Thesis (M.S.)--University of Michigan, 1992.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Introduction Complications of severe infection or acute trauma include a cascade of immunological dysfunctions known as SIRS (Systemic Inflammatory Response Syndrome), that affect response to treatment, prolonging and complicating the course of illness and jeopardizing clinical outcome. Timing and the nature of nutritional support in the Intensive Care Unit (ICU) setting may influence this process. Against this background, and despite some trials demonstrating beneficial clinical outcomes for the use of immune-modulating diets (IMD), the findings of the US summit on immune-enhancing enteral therapy concluded that the currently available enteral immune-enhancing formulas are “first-generation products” which may not be appropriate in patients with SIRS or severe sepsis. This highlights a need for alternative nutritional products that target the specific needs of this patient population. As such, Intestamin® is designed for use in severely stressed patients as an immune-modulating enteral feed supplement which aims to improve maintenance of gut barrier integrity and immune response. Aim The aim of this pilot study was to investigate the effect of Intestamin® administration to critically ill patients, and in particular, to determine if administration would impact on nosocomial infections, ventilation days and the length of stay in the ICU. Methods The study design was an open label, retrospective case control, analytical study, of patients admitted to the ICU in The Bay Hospital, Richards Bay, between January 2002 and November 2003, who received Intestamin®. Patients were selected for the study from post-surgery and post-trauma patients at high risk of sepsis and SIRS, and critically ill patients with manifested SIRS or severe sepsis. Development of respiratory and urinary sepsis was used as surrogate markers for progression to severe sepsis and SIRS. Additionally, duration of ventilation and ICU stay were considered representative of the response to treatment and degree of clinical complications. Results The findings of the study demonstrated a significant difference in the rates of respiratory infection(p=0.05), positive sputum and tracheal aspirate cultures(p=0.03) and urinary catheter tip cultures(p=0.04). with statistically lower rates in the intervention group compared to the control group. There were no significant differences in the rates of urinary tract infection, septicaemia or in combined sepsis rates between the two groups. There were statistically significant higher rates of positive pus cell counts in the sputum(p=0.003) and urine(p=0.01) in the intervention group, compared to the control group. No corresponding reduction in ventilation days or ICU stay was observed. Conclusion In this patient population, early enteral nutrition with specially formulated IMD, (Intestamin®), did result in a significant reduction in respiratory infections, but not in other types of sepsis, ICU or ventilator days in critically ill ICU patients. This positive finding in some, but not all endpoints collected, may reflect confounding factors in the small patient population or the choice of clinical endpoints, rather than a genuine limitation in the benefit. IMD remains a tantalizing and scientifically plausible intervention in this patient population, with larger clinical trials necessary to confirm outcomes. The study supports the safe use of Intestamin by the nasojejenal route in this patient population. / AFRIKAANSE OPSOMMING:Inleiding Komplikasies van erge infeksie of akute trauma sluit ‘n kaskade van immunologiese disfunsie in, bekend as SIRS (Sistemiese Inflammatoriese Respons Sindroom), wat die respons op behandeling affekteer, die verloop van siekte verleng en kompliseer asook die kliniese uitkoms beïnvloed. Tydsberekening en die aard van die voedingsondersteuning in die Intensiewe Sorg Eenheid (ISE) mag hierdie proses beinvloed. Teen hierdie agtergrond, en ten spyte van sommige studies wat die voordelige kliniese uitkoms vir die gebruik van immuun-modulerende diete (IMD) toon, het die “US summit” oor immuunverbeterde enterale terapie tot die gevolgtrekking gekom dat die huidige beskikbare enterale immuun-verbeterde formules, “eerste-generasie” produkte is, wat moontlik nie toepaslik is vir pasiente met SIRS of erge sepsis nie. Dit beklemtoon ’n behoefte aan alternatiewe voedingsprodukte wat die spesifieke behoeftes van die genoemde pasient populasie teiken. Intestamin® is ontwerp vir gebruik in erge gestresde pasiente as ‘n immuun-modulerende enterale voedingssupplement doelgerig om spysverteringskanaal integriteit te onderhou en immuniteit te verbeter. Doel Hierdie loodsstudie se doel was om die effek van Intestamin® toediening aan kritiek siek pasiente te ondersoek, spesifiek om vas te stel of die toediening impakteer op nosokomiale infeksies, ventilasie dae en dae in ISE. .Metode Die studie ontwerp was ‘n oop, retrospektiewe, geval kontrole, analitiese studie van pasiente opgeneem in die ISE van The Bay Hospital, Richardsbaai, tussen Januarie 2002 en November 2003, wat Intestamin® ontvang het. Pasiënte is geselekteer vir die studie uit post-chirurgies en post-trauma pasiente wat hoë risiko was vir sepsis en SIRS, en kritiek siek pasiente wat reeds manifisteer het met SIRS of