Yes / Background: Online communities hold great potential as interventions for health, particularly for the management of chronic illness. The social support that online communities can provide has been associated with positive treatment outcomes, including medication adherence. There are few studies that have attempted to assess whether membership of an online community improves health outcomes using rigorous designs. Objective: Our objective was to conduct a rigorous proof-of-concept randomized controlled trial of an online community intervention for improving adherence to asthma medicine. Methods: This 9-week intervention included a sample of asthmatic adults from the United Kingdom who were prescribed an inhaled corticosteroid preventer. Participants were recruited via email and randomized to either an “online community” or “no online community” (diary) condition. After each instance of preventer use, participants (N=216) were required to report the number of doses of medication taken in a short post. Those randomized to the online community condition (n=99) could read the posts of other community members, reply, and create their own posts. Participants randomized to the no online community condition (n=117) also posted their medication use, but could not read others’ posts. The main outcome measures were self-reported medication adherence at baseline and follow-up (9 weeks postbaseline) and an objective measure of adherence to the intervention (visits to site). Results: In all, 103 participants completed the study (intervention: 37.8%, 39/99; control: 62.2%, 64/117). MANCOVA of self-reported adherence to asthma preventer medicine at follow-up was not significantly different between conditions in either intention-to-treat (P=.92) or per-protocol (P=.68) analysis. Site use was generally higher in the control compared to intervention conditions. Conclusions: Joining an online community did not improve adherence to preventer medication for asthma patients. Without the encouragement of greater community support or more components / Funded by a pilot grant from the University of Leeds School of Psychology. A Fulbright Scholarship from the US-UK Fulbright Commission supported the first author

Objectives: To explore the pain mechanism and the origin of the pain and to evaluate a short-term pain relief treatment in women suffering from CPP persisting after childbirth in order to enable physiotherapeutic intervention. Material and methods: Thirty-six parous women with chronic pelvic pain persisting after childbirth were recruited at the Department of Physiotherapy, SundsvallHospital and by advertisements in newspapers and 29 parous women without chronic pelvic pain were recruited from an organized gynaecological screening at a midwifery surgery. All women were provoked by intra-pelvic palpation of 13 predetermined intra-pelvic landmarks. The provoked pain distribution was expressed in pain drawings and the pain intensity verbally on a Likert scale.Also, in a randomised controlled trial the 36 women with chronic pelvic pain were allocated to bilateral injection treatment with either triamcinolone or saline solutions, given once on the ischial spine with follow-up after four weeks. Results: Referred pain provoked on intra-pelvic landmarks follows a specific pattern. In general, pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions. In women with chronic pelvic pain the provoked pain distribution area and pain intensity were magnified as compared to women without chronic pelvic pain. In the clinical trial decreased pain intensity, decreased distribution of pain and improved physical function was achieved among the triamcinolone treatment group as compared to the saline treatment group. Also, a positive correlation was shown between reduced pain intensity and improved function. Conclusions: Referred pain patterns provoked on intra-pelvic landmarks in women with chronic pelvic pain persisting after childbirth are consistent with sclerotomal sensory innervations and indicates allodynia and central sensitisation. This suggests that pain mapping can be used to evaluate and confirm the pain experience and contribute to diagnosis. Also, the pain intensity provoked by stimulation of the intra-pelvic landmarks is suggested to be useful to differentiate women with chronic pelvic pain from those without. Corticosteroid treatment to the ischial spine resulted in decreased pain and increased function.

