Estudo transversal realizado em um hospital universitário de grande porte do sul do Brasil com o objetivo geral de analisar associações entre os discriminadores dos fluxogramas do Sistema de Triagem de Manchester (STM) e os Diagnósticos de Enfermagem (DE) segundo a taxonomia da NANDA-I em pacientes adultos de uma emergência clínica com prioridade clínica I (emergência) e II (muito urgente). Os objetivos específicos foram identificar as principais queixas, fluxogramas e discriminadores do STM e os DE mais frequentes. A amostra foi constituída de 219 pacientes, sendo 66 com prioridade clínica I e 153 com prioridade clínica II. A coleta de dados foi realizada no prontuário online dos pacientes. A análise estatística foi realizada pelo Statistical Package for Social Sciences (SPSS), versão 21.0, com uso do teste exato de Fisher ou qui-quadrado e o modelo de regressão de Poisson para estimar a razão de prevalência (RP). O estudo foi aprovado pelo Comitê de Ética e Pesquisa sob o n° 140145. Os resultados demonstraram como principais queixas dos pacientes a dispneia e a dor. Foi identificado o uso de 14 diferentes fluxogramas do STM, sendo os mais frequentes Dispneia em adulto, Mal estar em adulto e Dor torácica, seguidos de 16 diferentes discriminadores, sendo os mais prevalentes Dor precordial ou cardíaca, Saturação de oxigênio (Sat O2) muito baixa, Respiração inadequada, Pulso anormal e Déficit neurológico agudo. Entre os 14 diferentes DEs reais identificados, os mais prevalentes foram Padrão respiratório ineficaz e Dor aguda. Entre os nove diferentes DEs de risco identificados, os mais prevalentes foram Risco de perfusão tissular cerebral ineficaz, Risco de quedas e Risco de Glicemia instável. Houve associação estatisticamente significativa entre os discriminadores Dor precordial ou cardíaca e Dor intensa com o DE Dor Aguda (p < 0,001). O discriminador Dor precordial ou cardíaca também apresentou associação significativa com o DE Conforto Prejudicado (p = 0,008). Os discriminadores Sat O2 muito baixa e Respiração inadequada associaram-se significativamente ao DE Padrão respiratório ineficaz (p < 0,001). Pulso anormal apresentou associação significativa com o DE Débito cardíaco diminuído (p = 0,030), assim como Déficit neurológico agudo (p < 0,001) e Alteração súbita da consciência (p = 0,024) com o DE Negligência unilateral. Entre os diagnósticos de risco, os discriminadores Déficit neurológico agudo (p < 0,001) e Convulsionando (p = 0,009) associaram-se significativamente ao DE Risco de perfusão tissular cerebral ineficaz, assim como Hipoglicemia associou-se significativamente ao DE Risco de glicemia instável (p < 0,001). O discriminador Convulsionando ainda associou-se ao DE Risco de quedas (p = 0,037). Conclui-se que as associações estatisticamente significativas encontradas entre os discriminadores do STM e os DE estabelecidos estão baseadas em uma adequada coleta de dados do paciente, embora estas sejam etapas executadas em momentos e com objetivos diferentes na emergência. Isso permite um julgamento clínico acurado, que subsidia os enfermeiros para a seleção rápida do cuidado a ser prestado na busca de melhores resultados, além de otimizar o tempo e organizar o trabalho na unidade, favorecendo a segurança do paciente. / Cross-sectional study conducted in a large teaching hospital in the South of Brazil with the overall objective of analyze associations between the discriminators of the Manchester Triage System flowcharts (MTS) and the Nursing Diagnoses (ND) according to the taxonomy of NANDA-I in adult patients of an emergency room with clinical priority I (immediate) and II (very urgent). The specific objectives were to identify the main complaints, flowcharts and discriminators of the MTS and the most frequent ND. The sample was composed of 219 patients, being 66 with clinical priority I and 153 with clinical priority II. Data were collected in online patients’ records. A statistical analysis was performed by the Statistical Package for Social Sciences (SPSS), version 21.0, with the use of chi-square or Fisher’s exact test and Poisson regression model to estimate the prevalence ratio (PR). The study was approved by the Ethics and Research Committee under the number 140145. The results showed that the main complaints reported by the patients were dyspnea and chest pain. It was identified the use of 14 different flowcharts of the MTS, being the most frequent Dyspnea in adults, Illness in adults and Chest pain, followed by 16 different discriminators, being the most prevalent Precordial chest pain, very low Oxygen saturation (O2 Sat), Inadequate breathing, Abnormal pulse and Acute neurological deficit. Among the 14 different ND which were identified, the most prevalent ones were Ineffective breathing pattern and Acute pain. Among the nine different ND of risk which were identified, the most prevalent were Risk for ineffective cerebral tissue perfusion, Risk