erge sepsis. Ontwikkeling van respiratoriese en urinêre sepsis is gebruik as surrogaat merkers vir die progressie na erge sepsis en SIRS. Addisioneel is duur van ventilasie en ISE verblyf beskou as verteenwoordigend vir die respons op behandeling en die graad van kliniese komplikasies. Resultate Die bevindinge van die studie het betekenisvolle verskille aangedui in die voorkoms van respiratoriese infeksies(p=0.05), positiewe sputum en trachiale aspiraatkulture(p=0.03) en urine kateterpunt-kulture(p=0.04) met statistiese laer voorkoms in die intervensie groep in vergelyking met kontroles. Geen statistiese verskille in die voorkoms van urineweg-infeksies, septisemia of in gekombineerde sepsis voorkoms tussen die twee groepe is gevind nie. Daar was statistiese betekenisvolle hoër voorkoms van etterselle hoeveelhede in die sputum(p=0.030 en uriene(p=0.01) van die intervensie groep in vergelyking met die kontrole groep. Geen ooreenkomstige vermindering in ventilasie dae of ISE verblyf is opgemerk nie. Gevolgtrekking In hierdie pasiënt populasie, het vroeë enterale voeding met spesifieke geformuleerde IMD (Intestamin®), ‘n beduidende vermindering in respiratoriese infeksies getoon, maar nie in ander tipes sepsis, ISE of ventilasie dae by kritiek siek pasiente nie. Hierdie positiewe bevindinge in sommige. maar nie al die versamelde eindpunte nie, reflekteer moontlike bydraende faktore in die klein pasiënt populasie of die keuse van kliniese eindpunte, eerder as a ware beperking in die voordele. IMD bly steeds ‘n uitdagende en wetenskapilik uitsonderlike intervensie in hierdie pasiënt populasie, wat groter kliniese studies benodig om die uitkoms te bevestig. Die studie ondersteun die veilige gebruik van Intestamin® via die nasojejenale roete in kritiek siek pasiënte.

Bakgrund: Närstående till en person som vårdas på en intensivvårdsavdelning fyller en viktig funktion för dennas sjukdomsförlopp, utfall och rehabilitering. Närstående har själva behov under denna tid och det är viktigt att även dessa tillgodoses av sjuksköterskor. Behovet av information har i många studier påvisats vara det mest betydelsefulla för närstående.   Syfte: Syftet med studien var att undersöka sambandet mellan närståendes uppfattning om information korrelerat till deras uppfattning om bemötande, förtroende, stöd och delaktighet. Vidare var syftet att belysa närståendes upplevelser av omhändertagandet på en intensivvårdsavdelning. Metod: Studien var en enkätundersökning med mixad metod. Resultat: 206 enkäter skickades ut och 47 % (n=97) av respondenterna valde att delta. Resultatet visade att det fanns svaga till starka samband mellan information och bemötande/förtroende/stöd/delaktighet. Starkast samband sågs mellan variablerna information och förtroende samt mellan information och delaktighet. Respondenternas upplevelser resulterade i två teman; information och bemötande. Närstående upplevde att information var fundamentalt inom intensivvården och den önskades vara ärlig, tydlig och ges kontinuerligt. Respondenterna upplevde att bemötandet de fått under intensivvårdtiden både varit positivt och negativt. Slutsats: Positiva korrelationer har påvisats mellan information och bemötande, förtroende, stöd och delaktighet. Studien belyser även att närståendes upplevelse av omhändertagandet kan påverkas både positivt och negativt av information och bemötande. Kännedom om detta samt med hjälp av en familjefokuserad omvårdnad kan möjliggöra för intensivvårdssjuksköterskan att främja närståendes upplevelse och uppfattning under vårdtiden. / Background: Relatives to a person who is cared for in a critical care unit fill an important function for the patient’s disease progression, outcome and rehabilitation. Relatives themselves have needs during this period and it is important that also their needs are met by nurses. The need to receive information has been shown to be the most meaningful to relatives. Aim: The aim of the study was to examine whether relatives’ perception of information correlated with their perception of treatment, trust, support and participation. Furthermore, the aim was to highlight the way in which relative’s experience care at a critical care unit. Method: The study was conducted as a mixed method survey. Results: 206 surveys were sent out and 47% (n=97) of the respondents chose to participate. The result indicated that there are weak to strong correlation between information and treatment/trust/support/participation. The strongest correlation was observed between the variables information and trust, as well as information and participation. The respondents’ experiences resulted in two themes; information and treatment. Relatives perceived information as fundamental within critical care and preferred it to be honest, clear and continuous. The respondents had experienced the treatment they received during the critical care period as both positive and negative. Conclusion: Positive correlations has been found between information and treatment, trust, support and participation. The study also highlight that a relative’s experience of the care is impacted both positively and negatively by information and treatment. Knowledge about this and with help from a family focused care can make it possible for critical care nurses to encourage relative’s experience and perception about the time of care.

