Made available in DSpace on 2014-11-10T11:09:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-27Bitstream added on 2014-11-10T11:58:04Z : No. of bitstreams: 1 000788528.pdf: 1954056 bytes, checksum: 32e406d786aa994b16ea9a2117afb377 (MD5) / Delirium é uma manifestação de disfunção cerebral aguda, frequente em pacientes criticamente enfermos e está associado a aumento da morbidade e mortalidade. Na experiência das Unidades de Terapia Intensiva (UTI), esta situação afeta muitos pacientes durante o período de hospitalização, aumentando a frequência dos eventos à medida que o período de internação prolonga-se. Neste sentido, esta pesquisa buscou compreender os conceitos atribuídos ao Delirium pelos enfermeiros de UTI, bem como as estratégias utilizadas por eles na abordagem preventiva, diagnóstica e terapêutica no cuidado a pacientes que apresentam este diagnóstico. Foi um estudo qualitativo com Referencial Metodológico da Análise de Conteúdo, realizado em duas UTIs adulto de hospitais públicos do Estado de São Paulo-Brasil, sendo uma localizada no interior paulista e outra na capital. Os dados foram coletados no período de abril a julho de 2013, por meio de entrevista semi estruturada da qual participaram 18 enfermeiros do sexo feminino, com idades predominantes entre 25 e 30 anos e com 1 a 5 anos de atuação no cuidado a pacientes críticos. Os resultados do estudo deram origem a sete categorias nos seguintes temas: Delirium é confusão, agitação, alucinação e agressividade, possui múltiplas circunstâncias causais, associadas ao ambiente da UTI, a abstinência do uso de drogas e álcool, à doença psiquiátrica prévia e ao uso de fármacos/sedativos. Nos temas relacionados às estratégias possíveis para prevenção, emergiram: maior contato com a família, adequação funcional e estrutural do ambiente e intencionalidade de comunicação com o paciente. No que se refere ao diagnóstico do Delirium, os enfermeiros relataram que a alteração do comportamento o define, sendo necessária especial atenção aos sinais da comunicação não verbal. O tratamento do Delirium pode acontecer por restrição mecânica, como método ... / Delirium is a manifestation of acute brain dysfunction which is frequent in critically ill patients and associated with increased morbidity and mortality. In the experience of Intensive Care Units (ICUs), this situation affects many patients during the hospitalization period, and the frequency of events increases as the hospitalization period extends. With this regard, this study aimed at understanding the concepts attributed to Delirium by ICU nurses for preventive, diagnostic and therapeutic approaches in the care for patients showing this diagnosis. It was a qualitative study with a methodological framework based on Content Analysis and conducted in two adult ICUs in public hospitals in São Paulo state - Brazil, one of which was located in inner São Paulo state and the other in the state capital city. Data were collected from April to July 2013 by means of semi-structured interviews in which 18 female nurses whose ages were predominantly between 25 and 30 years and who had worked in the care for critical patients for 1 to 5 years participated. The results in the study originated seven categories according to the following topics: Delirium is confusion, agitation, hallucination and aggressiveness. It has multiple causal circumstances associated with the ICU environment, abstinence from drug and alcohol use, previous psychiatric disease and the use of pharmaceuticals/sedatives. In the topics related to possible prevention strategies, the following emerged: greater contact with one’s family, functional and structural adequacy of the environment and intentionality of communication with the patient. As regards the Delirium diagnosis, nurses reported that behavioral changes define it, and special attention must be paid to non-verbal communication signs. Delirium treatment may take place by mechanical restriction as a therapeutic method and by the use of pharmaceuticals as a means of patient restraint, pointing out verbal communication ...