Factorial randomised controlled trials (RCTs) evaluate two or more interventions simultaneously, enabling assessment of interactions between treatments. This thesis presents literature reviews, methodological reviews, simulation studies and applied case studies that explore methods for assessing cost-effectiveness based on factorial RCTs. My systematic review suggests that factorial RCTs account for around 3% of trial-based economic evaluations, although there is currently no guidance or methodological work indicating the most appropriate methods. Around 40% of published studies assumed no interaction between treatments and many were poorly-reported. Various mechanisms are likely to produce large interactions within economic endpoints such as costs, quality-adjusted life-years (QALYs) and net benefits. Failing to take account of interactions can introduce bias and prevent efficient allocation of healthcare resources. I developed the opportunity cost of ignoring interactions as a measure of the implications of this bias. However, allowing for small, chance interactions is inefficient, potentially leading to over-investment in research if trial-based evaluations are used to inform decisions about subsequent research. Nonetheless, analyses on simulated trial data suggest that the opportunity cost of adopting a treatment that will not maximise health gains from the healthcare budget is minimised by including all interactions regardless of magnitude or statistical significance. Different approaches for conducting economic evaluations of factorial RCTs (including regression techniques, extrapolation using patient-level simulation, and considering different components of net benefit separately) are evaluated within three applied studies, including both full and partial factorials with 2x2 and 2x2x2 designs. I demonstrate that within both trial-based and model-based economic evaluation, efficient allocation of healthcare resources requires consideration of interactions between treatments, and joint decisions about interacting treatments based on incremental cost-effectiveness evaluated “inside-the-table” on a natural scale. I make recommendations for the design, analysis and reporting of factorial trial-based economic evaluations based on the results of this thesis.

Producing speech is a highly complex task, involving the integration of sensory and linguistic information, with the precise, high-speed, co-ordination of muscles controlling breathing and the movement of the vocal folds and articulators. In spite of this complexity, producing fluent speech - moving smoothly from one speech sound to the next - can appear effortless. Speech fluency is highly socially valued, and the personal and societal costs of living with a disorder of fluency, such as developmental stuttering, are considerable. The outcomes of behavioural therapies to increase fluency are limited, however, especially for those seeking treatment in adulthood. The overarching aim of this thesis was to investigate how anodal transcranial direct current stimulation (A-TDCS) can be used to increase speech fluency, with a particular focus on the potential application to developmental stuttering. A-TDCS is a noninvasive brain stimulation technique that can enhance the effects of motor, speech, and language training. First, in a series of single-session experiments in typically fluent speakers, I demonstrated that applying A-TDCS over the left IFC increased speech motor learning relative to a sham control, but did not improve consolidation of this learning (chapter 2). Furthermore, I found that neither increasing stimulation intensity from 1 mA to 2 mA, nor changing from a unihemispheric to a bihemispheric configuration, had an additional effect on learning. Next, in single-session study with adults who stutter, I assessed the feasibility of using A-TDCS to improve fluency (chapter 3). Fluency was temporarily induced, by speaking in unison with another person, but the concurrent application of 1-mA unihemispheric A-TDCS over left inferior frontal cortex did not significantly prolong this fluency. Nevertheless, a trend towards stuttering reduction gave some indication that fluency might be increased using a multiple-session approach. Furthermore, I gained a number of important insights from these single-session studies, which I used to inform the design of the final multiple-session trial. In this final study, I completed a randomised controlled trial in 30 adult males with moderate to severe stuttering. Participants were randomized to receive either 1-mA A-TDCS or sham stimulation over left inferior frontal cortex combined with temporary fluency inducing behavioural techniques, for 20 minutes a day over 5 days (chapter 4). A-TDCS significantly reduced disfluency for at least 5 weeks following this intervention. The effect was specific to the speech impairment of development stuttering, as measures of the psycho-social consequences of stuttering were not modulated by A-TDCS. The findings of these studies offer significant promise for the future application of non-invasive stimulation as an adjunctive therapy for adults who stutter. In the concluding chapter, I discuss the important implications of my findings for the future use of this technique.