Bakgrund: Patienter som drabbas av svår sjukdom och vårdas på intensivvårdsavdelning upplever känslor av total förlust av kontroll, förstärkt av oförmågan att kommunicera. Att få kunskap, kontroll och inflytande över sin vård leder till mindre smärtlindring och kortare vårdtid. Patientcentrering i vården brister dock, vilket kan leda till ökade kostnader för såväl samhället som patienter. Syfte: Att identifiera och beskriva hinder mot empowerment till patienter inom intensivvård samt vilka möjligheter som finns för att överbrygga dessa hinder.  Metod: En systematisk litteraturstudie analyserad i två steg med meta-syntes enligt Evans samt meta-aggregation, inspirerad av Joanna Briggs’ Institute. Resultat: Både hinder och lösningar för empowerment till intensivvårdspatienten finns på flera plan. Sjukdomen gör att patienten förlorar förmåga till empowerment, vårdmiljön känns skrämmande, vårdpersonal upplevs vara avvisande och brister i arbetsmiljön leder till sämre möjlighet till delaktighet. Specialistsjuksköterskan inom intensivvård behöver ge patienten indirekt delaktighet, förklara vårdmiljön, skapa en ömsesidig relation och uppmuntra delaktighet. Ett stödjande ledarskap och goda arbetsvillkor är andra nödvändiga förutsättningar för detta.  Slutsats: Genom en ökad medvetenhet om de hinder som finns för empowerment till intensivvårdspatienten kan specialistsjuksköterskor och arbetsgivare aktivt arbeta för att komma över hindren och istället stärka patientens möjligheter att bli en del av vårdteamet. / Background: To become critically ill and be cared for at an ICU involves feelings of total loss of control, reinforced by the inability to communicate. Gaining knowledge, control and influence over the nursing care results in reduced need for pain relief and shorter stay in hospital. Patient centered care is however lacking. This might incur a higher cost for society, as well as the patient in the form of suffering.Aim: To identify and describe barriers to patient empowerment in critical care and what means there are to overcome these barriers. Method: Systematic literature review, analysed in two steps with meta synthesis according to Evans and meta aggregation, inspired by the Joanna Briggs’ Institute. Results: Barriers as well as possibilities for patient empowerment in ICU were found on various levels. Being critically ill disables the patient from feeling or receiving empowerment, the nursing environment is frightening, staff is perceived as dismissive and working conditions impede patient participation. The specialist nurse in intensive care needs to give the patient indirect participation, explain the nursing environment, create a mutual relationship and encourage participation. Good working conditions and a supportive workplace leadership are also required.  Conclusion: By being aware of what the barriers to patient empowerment in the ICU are, specialist nurses and employers can actively engage in the work to overcome them, as well as engaging in the support of the patient to become part of the care team.

