Made available in DSpace on 2016-04-28T20:37:40Z (GMT). No. of bitstreams: 1 Cristiane Palmeira de Oliveira Barreto.pdf: 2017234 bytes, checksum: 702acc48673d621e2b9f244d025493ec (MD5) Previous issue date: 2011-05-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The following dissertation has the purpose of studying the relation between mothering and mother s function in neonatal ICU. I intentionally propose to set a distance between the two concepts, being mothering the incumbency of the necessary caretaking for survival and mother s function, the practice of a symbolic function that relates the subject to its psychic constitution in its relation with the language field. In the present study, the inquiry consists in verifying whether the difficulty in practicing mothering, which occurs within the neonatal intensive care unit, may interfere with the conditions that support mother function or not, as a rule, practiced by the mother. The inquiry was conducted at a private hospital in São Paulo city, with mothers of both male and female babies, born preterm and admitted at the neonatal ICU and, subsequently, after discharge. The clinical extracts of the mother s saying during the interviews and presented in this paper are analyzed in the light of the Freud and Lacan psychoanalysis theory. And, regarding the investigation of the conditions for the performance of mother s function, I sought inspiration on the four theoretical axis formulated in the Clinical Indicators of Risk for the Child Development (IRDI). By listening to the mothers during and after the hospital admission reveals the presence of psychic impact caused by the preterm birth of a child and the admission in the neonatal ICU, as well as the difficulty in mothering the baby. Albeit, despite the psychic rapture, in the analysis of the symbolic function based on the four fundamental operations, deduced by me according to the IRDI -, it was possible to notice conditions for the mother s function to be performed / A presente dissertação tem como objetivo estudar a relação entre a maternagem e a função materna em UTI Neonatal. Proponho propositalmente um distanciamento entre os dois conceitos, onde à maternagem cabe a incumbência dos cuidados necessários à sobrevivência e à função materna o exercício de uma função simbólica - que remete o sujeito à dimensão de sua constituição psíquica por sua relação com o campo da linguagem. Neste trabalho, a investigação consiste em verificar se a dificuldade no exercício da maternagem, que ocorre no âmbito de uma unidade de terapia intensiva neonatal, pode interferir nas condições de sustentação da função materna, via de regra exercida pela mãe. A pesquisa foi realizada em um hospital da rede privada de saúde da cidade de São Paulo, com mães de bebês de ambos os sexos, nascidos prematuros e internados na UTI Neonatal e, posteriormente, no pós-alta. Os recortes clínicos das falas das mães em entrevista e apresentados neste trabalho são analisados à luz da teoria psicanalítica de Freud e de Lacan. E, para a investigação das condições para o exercício da função materna, inspirei-me nos quatro eixos teóricos formulados na pesquisa Indicadores Clínicos de Risco para o Desenvolvimento Infantil (IRDI). A escuta das mães durante e após a hospitalização revela a presença de sofrimento pelo impacto psíquico causado pelo nascimento prematuro de um filho e a internação em UTI Neonatal, bem como pela dificuldade em maternar o bebê. No entanto, apesar do arrebatamento psíquico, na análise da função simbólica a partir das quatro operações fundamentais, deduzidas por mim a partir dos IRDI -, foi possível notar as condições para que a função materna possa vir a se desempenhar

Submitted by Eunice Novais (enovais@uepg.br) on 2018-06-26T17:18:46Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Marcos Nader Amari.pdf: 2871707 bytes, checksum: 3efad844cbd1d0ff8bf2b8b2f91c88ce (MD5) / Made available in DSpace on 2018-06-26T17:18:46Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Marcos Nader Amari.pdf: 2871707 bytes, checksum: 3efad844cbd1d0ff8bf2b8b2f91c88ce (MD5) Previous issue date: 2018-05-18 / O presente estudo tem como objetivo comparar a estratificação de risco gestacional do Programa Rede Mãe Paranaense e sua relação com os internamentos dos recém-nascidos na Unidade de Terapia Intensiva Neonatal. Realizou-se um estudo quantitativo, longitudinal, epidemiológico, do tipo coorte, com acompanhamento dos internamentos dos recém-nascidos em unidade de terapia intensiva neonatal do Hospital Universitário Regional dos Campos Gerais no ano de 2016. Foi utilizado um instrumento de coleta de dados, aplicado aos pais, após o aceite do Termo de Consentimento Livre e Esclarecido. Também se obtiveram dados por análise documental em prontuários médicos. Os dados obtidos foram planilhados em Excel, e para análise estatística foi utilizado o Programa STATA. O público-alvo foi constituído de 70 recém-nascidos que foram internados em