for falls and Risk for unstable glycemia. There was statistically significant association between Precordial chest pain and Intense pain with ND of Acute Pain (p < 0,001). The discriminator Precordial chest pain has also showed significant association with Impaired comfort (p = 0,008). The discriminator very low O2 Sat and Inadequate breathing associated significantly with Ineffective breathing pattern (p < 0,001). Abnormal pulse showed significant association with Decreased cardiac deficit (p = 0,030) as well as Acute neurological deficit (p < 0,001) and Sudden change of consciousness (p = 0,024) with Unilateral neglect. Among risk diagnoses, the discriminator Acute neurological deficit (p < 0,001) and Seizuring (p = 0,009) were significantly associated with Risk for ineffective cerebral tissue perfusion as well as Hypoglycemia was significantly associated with Risk for unstable glycemia (p < 0,001). The discriminator Seizuring was also associated with Risk for falls (p = 0,037). It is concluded that statistically significant associations between the discriminators of the MTS and the established ND are based on an appropriate patient data collection even though they are steps performed in different moments and with different goals in emergency rooms. This allows an accurate clinical evaluation and that subsidizes the nurses for quick selection of care to be provided in the search for better results, besides optimizing time and organizing the work in the unit, promoting patients’ safety. / Estudio transversal realizado en un hospital universitario de gran porte del sur de Brasil con el objetivo general de analizar asociaciones entre los discernidores de los diagramas de flujo del Sistema Triaje de Manchester (STM) y los Diagnósticos de Enfermería (DE) según la taxonomía de NANDA-I en pacientes adultos de una emergencia clínica con prioridad clínica I (emergencia) y II (muy urgente). Los objetivos específicos fueron identificar las principales quejas, diagramas de flujo y discernidores del STM y los DE más frecuentes. La muestra fue constituída por 219 pacientes, siendo 66 con prioridad clínica I y 153 con prioridad clínica II. La colecta de datos fue realizada en el prontuario online de los pacientes. El análisis estadístico fue realizado por el Statistical Package for Social Sciences (SPSS), versión 21.0, con el uso del Test Exacto de Fisher o chi-cuadrado y el modelo de regresión de Poisson para estimar la razón de la prevalencia (RP). El estudio fue aprobado por el Comité de Ética y Pesquisa con el número 140145. Los resultados demostraron como principales quejas de los pacientes, la disnea y el dolor. Fue identificado el uso de 14 diagramas de flujo diferentes del STM, siendo los más frecuente Disnea en adultos, Malestar en adultos y Dolor toráxica, seguidos por 16 diferentes discernidores, siendo los más prevalentes el Dolor precordial o cardíaco, la Saturación de oxígeno (SAT O2) muy baja, la Respiración inadecuada, el Pulso anormal y el Déficit neurológico agudo. Entre los 14 diferentes DEs reales identificados, los más prevalentes fueron el Patrón respiratorio ineficaz y el Dolor agudo. Entre los nueve diferentes DEs de riesgo identificados, los más prevalentes fueron el Riesgo de perfusión tisular cerebral ineficaz, el Riesgo de caídas y el de Glicemia inestable. Hubo una asociación estadísticamente significativa entre los discernidores Dolor precordial o cardíaca y Dolor intenso, con DE Dolor agudo (p < 0,001). El discernidor Dolor precordial o cardíaco también presentó asociación significativa con DE Confort perjudicado (p = 0,008). Los discernidores SAT O2 muy baja y Respiración inadecuada se asociaron significativamente con el DE Patrón respiratorio ineficaz (p < 0,001). El Pulso anormal presentó asociación significativa con el DE Débito cardíaco disminuído (p = 0,030), así como el Déficit neurológico agudo (p < 0,001) y la Alteración súbita de conciencia (p = 0,024) con el DE Negligencia unilateral. Entre los diagnósticos de riesgo, los discernidores Déficit neurológico agudo (p <0,001) y Convulsionando (p = 0,009), se asociaron significativamente al DE Riesgo de perfusión tisular cerebral ineficaz, así como Hipoglicemia se asoció significativamente al DE Riesgo de glicemia inestable (p < 0,001). El discernidor Convulsionando aún se asoció al DE Riesgo de caídas (p = 0,037). Se concluye que las asociaciones estadísticamente significativas encontradas entre los discernidores del STM y los DE establecidos están basadas en una adecuada colecta de datos del paciente a pesar de ser etapas ejecutadas en momentos y con objetivos diferentes en la emergencia. Esto es lo que permite un juicio crítico acurado y que subsidia a los enfermeros para la selección rápida del cuidado que será proporcionado en la búsqueda de mejores resultados, además de optimizar el tiempo y organizar el trabajo en la unidad, favoreciendo la seguridad del paciente.