A pneumonia nosocomial é uma infecção prevalente e associada com elevados custos e morbi-mortalidade. A maioria destes episódios ocorre em pacientes criticamente doentes em ventilação mecânica. Os biomarcadores, como a proteína C-reativa, tem se mostrado uteis na avaliação da evolução dos pacientes, podendo se descrever padrões de resposta associados ao sucesso da terapia antimicrobiana e ao prognostico de paciente com pneumonia associada a ventilação mecânica. Nesta tese, apresenta-se uma revisão da literatura abordando aspectos da fisiopatologia, diagnostico e manejo da pneumonia associada a ventilação mecânica. Além disso, é feita a análise do uso de biomarcadores em duas populações especificas de pacientes criticamente doentes (pacientes com doença critica cronica e pacientes idosos). Foram avaliados 405 pacientes com diagnostico clínico de pneumonia associada a ventilação mecânica. Descreve-se que pacientes com doença critica crônica apresentam episódios de pneumonia associada a ventilação mecânica com pior prognostico do que pacientes que não apresentam doença critica crônica. Entretanto, esses achados não parecem associados a um comprometimento da resposta inflamatória, uma vez que nao houve diferença significativa nem nos níveis basais, nem na evolução dos níveis de proteína C-reativa comparando episódios de pacientes com doença critica crônica com aqueles sem esta condição, sugerindo que seu uso é válido nessa população de pacientes. Ainda, descreve-se a evolução dos pacientes com pneumonia associada a ventilação mecânica de acordo com a idade. A partir dos 65 anos, parece haver um efeito da idade na mortalidade dos pacientes com PAV. No entanto, não houve alteração na resposta da PCR ou na sua cinética nas primeiras 96h quando comparamos pacientes com diferentes faixas etárias a partir de um ponto de corte de 65 anos, também sugerindo a validade do uso deste biomarcador nesta população de pacientes. Estes achados originais permitem que estudos futuros avaliem intervenções baseadas em biomarcadores em pacientes com pneumonia nosocomial levando em consideração estas populações especificas de pacientes não avaliadas previamente na literatura. / Nosocomial pneumonia is a prevalent infection associated with higher costs and worse outcomes. Most episodes occur in mechanically ventilated critically ill patients. Biomarkers, such as C-reactive protein, are useful to assess patients evolution, allowing identification of patterns associated with antimicrobial treatment success and prognosis in ventilator-associated pneumonia patients. In this thesis, a literature review is presented evaluating aspects of pathopsysiology, diagnosis and management of ventilator-associated pneumonia patients. In addition, biomarker use in two specific populations (chronic critical illness and elderly) was assessed. Four hundred and five patients with ventilator associated pneumonia clinical diagnosis were evaluated. Patients with chronic critical illness presented ventilator-associated pneumonia episodes associated with worse prognosis. However, these findings were not associated with a compromise of inflamatory response, assessed by comparison of C-reactive protein basal levels and kinetis evolution in patients with and wihtout chronic critical illness, suggesting its use remains valid in this specific population. Still, evolution of ventilator-associated pneumonia according to age is described. After 65 years old, our data suggest an effect of age on mortality in ventilator-associated pneumonia patients. However, no change in C-reactive protein basal levels, response or kinetics within 96h was found when comparing patients younger and older than 65 years old, also suggesting this biomarker usefulness in this specific population. These original findings allow that future studies assessing intervention based on biomarkers evolution in patients with nosocomial pneumonia consider these specific populations, never assessed before in literature.

Objective: The survival rates for cardiac arrest patients to hospital discharge are very low. Post-arrest patients have an immune response and usually a period of immunosuppression. When CD3+ T cells activate, they switch from primarily relying on aerobic metabolism to primarily relying on anaerobic metabolism. The goal of this study is to characterize the immune system of post-cardiac arrest patients. The specific objectives are (1) to determine the time period after the occurrence of a cardiac arrest that a patient acquires an infection, (2) to identify the most common types of infections in post-arrest patients, (3) to compare in vitro the cellular oxygen consumption of immune cells post-cardiac arrest with healthy controls, and (4) to compare cell proliferation and ATP production of immune cells post-cardiac arrest with healthy controls. Methods: We conducted a retrospective chart review of 170 cardiac arrest patients (Beth Israel Deaconess Medical Center) who had return of spontaneous circulation. We measured oxygen consumption rates of peripheral blood mononuclear cells (PBMCs) in cardiac arrest patients and healthy controls. We also measured cell proliferation and ATP production of CD3+ T cells in cardiac arrest patients and healthy controls. Results: Of the 170 cardiac arrest patients we reviewed, 42% had at least one incidence of infection. The length of time from cardiac arrest to first positive culture was 4 days, with pneumonia and urinary tract infections the most common diagnoses. The PBMCs of cardiac arrest patients showed a significant decrease in oxygen consumption post arrest compared with healthy controls. When thiamine was added to the PBMC samples of cardiac arrest patients, there was a significant increase in oxygen consumption from baseline. There was no significant difference in cell proliferation or ATP production of CD3+ T cells between the two groups of post-cardiac arrest patients and healthy controls. Conclusion: Many patients suffer from infections post-cardiac arrest, and future research is needed on this subject. Our data support the hypothesis that post-arrest patients have a period of hyperimmune response followed by a period of immunosuppression.