Unidade de Terapia Intensiva Neonatal, sendo comparados com a estratificação gestacional de suas mães. A população materna foi composta de mulheres brancas (76%) com nível fundamental e médio de escolaridade e com idade média de 25 anos. O nível de escolaridade encontrado foi o fundamental e médio. As faixas salariais obtidas com maior frequência, de acordo com os critérios do IBGE, foram até 4 salários mínimos. Os partos atuais foram em sua maioria hospitalares e com discreto predomínio dos partos vaginais. Cerca de 100% das gestantes fizeram consultas de pré-natal, sendo que 68% realizaram mais de 5 consultas durante a gestação. Em relação à população dos recém-nascidos, 58% foram de prematuros, quando comparados a 42% de termos. Aproximadamente 46% nasceram com apgar maior que 8 no primeiro minuto. O peso de nascimento variou de 670 até 4385 gramas. A média de internamento foi de 20 dias, variando de 14 dias no paciente a termo e 23 dias no paciente prematuro. Com relação à comparação dos internamentos em relação à estratificação gestacional 65,72% foram as de risco habitual. Realizou-se uma correção da estratificação encontrada no estudo, a qual foi chamada estratificação corrigida. A correção aplicada foi pela raça, idade e número de partos anteriores e presença de aborto. Realizou-se análise de associação de risco e embora tenha sido encontrada uma razão de risco em alguns casos, com valores menores que 1, simulando uma proteção para algumas exposições, o valor de p não foi significativo. O mesmo não ocorreu para o desfecho diagnóstico, onde o valor de p foi de 0,01 e 0,05 para a estratificação encontrada e corrigida. A causa de internamento mais frequente foi a respiratória (p= 0,001) e a hipóxia, nos recém-nascidos prematuros e de termo, respectivamente. Em análise de regressão linear observou-se que o aumento de uma semana na idade gestacional dos prematuros, aumenta a nota de apgar do primeiro minuto. Muitos estudos ainda devem ser realizados sobre o assunto, no intuito de mobilizar gestores de saúde sobre estas novas Políticas Publicas de Saúde a fim de minimizar óbitos neonatais evitáveis. / The objective of this study is to compare the gestational risk stratification of the Parana’s Mother Network Program and its relationship with the hospitalizations of newborns in the Neonatal Intensive Care Unit. A quantitative, longitudinal, epidemiological study of the cohort type was carried out, with follow up of hospitalizations of newborns in the neonatal intensive care unit of the Hospital Universitário Regional dos Campos Gerais in the year 2016. It was used a data collection instrument, applied to the parents, after the acceptance of the Free and Informed Consent Term. Data can also be obtained by documentary analysis in medical records. The data obtained were mapped on Excel, and statistical analysis was carried out using the STATA Program. The target group consisted of 70 newborns who were admitted to the Neonatal Intensive Care Unit and compared with the gestational stratification of their mothers. The maternal population was composed of white women (76%), with a primary and secondary schooling level and with an average age of 25 years. The salary bands found most frequently, according to the IBGE criteria, were up to 4 minimum wages according to the IBGE criteria. The current deliveries were mostly hospital and with a discreet predominance of vaginal deliveries. About 100% of pregnant women had prenatal consultations, and 68% performed more than 5 consultations during pregnancy. In relation to the newborn population, 58% were premature, as compared to 42% of full-terms. Approximately 46% were born with Apgar score greater than 8 in the first minute. The birth weight ranged from 670 to 4385 grams. The mean hospitalization was 20 days, ranging from 14 days in the full-term patient to 23 days in the preterm patient. Regarding the comparison of hospitalizations in relation to gestational stratification, 65,72% were those at usual risk. A correction in the study of the stratification was performed, which was called corrected. The correction applied was by race, age and number of previous deliveries and presence of abortion. A risk association analysis was performed and although a risk ratio was found in some cases, with values lower than 1, simulating protection for some exposures, the p value was not significant. The same did not occur for the diagnostic outcome, where the p-value was 0,01 and 0,05 for the stratification found and corrected. The most frequent cause of hospitalization was the respiratory rate (p= 0,001) and hypoxia, in premature newborns and full-term, respectively. In linear regression analysis, it was observed that the increase in a week on gestational age of premature infants increases the apgar of the first minute. Many studies must be conducted on the subject, in order to mobilize health managers on these new Public Health Policies in order to minimize preventable neonatal deaths.