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, 2017. / Submitted by Raquel Almeida (raquel.df13@gmail.com) on 2017-12-11T19:19:05Z No. of bitstreams: 1 2017_SimoneRiosFonsecaRitter.pdf: 999026 bytes, checksum: efd6e9f2165ae4457741501006972717 (MD5) / Approved for entry into archive by Raquel Viana (raquelviana@bce.unb.br) on 2018-02-15T18:44:38Z (GMT) No. of bitstreams: 1 2017_SimoneRiosFonsecaRitter.pdf: 999026 bytes, checksum: efd6e9f2165ae4457741501006972717 (MD5) / Made available in DSpace on 2018-02-15T18:44:38Z (GMT). No. of bitstreams: 1 2017_SimoneRiosFonsecaRitter.pdf: 999026 bytes, checksum: efd6e9f2165ae4457741501006972717 (MD5) Previous issue date: 2018-02-15 / Introdução: O delirium é uma das síndromes mais frequentes no idoso admitido em uma unidade de emergência, caracterizado por início súbito com flutuações durante o dia; alteração do nível de consciência; perturbação global da cognição ou anormalidades perceptuais e comportamentais e é frequentemente não diagnosticado. Objetivos: Estimar prevalência de delirium em serviço de urgência e avaliar fatores associados, a acurácia diagnóstica do médico plantonista e adaptar o Abbreviated Mental Test Score (AMT) como teste de rastreio para delirium em idosos admitidos em uma unidade de urgência. Métodos: Estudo transversal realizado em serviço de urgência do Hospital Universitário de Brasília, de abril a junho/2014. Foi utilizado como parâmetro para o critério de delirium o Confusion Assessment Method Instrument (CAM). Foi coletado em prontuário dado de suspeita diagnóstica pelo médico plantonista. Adicionalmente, foram analisadas variáveis sociodemográficas, psicocomportamentais e fatores clínicos e realizadas análises multivariadas de modelos aditivos, utilizando-se o Epi Info 7.1.3.0. Foram aplicadas questões do AMT em versão traduzida e adaptada culturalmente, com quatro modelos distintos, mais modelos reduzidos, todos comparados ao CAM a partir da curva ROC (significância < 0,05; H0: ACS = 0,5) e a reprodutibilidade inter-avaliadores a partir do Índice Kappa, utilizando-se SPSS. Resultados: Amostra final de 110 participantes com média etária de 72,2 + 8,3 anos, sendo 56,4% homens e uma prevalência de delirium de 28,2%. Fatores associados significativamente ao delirium: sexo masculino (valor-p = 0,019), percepção da saúde como ruim ou muito ruim (valor-p = 0,033), demência prévia (valor-p < 0,001), história prévia de acidente vascular cerebral (valor-p = 0,014) e infecção bacteriana aguda (valor-p = 0,008). Médicos assistentes apresentaram taxa de 64,5% de não diagnóstico, com sensibilidade de 35,5%, especificidade de 100% e acurácia de 81,8%. O melhor dos quatro modelos completos do AMT, em amostra de 90 pacientes, apresentou sensibilidade de 78,3% e especificidade de 85,1%, com boa reprodutibilidade inter-avaliador (Kappa = 0,793). O melhor modelo reduzido foi de quatro itens, com sensibilidade de 82,6% e especificidade de 82,1% com Kappa de 0,746. Conclusões: A prevalência de delirium foi concordante com a literatura, mas ainda pouco diagnosticado no serviço estudado. A adaptação do AMT (completa e reduzida) mostrou-se adequada como alternativa para o rastreio rápido de delirium em idosos admitidos em urgência, quando comparada ao padrão ouro, principalmente para pacientes desacompanhados e sem déficit cognitivo prévio. / Introduction: Delirium is one of the most frequent syndromes in the elderly admitted in emergency unit, characterized by sudden onset with fluctuations during the day; alteration of the level of consciousness; cognitive impairment or perceptual and behavioral abnormalities and is often undiagnosed. Objectives: To estimate the prevalence of delirium in the emergency department and evaluate associated factors, the diagnostic accuracy of the attending physician and to adapt the Abbreviated Mental Test Score (AMT) as a screening test for delirium in elderly admitted to an emergency unit. Methods: A cross-sectional study carried out in the emergency department of the Hospital Universitário de Brasília from April to June/2014. The Confusion Assessment Method Instrument (CAM) was used as a parameter for delirium criteria. Data of suspected diagnosis by the attending physician was collected in medical records. In addition, sociodemographic, psycho-behavioral variables and clinical factors were analyzed, and multivariate analyzes of additive models were performed using Epi Info 7.1.3.0. We applied AMT questions in a translated and culturally adapted version, with four different models, more reduced models, all compared to CAM from the ROC curve (significance <0.05; H0: AUC = 0.5) and inter-evaluators reproducibility from the Kappa Index