight, sharp-edged lacerations of the trunk or an extremity, and read more , depending on the nature of the wound. It may even decrease pain. Do not introduce a cleansing agent directly into the wound because many are toxic to tissues and may interfere with wound healing. Occasionally, identified or suspected foreign bodies are deeply seated, requiring referral to a surgical specialist. This product is intended for intravenous administration only. 6. 7-Discard gloves and all used supplies in trash bag When it popped I continued to clean and put dressing on it. Try to rinse soap out of wound to prevent irritation. Moisten clean 44 gauze pads in the solution; squeeze out excess. Yes, maggots are creepy, crawly, and slimy. Or, place a cool cloth on the burn for the same length of time. Antiseptics, iodine, povidone iodine and traumatic wound cleansing. If significant oozing or bleeding seems possible, apply a sterile absorbent dressing over the nonadherent dressing. You may apply aloe vera throughout the day as needed. Skin Pharmacology and Physiology.2010; 23(1): 41-44. 1. Nursing New Zealand.1993; 1(3): 14-16. Do you need assistance sourcing parts of NSN 2815-01-446-9212 as soon as possible? Seek medical attention right away if: Stitches are usually needed for cuts longer than inch. Clean at least one inch beyond the end of the new . What? Wound hygiene (eg, cleansing, irrigation, and debridement), including thorough examination of the wound and surrounding tissues, promotes uncomplicated healing of traumatic skin wounds and is required prior to wound closure. Adequate anesthesia is important because these procedures may be painful, and insufficient anesthesia may result in insufficient cleansing, inspection, and debridement. Its not always necessary to use these if you have a minor cut or scrape. 4. Judging whether a wound actually needs to be cleansed or not is the first consideration. To prepare water that isn't straight from a sealed bottle to be clean enough to clean a wound, you need to: Filter it if it has any type of debris in it at all. Blot up excess moisture with a clean gauze pad. Warm area on the body. Adelaide The Joanna Briggs Institute [serial online] 2006; [cited 2012 Nov 1] 10(2). The cleansing of superficial traumatic wounds. Indeed, Flanagan11 argues that water has been used for centuries to treat wounds without any reported detrimental effects. Thanks. Wound Cleansing: Water or Saline? Simple flushing with a loaded syringe works well, with care not to use too much pressure so tissue is not disturbed. We do not control or have responsibility for the content of any third-party site. Simply put, dextrose is sugar derived from corn and it is chemically identical to glucose, or blood sugar. Please confirm that you are a health care professional. Large, A, Heinbecker, P. The Effect of Cooling on Wound Healing. lm an infection control nurse and just back from post basic in infection control l was taught not to use Normal saline solution for wound cleaning as it will enhance the growth of microorganism. Below are common types of wound cleansers: Normal saline solution. The whole purpose of cleansing a wound is to remove necrotic or infectious material from the wound to prevent or reduce infection. Thank you for your post regarding washing hands and donning new gloves. More specifically, the review will focus on the following questions: The management of chronic and acute wounds has changed significantly in the last decade. Davies C. Cleansing rites and wrongs. Gently wipe the wound from top to bottom in one motion, starting directly over the wound. We turn her every 2-3 hours so that she doesnt get sores. Otherwise, place a clean, sterile, nonstick bandage on the wound after cleaning it. Cleaning wounds. In addition, the situation is further complicated by studies showing that bacterial colonization of the wound does not necessarily indicate infection and that there is no need to remove the bacteria in the absence of clinical signs of infection.2. Delayed healing in these wounds is often associated with biofilm, and antimicrobial dressings can be effective in managing bioburden in chronic wounds. 