Introdução: Dados epidemiológicos sobre prevalência de perdas auditivas em países em desenvolvimento são insuficientes para o planejamento e execução de programas efetivos, visando à intervenção, prevenção e promoção em saúde. Além disso, ações de saúde na atenção básica, bem como nos serviços de média e alta complexidade não dão conta de atender ou mesmo conhecer a demanda, também pelo fato de existir um número limitado de profissionais da saúde que cuidam da audição. Dentro deste contexto, faz-se necessária a adoção de técnicas ou procedimentos acessíveis às áreas carentes do país, que não contam com recursos financeiros para a aquisição de tecnologia ou recursos humanos que possibilitem a identificação, o mais precoce possível, de grupos de risco para alterações auditivas. Com o avanço da tecnologia, métodos de triagem auditiva à distância são possíveis, inclusive como facilitadores em áreas onde não há especialistas. Sendo assim, a criação e validação de protocolos de teleaudiologia são fundamentais para que possam ser utilizados dentro de programas de saúde rotineiros. Objetivo: avaliar a acurácia e a viabilidade de execução da teleaudiometria, comparando-a à audiometria por varredura, tendo como padrão ouro a audiometria tonal, em escolares do ciclo I do ensino fundamental. Método: Participaram do estudo 243 escolares, sendo 118 meninos e 125 meninas, com idade média de 8,3 anos. Foram realizados os seguintes procedimentos: triagem por teleaudiometria com fones TDH39, com software que avalia a audição automaticamente nas frequências de 1000, 2000 e 4000 Hz a 25 dBNA, triagem por varredura audiométrica em cabina acústica (nas frequências de 1000, 2000 e 4000 Hz a 20 dBNA) e pesquisa dos limiares auditivos por meio de audiometria tonal em cabina acústica (nas frequências de 500, 1000, 2000 e 4000Hz). Resultados: Verificou-se que não existe associação entre os resultados normais e alterados nos testes auditivos e a variável sexo. Das 243 crianças que realizaram a audiometria tonal, 195 apresentaram limiares auditivos normais. Para a audiometria por varredura, 209 passaram e para a teleaudiometria, 188 passaram. Sendo assim, a habilidade diagnóstica dos métodos de triagem foi avaliada, encontrando-se os seguintes valores para teleaudiometria / audiometria por varredura: sensibilidade - 58% / 65%, especificidade - 86% / 99%, valor preditivo positivo - 51% / 91%, valor preditivo negativo - 89% / 92%, acurácia - 81% / 92%. A teleaudiometria e a varredura apresentaram concordância moderada pelo coeficiente Kappa. Além disso, foi avaliada a possibilidade diagnóstica de execução da teleaudiometria realizada em série ou em paralelo com a imitanciometria, indicando que a aplicação destes métodos em série melhora a especificidade e a aplicação dos testes em paralelo melhora a sensibilidade. Conclusão: Embora a audiometria por varredura apresente valores de sensibilidade e especificidade maiores, a teleaudiometria mostrou confiabilidade e viabilidade como método de triagem auditiva em escolares. Além disso, a teleaudiometria apresenta vantagens de aplicação em áreas remotas, onde não existe a disponibilidade de profissionais especializados e equipamentos específicos, o que pode reduzir custos em programas de triagem auditiva / Introduction: Epidemiological data on the prevalence of hearing loss in developing countries are insufficient for the planning and execution of effective programs, aimed at intervention, prevention and health promotion. In addition, health actions in primary care, as well as secondary and tertiary services are not enough to meet or even know the demand; this also occurs because there is a limited number of health professionals who care for the hearing. Within this context, it is necessary to adopt accessible techniques or procedures for the underserved areas of the country, that do not have financial resources for the purchase of technology or human resources to enable the identification, as early as possible, of risk groups for hearing disorders. With the advance of technology, distance hearing screening methods are possible, working as facilitators in areas where there are no experts. Thus, the creation and validation of teleaudiology protocols are essential so that they can be used in routine health programs. Objective: To evaluate the efficacy and feasibility of the teleaudiometry, comparing it to the sweep audiometry, considering pure tone audiometry as the gold standard, in school children of the first cycle in elementary school. Method: 243 students participated in this study, 118 boys and 125 girls, mean age 8.3 years. The following procedures were performed: teleaudiometry screening with TDH39 headphones and software that automatically evaluates hearing at the frequencies of 1000, 2000 and 4000 Hz at 25 dBHL, sweep audiometry screening in acoustic booth (at the frequencies of 1000, 2000 and 4000 Hz at 20 dBHL) and hearing thresholds search using pure tone audiometry in acoustic booth (at the frequencies of 500, 1000, 2000 and 4000 Hz). Results: It was found that there is no association between normal and abnormal results in hearing tests and the gender variable. Of the 243 children who underwent pure tone audiometry, 195 had normal hearing thresholds. For the sweep audiometry, 209 children passed the screening, and 188 passed the teleaudiometry. Therefore, the diagnostic capacity of the screening methods was evaluated, verifying the following values: for teleaudiometry / sweep audiometry: sensitivity - 58% / 65%, specificity - 86% / 99%, positive predictive value - 51% / 91%, negative predictive value - 89% / 92%, accuracy - 81% / 92%. The teleaudiometry and the sweep audiometry showed moderate agreement using the Kappa coefficient. Furthermore, the diagnostic possibility of performing teleaudiometry in series or in parallel with imitanciometry was evaluated, indicating that the application of these methods in series improves specificity and the application of parallel testing improves sensitivity. Conclusion: Although the sweep audiometry presented higher sensitivity and specificity values, teleaudiometry showed reliability and feasibility as a hearing screening method in school children. Moreover, teleaudiometry has application advantages in remote areas, where specialized professionals and specific equipment are not available, which can reduce costs in hearing screening programs

