Introdução: A assistência ao parto no Brasil tem enfrentado desafios nos últimos anos, no sentido de reduzir práticas desnecessárias e inseguras. No entanto, medidas utilizadas para acelerar o trabalho de parto e demais intervenções durante o trabalho de parto e parto ainda são frequentes e podem impactar negativamente as condições de vitalidade do recém-nascido. Objetivos: Analisar a associação entre os fatores sociodemográficos, organizacionais, obstétricos e assistenciais e desfecho neonatal desfavorável entre RNs de termo e estimar sua frequência. Método: Estudo transversal, a partir dos dados do inquérito nacional Nascer no Brasil, referentes à região Sudeste. A amostra foi composta por puérperas que tiveram RNs vivos, natimortos (peso 500 gramas e/ou idade gestacional 22 semanas), nascidos em hospitais com 500 partos em 2011 e 2012. Foram excluídos os recém-nascidos prematuros, gemelares e aqueles com malformações. A variável dependente desfecho neonatal desfavorável foi construída por meio da composição das variáveis intubação traqueal, massagem cardíaca, uso de drogas na reanimação neonatal, internação em UTI neonatal e Apgar <7 no 5.o minuto de vida no período pós-natal imediato. A associação entre as variáveis de interesse e a variável desfecho foi estimada por meio de regressão logística binária univariada e múltipla, calculando-se Odds ratio (OR) brutas e ajustadas com intervalos de confiança de 95 por cento (IC 95 por cento ). Resultados: A amostra foi composta por 8.783 mulheres e seus RNs. A proporção de RNs que apresentou desfecho neonatal desfavorável foi de 9,6 por cento (844). Ensino fundamental incompleto (OR=2,139; IC 95 por cento 1,292-3,540), baixo peso ao nascer (peso 2.500g; OR=2,822; IC 95 por cento 1,641-4,851), intercorrência obstétrica (OR=1,421; IC 95 por cento 1,055-1,914) e parto fórceps (OR=3,761; IC 95 por cento 1,824-7,754) constituíram fatores associados ao desfecho neonatal desfavorável. Discussão: Os fatores independentemente associados ao desfecho neonatal desfavorável na Região Sudeste do Brasil foram em sua maioria condições clínicas que têm influência sobre a condição do recém-nascido no período pós-parto imediato. Recém-nascidos com baixo peso e aqueles filhos de mulheres com problemas obstétricos têm condições como líquido amniótico reduzido ou insuficiência placentária que resultam em alterações da vitalidade. Mulheres com baixa escolaridade têm maior dificuldade em acessar os serviços de saúde, o que pode dificultar a identificação e tratamento de problemas obstétricos e baixo peso ao nascer. O parto fórceps pode representar a resolução de trabalhos de parto distócicos e também ser um marcador para os fetos cuja vitalidade encontrava-se alterada durante o trabalho de parto. Conclusões: Fatores clínicos e associados a desigualdades sociais têm impacto negativo sobre a vitalidade dos recém-nascidos. Os desfechos neonatais desfavoráveis ainda são pouco investigados, por isso ações que visem à melhoria da atenção pré-natal e do trabalho de parto, principalmente entre mulheres com baixa escolaridade e aquelas com complicações obstétricas, podem resultar em melhores desfechos de saúde para o recém-nascido. Encontramos uma proporção de 9,6 por cento (844) entre os recém-nascidos no termo gestacional que apresentaram desfecho neonatal desfavorável. Neste estudo foi possível observar a existência de associação entre fatores sociodemográficos, clínicos e assistenciais maternos e desfechos neonatais desfavoráveis entre os RNs de termo / Introduction: Childbirth care in Brazil has faced challenges in recent years to reduce unnecessary and unsafe practices. However, measures used to accelerate labour and other interventions during labour and delivery are still frequent and may negatively impact the vitality of the newborn. Objectives: To analyze the association between sociodemographic, organizational, obstetric and care factors and unfavorable neonatal outcomes among term newborns and to estimate the frequency of these outcomes. Method: A cross-sectional study, based on data from the national survey \"Birth in Brazil\" in the the Southeast region of Brazil. The sample consisted of mothers who had live births, stillbirths (weight 500 grams and / or gestational age 22 weeks) in hospitals with 500 births in 2011 and 2012. Premature babies, twins, preterm newborns and those with malformations were excluded from the analysis. The dependent variable \"unfavorable neonatal outcome\" was constructed through the composition of the variables tracheal intubation, cardiac massage, drug use in neonatal resuscitation, neonatal ICU admission, and Apgar <7 at the 5th minute of life in the immediate postnatal period. The association between the variables of interest and the outcome variable was estimated using univariate and multiple binary logistic regression, calculating crude and adjusted Odds Ratio (OR) with 95 per cent confidence intervals (95 per cent CI). Results: The sample consisted of 8,773 women and their newborns. The proportion of newborns