1 cm c. 2 cm d. 5cm 18. : CD003861. Piezoelectric crystals in the signal generator convert electricity into high-frequency sound waves, which are sent into read more ) should be obtained for deep wounds, puncture wounds, and other wounds that potentially involve a fracture or may contain foreign bodies (eg, teeth, glass, or splinters). Wash your hands thoroughly with soap and water. Insert the needle directly into the exposed subdermal layer of the wound edge (ie, do not insert the needle percutaneously) and advance the needle to the hub. JBI. Hold the spray bottle approximately Use a soft washcloth and mild soap to clean around the wound. that involves squirting, spraying, or pressure release of fluid will require the use of PPE (such as gloves, gown, and mask with eye shield) to prevent exposure to debris and airborne microorganisms. Sagittal proton densityweighted 3-tesla magnetic resonance image of the right knee shows meniscocapsular separation read more . Wound healing is impaired by various factors (eg, bacterial contamination, foreign bodies, wound ischemia, host factors). Atiyeh BS, Dibo SA, Hayek SN. Moisten 44 gauze pads in the solution; squeeze out excess. No. Dosage: Adults: The usual adult dosage range for cefuroxime (cefuroxime (cefuroxime injection) injection) is 750 mg to 1.5 grams every 8 hours, usually for 5 to 10 days. Remove any jewelry you have on your hands and/or wrists. For wounds that require closure, the closure can be done using simple interrupted sutures How To Repair a Laceration With Simple Interrupted Sutures Uncomplicated epidermal closure is most often done using simple interrupted sutures. However, use normal saline solution instead of water for wounds with exposed bone or tendon. For more protection, wear disposable gloves. Paper tape may be less irritating to sensitive skin. There should be debris or blood in the wound that needs to be rinsed out. Actively bleeding wounds should not be irrigated, because irrigation may disturb clot formation; hemostasis must precede irrigation. Yes, your moms wound does need to be seen by either a physician, nurse practitioner, or wound specialist. Gently wipe away any remaining cleansing agent and dried blood or skin debris using moistened gauze. A three-step search strategy will be used in this review. To continue reading this clinical article please log in or subscribe. Each type of wound is best treated based on its etiology. For an open wound: Stop using the cream or ointment if a rash appears. Therefore, one opened, saline bottles should be discarded within 24 hours of opening. When irrigating a wound, how far above the wound should the tip of the syringe be? Elevation and use of a proximally placed compression tourniquet are often helpful in achieving hemostasis of hand wounds. Crystalloid solutions contain solutes such as electrolytes or dextrose, which are easily mixed and dissolvable in solution. This bitesize learning video series explores the different types of mattresses that are used in clinical settings and how to choose wisely to reduce pressure ulcer risk. Beam, JW. Heres a review of how to choose and use a wound cleanser so you can see if your practice is up to date. They can become delirious (ICU delirium). Over-the-counter skin antibiotics, like Neosporin or Polysporin, help keep the skin moist and ward off infection. Saline can clean cuts and scrapes. Keyword Highlighting Does it really need to be cleansed, or are we actually doing harm to the wound? Eyewash Spray Eyewash spray to flush the eye in emergency situations. This article explains the circumstances in which it is appropriate to cleanse a wound, when it is appropriate to use tap water and when a sterile solution is recommended. Care of lacerations Enables prompt healing Minimizes risk of infection Optimizes cosmetic results read more : Document the wound's history, location, size, degree of contamination, foreign bodies, associated injuries (eg, fractures and muscle and tendon disruptions), and neurovascular status distal to the wound. However, they have not been proven to reduce infection or enhance healing. Everyone knows that you cleanse a wound before dressing it. Avoid clamping blood vessels to avoid inadvertently clamping tendons, nerves, or other important structures. Please try again soon. Irrigate the laceration using sterile saline in a 35- or 60-mL syringe (preferably with a splash guard attached but otherwise via a plastic catheter). Rev. Does it need to be cleansed? 4. We are a rural hospital and rely upon irrigating wounds with a 35 ml syringe and 18g catherer, using normal saline. 