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-09-08T19:21:08Z No. of bitstreams: 2 Dissertacão - Taynara Cristina Gomes - 2016.pdf: 2697158 bytes, checksum: efd1f7ed4fcc4ac2659d5cde95cc18fd (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-09T14:50:58Z (GMT) No. of bitstreams: 2 Dissertacão - Taynara Cristina Gomes - 2016.pdf: 2697158 bytes, checksum: efd1f7ed4fcc4ac2659d5cde95cc18fd (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-09T14:50:58Z (GMT). No. of bitstreams: 2 Dissertacão - Taynara Cristina Gomes - 2016.pdf: 2697158 bytes, checksum: efd1f7ed4fcc4ac2659d5cde95cc18fd (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-07-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The congenital transmission is considered one of the main pathways of Trypanosoma cruzi infection. Retrospective studies of pregnant women population with Chagas disease (CD) allow the study of the epidemiological profile of this population which contributes to the knowledge of the congenital CD prevalence in Brazil. This study evaluated the triage of T. cruzi congenital infection in new-borns through the newborn screening aiming the precocious detection of congenital transmission as well as its retrospective analysis of the seroepidemiological profile of the infected pregnant women dwelling in Goias State in a period of three years (2013-2015). The retrospective study used the data base of the Association of Parents and Friends of Special Needs Individuals (APAE) of Goiania. The analysis showed that the prevalence of CD infected pregnant women from 0.24% to 0.17%, with a decrease throughout the years. Most of these pregnant women had ≥31 years old, which is in accordance with the success of Triatoma infestans vectorial transmission control and transfusional control programmes, improvement in dwellings and better efficacy in diagnostics and therapeutics. The prospective study used the IFI and ELISA techniques for serology and filter paper detection. A total of 967 samples of dry blood in filter paper were collected in three public health units in Goiania and Aparecida de Goiania. From these samples 19 (1.96%) which were collected in filter paper from newborns were from mothers who declared to have CD. Results showed that 8 (42%) from the 19 samples were reagent to IgG anti-T. cruzi in both technique used. Peripheral blood was collected in seven mothers and their respective children. The serum samples were analyzed and the results confirmed IgG positive serology anti-T. cruzi with rates and titulation similar between mother and their respective newborn. Also there was accordance between the serology and the filter paper results which validates this strategy in the newborn screening triage from children from chronically infected mother. This study highlights the importance of the prenatal and neonatal care that precociously identifies the T. cruzi infection and also of programmes of health education about CD to the pregnant women population. / A transmissão congênita é considerada uma das principais vias de infecção pelo Trypanosoma cruzi. Estudos retrospectivos da população de gestantes com doença de Chagas (DC) viabilizam o estudo do perfil epidemiológico desta população, contribuindo para conhecimento da prevalência da DC congênita no Brasil. Este estudo avaliou a triagem de infecção por T. cruzi em recém-nascidos através do teste do pezinho, visando o diagnóstico precoce da transmissão congênita, como também a análise restrospectiva do perfil soroepidemiológico de gestantes infectadas residentes no estado de Goiás em um período de três anos (2013-2015). Para o estudo retrospectivo foi utilizado a base de dados da Associação de Pais e Amigos dos Excepcionais (APAE) de Goiânia. As análises mostraram que a prevalência de gestantes com DC variou de 0,24% a 0,17%, apresentando um declínio com o decorrer dos anos. Foi também possível evidenciar que a maioria destas gestantes possuía idade ≥31 anos, dados que corroboram com o sucesso de programas de controle da transmissão vetorial pelo Triatoma infestans e transfusional, melhoria habitacional e melhor eficiência do diagnóstico e da terapêutica. Para o estudo prospectivo foram utilizados os métodos de IFI e ELISA para a sorologia tanto em papel filtro (PF) e soro. Um total de 967 amostras de sangue seco em papel filtro (PF) foi coletado em três unidades de saúde pública em Goiânia e Aparecida de Goiânia, destes, 19 (1,96%), amostras de sangue em PF de RN foram de mães que se autodeclararam com a doença de Chagas. Os resultados mostraram que oito (42%) destas 19 amostras foram reagentes para IgG anti-T. cruzi em ambas as técnicas. Foi coletado sangue periférico em sete mães com seus respectivos filhos. As amostras de soro foram analisadas e os resultados confirmaram sorologia IgG anti-T. cruzi com índices e titulações semelhantes entre mães e seus respectivos RN, havendo concordância entre os resultados obtidos pela sorologia e o PF, validando esta estratégia na triagem dos RN de mães cronicamente infectadas. Este estudo salienta a importância de um acompanhamento pré-natal e neonatal que identifique precocemente a infecção por T. cruzi e também programas de conscientização sobre a DC na população de gestantes.