who presented an unfavorable neonatal outcome was 9.6 per cent (844). Incomplete primary education (OR = 2.139, 95 per cent CI 1.292-3.540), low birth weight (weight 2.500g, OR = 2.822, 95 per cent CI 1.641-4.851), obstetric complication (OR = 1.421, 95 per cent CI 1.055-1.914) and Forceps (OR = 3.761, 95 per cent CI, 1.824-7.754) were factors associated with unfavorable neonatal outcome. Discussion: Factors independently associated with unfavorable neonatal outcomes in the Southeast Region of Brazil were mostly clinical conditions that influence the condition of the newborn in the immediate postpartum period. Infants with low birth weight and those of women with obstetric problems have conditions such as reduced amniotic fluid or placental insufficiency that result in changes in vitality. Women with low schooling have greater difficulty in accessing health services, which make it difficult to identify and treat obstetric problems and low birth weight. Forceps delivery may represent resolution of dystocic labor and was also be a marker for fetuses whose vitality was altered during labor. Conclusions: Clinical factors associated with social inequalities have a negative impact on the vitality of newborns. Negative neonatal outcomes are still poorly investigated, so actions aimed at improving prenatal care and labor, especially among women with low schooling and those with obstetric complications, may result in better health outcomes for the newborn. We found a proportion of 9.6 per cent (844) among neonates in the gestational term who presented an unfavorable neonatal outcome. In this study it was possible to observe the existence of an association between sociodemographic, clinical and maternal care factors and unfavorable neonatal outcomes among the term newborns

O objetivo desse estudo é o desenvolvimento de um sistema especialista em um ambiente hospitalar para apoiar o diagnóstico médico de pacientes críticos com suspeita de Sepse em unidades de terapia intensiva. Como objetivos específicos, a plataforma desenvolvida emitirá alerta após o processamento em tempo real de todas as informações conforme protocolo de sepse da unidade referente a cada paciente como: exames laboratoriais, monitoramentos, integração com o prontuário eletrônico, indicando assim ao médico quais pacientes necessitam de prioridade naquele momento. Os pacientes serão classificados de acordo as informações processadas acima e identificados no sistema com as cores: vermelho (risco eminente), amarelo (médio risco), verde (baixo risco). Tais informações não devem ser tomadas como únicas, mas como técnica auxiliar e principalmente necessárias para as organizações hospitalares que buscam melhorias de desempenho através de soluções integradas orientadas a eventos. Com base na epidemiologia e um estudo longitudinal, o estudo se ocupa a avaliar o sistema desenvolvido identificando através de gráficos e indicadores as seguintes informações: tempo de tratamento na unidade, tempo de decisão do médico, tempo de iniciação com antibiótico, tempo médio de resultados laboratoriais, altas clínicas e mortalidade. Serão utilizadas no estudo duas amostras de grupo de pacientes adultos maiores de 18 anos em uma unidade de terapia intensiva com suspeita de sepse que chegam à Rede Pública de Saúde, comparando através de um estudo epidemiológico longitudinal, pacientes que passaram pela unidade nos três meses com o sistema implantado e outra amostra com pacientes nos três meses anteriores ao sistema. / The aim of this study is to develop an expert system in a hospital environment to support the medical diagnosis of critically ill patients with suspected sepsis in intensive care units. The specific objectives, the developed platform will issue warning after real-time processing of all information as unit sepsis protocol for each patient as laboratory tests, monitoring, integration with electronic medical records, thus indicating to the physician which patients need priority at that time. Patients will be classified according the information processed above and identified in the system with the colors: red (imminent risk), yellow (medium risk), green (low risk). Such information should not be taken as single, but as a technical assistant and mainly needed for hospital organizations seeking performance improvements through integrated solutions oriented events. Based on the epidemiology and a longitudinal study, the study is concerned to evaluate the system developed by identifying through graphs and indicators the following information: the unit treatment time, doctor\'s decision time, start time antibiotic, average time results laboratory, clinical and high mortality. Will be used to study two largest group of adult patients samples of 18 years in an intensive care unit with suspected sepsis arriving to the Public Health Network, comparing through a longitudinal epidemiological study, patients who had the unit in the three months to the implanted system and another sample of patients in the three months prior to the system.