using SPSS. Results: Final sample of 110 participants with mean age of 72.2 + 8.3 years, 56.4% of men and a prevalence of delirium of 28.2%. Factors significantly associated with delirium: male sex (p-value = 0.019), poor or very poor health perception (p-value = 0.033), previous dementia (p-value <0.001), previous history of stroke (p-value = 0.014) and acute bacterial infection (p-value = 0.008). Physicians assistants had a non-diagnostic rate of 64.5%, with sensitivity of 35.5%, specificity of 100% and accuracy of 81.8%. The best of the four complete AMT models, in a sample of 90 patients, presented sensitivity of 78.3% and specificity of 85.1%, with good inter-rater reproducibility (Kappa = 0.793). The best reduced model was of four items, with sensitivity of 82.6%, specificity of 82.1% and Kappa = 0.746. Conclusions: The prevalence of delirium was consistent with the literature, but still little diagnosed in the service studied. AMT adaptation (complete and reduced) was adequate as an alternative for the rapid screening of delirium in elderly admitted in emergency, when compared to the gold standard, mainly for unaccompanied patients and without previous cognitive deficit.

abstract: Greater than half of older adults who are admitted to an acute care setting experience delirium with an estimated cost between four to twenty billion dollars annually in the United States. As a strategy to address the gap between research and practice, this feasibility study used the Roy Adaptation Model to provide a theoretical perspective for intervention design and evaluation, with a focus on modifying contextual stimuli in a Trauma Intensive Care and a Trauma Orthopedic Unit setting. The study sample included older hospitalized patients in a Trauma Intensive Care and a Trauma Orthopedic setting where there is a greater incidence for delirium. Study participants included two groups, with one group assigned to receive either a music intervention or usual care. The music intervention included pre-recorded music, delivered using an iPod player with soft headsets, with music self-selected from a collection of music compositions with musical elements of slow tempo and simple repetitive rhythm that influence delirium prevention. For the proposed study a music intervention dose included intervention delivery for 60 minutes, twice a day, over a three day period following admission. Physiologic variables measured included systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate, which were electronically monitored every four hours for the study. The Confusion Assessment Method was used as a screening tool to identify delirium in the admitted patients. Specific aims of this feasibility study were to (a) examine the feasibility of a music intervention designed to prevent delirium among older adults, and (b) evaluate the effects of a music intervention designed to prevent delirium among older adults. Findings indicate there was a significant music group by time interaction effect which suggests that change over time was different for the music and usual care group. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2015

Orientador: Solange Bigal / Banca: Adriana da Rosa Amaral / Banca: Hélio Rebello Cardoso Júnior / Resumo: Uma escuta contemplativa dos acontecimentos sonoros do Psychedelic Trance. Agenciadas por Deleuze e Guattari, desde a gênese da música eletrônica, as afecções bergonianas nietzscheanas e espinosanas se desdobram em Psytrance, uma composição afectivo-sonora da mídia eletrônica. / Abstract: A contemplative audition of the sonorous events of the Psychedelic Trance. By the texture of Deleuze and Guatarri meaning, since the eletronic music genesis, the Bergson, Nietzsche and Espinosa affections unfold in Psytrance, an affective-sonorous composition of the eletronic media. / Mestre

Made available in DSpace on 2014-06-11T19:24:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-09-15Bitstream added on 2014-06-13T19:07:15Z : No. of bitstreams: 1 lemos_sm_me_bauru.pdf: 766787 bytes, checksum: ccf5175c2fc664ef285a68a7ee9afed7 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Uma escuta contemplativa dos acontecimentos sonoros do Psychedelic Trance. Agenciadas por Deleuze e Guattari, desde a gênese da música eletrônica, as afecções bergonianas nietzscheanas e espinosanas se desdobram em Psytrance, uma composição afectivo-sonora da mídia eletrônica. / A contemplative audition of the sonorous events of the Psychedelic Trance. By the texture of Deleuze and Guatarri meaning, since the eletronic music genesis, the Bergson, Nietzsche and Espinosa affections unfold in Psytrance, an affective-sonorous composition of the eletronic media.