A triagem psicológica é uma prática geralmente utilizada em instituições públicas de saúde psicológica, a fim de selecionar a parcela da população interessada que pode ser abarcada pelos serviços oferecidos e encaminhar o interessado para um atendimento adequado à sua demanda. Por se tratar de uma avaliação psicológica, embora de caráter inicial e breve, abrange funções e características complexas, que devem ser constantemente estudadas, e não é isenta de referenciais teórico-clínicos. É, entretanto, realizada geralmente de modo breve e apenas como uma coleta de dados pessoais dos clientes, o que pode agravar problemas freqüentes em clínicas, tais como o desperdício do momento precioso para um atendimento imediato (o momento em que o cliente procura ajuda), bem como o abandono precoce de terapia, quando decorrente de encaminhamento pouco adequado à demanda. Modelos de triagens interventivas, cada qual com especificidades teóricas e técnicas, são propostos como uma alternativa para lidar com alguns destes problemas. Realizam avaliação e assistência. O objetivo da presente pesquisa foi o de analisar alguns alcances da experiência da realização de atendimentos em uma modalidade de triagem interventiva. Esta pesquisa deu continuidade a um projeto anterior, 2004, inicialmente denominado Consultas Psicológicas, que estudou um atendimento de recepção com retornos, oferecido a pessoas que não haviam conseguido uma das seis vagas semanais para a triagem de uma clínica-escola universitária paulistana. Em 2006, passou a ser denominado Triagem Estendida. A proposta do atendimento consistia em realizar triagem com até seis encontros, uso entrevistas-clínicas semi-abertas e sob referencial psicanalítico. O atendimento tinha dois objetivos centrais: por um lado realizar de modo mais detalhado a tradicional coleta dos dados do cliente, com elaborações sobre a queixa, necessidade e interesses dos clientes, visando ofertar encaminhamento adequado; por outro, oferecer acolhimento psicológico no momento da procura, promovendo alívio terapêutico se possível, a fim de lidar com algumas das demandas pontuais dos clientes. Tratou-se de uma pesquisa clínico-qualitativa, com o estudo de 10 casos, com a finalidade de avaliar os alcances da modalidade aplicada. Discutiu-se se os objetivos planejados puderam ser atingidos e os benefícios da modalidade para o cliente e para a organização do fluxo institucional da clientela. Em consonância com outros estudos, verificou-se o potencial atingido da triagem como espaço terapêutico significativo ao oferecer acolhimento e aprofundamento da compreensão do conflito. Verificou-se que os encaminhamentos ocorreram após o cliente ter obtido informações sobre psicoterapia e havendo maior participação do mesmo nesta escolha. A opinião dos participantes em relação ao atendimento recebido (obtida através de um follow up) foi positiva para a maioria. Após um ano do término da triagem, alguns haviam seguido o encaminhamento proposto, outros haviam achado o atendimento em Triagem Estendida suficiente. Esta divisão sugeriu existirem os dois tipos de demandas, por atendimento focal e prolongado, cada qual diferentemente contemplado e elaborado em uma recepção estendida. Embora existam dificuldades para a implementação deste tipo de atendimento em função da necessidade da articulação com os outros serviços, uma escuta inicial prolongada mostrou-se efetiva como recurso para lidar com problemas institucionais. / The psychological screening is a practice commonly used in public mental health institutions in order to select the portion of the population interested in psychotherapy that can be encompassed by the services offered and to refer the user (patient) to an appropriate service to their demand. Because it is a psychological evaluation, although initial and brief, comprises functions and complex technical features, which must be studied, and also is not exempt from theoretical-clinical references. It is, however, generally carried out in a brief way (simplistic way), and just as the collection of personal data of the patient, what can aggravate frequent problems in clinics such as the wastefulness of the precious moment for an immediate psychological assistance (the one in which the client seeks help), as well as the premature discontinuation of therapy (dropout), when it is a result from an inadequate referral, with regard to the client\'s request and necessity. Models of psychological interventional trials, each one with its specific technical and theory, are proposed as an alternative to deal with some of these problems. They perform both, evaluation and assistance. The objective of this research was to analyze some of the reaches of an accomplishment experience of consultations in an interventional screening modality. This study gave continuity to a previous project, 2004, initially called the Psychological Consultations, that studied a reception with the returns, offered to those who had not had one of six vacant per week for the psychological screening in a school-clinic of São Paulo. In 2006, came to be called Screening Extended. The proposed service was to perform screening of up to six meetings, with semi-structured clinical interviews and under psychoanalytic point of view. The service had two main objectives: firstly perform on detail the traditional gathering of user data, with specific details of