The purpose of this study was to identify the strengths and weaknesses of a pre-operative health education programme provided to cardiac surgery patients at a private hospital in Gauteng. A questionnaire was used to collect data and indicated that most patients were satisfied with the pre-operative education that they received before their cardiac surgery procedure, and therefore felt well prepared for the operation. It is, however, evident that family involvement with pre-operative education was not satisfactory. This lack of family involvement is a limitation in the present programme. The study also noted that patients must be informed about visiting hours, and the intense feeling of the endotracheal tube post-operatively should be emphasised. / Health Studies / M.A. (Health Studies)

The abstract on the file is incorrect, use the the one in the system as it summerizes the full text. / This attempted to describe factors contributing to sleep deprivation in the a multidisciplinary intensive care unit in KwaZulu-Natal Province. A quantitative, descriptive research design was adopted and structured interviews were conducted with 34 adult patients. Most factors contributing to these patients' sleep deprivation are basic physiological needs. Much can be done to enhance patients' abilities to sleep if noise (from alarms, monitors, televisions, telephones and footsteps) could be controlled, patients' pain would be managed effectively, doctors would visit the patients regularly, doctors and nurses use lay terms when talking to patients. Visible clocks and windows will help patients to maintain time orientation. Friendly, approachable and respectful nurses who introduce themselves to the patients help' to reduce patients' stress levels and improve their abilities to sleep. / Health Sciences / M.A. (Health Studies)

O objetivo desse estudo é o desenvolvimento de um sistema especialista em um ambiente hospitalar para apoiar o diagnóstico médico de pacientes críticos com suspeita de Sepse em unidades de terapia intensiva. Como objetivos específicos, a plataforma desenvolvida emitirá alerta após o processamento em tempo real de todas as informações conforme protocolo de sepse da unidade referente a cada paciente como: exames laboratoriais, monitoramentos, integração com o prontuário eletrônico, indicando assim ao médico quais pacientes necessitam de prioridade naquele momento. Os pacientes serão classificados de acordo as informações processadas acima e identificados no sistema com as cores: vermelho (risco eminente), amarelo (médio risco), verde (baixo risco). Tais informações não devem ser tomadas como únicas, mas como técnica auxiliar e principalmente necessárias para as organizações hospitalares que buscam melhorias de desempenho através de soluções integradas orientadas a eventos. Com base na epidemiologia e um estudo longitudinal, o estudo se ocupa a avaliar o sistema desenvolvido identificando através de gráficos e indicadores as seguintes informações: tempo de tratamento na unidade, tempo de decisão do médico, tempo de iniciação com antibiótico, tempo médio de resultados laboratoriais, altas clínicas e mortalidade. Serão utilizadas no estudo duas amostras de grupo de pacientes adultos maiores de 18 anos em uma unidade de terapia intensiva com suspeita de sepse que chegam à Rede Pública de Saúde, comparando através de um estudo epidemiológico longitudinal, pacientes que passaram pela unidade nos três meses com o sistema implantado e outra amostra com pacientes nos três meses anteriores ao sistema. / The aim of this study is to develop an expert system in a hospital environment to support the medical diagnosis of critically ill patients with suspected sepsis in intensive care units. The specific objectives, the developed platform will issue warning after real-time processing of all information as unit sepsis protocol for each patient as laboratory tests, monitoring, integration with electronic medical records, thus indicating to the physician which patients need priority at that time. Patients will be classified according the information processed above and identified in the system with the colors: red (imminent risk), yellow (medium risk), green (low risk). Such information should not be taken as single, but as a technical assistant and mainly needed for hospital organizations seeking performance improvements through integrated solutions oriented events. Based on the epidemiology and a longitudinal study, the study is concerned to evaluate the system developed by identifying through graphs and indicators the following information: the unit treatment time, doctor\'s decision time, start time antibiotic, average time results laboratory, clinical and high mortality. Will be used to study two largest group of adult patients samples of 18 years in an intensive care unit with suspected sepsis arriving to the Public Health Network, comparing through a longitudinal epidemiological study, patients who had the unit in the three months to the implanted system and another sample of patients in the three months prior to the system.

