Thesis (Ph. D.)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains xviii, 167 p.; also includes graphics (some col.) Includes bibliographical references (p. 115-121). Available online via OhioLINK's ETD Center

Thesis (Ph.D.) - University of Queensland, 2004. / Includes bibliography.

Orientador: Rosana Rossi Ferreira / Banca: Margarida Juri Saeki / Banca: Eliana Maria Ravasi Stéfano Semionato / Resumo:O aprimoramento de uma formulação envolve várias etapas importantes que englobam desde o conhecimento das características dos insumos utilizados, até a comprovação que a aplicação é segura para posterior comercialização. O objetivo deste trabalho é o de estudar a utilização da quitosana, plasma fresco congelado (PFC) e concentrado de plaquetas (CP) no reparo de tecidos epiteliais principalmente por feridas crônicas de etiologia venosa. Para tal serão produzidas membranas transdérmicas de quitosana associadas ao PFC e CP com a utilização de um agente reticulante adsorvido em diferentes concentrações. Estima-se que quase 3% da população brasileira é portadora desse tipo de lesão, que se eleva para 10% no caso dos diabéticos, e que em torno de 4 milhões de pessoas sejam portadoras de lesões crônicas ou tenham algum tipo de complicação no processo de cicatrização. Busca-se, portanto, novos recursos e tecnologias que possibilitem o acesso da população a um tratamento eficiente, eficaz e de baixo custo / Abstract:The improvement of a formulation involves several important steps that range from knowledge of the characteristics of the inputs used, until proof that the application is safe for commercialization. The objective of this work is to study the use of chitosan and platelet concentrates CP in the repair of epithelial tissues mainly by chronic venous wounds. This will be produced transdermal membranes chitosan CP associated with the use of cross linking agents adsorbed at various concentrations. It is estimated that nearly 3% of the population suffer from this type of injury, which rises to 10% for diabetics, and that around 4 million people are suffering from chronic injuries or have some type of complication in the process healing. Search, therefore, new features and technologies that enable the population access to a treatment effective, efficient and low cost / Mestre

Made available in DSpace on 2014-06-11T19:23:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-04-12Bitstream added on 2014-06-13T20:10:22Z : No. of bitstreams: 1 alvarado_lg_me_botfm.pdf: 1760073 bytes, checksum: e4d09ac4f0fa7011862a2bf823b68c57 (MD5) / The improvement of a formulation involves several important steps that range from knowledge of the characteristics of the inputs used, until proof that the application is safe for commercialization. The objective of this work is to study the use of chitosan and platelet concentrates CP in the repair of epithelial tissues mainly by chronic venous wounds. This will be produced transdermal membranes chitosan CP associated with the use of cross linking agents adsorbed at various concentrations. It is estimated that nearly 3% of the population suffer from this type of injury, which rises to 10% for diabetics, and that around 4 million people are suffering from chronic injuries or have some type of complication in the process healing. Search, therefore, new features and technologies that enable the population access to a treatment effective, efficient and low cost

Background: Recent data suggest that anesthesiologic interventions-e.g., the choice of the anesthetic regimen or the administration of blood products-might play a major role in determining outcome after tumor surgery. In contrast to adult patients, only limited data are available regarding the potential association of anesthesia and outcome in pediatric cancer patients. Methods: A retrospective multicenter study assessing data from pediatric patients (0-18 years of age) undergoing surgery for nephroblastoma between 2004 and 2018 was conducted at three academic centers in Europe. Overall and recurrence-free survival were the primary outcomes of the study and were evaluated for a potential impact of intraoperative administration of erythrocyte concentrates, the use of regional anesthesia and the choice of the anesthetic regimen. The length of stay on the intensive care unit, the time to hospital discharge after surgery and blood neutrophil-to-lymphocyte ratio were defined as secondary outcomes. Results: In total, data from 65 patients were analyzed. Intraoperative administration of erythrocyte concentrates was associated with a reduction in recurrence-free survival (hazard ratio (HR) 7.59, 95% confidence interval (CI) 1.36-42.2, p = 0.004), whereas overall survival (HR 5.37, 95% CI 0.42-68.4, p = 0.124) was not affected. The use of regional anesthesia and the choice of anesthetic used for maintenance of anesthesia did not demonstrate an effect on the primary outcomes. It was, however, associated with fewer ICU transfers, a shortened time to discharge and a decreased postoperative neutrophil-to-lymphocyte ratio. Conclusions: The current study provides the first evidence for a possible association between blood transfusion as well as anesthesiologic interventions and outcome after pediatric cancer surgery.