customer\'s needs, requests and interests, in order to offer appropriate referral; secondly, offers care at the moment in which there was a request for help promoting therapeutic relief if possible, in order to deal with specific demands. This was a clinical-qualitative research, with the study of 10 cases, with the aim of assessing the scope of the modality when it is applied. It was discussed if the planned objectives were achieved and what were the benefits of the modality for the patient and for the way of organizing the flow routine of institutional users. In line with other studies, there was a screening as a significant therapeutic space as it hosted the patient and provided a better understanding of the conflict. It was observed that the referral for an therapy occurred after the client have obtained information about psychotherapy and that there was a greater involvement of it at that choice. The participants\' opinions regarding the care received (obtained through a follow up) were positive for most. One year after the completion of the assistance, some had followed the referral to therapy; others thought that the received care was already enough. This bifurcation has suggested that there are two types of demands, for focal and prolonged care, each one differently embraced and elaborated in an extended reception. Although there are difficulties in implementing this type of service due to the need for coordination with other services, an initial prolonged listening proved to be effective as a resource for dealing with some institutional problems.

Introduction : Trauma is the leading cause of death in patients between the ages of 1-44 years in South Africa. Taking these statistics into consideration it is essential to better resuscitation strategies in order to improve outcome of trauma patients. Compensated and uncompensated haemorrhagic shock is frequently under diagnosed in trauma patients, which has a definitive effect on mortality. Concerns about inadequate monitoring of patients through the use of only physiological end points are raised. Methods : A comprehensive literature review was conducted on resuscitation strategies for patients presenting with haemorrhagic shock. Physiological and metabolic end points of resuscitation were identified to guide resuscitation strategies. A quantitative, retrospective, non-experimental, descriptive, correlational and crosssectional research design was chosen for this study. Data was collected by using biophysical measures, namely clinical audit checklists. Results : Lactate was identified as a good indicator to predicting mortality in patients presenting with shock caused by haemorrhage. Special consideration to patients’ age and physiological status should be made during resuscitation. The consequence of delayed resuscitation in haemorrhagic shock patients is associated with an increase in mortality that can be prevented. It is found that serum blood lactate levels taken over time are good predictors of patient survival rates. Patients presenting with a raised serum blood lactate level for more than 24-hours has an increase in mortality rate. Conclusion : Emergency nurse practitioners are responsible for the monitoring of patients admitted to the emergency unit with haemorrhagic shock. The use of serum lactate levels during the first 24-hours of the resuscitation of patients with haemorrhage can assist with the implementation of strategies to reverse the effect haemorrhagic shock on cellular level in these patients. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted

No description available.

Prehospital management of patients who are traumatically injured within the state of Florida starts with the use of the Florida Adult Trauma Scorecard Methodology. The scorecard methodology may indicate that a patient is a Trauma Alert based on applied physiological and other judgment criteria. However, patients may be transported via Helicopter Emergency Medical Services (HEMS) without justified physiological needs. Rawls’ theory of justice posits that a fair and equal distribution of social resources is essential to public wellbeing. To evaluate this premise regarding prehospital trauma transports, archival 2015 data from the Florida Department of Health Trauma Registry was obtained. Using logistic regression, each trauma scorecard assessment criteria was individually and collectively evaluated regarding its predictive likelihood of a scene responder requesting HEMS versus ground ambulance transport. Controlling for trauma center locations, all five of the triage classifications illustrated a significant likelihood (p = 0.000) of HEMS transportation requests. Category 4 (EMS Judgment) predicted the highest likelihood of HEMS transport requests (b = 2.39, Wald X2(1) = 2026.88, OR = 10.9, p = .000, CI [9.83, 12.09]). Categories 4 (14.7%) and 6 (Local Criteria; [25.8%]) illustrated unexpectedly high percentages of emergency department discharge when Trauma Alert patients were HEMS transported. Over triage of patients to HEMS without meeting physiologic criteria provides less than an equal and fair distribution of public and private resources. State-level social change can be realized through HEMS transport criteria modifications applying more stringent application of physiologic patient condition scoring when determining the mode of prehospital scene response transport.