De nombreuses études au cours des dernières décennies ont porté sur l'effet l’îlot de chaleur urbain (ICU). Les efforts initiaux visant à comprendre les facteurs qui influent sur l’ICU ont contribué à la mise en place de solutions et de stratégies d'atténuation adaptées. Les stratégies d'atténuation comprennent généralement l'augmentation de l'albédo urbain (réflectivité au rayonnement solaire) et l'évapotranspiration. Les augmentations d'albedo sont obtenues grâce à des technologies de toiture et de pavage ayant un albédo élevé. Une augmentation de l'évapotranspiration est obtenue par une combinaison de la diminution de la fraction de surfaces imperméables et la plantation de végétation dans les zones urbaines. Le confort thermique extérieur est défini à partir d’indices prenant en compte différents paramètres physiques et traduit la perception et la satisfaction des piétons. Ce confort est très difficile à obtenir en climat chaud et aride. Par conséquent, le travail présenté dans ce document met l'accent sur les méthodes appropriées pour réduire l’ICU et ainsi améliorer le confort thermique en plein air des piétons. Jusqu’à présent, peu de recherches ont été menées sur le confort thermique extérieur dans un climat chaud et aride. Les études sur l'atténuation de l'ICU et le confort thermique extérieur sont pratiquement inexistantes pour la ville de Bagdad. Bagdad a un tissu urbain complexe avec des constructions modernes, des maisons traditionnelles et des éléments caractéristiques du patrimoine local. Le climat en été est chaud, et les mois d'été sont considérés comme la plus longue saison avec près de 7 mois de l'année. Dans un premier temps, cette étude se concentre sur l'étude des stratégies d'atténuation à envisager afin d’évaluer comment le confort des piétons est affecté par les choix de conception des constructions, en comparant un quartier traditionnel à un quartier moderne. L’étude envisage ensuite la façon dont la végétation et les ombrages contribuent à réduire l'effet de l'ICU et à améliorer le confort thermique extérieur. Quatre scénarios différents sont élaborés pour évaluer le rôle d’éléments végétaux tels que les arbres, l'herbe et les différents modèles d'ombrage. L'évaluation a été effectuée le jour le plus chaud de l'été, la température radiante moyenne, l'humidité spécifique, la température de l'air et les distributions de la vitesse du vent ont été analysées à l'aide du logiciel ENVI-met. Le confort thermique est ensuite évalué à l'aide des indices thermiques de la température équivalente physiologique PET et du PMV étendu aux ambiances extérieures. En outre, une proposition de solution est abordée afin d’étudier son impact sur le confort thermique pour la journée la plus chaude (situation extrême) et une journée typique d’été. Les résultats ont révélé une amélioration du confort thermique dans la journée typique d’été. L'étude montre comment les facteurs urbains tels que le rapport d'aspect, la couverture végétale, les ombres et la géométrie du quartier sont des éléments cruciaux que les urbanistes et les municipalités doivent prendre en compte, en particulier pour les nouveaux aménagements urbains dans un climat chaud et aride. Une proposition d’aménagement global pour atténuer les ICU dans le cas d’un nouveau quartier sous climat aride, est détaillée en fin de mémoire. / Numerous studies over the past several decades focused on the effect of the Urban Heat Island. Initial efforts on understanding the factors affecting UHI contributed to proceed the appropriate solutions and mitigation strategies. Mitigation strategies comprise increase both urban albedo (reflectivity to solar radiation), and evapotranspiration. Albedo increases are obtained through high albedo roofing and paving technologies. An increase in evapotranspiration is achieved through a combination of decreasing the fraction of impervious surfaces