Introdução: A reanimação fluídica da criança queimada é um desafio devido à intolerância à insuficiente ou excessiva oferta de líquidos. Há dúvidas em relação à utilização de solução coloide na ressuscitação volêmica e também quanto ao melhor momento a ser administrada. O momento ideal para a administração de albumina permanece em foco de debate, se deveria ser utilizada como estratégia de resgate, quando o volume de cristaloide infundido se torna excessivo, ou rotineiramente, como intervenção primária em pacientes com queimaduras extensas. Objetivos: Avaliar e comparar quanto a evolução clínica de crianças com lesões térmicas que receberam abordagem de infusão precoce (entre 8 e 12 horas do acidente) de solução coloide natural versus crianças que receberam abordagem de infusão tardia (após 24 horas do acidente) da mesma solução para reanimação na fase aguda. Metodologia: Ensaio Clínico Randomizado Controlado, realizado no Centro de Tratamento de Queimados do Hospital Universitário de Londrina. Foram estudadas 46 crianças (1 a 12 anos), apresentando entre 15% e 45% de Superfície Corporal Queimada, admitidas até a 12a hora após o acidente. Intervenção: Para a ressuscitação hídrica dos pacientes, foi utilizada solução cristaloide baseada na Fórmula de Parkland modificada, ajustada de acordo com o débito urinário. O Grupo Intervenção (23 pacientes) foi randomizado para receber solução de albumina entre 8 e 12 horas do acidente, e o Grupo Controle (23 pacientes) recebeu a mesma solução após 24 horas do acidente. Resultados: Houve possibilidade de redução de infusão de solução cristaloide durante o período de ressuscitação dos pacientes. O grupo Intervenção recebeu um volume de solução cristaloide com uma mediana de -31,99% (P=0,025) no 1º dia, -19,37% (P=0,002) no 2º dia e -45,3% (P=0,002) no 3º dia de ressuscitação. Não foram observadas diferenças significantes entre os grupos em relação à diurese. A incidência acumulada de fluid creep na população estudada foi de 30,43% (n=14). O RR para o desenvolvimento do fluid creep no Grupo Intervenção foi de 0,0769 (IC 95% 0,0109 a 0,5407). A mediana do tempo de internação dos pacientes do Grupo Controle foi de 18 (15-21) dias e a do Grupo Intervenção foi de 14 (10-17) dias, P=0,004. Conclusões: A infusão precoce de solução de albumina em crianças com queimaduras entre 15% e 45% de superfície corporal reduziu a necessidade de infusão de solução cristaloide no período de ressuscitação. Foram identificados significativamente menos casos de fluid creep e observado menor tempo de internação entre pacientes que receberam albumina precocemente / Introduction: The fluidic resuscitation of burned children is a challenge due to intolerance to insufficient or excessive supply of liquids. There are questions regarding the use of colloids in fluid resuscitation solution as well as the timing of the administration. The ideal time for the administration of albumin, in other words whether it should be used as a rescue strategy when the volume of crystalloid infused becomes excessive, or routinely, as primary intervention for patients with extensive burns, remains in the focus of discussion. Objectives: Evaluate the clinical outcomes of children with burn injuries who have received early infusion treatment (between 8 and 12 hours after the accident) with natural colloids solution compared to the children who have received late infusion treatment (24 hours after the accident) with the same solution, in order to resuscitate them in the acute phase. Methods: Randomized Controlled Trial carried out at the Burn Treatment Center, State University of Londrina. Forty-six children (1 to 12 year olds) who had between 15% and 45% total body surface area and were admitted up to 12 hours after the accident were studied. Intervention: For the fluid resuscitation of patients, a crystalloid solution based on modified Parkland Formula was adjusted according to urine output. The Intervention Group (n= 23) were randomized to receive albumin solution between 8 and 12 hours after the accident and the Control Group (n= 23) received the same solution later than 24 hours after the burn injury. Results: During the resuscitation of patients, it was possible to reduce the infusion of crystalloid solution. The Intervention Group required a volume of crystalloid solution with a median of -31.99% (P = 0.025) on day 1, - 19.37% (P = 0.002) on day 2 and -45.3% (P = 0.002) on day 3 of resuscitation. No significant differences were observed in the groups in relation to diuresis. The cumulative incidence of fluid creep in the population studied was 30.43% (n=14). The RR for the development of fluid creep in the Intervention Group was 0.0769 (IC 95% 0.0109 to 0.5407). The patients in the Control Group spent an average time of 18 (15-21) days in hospital, while the patients in the Intervention Group spent 14 (10-17) days, P=0,004. Conclusions: The early infusion of albumin solution in children with 15% to 45% total body surface area reduced the need of crystalloid infused during the resuscitation period. Significantly lower cases of fluid creep were identified and lower length of stay was observed among patients who were treated earlier with albumin