Orientador: Eliana Mara Braga / Banca: Silvia Maria Cristina Mangini Bocchi / Banca: Monica Martins Trovô Araujo / Resumo: Delirium é uma manifestação de disfunção cerebral aguda, frequente em pacientes criticamente enfermos e está associado a aumento da morbidade e mortalidade. Na experiência das Unidades de Terapia Intensiva (UTI), esta situação afeta muitos pacientes durante o período de hospitalização, aumentando a frequência dos eventos à medida que o período de internação prolonga-se. Neste sentido, esta pesquisa buscou compreender os conceitos atribuídos ao Delirium pelos enfermeiros de UTI, bem como as estratégias utilizadas por eles na abordagem preventiva, diagnóstica e terapêutica no cuidado a pacientes que apresentam este diagnóstico. Foi um estudo qualitativo com Referencial Metodológico da Análise de Conteúdo, realizado em duas UTIs adulto de hospitais públicos do Estado de São Paulo-Brasil, sendo uma localizada no interior paulista e outra na capital. Os dados foram coletados no período de abril a julho de 2013, por meio de entrevista semi estruturada da qual participaram 18 enfermeiros do sexo feminino, com idades predominantes entre 25 e 30 anos e com 1 a 5 anos de atuação no cuidado a pacientes críticos. Os resultados do estudo deram origem a sete categorias nos seguintes temas: Delirium é confusão, agitação, alucinação e agressividade, possui múltiplas circunstâncias causais, associadas ao ambiente da UTI, a abstinência do uso de drogas e álcool, à doença psiquiátrica prévia e ao uso de fármacos/sedativos. Nos temas relacionados às estratégias possíveis para prevenção, emergiram: maior contato com a família, adequação funcional e estrutural do ambiente e intencionalidade de comunicação com o paciente. No que se refere ao diagnóstico do Delirium, os enfermeiros relataram que a alteração do comportamento o define, sendo necessária especial atenção aos sinais da comunicação não verbal. O tratamento do Delirium pode acontecer por restrição mecânica, como método... / Abstract: Delirium is a manifestation of acute brain dysfunction which is frequent in critically ill patients and associated with increased morbidity and mortality. In the experience of Intensive Care Units (ICUs), this situation affects many patients during the hospitalization period, and the frequency of events increases as the hospitalization period extends. With this regard, this study aimed at understanding the concepts attributed to Delirium by ICU nurses for preventive, diagnostic and therapeutic approaches in the care for patients showing this diagnosis. It was a qualitative study with a methodological framework based on Content Analysis and conducted in two adult ICUs in public hospitals in São Paulo state - Brazil, one of which was located in inner São Paulo state and the other in the state capital city. Data were collected from April to July 2013 by means of semi-structured interviews in which 18 female nurses whose ages were predominantly between 25 and 30 years and who had worked in the care for critical patients for 1 to 5 years participated. The results in the study originated seven categories according to the following topics: Delirium is confusion, agitation, hallucination and aggressiveness. It has multiple causal circumstances associated with the ICU environment, abstinence from drug and alcohol use, previous psychiatric disease and the use of pharmaceuticals/sedatives. In the topics related to possible prevention strategies, the following emerged: greater contact with one's family, functional and structural adequacy of the environment and intentionality of communication with the patient. As regards the Delirium diagnosis, nurses reported that behavioral changes define it, and special attention must be paid to non-verbal communication signs. Delirium treatment may take place by mechanical restriction as a therapeutic method and by the use of pharmaceuticals as a means of patient restraint, pointing out verbal communication ... / Mestre