Aim The thesis set out to examine validations of three observational pain assessment tools and establish nurses’ expectations of them and the factors that might influence them within intensive care unit (ICU) settings. Background The guidelines to pain assessment specific to ICU patients have been of great interest to health professionals over the last 20 years. Pain assessment remains a challenge for most ICU patients due to the difficulty of assessing pain with any precision. Evidence suggests that the Behavioural Pain Scale (BPS) and Critical- Care Pain Observation Tool (CPOT) have demonstrated sound psychometric properties. A review of the relevant literature highlighted the fact that no such studies have yet been conducted with a similar homogenous group in Asia. The Wong-Baker Face Pain Rating Scale (FPRS) is currently widely used for nonverbally communicating patients (NVCPs) with pain in ICU settings, and is even recommended for use with children. Valid assessment tools are required for effective pain assessment in ICU settings, particularly in patients who are experiencing communication difficulties. Design An embedded mixed methods design was employed to: 1) translate Chinese versions of BPS and CPOT, 2) test their validity and reliability of in comparison with FPRS, and 3) establish the nurses’ expectations about the three study scales when undertaking pain assessment by using semi-structured focus group interviews. Methods This thesis initially reviews the literature available to select the most appropriate scales for assessing pain in critically-ill NVCPs. The selected scales were then translated into a Traditional-Chinese version using established procedures for the Taiwanese context. Evaluations of the three pain scales were gathered using quantitative measures of pain scores in NVCPs experiencing painless/painful interventions. These were further compared with a few focus groups to establish the feasibility and utility of the three pain scales. The psychometric properties of the pain scales were assessed for reliability by using internal consistency and inter-rater agreement) and for validity by using content validity, concurrent validity, discriminant validity, and responsiveness. The validity was evaluated using ANOVA to compare the changes between the different procedures. The significance level was set at 0.05. As for the analysis of the qualitative data, this study typically follows the path of aggregating the words into themes of information and presenting the diversity of ideas gathered during the data collection. Results For the 2068 observations in 237 patients, there were no statistical differences between the characteristics of the BPS, CPOT, and FPRS groups. Validity was demonstrated by changes from baseline in the scores of the three groups, which were significantly higher during suction (p < 0.001). In regard to the result for the criterion validity, both BPS and CPOT had moderate positive correlations with FPRS. The internal consistency was excellent; the Cronbach’s α was 0.700 for BPS and 0.821 for CPOT when all items were included. The majority of nurses preferred to use BPS to assess pain in their clinical practice. When the nurses were asked how long they needed and how easy they found it to complete the assessments using these tools, they all agreed that each patient assessments were easier and took the least time when they used FRPS. However, the nurses considered that the most effective pain reaction during nociceptive procedures had been assessed by using BPS. Even though all of the participant nurses stated that CPOT provides a detailed item-description about pain behaviour, it also provided the biggest obstacle to use because of its ambiguous indicators. Conclusions BPS, CPOT and FRPS provide potentially useful measurement scales for assessing pain in ICU NVCPs. However, judging from the inconsistencies between the nurses’ replies, the results could reflect a conflict between the need to use a validated measure of pain for NVCPs on the one hand and managing a heavy workload in the ICU on the other. This study opens up an avenue for investigating further the link between the underlying conceptions of pain behaviour and the effectiveness of pain assessments in NVCPs when using an objective pain measurement.