Contexte: L’utilisation efficiente des ressources en soins intensifs représente un défi potentiellement surmontable dans un contexte de régionalisation des services. Conséquemment, il importe de convenir de critères homogènes et transparents permettant de trier et de transporter les patients là où ils peuvent recevoir les soins nécessaires à leur condition. Objectif: L’objectif principal de cette étude est d’identifier et d’évaluer les publications définissant les critères utilisés pour prioriser ou refuser une admission aux soins intensifs. Méthodes: Nous avons entrepris une revue systématique en accord avec les lignes directrices PRISMA. Nous avons identifié tous les articles pertinents publiés jusqu’au 8 novembre 2016 au moyen des bases de données PubMed, Embase, Medline, EBM Reviews, CINAHL Complete, les bases de données recensant la littérature grise ainsi qu’en effectuant une revue manuelle d’articles supplémentaires. Nous avons ensuite évalué la qualité des articles retenus selon une échelle d’appréciation que nous avons développée. Finalement, nous avons extrait puis évalué chaque critère individuel en plus de les regrouper par thème. Résultats: L’étude nous a permis d’identifier 5818 abrégés. Nous avons révisé 416 articles exhaustivement pour en retenir 129 qui correspondent aux critères d’inclusion. Il s’agit d’articles de recherche originale (34%), de lignes directrices (26 %) ou de revues de la littérature (21 %). Nous avons extrait 200 critères de triage et de transport au sein des 129 articles. Ceux-ci proviennent surtout des États-Unis (43 %) et privilégient un mécanisme d’exclusion (71 %) plutôt que de priorisation (17 %) des clientèles. Peu d’articles abordent les critères de transport (4 %). Nous avons classifié les critères selon qu’ils soient reliés à l’un ou l’autre des quatre thèmes qui ont émergé de notre analyse : au patient; à la condition clinique; au médecin qui évalue le cas; ou au contexte. Le critère le plus fréquemment cité est celui de la préférence du patient suivi de l’évaluation du médecin. Conclusion: Une revue systématique a permis de générer une liste de 200 critères utilisés pour prioriser ou exclure certains types de patients dans un état critique. Malgré les limites de notre étude, celle-ci peut permettre aux cliniciens et aux preneurs de décision de concevoir des politiques de triage et d’admission au niveau local, régional ou national. De plus, l’étude identifie des champs de recherche potentiels où le développement de critères spécifiques et mesurables pourrait contribuer au développement de lignes directrices diminuant la variabilité dans les pratiques et améliorant le processus d’admission aux soins intensifs. / Context: Intensive care bed unavailability negatively affects patients' outcomes. Strategies that reduce inefficient use of resources and reduce unavailability may increase quality and accessibility of critical care. As advocacy for regionalization of critical care resources increases, there is a need for agreed triage and transport criteria. However, outside of the trauma population, such agreed criteria and recommendations are lacking. Objective: We aimed to identify and appraise articles defining criteria used to prioritize or withhold a critical care admission. Methods: We undertook a systematic review according to PRISMA guidelines. Relevant articles were identified through searches of PubMed, Embase, Medline, EBM Reviews, CINAHL Complete from inception until November 8th, 2016. We also undertook searches through gray literature as well as a manual review of references. We then assessed the quality of identified articles through an appraisal scale we developed. Finally, we extracted and evaluated all criteria within the articles and grouped them by theme. Results: A total of 5818 abstracts were identified. After screening, we reviewed 416 articles in full and 129 articles met study criteria. These articles were mainly original research (34%), guidelines (26%) and reviews (21%). Amongst them, we identified 200 unique triage and transport criteria. Most articles were published in the United States (43%) and highlighted exclusion criteria (71%) rather than a prioritization mechanism (17%). Very few articles pertained to transport of critically ill patients (4%). We classified criteria as they related to one of four emerging themes: patient, condition, physician and context. The most commonly found triage criteria was patient preference followed by physician’s assessment that the patient was too well to benefit from ICU admission. Conclusion: A systematic review aimed at identifying triage and transport criteria used to prioritize or exclude certain patient populations under different settings helped to generate a list of 200 criteria classified within 4 themes. Despite its limitations, this study may help clinicians and decision makers devise local, regional or national ICU triage criteria. It also identifies gaps in knowledge where future clinical research yielding specific and measurable criteria tailored to clearly defined patient populations may help to decrease ICU triage variability.