Vården som utförs på intensivvårdsavdelningar präglas av övervakningsutrustning vilket kan medföra svårigheter för de närstående att komma nära den som vårdas. De gånger när livsuppehållande behandling inte räcker till tar vården en annan riktning och övergår till palliativ vård på IVA. Som omvårdnadsansvarig för patienten befinner sig intensivvårdsjuksköterskan ofta nära de närstående. För att kunna främja mötet med närstående behövs en förmåga att kunna sätta sig in i de närståendes livsvärld. Studiens syfte var att belysa intensivvårdssjuksköterskans upplevelse av att möta närstående till patienter där livsuppehållande behandling avvecklats och övergår till palliativ vård på IVA. För att besvara studiens syfte har sex intensivvårdssjuksköterskor intervjuats. För att genomföra intervjuerna tillämpades en intervjuguide med öppna frågor. Data analyserades med kvalitativ innehållsanalys, vilket resulterade i åtta subkategorier och tre kategorier. Studiens resultat visar att interaktionen mellan närstående och intensivvårdssjuksköterskan påverkas av övervakningsutrustningen samt om mötet sker på flerbäddsrum. Att ha en relation med de närstående och att vara delaktig i brytpunktsamtalet upplevdes som viktiga faktorer för intensivvårdssjuksköterskans bemötande med närstående. En förutsättning för att kunna balansera närvaro med distans i mötet med de närstående är att intensivvårdsjuksköterskan har en förmåga att själv reflektera över existentiella frågor. Vidare framkommer det att intensivvårdssjuksköterskan upplever sig vägleda de närstående genom ett svårt skede i livet. / Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård

Introdução: A readmissão de pacientes nas unidades de terapia intensiva (UTIs) está associada a piores desfechos durante a internação hospitalar. Através da análise de preditores existe a possibilidade de identificar os pacientes sob risco de readmissão e planejar possíveis intervenções visando melhorar a segurança destes pacientes. Objetivos: Avaliar o desempenho da saturação venosa central (SvcO2), do lactato, do déficit de bases (DB), dos níveis de proteína C reativa (PCR), do Sequential Organ Failure Assessment (SOFA), do Stability and Workload Index for Transfer (SWIFT) escore do dia da alta da UTI como preditores e fatores de risco para readmissão de pacientes na unidade de terapia intensiva (UTI), além de verificar a frequência de readmissões na UTI. Métodos: O estudo avaliou pacientes criticamente enfermos internados consecutivamente na unidade de terapia intensiva do Hospital Nossa Senhora da Conceição que receberem alta da UTI, no período entre Agosto/2011 e Agosto/2012. Resultados principais: Utilizando análise multivariada o SOFA e o SWIFT da alta foram identificados como fatores de risco independentemente associados à readmissão na UTI. Entretanto, com uma área sob a curva receiver operating characteristic (ROC) de 0,63 e 0,66 respectivamente, estes escores podem não ter grande aplicabilidade clínica em nossa população. A PCR, a SvcO2, o DB e o lactato não estão associados a readmissão de pacientes críticos. Conclusões: Apesar do grande impacto clínico e econômico associado à readmissão de pacientes na UTI, nossa capacidade para discriminar os pacientes sob risco de readmissão e objetivar os critérios de alta dos pacientes críticos segue inadequada. / Background: Readmission of patients in intensive care units (ICUs) is associated with worse outcomes during hospitalization. Possibly, identifying patients at risk for readmission through the analysis of predictors, some intervention may be planned for the security of these patients. Objectives: To evaluate the performance of central venous oxygen saturation (ScvO2), lactate, base deficit (BD), C-reactive protein (CRP), the Sequential Organ Failure Assessment (SOFA) score and the Stability and Workload Index for Transfer (SWIFT) score at the day of discharge from the intensive care unit (ICU) as predictors and risk factors for readmission or unexpected death among critically ill patients and to identify the frequency of readmissions in the ICU. Design: Prospective observational study. Location: academic