and planting vegetation in urban areas. The outdoor thermal comfort is influenced by the perception and satisfaction of the pedestrians, especially in hot and arid climates. Consequently, this work focuses on the appropriate methods for reducing the Urban Heat Island and thus to enhance the pedestrians outdoor thermal comfort. However, there is limited research conducted on the outdoor thermal comfort in hot and arid climate. The studies on the mitigation the Urban Heat Island and the outdoor thermal comfort are almost non-existent for Baghdad city. Baghdad has a complex urban fabric with modern design constructions buildings, traditional and heritage houses. The climate in summer is hot, and summer months are considered the longest season with nearly 7 months of the year. This study focuses on investigating possible mitigation strategies to ensure how pedestrian comfort is affected by the constructions design choices comparing a traditional district to a modern one, and on how vegetation and shading patterns contribute to reducing the effect of UHI and improving the outdoor thermal comfort. Four different scenarios are designed to assess the role of vegetation elements such as trees, grass, and different shading patterns. The evaluation was performed on the hottest day in summer, the mean radiant temperature, specific humidity, air temperature, and wind speed distributions have been analyzed using ENVI-met software. Thermal comfort is assessed using the thermal indices the Physiological Equivalent Temperature PET and the Predicted Mean Vote PMV. Also, a proposal model is designed to evaluate the thermal comfort on the hottest day and the typical day in summer. The results revealed an improvement on thermal comfort in the typical day in summer. The study shows how the urban factors such as the aspect ratio, vegetation cover, shadings, and geometry of the canyon are crucial elements that urban planners and municipalities have to take into account, especially for new urban developments in hot, arid climate.

Patients admitted to intensive care unit (ICU) are known to develop significant impairments in physical function. Patients with critical illness suffer up to 30% reductions in muscle size within the first ten days of admission to the ICU. Muscle strength testing, Medical Research Council-sum score, is current gold-standard to diagnosis ICU-acquired weakness and predicts risk of mortality and long-term physical function. Muscle power different from muscle strength in that it accounts for velocity of movement, is potentially a better independent predictor of function that has not been studied in this population. In addition, we hypothesize that muscle size and quality measured through ultrasound imaging has better applicability and prediction that strength testing. Therefore, we prospectively collected data surrounding these muscle parameters in patients admitted to the medicine ICU at University of Kentucky. Primary outcomes included physical function, muscle power with a novel assessment tool for the critically ill population, muscle strength, and muscle size and quality assess through ultrasound imaging. 36 patients admitted to ICU and 18 aged-matched controlled were enrolled. Patients had significantly lower scores on muscle power assessment at ICU discharge (33.6 ±19.0 W; t= 4.01, p < 0.001) and at hospital discharge (40.9 ±16.5 W; t= 4.81, p < 0.001) in comparison to controls (59.3± 14.7 W). Patients with better scores on muscle power assessment had significantly better scores on physical function measures (Six-minute walk test; rs = 0.548, p = 0.0001). Muscle size (cross-sectional area of rectus femoris muscle) and muscle power were strongly correlated (rs = 0.66, p < 0.0001). These data suggest that patients with critical illness have significantly reduced muscle power which directly related to deficits in physical function.