5. Symptoms of Swelling in Cats. How can I heal my dogs wound fast? Eyebrows must remain intact to achieve accurate alignment of wound edges during suturing. window.googletag = window.googletag || {cmd: []}; googletag.cmd.push(function() { googletag.defineSlot('/21733458972/WCA_MedRecATF', [300, 250], 'div-gpt-ad-1625090148207-0').addService(googletag.pubads()); googletag.pubads().enableSingleRequest(); googletag.pubads().collapseEmptyDivs(); googletag.enableServices(); }); window.googletag = window.googletag || {cmd: []}; googletag.cmd.push(function() { googletag.defineSlot('/21733458972/WCA-MedRecBTF', [300, 250], 'div-gpt-ad-1625090148207-2').addService(googletag.pubads()); googletag.pubads().enableSingleRequest(); googletag.pubads().collapseEmptyDivs(); googletag.enableServices(); }); Powered by HealthCom Media:All rights reserved. The trusted provider of medical information since 1899, How To Cleanse, Irrigate, Debride, and Dress Wounds, How To Repair a Laceration With Simple Interrupted Sutures, How To Do Plastic Surgical Repair With Buried Deep Dermal Sutures, How To Repair a Laceration With Horizontal Mattress Sutures, How To Repair a Laceration With a Subcuticular Running Suture, How To Repair a Laceration With Vertical Mattress Sutures, Last review/revision Mar 2021 | Modified Sep 2022. Just flushing with a solution should be good enough, but I have seen some nurses muck around in the wound, touching and stroking it. Kaehn K. Polihexanide: a Safe and Highly Effective Biocide. A number of commercial cleansers are actually toxic to the wound unless they are diluted 10 to 100 fold.2 Surprisingly, tap water is as useful as normal saline and has the benefit of being less expensive and overall having better patient acceptance.3. Can you explain the implications of wound healing when saline from the fridge is used? Here is a quick description of glove changing according to infection control guidelines: The content is not intended to substitute manufacturer instructions. Generally, wound irrigation Debride all devitalized and necrotic tissue: Stabilize the wound edge with forceps, then cut away the devitalized tissue with a scalpel or iris scissors. Mechanisms of delayed wound healing by commonly used antiseptics. Accessed April 1, 2013. 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It just seems wrong to be advised not to change gloves after cleansing a wound thereby potentially infecting a wound. [serial online]. All rights reserved. Moisten 44 gauze pads in the solution; squeeze out excess. ). But what about a pink, clean, granulating wound that just had a clean, intact dressing removed? For conventional read more and ultrasonography Ultrasonography In ultrasonography, a signal generator is combined with a transducer. Ulcerations. In this regard, this review will focus in two types of outcomes: Both analyses will be divided in three groups: This review will only consider experimental study designs including randomised controlled trials, non-randomised controlled trials, or other quasi-experimental studies, including before and after studies for inclusion. Wound hygiene and closure techniques need not be sterile procedures. 3. Spray cleansers may be applied directly to the wound or sprayed onto clean 44 gauze pads and then applied to the wound. Philadelphia, PA: Lippincott Williams & Wilkins; 2012. http://woundcareadvisor.com/apple-bites-vol1-no4/. Clean Cut or Wound Gently clean with soap and warm water. The authors thank the support provided by Health Sciences Research Unit - Nursing (UICISA-E), hosted by the Nursing School of Coimbra (ESEnfC). Pull back on the plunger to exclude intravascular placement. Please elaborateThank you Donna, Am wondering if in after cleaning an open wound, it is better to pack with equal a n b or iodine. Plain x-rays are sensitive for glass ( 1 mm) and most inorganic material (eg, stones). Be careful not to place circumferential wraps too tightly, which may lead to excessive compression and subsequent ischemia. Manual cleansing technique teaspoon. Position the patient so that the cleansing solution will flow by gravity from the upper end of the wound to the lower end. Please try after some time. See your doctor if any large blisters form. Mix in food . Nursing Management of Chronic Wounds.1997; Mosby, London. Care of lacerations Enables prompt healing Minimizes risk of infection Optimizes cosmetic results read more regarding which wounds may benefit from delayed closure or no closure.) Wound healing typically progresses through four phases: hemostasis, inflammation, cell proliferation or granulation and repair, and epithelialization and remodeling of scar tissue. Click here to see examples of wound cleansers. Just follow these steps: If you have a burn, rinse the area under cool (not cold) water for 10 to 15 minutes. Wound healing is impaired by various factors (eg, bacterial contamination, foreign bodies, wound ischemia, host factors). Face mask and safety glasses (or a face shield), head cap, gown, gloves (sterile if preferred, but these are nonsterile procedures), Sterile