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta dissertação tem como objetivo principal o estudo da narrativa A Confissão de Lúcio, de Mário de Sá-Carneiro, através do estranho e seu duplo, na perspectiva freudiana. Além disso, os conceitos de eu e outro, na visão de Jacques Lacan. É realizado o estudo de alguns poemas e correspondências, bem como de fragmentos de outros textos em prosa do escritor português. Temas como: o desejo de morte, a angústia, o delírio, o amor e o gozo também são abordados. Destaca-se a importância da cidade de Paris que comparece na obra de Sá-Carneiro, como símbolo da modernidade / This dissertation has as main objective the study of narrative A Confissão de Lucio from Mário de Sá-Carneiro, through the strange and his double on freudian perspective. Moreover, the concepts of self and other, in the view of Jacques Lacan. It carried out a study of some poems and letters, as well fragments of other texts in prose from the portuguese writer. Topics such as: the desire for death, anguish, delirium, love and pleasure are also discussed. The study highlights the importance of Paris which appears in Sá-Carneiros fiction as a symbol of modernity

Ce travail tente de dégager le rôle de la représentation du délire dans la transformation du genre romanesque en Europe entre les années 1920 et les années 1940. L’étude s’intéresse donc aux crises d’hallucination et de délire qui ponctuent la narration dans plusieurs grands romans de langues anglaise [le chapitre 15 d’Ulysse de James Joyce et Mrs Dalloway de Virginia Woolf], allemande [Die Blendung d’Elias Canetti, Berlin Alexanderplatz d’Alfred Döblin et Le Loup des steppes de Hermann Hesse] et française [Voyage au bout de la nuit, Mort à crédit, Guignol’s band de Louis-Ferdinand Céline et Moravagine de Blaise Cendrars]. Si le délire romanesque est un enjeu dans ces années, c’est que son identification pose problème : les limites entre le réel et le délire sont en effet souvent brouillées. Dans certains romans, la prolifération du délire est telle qu’elle peut faire vaciller l’ensemble de la narration, le récit pouvant être interprété dans sa globalité comme le fruit d’un délire. Cette transformation n’est pas sans lien avec la révolution du champ de la psychopathologie qui bouleverse l’époque : les romanciers connaissent souvent assez bien les modes d’observation psychiatrique et s’intéressent de près à la psychanalyse, déjà très reconnue. Reste que le délire romanesque se dérobe aux lectures médicales : composé d’éléments hétérogènes et parfois impossibles, obéissant à des changements imprévisibles et déroutants, il échappe à une logique strictement individuelle, et ouvre à une représentation des troubles de l’époque. Introduisant une brèche dans la frontière entre fiction et réalité, il devient un espace politique où le roman s’interroge sur ses propres pouvoirs. / This study highlights the role of the representation of delirium in the transformation of the European novel between the 1920s and the 1940s. Of central importance are the hallucinatory and delirious episodes that punctuate the narration in several major novels in English [chapter 15 of Ulysses of James Joyce and Mrs Dalloway of Virginia Woolf], German [Die Blendung of Elias Canetti, Berlin Alexanderplatz of Alfred Döblin and Steppenwolf of Hermann Hesse] and French [Journey to the end of night, Death on the installment plan, Guignol’s band of Louis-Ferdinand Céline and Moravagine of Blaise Cendrars]. Delirium is an issue in these years because it can no longer be easily defined: the line between reality and delirium has become blurred. In some novels, the proliferation of delirium is so prevalent that it destabilizes the narration itself, inviting the reader to interpret the whole story as the result of delirium. This transformation is doubtless linked to the revolution of psychopathology that deeply affects the period: the novelists know, often well, the methods of psychiatric observation and follow closely psychoanalysis, which by this time was well established. But fictional delirium eludes purely medical readings: composed of heterogeneous and sometimes impossible elements, submitted to unpredictable and puzzling changes, it resists a singular explanation, and serves as a window into the troubles of the time. By breaching the boundary between fiction and reality, fictional delirium becomes a political space where the novel puts into question its own powers.