Orientador: Marcone Lima Sobreira / Resumo: Introdução: O tratamento mais comum para a insuficiência venosa na gravidez são as meias de compressão, entretanto ainda não há evidência científica sobre sua eficácia. Objetivo: avaliar a eficácia do uso de meias de compressão no refluxo venoso e na prevenção de varizes nos membros inferiores de gestantes, bem como analisar a percepção sobre as vantagens e desvantagens quanto ao seu uso. Método: Foi realizado um ensaio clínico controlado, randomizado, cego. Foram incluídas 60 gestantes saudáveis, com 10 a 13 semanas de gravidez, de idade entre 18 e 40 anos, com pulsos distais normais, distribuídas em 2 grupos: grupo 1 (n=30) usou de meia de compressão por 8 horas diárias e grupo 2 controle (n=30), que não utilizou a meia. Foram analisados o refluxo venoso, diâmetro da Veia Safena Magna-VSM e Veia Safena Parva- VSP, por meio do eco Doppler, bem como sintomatologia e classificação CEAP, no início e no final da gestação, por um pesquisador, no laboratório vascular da Faculdade de Medicina de Botucatu, Unesp. Os testes estatísticos paramétricos e não paramétricos foram realizados ao nível de significância de 5%. Resultado: Os valores do refluxo na VSM proximal, no início e no final da pesquisa, foram respectivamente 0,13s e 0,04s (p<0,0001) na perna direita e 0,17s e 0,03s (p<0,0001) na perna esquerda do grupo 1. No grupo 2, essa mesma variável apresentou 0,02s e 0,34s (p<0,0001) na perna direita e 0,03s e 0,29s (p<0,0001) na perna esquerda. Os diâmetros da VSM proximal na perna... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The most common treatments for venous insufficiency in pregnancy are compression stockings, though there is still no scientific evidence for its efficacy. Objective: To evaluate the efficacy of compression stockings use on venous reflux and prevention of varicose veins in the lower limbs of pregnant women, as well as to analyze the perception of the advantages and disadvantages with its use. Methods: A randomized controlled clinical trial, blinded, was conducted. Sixty healthy pregnant women, 10 to 13 weeks pregnant, aged 18 to 40 years, with normal distal pulses, were divided into 2 groups: group 1 (n = 30) used compression stockings for 8 hours daily and group 2 control (n = 30), who did not use the stockings. The venous reflux, the diameter of the Great Saphenous Vein – GSV and of he Small Saphenous Vein - SSV were analyzed by DOPPLER US, as well as symptomatology and CEAP classification, at the beginning and at the end of pregnancy, by a researcher in the vascular laboratory of the Botucatu Medical School, Unesp. Parametric and non-parametric statistical tests were performed at a significance level of 5%. Results: The values of reflux in the proximal GSV, at the beginning and at the end of the study, were respectively 0.13s and 0.04s (p<0.0001) in the right leg and 0.17s and 0.03s (p<0,0001) in the left leg of group 1. In the group 2, this same variable presented 0.02s and 0.34s (p<0.0001) in the right leg and 0.03s and 0.29s (p <0.0001) in the left leg. Th... (Complete abstract click electronic access below) / Doutor

Introdução: A reanimação fluídica da criança queimada é um desafio devido à intolerância à insuficiente ou excessiva oferta de líquidos. Há dúvidas em relação à utilização de solução coloide na ressuscitação volêmica e também quanto ao melhor momento a ser administrada. O momento ideal para a administração de albumina permanece em foco de debate, se deveria ser utilizada como estratégia de resgate, quando o volume de cristaloide infundido se torna excessivo, ou rotineiramente, como intervenção primária em pacientes com queimaduras extensas. Objetivos: Avaliar e comparar quanto a evolução clínica de crianças com lesões térmicas que receberam abordagem de infusão precoce (entre 8 e 12 horas do acidente) de solução coloide natural versus crianças que receberam abordagem de infusão tardia (após 24 