drapes, towels (for wound debridement and suturing), Wound cleansing, inspection, debridement (not all items are required for simple repairs), Antiseptic solution (eg, chlorhexidine, povidone-iodine), Sterile gauze squares (eg, 10 cm 10 cm [4 inch 4 inch]), Pneumatic tourniquet (or blood pressure cuff), commercial hemostatic agent, as needed to assist hemostasis. Please enable scripts and reload this page. About The Author Platelet-rich plasma (PRP) and hypertonic dextrose solutions are commonly used injectates in regenerative medicine, sometimes used simultaneously. there is a controversey at work if you need to change gloves and wash hands prior to applying clean treatment/dressing, Kelly, Without seeing your wound, I cannot tell you if your treatment is correct. a. Available from: 15. Huxtable K. Ritual cleansing. 17. 8. You may search for similar articles that contain these same keywords or you may Some error has occurred while processing your request. Pour the irrigation solution into the irrigation tray. Diagnosis and management of foreign bodies in wounds are a critical part of wound hygiene. 2006; 41(2): 196-197. However, normal saline. Surfactants are agents that facilitate removal of wound contaminants. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Method and cleaning solution will vary based on the type of wound. Thanks! Step 1. 5% Dextrose, 0.45% Sodium Chloride and 30 mEq/L Potassium Chloride Injection, USP, 1000 ml, Viaflex Plastic Container, 14/cs (Rx) Rating Required Select Rating 1 star (worst) 2 stars 3 stars (average) 4 stars 5 stars (best) Wash your hands for at least 20 seconds. Khan MN, Naqvi AH. Thus, the purpose of this systematic review is to investigate the effectiveness of cleansing solutions for wound treatment in clinical practice. Wound hygiene (eg, cleansing, irrigation, and debridement), including thorough examination of the wound and surrounding tissues, promotes uncomplicated healing of traumatic skin wounds and is required prior to wound closure. Follow these steps: wash and dry your hands thoroughly wear disposable gloves if available Rinse the wound in clear water to loosen and remove dirt and debris. 4. Signs of swelling include: General puffiness. Also, Here is a link to a detailed step by step procedure of non-sterile dressing change. In pathology, a wound is an acute injury that damages the epidermis of the skin. Cleaning a wound removes loose debris and planktonic (free-floating) bacteria, provides protection to promote an optimal environment for healing, and facilitates wound assessment by optimizing visualization of the wound. You should clean a wound every time you change a dressing, unless it's contraindicated. Depending on wound location, patients can do this themselves; local anesthesia may be needed. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 7th ed. (See Lacerations Lacerations Lacerations are tears in soft body tissue. For missing information or data that needs clarification, the authors of primary studies will be contacted. Complications The most common wound complications are: Initially wash heavily contaminated wounds, eg, using tap water and a gentle hand soap. Pat the tissue surrounding the wound dry 7. Spray cleansers 2. How can that be a dilemma? It comes with a self-assessment enabling you to test your knowledge after reading it, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 10th Floor, Southern House, Wellesley Grove, Croydon, CR0 1XG, We use cookies to personalize and improve your experience on our site. Use a new 44 gauze pad for eachcircle. Baxter 1A0692 - MEDLINE CANNOT DISTRIBUTE-SOLUTION, N, 12/CS ; Shipping. Prolotherapy for failed back surgery syndrome. These symptoms are unpleasant for patients and often interfere with read more and analgesia Analgesia Intensive care unit (ICU) patients are often agitated, confused, and uncomfortable. Hess CT (ed.). 3. Br J Nurs .2000; 9 (Suppl 19):S28-38. Maggots' excretions soothe inflamed wounds, speeding healing. Dealey C. Tratamento de Feridas: um guia para enfermagem.1. After you have finished cleaning the wound, dispose of the waste in a trash bag; then remove and discard your gloves and any other PPE you used. The databases to be searched will include: CINAHL Plus with Full Text, MedicLatina, Academic Search Complete, MEDLINE with Full Text, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Nursing & Allied Health Collection: Comprehensive (via EBSCO); Elsevier - Science Direct (via b-on - Online Knowledge Library); Scielo - Scientific Electronic Library Online.
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