Thesis (D.P.H.)--University of Michigan.

Dissertation (D.P.H.)--University of Michigan.

Made available in DSpace on 2014-12-17T14:46:38Z (GMT). No. of bitstreams: 1 MaisaAS.pdf: 2002111 bytes, checksum: 3639909687907c825b2fac2980223c4c (MD5) Previous issue date: 2008-12-23 / Prospective descriptive study with quantitative approach, which aimed to analyze the relationship of the knowledge of Nurses and conduct assistance during the process of transfusion, to patients in the ICU of a university hospital in Natal-RN. The sample consisted of 27 professionals from the nursing staff (5 nurses and 22 nursing technicians), climbing in the ICU during the period of data collection. Data collection was through a questionnaire and structured form of observation, in addition to consulting the diary. The results were organized in SPSS 15.0, tabulated, cathegorized and analyzed by descriptive and inferential statistics. The results show a young population, aged between 21 and 32 years (63.0%), female (85.2%). Among those surveyed were the main type of stock, mostly technical, nursing (ρ= 0006), which have little time to experience - up to 2 years (ρ= 0008), did not know the DRC in 153 (ρ= 0019), held greater number of pipelines care in blood (ρ= 0018), the non-participation in training and feel informed about the process of transfusion, showed no significant differences. As for officials, highlighted only the time to experience more than 2 years, carrying out fewer procedures and feel informed about the blood. As for the pipes during the transfusion process, I found that the majority of pipes observed in both the stock and the staff were inadequate, with predominance in the first, both in the pursuit of conduct regarding the shortfall. The averages of inappropriate conduct, predominantly developed by stock, were higher in all stages for appropriate conduct. Analyzing the knowledge about the disease process, the stock market were those who had lower scores of knowledge in three stages. As the relationship between the pipes care and knowledge, we see that at all stages of the process of transfusion inadequate knowledge of the averages were higher, taking a significant difference in the stages pre-transfusion (ρ= 0012). When analyzing the average of pipes behind, we see that in inappropriate conduct were significantly higher (ρ= 0031), who had searched in inadequate knowledge. As for the frequency of total procedures performed, we found a significant predominance (ρ= 0049) of inappropriate conduct (88.9%) of which 81.5% were developed by professionals who had inadequate knowledge, showing moderate correlation (r = 0,516) and odds ratio of 2,750 times the development of inappropriate conduct in trade with inadequate knowledge. We conclude that the professionals surveyed, especially the technicians of nursing stock, showed serious deficiencies with regard to the development of pipelines and knowledge of the transfusion process, showing the inadequacy to develop this therapy. Facing the foregoing, we accept the alternative hypothesis proposed in the study, because we show that the inadequacy of knowledge about the process of transfusion influence in inappropriate conduct implemented by the nursing staff in ICU. / Estudo descritivo prospectivo, com abordagem quantitativa, que objetivou analisar a rela??o entre o conhecimento dos profissionais de enfermagem e as condutas assistenciais prestadas, durante o processo transfusional, aos pacientes na UTI de um hospital universit?rio em Natal-RN. A amostra foi composta por 27 profissionais da equipe de enfermagem (5 enfermeiros e 22 t?cnicos de enfermagem), escalados para a UTI durante o per?odo da coleta de dados, coleta esta realizada por meio de question?rio e formul?rio de observa??o estruturados, al?m da consulta ao prontu?rio. Esses resultados foram organizados no programa SPSS 15.0, tabulados, categorizados e analisados por meio de estat?stica descritiva e inferencial. Os resultados mostram uma popula??o jovem, na faixa et?ria entre 21 e 32 anos (63,0%), do sexo feminino (85,2%). Dentre os pesquisados houve predomin?ncia de bolsistas, em sua maioria t?cnicos de enfermagem (ρ= 0,006), os quais possuem pouco tempo de experi?ncia, at? 2 anos (ρ= 0,008), n?o conhecem a RDC no 153 (ρ= 0,019), realizaram o maior n?mero de condutas assistenciais na hemotransfus?o (ρ= 0,018), a n?o participa??o de treinamentos e a falta de informa??o sobre o processo transfusional n?o resultaram em diferen?as significativas. Quanto aos funcion?rios, destacaram-se apenas o tempo de experi?ncia superior a 2 anos, a