horas do acidente) da mesma solução para reanimação na fase aguda. Metodologia: Ensaio Clínico Randomizado Controlado, realizado no Centro de Tratamento de Queimados do Hospital Universitário de Londrina. Foram estudadas 46 crianças (1 a 12 anos), apresentando entre 15% e 45% de Superfície Corporal Queimada, admitidas até a 12a hora após o acidente. Intervenção: Para a ressuscitação hídrica dos pacientes, foi utilizada solução cristaloide baseada na Fórmula de Parkland modificada, ajustada de acordo com o débito urinário. O Grupo Intervenção (23 pacientes) foi randomizado para receber solução de albumina entre 8 e 12 horas do acidente, e o Grupo Controle (23 pacientes) recebeu a mesma solução após 24 horas do acidente. Resultados: Houve possibilidade de redução de infusão de solução cristaloide durante o período de ressuscitação dos pacientes. O grupo Intervenção recebeu um volume de solução cristaloide com uma mediana de -31,99% (P=0,025) no 1º dia, -19,37% (P=0,002) no 2º dia e -45,3% (P=0,002) no 3º dia de ressuscitação. Não foram observadas diferenças significantes entre os grupos em relação à diurese. A incidência acumulada de fluid creep na população estudada foi de 30,43% (n=14). O RR para o desenvolvimento do fluid creep no Grupo Intervenção foi de 0,0769 (IC 95% 0,0109 a 0,5407). A mediana do tempo de internação dos pacientes do Grupo Controle foi de 18 (15-21) dias e a do Grupo Intervenção foi de 14 (10-17) dias, P=0,004. Conclusões: A infusão precoce de solução de albumina em crianças com queimaduras entre 15% e 45% de superfície corporal reduziu a necessidade de infusão de solução cristaloide no período de ressuscitação. Foram identificados significativamente menos casos de fluid creep e observado menor tempo de internação entre pacientes que receberam albumina precocemente / Introduction: The fluidic resuscitation of burned children is a challenge due to intolerance to insufficient or excessive supply of liquids. There are questions regarding the use of colloids in fluid resuscitation solution as well as the timing of the administration. The ideal time for the administration of albumin, in other words whether it should be used as a rescue strategy when the volume of crystalloid infused becomes excessive, or routinely, as primary intervention for patients with extensive burns, remains in the focus of discussion. Objectives: Evaluate the clinical outcomes of children with burn injuries who have received early infusion treatment (between 8 and 12 hours after the accident) with natural colloids solution compared to the children who have received late infusion treatment (24 hours after the accident) with the same solution, in order to resuscitate them in the acute phase. Methods: Randomized Controlled Trial carried out at the Burn Treatment Center, State University of Londrina. Forty-six children (1 to 12 year olds) who had between 15% and 45% total body surface area and were admitted up to 12 hours after the accident were studied. Intervention: For the fluid resuscitation of patients, a crystalloid solution based on modified Parkland Formula was adjusted according to urine output. The Intervention Group (n= 23) were randomized to receive albumin solution between 8 and 12 hours after the accident and the Control Group (n= 23) received the same solution later than 24 hours after the burn injury. Results: During the resuscitation of patients, it was possible to reduce the infusion of crystalloid solution. The Intervention Group required a volume of crystalloid solution with a median of -31.99% (P = 0.025) on day 1, - 19.37% (P = 0.002) on day 2 and -45.3% (P = 0.002) on day 3 of resuscitation. No significant differences were observed in the groups in relation to diuresis. The cumulative incidence of fluid creep in the population studied was 30.43% (n=14). The RR for the development of fluid creep in the Intervention Group was 0.0769 (IC 95% 0.0109 to 0.5407). The patients in the Control Group spent an average time of 18 (15-21) days in hospital, while the patients in the Intervention Group spent 14 (10-17) days, P=0,004. Conclusions: The early infusion of albumin solution in children with 15% to 45% total body surface area reduced the need of crystalloid infused during the resuscitation period. Significantly lower cases of fluid creep were identified and lower length of stay was observed among patients who were treated earlier with albumin