abstract: Critical care environments are complex in nature. Fluctuating team dynamics and the plethora of technology and equipment create unforeseen demands on clinicians. Such environments become chaotic very quickly due to the chronic exposure to unpredictable clusters of events. In order to cope with this complexity, clinicians tend to develop ad-hoc adaptations to function in an effective manner. It is these adaptations or "deviations" from expected behaviors that provide insight into the processes that shape the overall behavior of the complex system. The research described in this manuscript examines the cognitive basis of clinicians' adaptive mechanisms and presents a methodology for studying the same. Examining interactions in complex systems is difficult due to the disassociation between the nature of the environment and the tools available to analyze underlying processes. In this work, the use of a mixed methodology framework to study trauma critical care, a complex environment, is presented. The hybrid framework supplements existing methods of data collection (qualitative observations) with quantitative methods (use of electronic tags) to capture activities in the complex system. Quantitative models of activities (using Hidden Markov Modeling) and theoretical models of deviations were developed to support this mixed methodology framework. The quantitative activity models developed were tested with a set of fifteen simulated activities that represent workflow in trauma care. A mean recognition rate of 87.5% was obtained in automatically recognizing activities. Theoretical models, on the other hand, were developed using field observations of 30 trauma cases. The analysis of the classification schema (with substantial inter-rater reliability) and 161 deviations identified shows that expertise and role played by the clinician in the trauma team influences the nature of deviations made (p<0.01). The results shows that while expert clinicians deviate to innovate, deviations of novices often result in errors. Experts' flexibility and adaptiveness allow their deviations to generate innovative ideas, in particular when dynamic adjustments are required in complex situations. The findings suggest that while adherence to protocols and standards is important for novice practitioners to reduce medical errors and ensure patient safety, there is strong need for training novices in coping with complex situations as well. / Dissertation/Thesis / Ph.D. Biomedical Informatics 2012

Orientador: Silvana Andrea Molina Lima / Resumo: O objetivo deste trabalho foi avaliar a evidência científica disponível sobre o uso das bombas de infusão inteligentes em pacientes hospitalizados. Foi realizado um estudo, de acordo com Diretrizes Metodológicas propostas pelo Ministério da Saúde para a elaboração de pareceres técnico-científicos (PTC). Foi realizada uma busca até 14 de novembro de 2017 nas bases de dados The Cochrane Library, EMBASE, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e de Avaliações de Tecnologias de Saúde (ATS), não houve restrição de idioma e ano de publicação do artigo. Os resultados das bases de dados foram agrupados e eliminados os estudos em duplicatas. Em seguida, aplicados os critérios de elegibilidade para os títulos e resumos, restando 51 estudos para leitura completa. Após leitura dos artigos na íntegra, foram selecionados 6 estudos, que incluíram revisão sistemática sem metanálise, três estudos observacionais sem comparador e dois estudos observacionais do tipo antes e depois. Os estudos não apresentaram dados conclusivos para redução do número de eventos ocorridos. Para a interceptação de erros/prevenção de erros, os estudos demonstraram que a bomba inteligente interceptou e impediu diversos erros como frequência, dose e programação erradas. Para os custos, o estudo de revisão sistemática sem metanálise inclui um estudo que apresentou redução de custos da Bomba de Infusão Inteligente pelos possíveis eventos adversos evitáveis. A recomendação é incerta,... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Title: Intelligent Infusion Pump versus Conventional Infusion Pump: Comparison of cost and safety. Recommendation for the use of technology: ( ) In favor of (X) Uncertain ( ) Against Brief justification for the recommendation: Studies with little scientific evidence, the costs with the materials, the need to qualify, the construction of a library, among other strategies. Population: Patients hospitalized Technology: Intelligent Infusion Pumps Comparator: Conventional Infusion Pumps Search and analysis of scientific evidence: A search was performed to 2017, November 14 in the databases The Cochrane Library, EMBASE, PubMed and Latin American, Caribbean Literature in Health Sciences (LILACS) and the Health Technology Assessment (ATS). There was no language restriction and year of publication of the article. The results of the databases were grouped and the duplicate studies were eliminated. Then, the eligibility criteria for titles and abstracts were applied, leaving 51 studies for complete reading. After reading the articles in full, 06 studies were selected. Summary of results of selected studies: Six studies were included: one systematic review without meta-analysis, three observational studies without comparator, and two before-after observational studies. The studies did not present conclusive data to reduce the number of events that occurred. For error interception / error prevention, studies have shown that the smart pump intercepted and prevented various errors such as f... (Complete abstract click electronic access below) / Mestre