realiza??o de menor n?mero de procedimentos e se sentirem informados sobre a hemotransfus?o. Em rela??o ?s condutas durante o processo transfusional, constatamos que, na maioria, as condutas observadas, tanto dos bolsistas como dos funcion?rios foram inadequados, com predomin?ncia nos primeiros, tanto na realiza??o das condutas quanto na inadequa??o. As m?dias das condutas inadequadas, predominantemente desenvolvidas pelos bolsistas, foram maiores em todas as etapas em rela??o ?s condutas adequadas. Analisando o conhecimento sobre o processo transfusional, os bolsistas foram os que apresentaram os menores escores de conhecimento nas tr?s etapas. Quanto ? rela??o existente entre as condutas assistenciais e o conhecimento, verificamos que em todas as etapas do processo transfusional as m?dias de conhecimentos inadequados foram superiores, tendo diferen?a significativa nas etapas pr?-transfusional (ρ= 0,012). Ao analisarmos a m?dia de condutas desenvolvidas, verificamos que nas condutas inadequadas foram significativamente maiores (ρ= 0,031) nos pesquisados que apresentaram conhecimentos inadequados. Quanto ? frequ?ncia total de procedimentos realizados, verificamos uma predomin?ncia significativa (ρ= 0,049) de condutas inadequadas (88,9%), das quais 81,5% foram desenvolvidas por profissionais que tiveram conhecimento inadequado, apresentando moderada correla??o (r = 0,516) e raz?o de chance de 2,750 vezes de desenvolvimento de condutas inadequadas nos profissionais com conhecimentos inadequados. Conclu?mos que os profissionais pesquisados, principalmente os t?cnicos de enfermagem bolsistas, apresentaram defici?ncias graves no tocante ao desenvolvimento das condutas e conhecimento sobre o processo transfusional, denotando a inadequa??o para desenvolver essa terap?utica. Diante do exposto, aceitamos a hip?tese alternativa proposta no estudo, pois evidenciamos que a adequa??o do conhecimento sobre o processo transfusional influenciou nas condutas adequadas implementadas pela equipe de enfermagem na UTI.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-04-17T11:07:00Z No. of bitstreams: 1 DISS MP Cláudio Medeiros. 2015.pdf: 915597 bytes, checksum: 88f7004fc59d4cbe39fb73ca3fa416b4 (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-04-20T11:00:53Z (GMT) No. of bitstreams: 1 DISS MP Cláudio Medeiros. 2015.pdf: 915597 bytes, checksum: 88f7004fc59d4cbe39fb73ca3fa416b4 (MD5) / Made available in DSpace on 2015-04-20T11:00:53Z (GMT). No. of bitstreams: 1 DISS MP Cláudio Medeiros. 2015.pdf: 915597 bytes, checksum: 88f7004fc59d4cbe39fb73ca3fa416b4 (MD5) / O emprego de tecnologias gerenciais que buscam a melhoria do desempenho com a satisfação do cidadão na Administração Pública brasileira cresceu, sobretudo a partir do movimento de Reforma Gerencial desencadeado na década de 90. Dentre estas tecnologias destaca-se a Gestão da Qualidade, especialmente, os Sistemas de Gestão da Qualidade ISO 9001:2008. Com base em modelos lógicos causais, operacionais e teóricos, este estudo avaliou a implantação do Programa de Gestão da Qualidade IS0 9001:2008 na Coordenação Geral de Sangue e Hemoderivados, do Ministério da Saúde (CGSH/MS), identificando as motivações para implantação, o grau de implantação, os fatores que favoreceram e dificultaram e os efeitos decorrentes, percebidos até o momento. Constatou-se que o Sistema de Gestão da Qualidade (SGQ) encontra-se parcialmente implantado. Em termos de seus componentes, é completa a implantação dos documentos e procedimentos, e são parciais as implantações da capacitação da força de trabalho, do mapeamento e da padronização dos processos, da adequação aos requisitos da ISO 9001, das auditorias internas. Quanto ao componente da certificação externa, a implantação ainda é incipiente. Os motivos que levaram à implantação foram de caráter interno, relacionados à organização e à melhoria do desempenho. A certificação externa foi considerada motivo secundário. O elemento de maior destaque nos fatores que favoreceram a implantação foi a liderança desempenhada pelo Coordenador Geral, seguida e reproduzida pelos responsáveis de áreas junto à suas respectivas equipes de trabalho. As dificuldades identificadas foram relacionadas a aspectos operacionais como limitações de entendimento da norma, falta de sistema de informática e capacitação deficiente. Como efeitos, foram identificadas as melhorias da organização e da rotina com reflexos nos resultados organizacionais. O acréscimo de trabalho sentido pelos técnicos foi considerado um efeito negativo do programa, o que pode vir a ser uma ameaça à sua continuidade.