Bakgrund: Distriktssköterskan triagerar dagligen patienter med psykisk ohälsa i primärvården. Psykisk ohälsa är mångfacetterat och till viss del tabubelagt i samhället. Detta kräver att distriktssköterskan har god kännedom om psykisk ohälsa och hur den kan uttrycka sig hos olika patienter. Distriktssköterskan behöver även ha ett holistiskt synsätt med personcentrerad vård i fokus. Syfte: Syftet med studien var att belysa distriktssköterskans erfarenheter av triagering av patienter med psykisk ohälsa inom primärvården. Metod: En kvalitativ intervjustudie med åtta distriktssköterskor/sjuksköterskor verksamma i primärvården. Analysmetoden var kvalitativ innehållsanalys. Resultat: Resultatet var tre kategorier och tio underkategorier. De tre kategorierna var: Brister i utbildning, Utmaningar vid triagering samt Brister i samverkan. Resultatet visade att distriktssköterskan behöver ha mer kunskap om psykisk ohälsa samt ha de förutsättningar som krävs för att genomföra en bra triagering såsom stödverktyg och trygghet i dialog om självmordstankar hos patienten. Distriktssköterskan behöver vara medveten om somatisering och dess påverkan i triageringen. Samarbetet mellan primärvården och öppen psykiatriska mottagningen behöver förbättras. Konklusion: För att triagering av psykisk ohälsa ska bli bättre behöver distriktssköterskan erhålla mer utbildning av psykisk ohälsa. Där har både arbetsgivare och utbildningsansvariga ett ansvar att påverka möjligheterna till triagering av psykisk ohälsa i primärvården. Distriktssköterskan behöver även ha stödverktyg för att säkerhetsställa likvärdig triagering av psykisk ohälsa i primärvården. / Background: The district nurse triage daily patients with mental illness in primary care. Mental illness is multifaceted and to some extent taboo in society. This requires that the district nurse has a good knowledge of mental illness and how it can express itself in different patients. The district nurse also needs to take a holistic approach with person-centred care in focus. Aim: The aim was the district nurse experiences with triage of patients with mental illness in primary care. Method: A qualitative research approach based on interviews with eight district nurse/nurse active in primary care. Qualitative content analysis. Result: The result was three categories and ten subcategories. The three categories were: Deficiencies in education, Challenges in triage and Deficiencies in collaboration. The results showed that the district nurse needs to have more knowledge about mental illness and have the conditions required to carry out a good triage, such as support tools and security in dialogue about suicidal thoughts in the patient. The district nurse needs to be aware of somatization and its impact on triage. The collaboration between primary care and the open psychiatric clinic needs to be improved. Conclusion: In order for triage of mental illness to improve, the district nurse needs to receive more training in mental illness. There, both employers and education managers have a responsibility to influence the opportunities for triage of mental illness in primary care. The district nurse also needs support tools to ensure equivalent triage of mental illness in primary care.

Indiana University-Purdue University Indianapolis (IUPUI) / While most sealants available are resin-based, glass ionomer-based cements can be used as sealants, with the advantage of being more tolerant to moisture during placement and of releasing fluoride. The objective of this study was to evaluate the influence of different fissure conditioning techniques on penetration and microleakage of glass ionomer (GI) and resin-modified glass ionomer cements (RMGI) used as sealants. Clinically sound extracted human molars were distributed into nine experimental groups (n = 15 each). Group 1 (control) was sealed with resin-based sealant (Delton) following clinically accepted techniques. Groups 2 through 6 were sealed with RMGI (Vitremer) after having the fissure conditioned with either polyacrylic acid (RMGI-control), 35-percent H3PO4, low viscosity 35-percent H3PO4 with a surfactant, self-etch conditioner, or 35-percent H3PO4 followed by self-etch conditioner. Groups 7 through 9 were sealed with GI sealant (Fuji Triage) after having the fissures conditioned with either polyacrylic acid (GI-control), 35- percent H3PO4 or low viscosity 35-percent H3PO4 with a surfactant. After aging through thermocycling (2500 cycles), specimens were incubated in methylene blue for four hours and sectioned at multiple locations. Digital images were obtained using a digital stereomicroscope, and microleakage was determined by scoring the dye penetration along the enamel-sealant interface. The penetration of the material was determined by calculating the percentage of the total length of the fissure penetrated by the material. Results: The use of self etch-conditioner significantly increased RMGI penetration, while surface conditioning with 35-percent phosphoric acid with surfactant significantly decreased microleakage of GI. The resin-based sealant placed after 35-percent phosphoric acid surface conditioning showed the best penetration and the least level of microleakage. In conclusion, results from this study suggest that the placement of glass ionomer-based sealants can be enhanced by modifying current conditioning methods.