Submitted by MICHELE CRISTINA BATISTON (mbatiston@bol.com.br) on 2018-08-08T22:41:37Z No. of bitstreams: 1 dissertaçao_mestrado_michele_batiston.pdf: 621517 bytes, checksum: 9fb79643cf6fe14c3e097f3181fa7d8e (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-08-09T14:06:35Z (GMT) No. of bitstreams: 1 batiston_mc_me_bot.pdf: 621517 bytes, checksum: 9fb79643cf6fe14c3e097f3181fa7d8e (MD5) / Made available in DSpace on 2018-08-09T14:06:35Z (GMT). No. of bitstreams: 1 batiston_mc_me_bot.pdf: 621517 bytes, checksum: 9fb79643cf6fe14c3e097f3181fa7d8e (MD5) Previous issue date: 2018-07-12 / O objetivo deste trabalho foi avaliar a evidência científica disponível sobre o uso das bombas de infusão inteligentes em pacientes hospitalizados. Foi realizado um estudo, de acordo com Diretrizes Metodológicas propostas pelo Ministério da Saúde para a elaboração de pareceres técnico-científicos (PTC). Foi realizada uma busca até 14 de novembro de 2017 nas bases de dados The Cochrane Library, EMBASE, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e de Avaliações de Tecnologias de Saúde (ATS), não houve restrição de idioma e ano de publicação do artigo. Os resultados das bases de dados foram agrupados e eliminados os estudos em duplicatas. Em seguida, aplicados os critérios de elegibilidade para os títulos e resumos, restando 51 estudos para leitura completa. Após leitura dos artigos na íntegra, foram selecionados 6 estudos, que incluíram revisão sistemática sem metanálise, três estudos observacionais sem comparador e dois estudos observacionais do tipo antes e depois. Os estudos não apresentaram dados conclusivos para redução do número de eventos ocorridos. Para a interceptação de erros/prevenção de erros, os estudos demonstraram que a bomba inteligente interceptou e impediu diversos erros como frequência, dose e programação erradas. Para os custos, o estudo de revisão sistemática sem metanálise inclui um estudo que apresentou redução de custos da Bomba de Infusão Inteligente pelos possíveis eventos adversos evitáveis. A recomendação é incerta, indicando a necessidade de elaboração de novos estudos como ensaios clínicos randomizados e avaliações econômicas. / Title: Intelligent Infusion Pump versus Conventional Infusion Pump: Comparison of cost and safety. Recommendation for the use of technology: ( ) In favor of (X) Uncertain ( ) Against Brief justification for the recommendation: Studies with little scientific evidence, the costs with the materials, the need to qualify, the construction of a library, among other strategies. Population: Patients hospitalized Technology: Intelligent Infusion Pumps Comparator: Conventional Infusion Pumps Search and analysis of scientific evidence: A search was performed to 2017, November 14 in the databases The Cochrane Library, EMBASE, PubMed and Latin American, Caribbean Literature in Health Sciences (LILACS) and the Health Technology Assessment (ATS). There was no language restriction and year of publication of the article. The results of the databases were grouped and the duplicate studies were eliminated. Then, the eligibility criteria for titles and abstracts were applied, leaving 51 studies for complete reading. After reading the articles in full, 06 studies were selected. Summary of results of selected studies: Six studies were included: one systematic review without meta-analysis, three observational studies without comparator, and two before-after observational studies. The studies did not present conclusive data to reduce the number of events that occurred. For error interception / error prevention, studies have shown that the smart pump intercepted and prevented various errors such as frequency, dose and wrong programming. For costs, the systematic review study without meta-analysis includes a study that presented cost savings of the Smart Infusion Pump for possible avoidable adverse events. Quality of Evidence: The included studies were considered of low evidence quality. Synthesis of Economic Information: The average cost of the inputs of conventional peristaltic infusion pumps is R $ 17.00 (equipment only), for intelligent peristaltic pumps it is R $ 38.00 (value of equipment only, pumps syringe infusion are conventional or intelligent use the same input that costs on average $ 8.50 (20 ml syringe and extender).