Um die Qualität von Blutprodukten nach GMP zu überprüfen, wurden 72 Blutspenden bzw. ihre Folgeprodukte Erythrozytenkonzentrat in PAGGS-M, gefiltertes Erythrozytenkonzentrat und Fresh Frozen Plasma untersucht. Zusätzlich wurden an jeweils 12 Blutderivaten, die z.T. nicht zum Routineprogramm des Blutspendedienstes der Abteilung für Klinische Hämostaseologie und Transfusionsmedizin in Homburg/Saar gehören, Messungen durchgeführt, um ihre Qualität am Herstellungstag und am Ende der Haltbarkeit zu bestimmen. Als letztes wurden schließlich auch rheologische Parameter an 21 Erythrozytenkonzentraten in PAGGS-M und Fresh Frozen Plasma über einen Zeitraum von 28 Tagen gemessen und dokumentiert. Die Messung der Parameter, sowohl hämatologische als auch hämostaseologische und hämorheologische, erfolgte nach Standardmethoden. Die Ergebnisse waren insgesamt nicht zufriedenstellend. Ausschlaggebende Grundlage der Untersuchung sind die GMP-Richtlinien, die sich an den europäischen Normen orientieren. Zwar zeigten die Produkte, die routinemäßig hergestellt werden, wie auch die, die nur für diese Untersuchung produziert wurden, in vielen Bereichen ein Übereinstimmen mit den Vorschriften. Speziell auch die Qualität der gefilterten Erythrozytenkonzentrate, die besonders für Immunsupprimierte wegen ihres niedrigen Gehalts an Leukozyten verwendet werden, war in vielen Fällen gut. Die Ergebnisse der rheologischen Messungen glichen denen anderer Studien: so wurde ein Abfall der Fließfähigkeit über den Meßzeitraum hinweg beobachtet, was auf ein leichtes Schwellen der Zellen und eine Zunahme der Rigidität zurückzuführen ist. Fast durchgängig wich der Meßwert für den Hämatokrit der EK von der Richtlinie ab, am stärksten in PAGGS-M. Als Grund hierfür wurde eine Meßungenauigkeit des elektronischen Zellzählers bzw. die Methode der Bestimmung angesehen, so daß eine echte Abweichung als unwahrscheinlich anzusehen ist. Jedoch wurde die vorgeschriebene maximale Hämolyserate mit Ablauf der Haltbarkeit häufig überschritten, ebenso wie die gemessenen Leukozytenzahlen. Eine Vielzahl der Plasmen war durch Erythrozyten und Leukozyten kontaminiert. Durch häufige Waschvorgänge beim Auftauen von tiefgefrorenen EK wurde ein erhöhter Hb-Überstand erzeugt, das geforderte Mindestvolumen wurde dabei unterschritten. Daher ist festzuhalten, daß für jede untersuchte Produktgruppe Abweichungen festgestellt wurden, die in diesem Maße nicht tolerabel sind. Damit ist die Qualität der Produkte insgesamt als unzureichend zu bezeichnen. Der hier geführte Nachweis dieser Abweichungen ermöglichte die Einführung geänderter Herstellungsverfahren, so daß die heute erzeugten Produkte den Qualitätsvorschriften entsprechen. / 72 blood donations and their follow-up products (red blood cell concentrates resuspended in PAGGS-M, leukocyte-reduced red cell concentrates and fresh frozen plasma) were investigated to check their quality. Additionally, tests were performed on blood components of which most were not part of the routine program in the Department of Hemostaseology and Transfusion Medicine in Homburg/Saar. Finally, rheological parameters of red blood cell concentrates in PAGGS-M and of fresh frozen plasma were measured and documented over a period of 28 days. The results were not satisfying. Both the routine products and the blood components which were only produced for this study met the GMP-guidelines in many cases. Especially the quality of leukocyte-reduced red blood cell concentrates which are used especially for the transfusion for immunocompromised patients was good. The results of the rheological measurements were similar to those of other studies: decreasing flow over a period of time which was put down to slight swelling of the cells and to a rise in erythrocyte rigidity. The average hematokrit of red cell concentrates was generally too low especially in PAGGS-M. The reason for this was thought to be the electronic cell counter or rather the method of measuring. Hemolysis after storage and mean leucocyte count often exceeded the official dates. Many samples of the FFP were contaminated with red and white blood cells. Repeated washing after thawing of frozen red blood cell concentrates caused an excess of extracellular haemoglobin and low concentrate volumes. Any deviation from the guidelines is not tolerable. After this study adjustments in the production could be made so blood products now meet all of the requirements.