A confecção de próteses totais envolve uma série de procedimentos técnicos complexos. No entanto, a simplificação dessa sequência de procedimentos pode ser tão eficazes quanto os convencionais, mas com menor gasto de tempo e recursos. O objetivo deste estudo foi quantificar os custos envolvidos com a confecção de próteses totais com um método simplificado em comparação a um convencional. A amostra foi formada por pacientes desdentados totais solicitando tratamento com próteses totais duplas, que foram divididos aleatoriamente em dois grupos: o Grupo S recebeu próteses totais confeccionadas por um método simplificado, enquanto que o Grupo C recebeu próteses confeccionadas convencionalmente. Os custos diretos e indiretos de cada procedimento foram calculados por participante, incluindo sessões imprevistas. O estudo foi realizado com 19 e 21 participantes nos grupos S e C, respectivamente, e comparações entre os dois grupos foram feitas por meio dos testes de Mann-Whitney e t de Student (&alpha;=0,05). A confecção das próteses demandou do operador um tempo mediano de 173,2 e 284,5 min. para os grupos S e C, respectivamente, enquanto os tempos para o auxiliar foram 46,6 e 61,7 min. (diferenças significantes, P<0,05). Os grupos não diferiram significantemente na fase de ajustes pós-instalação. O grupo S também apresentou valores menores que C durante a fase de confecção, mas não durante os ajustes, para custos com materiais empregados e tempo despendido pelo paciente. No total, o método simplificado reduziu o custo direto do tratamento em 34,9%. Conclui-se que o método simplificado é menos oneroso ao paciente e sistema de saúde, quando comparado a um protocolo convencional para a reabilitação do paciente edentado. / Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lower use of time and resources. The aim of this study is to quantify the costs of complete denture fabrication by means of a simplified method compared with a conventional protocol. A sample of edentulous patients needing conventional maxillary and mandibular complete dentures was randomly divided into: group S, which received dentures fabricated by means of a simplified method, and group C, which received conventionally fabricated dentures. We calculated direct and indirect costs for each participant including unscheduled procedures. This study assessed 19 and 20 participants allocated in groups S and C, respectively, and comparisons between groups were conducted by means of the Mann-Whitney and Students t test (&alpha;=0,05). Complete denture fabrication demanded median time periods of 173,2 and 284,5 min from the operator for groups S and C respectively, and 46.6 and 61.7 min from the dental assistant (significant differences, P<0.05). There was no difference between groups regarding postinsertion adjustments. Group S also showed lower values than C during the fabrication stage, but not during adjustments, for costs with materials and time spent by patients. In summary, the simplified method reduced direct treatment costs in 34.9%. It can be concluded that the simplified method is less costly for patients and health system when compared with a conventional protocol for the rehabilitation of edentulous patients.

Os mecanismos fisiológicos de detecção e controle da sede no paciente cirúrgico idoso ocorrem de forma diferenciada do que em adultos e crianças o que justifica o investimento na condução de estudos sobre estratégias que podem proporcionar alívio deste sintoma com o uso de temperatura fria e volume pequeno. O objetivo do estudo foi comparar a intensidade e o desconforto da sede de pacientes idosos que degustaram o picolé mentolado com a sede de pacientes idosos que receberam o cuidado usual, no pós-operatório imediato. Trata-se de ensaio clínico randomizado em paralelo com dois grupos, realizado em sala de recuperação pós-anestésica de hospital público de ensino no sul do Brasil. A amostra foi composta de 50 pacientes idosos em pós-operatório imediato, os quais foram alocados em dois grupos, sendo 25 no grupo controle e 25 no grupo experimental, sem perda de seguimento. Os critérios de inclusão foram: pacientes com idade >= 60 anos; estar em jejum; verbalizar sede e ter sido aprovado na avaliação do Protocolo de Segurança no Manejo da Sede. Os pacientes com restrições à ingesta ou deglutição, bem como os que autorreferiram alergia à menta, foram excluídos. Os pacientes alocados no grupo controle receberam o cuidado usual de rotina da instituição, onde o estudo foi conduzido, que consiste na manutenção do jejum. Já os pacientes alocados no grupo experimental receberam um picolé mentolado de 20 ml. Os desfechos primários de interesse foram a intensidade e o desconforto da sede, sendo que ambos foram