tertiary hospital in Brazil. Patients: A total of 1,360 patients admitted to a 59 beds medical-surgical ICU from August 2011 to August 2012. Methods: We compared the characteristics and laboratory data of readmitted patients and not readmitted patients discharged from the ICU. Through multivariate analysis we identified potential risk factors independently associated with readmission. Main results: SOFA and SWIFT were identified as significant risk factors for ICU readmission. However, with an area under the ROC curve of 0.63 and 0.66, these scores would appear to have limited clinical applicability in our population. CRP, ScvO2, BD and lactate were not associated with readmission of critically ill patients. Conclusions: Perfusion and inflammatory markers are not good predictors of ICU readmission. Despite the clinical and economic impact associated with readmission in ICU, our ability to predict which patients will be readmitted is still inadequate.

Nursing Care for Terminal Patients in Intensive Care Units by Pervell Dunbar Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2015 Although the goal of the ICU has always been to save lives, ICU now additionally provides end-of life (EOL) care. The objective of this project was to provide ICU nurses with a comprehensive awareness of physical, emotional, and spiritual EOL care issues of patients and their families in order to be better equipped to handle EOL care. The framework used was Jean Watson's Caring model (10 Caritas). A literature review revealed a poster previously used by a major health organization as a conversation starter to facilitate decision-making among ICU nurses, EOL patients, and their families related to EOL issues. The purpose of this quality improvement initiative was to introduce and implement an educational EOL tool that would engage patients and family members in meaningful and useful conversations with ICU nurses. Twenty seven ICU nurses were selected by the unit's director to attend a PowerPoint presentation on the use of the EOL educational poster. Four ICU nurses were chosen by the director to be champions for this project. After the presentation, there was a period for questions and answers, and the ICU nurses were requested to give feedback on the presentation. The result from the feedback revealed that EOL care is outside previous practice and may require extra education and support. These comments substantiated similar conclusions from other researchers as described in this paper. With an increase in EOL training for ICU nurses and the implementation of EOL teaching tools like the poster used in this study, ICU nurses may be better able to have conversations with EOL patients and families, thus improving patient care.

<p>Inom intensivvården har utvecklingen av medicinteknisk utrustning de senaste tio åren gått mycket fort framåt och blivit allt mer avancerad. Utbildning och kompetensutveckling inom medicinsk teknik skaar en trygg och säker miljö för både patient och vårdpersonal och är ett led i patientsäkerhetsarbetet. Utbildning inom medicinsk teknik har sett olika ut genom åren och webbaserad utbildning är ett inlärningssätt. Syftet med examensarbetet var att beskriva intensivvårdssjuksköterskors uppfattningar av webbaserat utbildningsverktyg för medicinteknisk utrustning ur ett patientsäkerhetsperspektiv. Datainsamlingen skedde genom semistrukturerade intervjuer av åtta intensivvårdssjuksköterskor på ett sjukhus i Mellansverige. En fenomenografisk ansats användes i analysen och utfallsrummet presenterades utifrån tre kategorier som beskrev sjuksköterskornas uppfattningar. Resultatet visade att sjuksköterskorna uppfattade webbaserad utbildning TILDA som ett arbetsredskap för att inhämta kunskap och förståelse om den medicintekniska utrustningen, vilket ledde till att de kände sig tryggare och säkrare med handhavandet av medicinsk teknik i patientvården. Sjuksköterskorna uppfattade även att utbildningsmöjligheterna med TILDA påverkades av tid och miljö. Verksamheter som står inför valet att införa webbaserad utbildning bör noggrant tänka igenom hur deras organisation ser ut för att på bästa sätt ge vårdpersonalen möjlighet till en tillfredsställande kompetensutveckling.