Bakgrund   The Gugging Swallowing Screen - Intensive Care Unit (GUSS-ICU) är ett screeningtest med syfte att fånga upp indikationer på sväljsvårigheter efter långvarig intubering hos inneliggande patienter på intensivvårdsavdelningar (IVA). I dagsläget finns det inget svenskt översatt och validerat screeningtest för omvårdnadspersonalen att använda vid bedömning av sväljförmågan efter extubering på IVA. Syfte Syftet med studien var att översätta det internationella screeningtestet GUSS-ICU till svenska för användning i en svensk intensivvårdspopulation. Vidare syftade studien till att utföra en pilotstudie av den svenska versionen på extuberade patienter på IVA. Metod En framåt-bakåtöversättningsmetod användes vid översättningen av screeningtestet GUSS-ICU. Översättningsprocessen omfattade tre steg: framåtöversättning, granskning och kommentarer från en expertpanel och en bakåtöversättning. I översättningsprocessen deltog två logopedstudenter, två handledare, en expertgrupp och en översättare. Expertgruppen bestod av 10 deltagare med olika professioner inom hälso- och sjukvården. Fem inneliggande patienter från IVA planerades delta i en pilottestning av den svenska översättningsversionen. En innehållsanalys genomfördes för att kunna jämföra samtliga översättningar. Syftet med jämförelsen var att identifiera skillnader i ord och satser samt kulturella och kontextuella skillnader. Resultat       Studien resulterade i en svensk översättning (GUSS-IVA) av screeningtestet GUSS-ICU. Analysen visade på skillnader i val av ord, koncept och satser mellan de olika översättningarna. Flertalet skillnader var ej betydelseskiljande utan analyserades istället som resultat av skillnader i erfarenhet, kunskap och språkbruk. Översättningsmetoden bidrog till språklig, kontextuell och kulturell anpassning av översättningen. Slutsats Den svenska versionen av GUSS-ICU stämmer bra överens med originalversionen och enbart ett fåtal skillnader observerades mellan översättningarna. Skillnaderna mellan bakåtöversättningen och originalversionen var inte betydelseskiljande, vilket tyder på att den svenska versionen mäter det den avser att mäta. Framtida studier behöver pilottesta och validera den svenska versionen av GUSS-ICU, innan testet kan implementeras i en svensk intensivvårdspopulation. / Validering av screeningtest för sväljsvårigheter för användning inom svensk vårdkontext

Bakgrund: Specialistsjuksköterskor med inriktning mot intensivvård har ansvar för omvårdnaden av de svårast sjuka patienterna samt kommunicerar med deras närstående. Coronaviruset (SARS-CoV-2) även kallad för Covid-19, leder till en atypisk form av akut andningsbesvär som i vissa fall kräver ventilatorbehandling. Dessa patienter kommer alla att behöva urträning ur respiratorn inför extubation. Urträning initieras oftast på intensivvårdsavdelningen och tillhör intensivvårdssjuksköterskans arbete. En förkortad ventilatorbehandling kan minska patientens lidande, mortaliteten och sänka samhällskostnader. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskors framgångsfaktorer för ventilatorurträning av patienter med Covid-19. Metod: Vi har använt oss av kvalitativ metod och intervjuat åtta intensivvårdssjuksköterskor i Västra Sverige. Intervjuerna analyserades kvalitativ innehållsanalys med manifest ansats som resulterade i tre kategorier. Resultat: Denna kvalitativa intervjustudie visade att en längre och svårare urträningsprocess kräver tålamod och försiktighet. Samtliga intensivvårdssjuksköterskor beskrev urträningsprocessen för patienter med Covid-19 som både längre och svårare i jämförelse med patienter som ventilatorbehandlats av andra orsaker. Tidiga insatser kan lindra sjukdomsförlopp och underlätta urträningen. Intensivvårdssjuksköterskorna beskrev att de under pandemin lärt sig använda både medicinska och omvårdnadsmässiga insatser tidigt för att bromsa, lindra eller förhindra ett progrederande sjukdomsförlopp. Mobilisering, teamsamverkan och kontinuitet var viktigt vid urträning och framgångsfaktorer som påverkades av personalens kompetens, stressnivå och andraorganisatoriska faktorer. Slutsats: Denna kvalitativa intervjustudie visade att intensivvårdssjuksköterskor upplever att erfarenhet under pandemins gång har förbättrat förutsättningarna för patienter med Covid-19 i behovav urträning från ventilatorbehandling. Och dessa lärdomar ligger till grund för de faktorer som i dagsläget ofta ligger till grund för en framgångsrik ventilatorurträning. Deras erfarenhet och kunskaper skiljer sig åt och resultatet tyder på att mer utbildning och kontinuitet krävs för att kunna ge en säkrare vård.

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