Delirium är ett allvarligt psykiskt syndrom som är vanligt förekommande hos äldre patienter. Förändrad uppfattning av tid och rum, hallucinationer, störningar i medvetandegrad, känsloliv samt minne är några symptom en deliriös person kan uppleva. Utöver obehaget dessa symptom orsakar hos en person kan delirium på sikt utgöra en risk utveckling av bland annat permanent kognitiv nedsättning, och i värsta fall kan syndromet leda till döden. Syftet med studien var att sammanställa kunskaper kring sjuksköterskors identifiering av delirium hos äldre personer. Tre forskningsfrågor skapades för att kunna besvara syftet: Vilka riskfaktorer beskrivs för att utveckla delirium? Vilka skattningsinstrument kan användas för att identifiera delirium? Vilka hinder och förutsättningar finns det för att identifiera delirium? Studien har genomförts som en integrerad litteraturöversikt. Sökning efter litteratur genomfördes i två databaser och kompletterades med manuell sökning, detta resulterade i sexton artiklar vilka analyserades och detta resulterade i tre grupper samt fem undergrupper. Grupperna består av frågeställningarna och undergrupper består av: RADAR; CAM; DOSS; Nu-Desc; Comprehensive nursing assessment. Fynden i studien visade på att riskfaktorerna för att utveckla delirium är många, och att hög ålder är den största riskfaktorn. Bedömningsinstrument finns i ett antal olika former och kan vara till stor hjälp för sjuksköterskor när det gäller identifiering av delirium. Hindren och utmaningarna är många, ett stort hinder är deliriums förmåga att maskera sig som andra sjukdomar såsom demens. Slutligen finns det förutsättningar för att delirium ska kunna identifieras, en av de viktigaste förutsättningarna är tillräckliga resurser i form av personal och tid, för att sjuksköterskor ska kunna få spendera tid med patienterna och på så vis lättare kunna identifiera förändringar som kan tyda på delirium. Sjuksköterskor är i behov av de verktyg som krävs för att kunna förbättra identifikationen och ge de äldre patienterna möjlighet till ökat välbefinnande och en god hälsa.

Delirium is a disturbance of consciousness and cognition that affects many terminally ill patients before death. It can manifest as confusion, hallucinations, and restlessness, all of which are known to be distressing to patients, families, and professional caregivers. Underlying the contemporary palliative care movement is a belief in the idea that a good death is possible; that dying can be made better for patients and families through the proper palliation of distressing symptoms and through proper attention to psychological, social, and spiritual issues that affect wellbeing at the end of life. Given that delirium is potentially disruptive to all that the good death assumes, i.e., mental awareness, patient-family communication, peace and comfort, the question was asked: What is the relationship between end-of-life delirium and the good death in hospice care? Ethnographic fieldwork was conducted at a freestanding residential hospice over a period of 15 months in a suburban community in eastern Canada. The research methods included participant observation (320 hours over 80 field visits), interviews with 28 hospice caregivers, and document analysis. The findings of this study provide an in-depth examination of the nature of caregiving relationships with patients and with families in end-of-life care. They illustrate how a commitment toward providing for the good death prevails within the cultural community of hospice, and how the conceptualization, assessment, and management of end-of-life delirium are organized within such a commitment. In this setting, experiences of conscious and cognitive change in dying are woven by hospice caregivers into a coherent system of meaning that is accommodated into prevailing scripts of what it means to die well. At the same time, delirium itself provides a facilitative context whereby processes of supporting families through the patient’s death are enabled. This study highlights the relevance of considering the contextual and cultural features of individual end-of-life care settings that wish to examine, and perhaps improve, the ways in which care of delirious patients and their families is provided.