</p> / <p>The last decade the development of technology within intensive care have proceed very fast and become more advanced. Education and professional development within technology creates a safe and secure environment for both patient and healthcare staff wich is a part of the patient safety work. Education within technology has varied over the years and web-based education is one way of learning. The aim of this project was to describe ICU nurses conceptions of a web-based learning tool for medical technology from a patient safety perspective. Data was collected by semi structured interviews with eight ICU nurses in a hospital in Sweden. A phenomenographic approach was used in the analysis and the outcome space consisted of three categories which described the nurses conceptions. The results showed that nurses conceived web-based learning TILDA as a work tool to acquire knowledge and understanding about the medical technology which led to a safe and secure handle with the technology in patient care. The nurses also conceived that web-based learning TILDA was influenced by time and environment. Organisations who consider implementing web-based learning have to carefully consider how they best can provide the healthcare staff an opportunity to a satisfactory professional development.</p>

Inom intensivvården har utvecklingen av medicinteknisk utrustning de senaste tio åren gått mycket fort framåt och blivit allt mer avancerad. Utbildning och kompetensutveckling inom medicinsk teknik skaar en trygg och säker miljö för både patient och vårdpersonal och är ett led i patientsäkerhetsarbetet. Utbildning inom medicinsk teknik har sett olika ut genom åren och webbaserad utbildning är ett inlärningssätt. Syftet med examensarbetet var att beskriva intensivvårdssjuksköterskors uppfattningar av webbaserat utbildningsverktyg för medicinteknisk utrustning ur ett patientsäkerhetsperspektiv. Datainsamlingen skedde genom semistrukturerade intervjuer av åtta intensivvårdssjuksköterskor på ett sjukhus i Mellansverige. En fenomenografisk ansats användes i analysen och utfallsrummet presenterades utifrån tre kategorier som beskrev sjuksköterskornas uppfattningar. Resultatet visade att sjuksköterskorna uppfattade webbaserad utbildning TILDA som ett arbetsredskap för att inhämta kunskap och förståelse om den medicintekniska utrustningen, vilket ledde till att de kände sig tryggare och säkrare med handhavandet av medicinsk teknik i patientvården. Sjuksköterskorna uppfattade även att utbildningsmöjligheterna med TILDA påverkades av tid och miljö. Verksamheter som står inför valet att införa webbaserad utbildning bör noggrant tänka igenom hur deras organisation ser ut för att på bästa sätt ge vårdpersonalen möjlighet till en tillfredsställande kompetensutveckling. / The last decade the development of technology within intensive care have proceed very fast and become more advanced. Education and professional development within technology creates a safe and secure environment for both patient and healthcare staff wich is a part of the patient safety work. Education within technology has varied over the years and web-based education is one way of learning. The aim of this project was to describe ICU nurses conceptions of a web-based learning tool for medical technology from a patient safety perspective. Data was collected by semi structured interviews with eight ICU nurses in a hospital in Sweden. A phenomenographic approach was used in the analysis and the outcome space consisted of three categories which described the nurses conceptions. The results showed that nurses conceived web-based learning TILDA as a work tool to acquire knowledge and understanding about the medical technology which led to a safe and secure handle with the technology in patient care. The nurses also conceived that web-based learning TILDA was influenced by time and environment. Organisations who consider implementing web-based learning have to carefully consider how they best can provide the healthcare staff an opportunity to a satisfactory professional development.