avaliados inicialmente (T0) e novamente (T1) após 20 minutos da intervenção ou cuidado usual. A intensidade da sede foi mensurada por meio da Escala Numérica (zero significa nenhuma sede e 10 a maior sede já vivenciada pelo paciente), e o desconforto da sede pela Escala de Desconforto da Sede Perioperatória (pontuação de zero a 14 pontos, sendo zero a ausência de desconforto e 14 corresponde ao desconforto mais intenso relacionado à sede). A mediana da intensidade e do desconforto da sede inicial (T0) foi de 6,0 para os participantes alocados no grupo experimental, e 5,0 para a intensidade e 6,0 para o desconforto da sede para os participantes alocados no grupo controle. Para a comparação das mudanças nos escores da Escala Numérica e da Escala de Desconforto da Sede Perioperatória entre o grupo experimental e o grupo controle (valor final menos valor inicial), o teste de Mann-Whitney foi empregado para diferenças de medianas. Os resultados do ensaio clínico randomizado demonstraram que houve diminuição estatisticamente significante na intensidade (p<0,001) e no desconforto da sede (p<0,001) dos pacientes cirúrgicos idosos, após vinte minutos da degustação do picolé mentolado quando comparados à intensidade e desconforto da sede dos pacientes que receberam o cuidado usual, no pósoperatório imediato. Considerando a escassez de evidências sobre estratégias para manejo da sede do paciente cirúrgico idoso, o picolé mentolado é uma estratégia inovadora e segura, podendo se tornar método de escolha para uso na prática clínica / Physiological mechanisms of detection and control of thirst in the elderly surgical patient occur differently than in adults and children, which justifies the investment in conducting studies on strategies that can provide relief of this symptom with use of cold temperature and small volume. The aim of the study was to compare thirst intensity and discomfort of elderly patients who savoured mentholated popsicle with thirst of elderly patients who received the usual care in the immediate postoperative period. This is a randomized controlled clinical trial in parallel with two groups, conducted in a post anesthesia care unit of a public teaching hospital in southern Brazil. The sample consisted of 50 elderly patients in the immediate postoperative period, who were allocated in two groups, 25 in the control and 25 in the experimental group, without follow-up losses. Inclusion criteria were: patients aged >= 60 years; being fasting; verbalize thirst and having been approved in the assessment of Safety Protocol of Thirst Management. Patients with restrictions to ingestion or swallowing, as well as those who self-referred peppermint allergy, were excluded. Patients assigned to the control group received usual routine care of the institution where the study was conducted, which consists in maintenance of fasting. Patients assigned to the experimental group received a 20 ml mentholated popsicle. Primary outcomes of interest were thirst intensity and discomfort, both of which were assessed initially (T0) and again (T1) after 20 minutes of the intervention or usual care. Thirst intensity was measured using a Numerical Scale (zero means no thirst and 10 the greatest thirst ever experienced by patient), and thirst discomfort by Perioperative Thirst Discomfort Scale (score of zero to 14 points, being zero the absence of discomfort and 14 corresponds to the most intense discomfort related to thirst). Median of initial thirst intensity and discomfort (T0) was 6.0 for the participants assigned to the experimental group, 5.0 for thirst intensity and 6.0 for thirst discomfort for the participants assigned to the control group. Mann-Whitney test was used evaluating differences in medians, comparing changes in Numerical Scale and in Perioperative Thirst Discomfort Scale between the experimental group and the control group (final value minus initial value). Results of the randomized clinical trial demonstrated that there was a statistically significant decrease in thirst intensity (p <0.001) and discomfort (p <0.001) of elderly surgical patients, after twenty minutes of tasting the mentholated popsicle when compared to thirst intensity and discomfort of the patients who received the usual care, in the immediate postoperative period. Considering the shortage of evidence on strategies for thirst management of elderly surgical patient, mentholated popsicle is an innovative and safe strategy, and may become a method of choice for use in clinical practice

<p>Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care.</p>