Patients who require mechanical ventilation (MV) are at risk for developing ventilator associated pneumonia (VAP). Nurses’ adherence to sedation vacations (SVs) has a direct impact on the development of VAP, because SVs have been shown to reduce patients’ average duration of MV and length of stay (LOS) in the intensive care unit (ICU). The purposes of this study guided by Donabedian’s (1966) model were to quantify nurses’ level of adherence to SVs, in relation to the health outcomes of critically ill patients, and identify the barriers and facilitators to performing SVs. A correlational design was used. The design included three components: abstraction of patient data from the electronic medical record (EMR) (n=79 with VAP and n=79 without VAP), administration of surveys to ICU nurses (N =34), and vignettes related to SVs. Analyses included descriptive statistics, t-tests, correlations, and analyses of covariance. Most nurses held a Bachelors degree (70.6%), had < 9 years of ICU experience (52.9%), worked in a medical ICU (47.1%), and reported high confidence in managing SVs (M =8.88, SD =1.25). The majority of patients (N =158) were Black (58.2%), males (56.3%), and on average middle-aged (M =61.5, SD =14.91), with a long ICU LOS (M =15.5, SD =11.84), extended duration of MV (M =9.5, SD =8.47), and high acuity (APACHE III) (M =70.2, SD =25.42). The nurses’ education, advanced certification, and ICU experience were not associated with the appropriate implementation of SVs in the vignettes. On average nurses’ had low scores on the vignettes (M =6.97, SD =2.21; possible range =0-14). The adherence rate of nurses’ implementation of SVs, determined using EMR data, was also low (M =24%; SD =23%). There were higher rates of SV adherence in patients without VAP (p (p < .01), and a duration of MV < 6 days (p =.04). These findings indicate that even with established protocols, nurses may not consistently implement the evidenced-based interventions that have been shown to prevent nosocomial infections. Future research is needed to improve nursing practice and the quality of care in this patient population.

Objective of the work: The purpose of this quantitative retrospective comparative study was to register possible cases of augmentedted renal clearance (ARC) in patients of Hospital of Lithuanian University of Health Sciences and analyse the differences in assessments of cases of Augmented Renal Clearance and the drug therapy problems related to ARC. Tasks: To achieve the objective, several tasks were performed: 1) to register possible ARC patients cases as assessed by Cocroft-Gault and their possible associated reasons; 2) to analyse differences in three equations used for GFR estimation: Cocroft-Gault, MDRD simplified, and CKD-EPI. 3) compare the therapies of the patients and determine the drugs that are in risk of being underdosed when ARC is present. Methodology: An ARC survey (appendix 1) was filled about patients from various departments of Clinics during the period of 2013 03 04 – 2014 08 15. All patients were selected according serum creatinine values that were 50 µmol/l. or less. Two goups of patients were assigned for analysis: patients were grouped according Cocroft - Gault creatinine clearance values: (1) ARC group A CrCl >130 ml./min and (2) comparative Non-ARC group B CrCl 90-130 ml./min. Data were analyzed by using descriptive and comparative statistical analysis, considering statistically significant difference between the groups if p value was <0.05. Results and conclusions: 1. In the research group and comparative groups were 31 patients selected... [to full text] / Darbo tikslas: Šio kiekybinio retrospektyvaus palyginamojo darbo tikslas buvo surinkti duomenis apie padidinto inkstų klirenso PIK atvejus Lietuvos sveikatos mokslų universiteto ligonines Kauno klinikose. Buvo siekiama išanalizuoti sirtumus tarp skirtingų PIK įvertinimo būdų ir įvertinti galimas su PIK susijusias terapijos problemas. Uždaviniai: norint pasiekti užsibrėžtus tikslus šie uždaviniai buvo iškelti: 1) užregistruoti PIK atvejus ir nustatyti jų galimas priežastis. 2) apskaičiuoti GFG trimis skirtingomis formulėmis (Cocroft-Gault, MDRD, CKD-EPI) ir išanalizuoti skirtumus. 3) palyginti pacientų terapijas ir nustatyti, kurie vaistai galimai yra subterapinio dozavimo rizikoje Metodika: PIK anketa ( 1 priedas) buvo pildoma apie pacientus iš skirtingų Kauno klinikų skyrių, laikotarpiu nuo 2013 03 04 iki 2014 08 15. Visi pacientai buvo parinkti pagal kreatinino kiekį serume – 50 μmol/l.. ir mažiau. Dvi pacientų grupės buvo parinktos analizei: pacientai buvo sugrupuoti pagal kreatinino klirensą į (1) PIK A grupę – CrCl > 130 ml./min. ir (2) palyginamąją B grupę – CrCl 90-130 ml./min. Duomenys buvo analizuojami naudojant palyginamąją ir aprašomąją statistiką. Skirtumai tarp grupių buvo laikomi statistiškai reikšmingi, kai p reikšmė buvo <0.05. Rezultatai ir išvados: 1. Abiejose grupėse buvo surinkta po 31 pacientą (iš viso 62 pacientai). Remiantis darbo rezultatais, galima daryti išvadą, kad PIK (kai GFG yra 130ml/min. ir daugiau) nustatymui naudojant Cocroft-Gault formulę... [toliau žr. visą tekstą]

In recent years, the focus on augmented renal clearance increased as it was found by other researchers to result in subtherapeutic drug dosing concentrations. Accurate assessment of renal function is important for prescribing optimal dosis of pharmaceuticals for ARC patients. Objective of the work: The purpose of this quantitative retrospective comparative study was to register possible cases of Accelerated renal clearance in patients of Hospital of Lithuanian University of Health Sciences Kaunas Clinics and analyse the differences in assessments of cases of Augmented Renal Clearance and the possible risks of ARC for therapy. Tasks: To achieve the objective several tasks were raised: 1) to register possible ARC patients cases as assessed by Cocroft-Gault and their possible associated reasons; 2) to analyse differences in three for GFR estimation used equations (Cocroft-Gault, MDRD simplified, and CKD-EPI). 3) determine the risk drugs for changed renal elimination. Methodology: ARC survey (appendix 1) was filled about patients from various departments of Clinics during the period of 2013 03-04 – 2013 12-20. All patients were selected according serum creatinine values that were 50 µmol/l. or less. Two goups of patients were assigned for analysis: patients were grouped according Cocroft - Gault creatinine clearance values: (1) ARC group A CrCl >130 ml./min and (2) comparative Non-ARC group B CrCl 90-130 ml./min. In the group A were 31 and in the group B - 5 patients... [to full text] / Pastaraisiais metais labai išaugo tyrimų apie padidintą inkstų klirensą (PIK), nes pagal keleto tyrejų duomenis šios būklės pasekmė yra subterapinės vaistų koncentracijos. Tikslus inkstų funkcijos nustatymas yra labai svarbus norint parinkti optimalias terapines vaistų dozes padidinto inkstų klirenso pacientams. Darbo tikslas: Šio kiekybinio retrospektyvaus palyginamojo darbo tikslas buvo surinkti duomenis apie padidinto inkstų klirenso PIK atvejus Lietuvos sveikatos mokslų universiteto ligonines Kauno klinikose. Buvo siekiama išanalizuoti sirtumus tarp skirtingų PIK įvertinimo būdų ir įvertinti galimas PIK rizikas terapijai Uždaviniai: norint pasiekti užsibrėžtus tikslus šie uždaviniai buvo iškelti: 1) užregistruoti PIK atvejus ir nustatyti jų galimas priežastis. 2) apskaičiuoti GFG trimis skirtingomis formulėmis (Cocroft-Gault, MDRD, CKD-EPI) ir išanalizuoti skirtumus. 3) nustatyti vaistus, kurie gali būti pakitusios inksų eliminacijos rizikoje. Metodika: PIK anketa ( 1 priedas) buvo pildoma apie pacientus iš skirtingų Kauno klinikų skyrių, laikotarpiu nuo 2013 04 03 iki 2013 12 20. Visi pacientai buvo parinkti pagal kreatinino kiekį serume – 50 µmol/l.. ir mažiau. Dvi pacientų grupės buvo parinktos analizei: pacientai buvo sugrupuoti pagal kreatinino klirensą į (1) PIK A grupę – CrCl > 130 ml./min. ir (2) palyginamąją B grupę – CrCl 90-130 ml./min. A grupėje buvo parinktas 31 pacientas ir B grupėje 5 pacientai. Rezultatai: Vidutinės GFG reikšmės tiriamojoje... [toliau žr. visą tekstą]