Each year, approximately 3 million people in the United States develop a pressure ulcer. Although a preventable complication, pressure ulcers are among the top 5 adverse outcomes in the acute care setting with the prevalence as high as 42% in the intensive care unit (ICU). The purpose of this systematic review was to evaluate the inclusion of the Braden Scale as part of a multicomponent pressure ulcer intervention protocol, or care bundle, to identify geriatric patients hospitalized in the ICU who were at risk for pressure ulcers. The Cochrane protocol guided this review; findings were reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Through a structured search strategy in 6 electronic databases, 409 studies were reviewed, of which 11 studies were analyzed and the data included in a literature review matrix for synthesis. Four key findings emerged from the data analysis: effective pressure ulcer prevention programs use a risk assessment, daily reassessment of risk, daily skin inspections, moisture removal strategies, nutritional support and hydration, and offloading pressure; the Braden Scale is effective in detecting pressure ulcer risk in the ICU; an evidence-based bundle is effective in preventing pressure ulcer development; and decreased risk for pressure ulcer development increases patient safety, improves quality of care, and reduces the overall cost of care. The findings from this project can result in positive change by providing the evidence to guide improvements in pressure ulcer protocols to increase the quality of care and decrease the incidence of pressure ulcers in the ICU.

No description available.

<p>Den sociala och fysiska miljö som omger måltiden är av stor betydelse för den äldre patienten. Syftet med studien var att beskriva äldre patienters måltidsmiljö och dess effekter ur ett omvårdnadsperspektiv. Metoden som användes var en litteraturstudie. Litteratursökningen har skett i databaserna CINAHL och Medline. Efter urval och granskning återstod 12 artiklar som var publicerade mellan åren 1994-2005, åtta kvalitativa och fyra kvantitativa artiklar. Efter databearbetningen framkom de två huvudkategorierna yttre och inre miljö. Den yttre miljön beskriver måltidsplatsen, medpatienter, personalen och maten samt dess positiva och negativa effekter. Den inre miljön beskriver patientens känslor av välbefinnande och olust som kan uppstå när måltiden intas tillsammans med andra. Huvudresultatet visade att måltidsmiljön är mer än den fysiska miljö patienten befinner sig i och skildrar känslor som uppstår under den sociala samvaron vid måltider. Genom att vara lyhörd för patientens egna upplevelser finns förutsättningar att skapa en måltidsmiljö som ger positiva effekter.</p>

Den sociala och fysiska miljö som omger måltiden är av stor betydelse för den äldre patienten. Syftet med studien var att beskriva äldre patienters måltidsmiljö och dess effekter ur ett omvårdnadsperspektiv. Metoden som användes var en litteraturstudie. Litteratursökningen har skett i databaserna CINAHL och Medline. Efter urval och granskning återstod 12 artiklar som var publicerade mellan åren 1994-2005, åtta kvalitativa och fyra kvantitativa artiklar. Efter databearbetningen framkom de två huvudkategorierna yttre och inre miljö. Den yttre miljön beskriver måltidsplatsen, medpatienter, personalen och maten samt dess positiva och negativa effekter. Den inre miljön beskriver patientens känslor av välbefinnande och olust som kan uppstå när måltiden intas tillsammans med andra. Huvudresultatet visade att måltidsmiljön är mer än den fysiska miljö patienten befinner sig i och skildrar känslor som uppstår under den sociala samvaron vid måltider. Genom att vara lyhörd för patientens egna upplevelser finns förutsättningar att skapa en måltidsmiljö som ger positiva effekter.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24844号 / 社医博第133号 / 新制||社医||13(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 近藤, 尚己, 教授 川上, 浩司, 教授 平井, 豊博 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

No description available.

Introdução: Disfunção cognitiva pós-operatória (POCD) é um evento adverso multifatorial mais frequente em pessoas com idade superior a 60 anos ou doenças neurológicas e psiquiátricas. Este estudo avaliou o efeito da dexametasona sobre a incidência de POCD em idosos após cirurgia não cardíaca sob anestesia geral. Métodos: Cento e quarenta pacientes (ASA I-II, idade 60-87 anos) participaram deste estudo prospectivo, randomizado, envolvendo a administração ou não de 8 mg de dexametasona IV antes da indução anestésica para anestesia geral profunda ou superficial de acordo com o índice bispectral. Os testes neuropsicológicos foram aplicados no pré-operatório e em 3, 7, 21, 90 e 180 dias após a cirurgia e comparados com os dados normativos. Enolase específica do neurônio e S100beta foram avaliados antes e 12 horas após a indução da anestesia. A regressão linear com inferência baseada no método de equações de estimação generalizadas (GEE) foi aplicado, seguido pelo teste post-hoc de Bonferroni, considerando P <0,05 como significativo. Resultados: No terceiro dia pós-operatório, POCD foi diagnosticada em 25,2% dos pacientes que receberam a dose de dexametasona e anestesia profunda, 15,3% nos pacientes que receberam a dose da dexametasona e anestesia superficial, 68,2% do grupo de anestesia profunda e 27,2% do grupo de anestesia superficial (p < 0,0001). Os testes neuropsicológicos demonstraram que a anestesia superficial e a dose de dexametasona antes da indução anestésica diminuiu a incidência de POCD, especialmente para as funções memória e atenção e para a função executiva. A administração de dexametasona preveniu o aumento nos níveis séricos de S100beta no pós-operatório (p < 0,002) bem como está relacionado com uma diminuição significativa nos níveis séricos de enolase específica de neurônio (NSE) (p < 0,001). A memória imediata apresentou diferença entre pacientes com e sem alelo APOe4 (p = 0,025) independente do momento de avaliação. A memória de longo prazo apresentou alteração ao longo dos momentos de avaliação em pacientes com e sem a presença do APOe4 (p = 0,006 e p = 0,017 respectivamente). Pacientes com o alelo APOe4 apresentaram maior percentual de disfunção para memória imediata que os pacientes sem o alelo (p = 0,003). Os pacientes sem o alelo APOe4 apresentaram redução de disfunção para o processo de flexibilidade mental após 180 dias quando comparado aos demais momentos (p < 0,05) e os pacientes com a presença do alelo não apresentaram qualquer alteração estatisticamente significativa (p > 0,999), sendo que após 180 dias os pacientes com o alelo APOe4 apresentaram alteração na função executiva para a flexibilidade mental quando comparados aos pacientes sem o alelo (p < 0,001). Conclusão: A dexametasona pode minimizar a incidência de POCD em pacientes idosos submetidos a cirurgia não cardíaca, especialmente quando associada à anestesia superficial. Efeito da dexametasona sobre os níveis séricos S100beta e NSE pode estar relacionado com algum grau de neuroproteção / Background: Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients or people aged over 60 years, neurological and psychiatric diseases. This study evaluated the effect of dexamethasone on POCD incidence after non-cardiac surgery and general anesthesia. Methods: One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective randomized study involving the administration or not of 8 mg of IV dexamethasone before deep or superficial anesthesia according to bispectral index. Neuropsychological tests were applied preoperatively and at 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. Neuron specific enolase and S100beta were evaluated before and 12 hours after induction of anesthesia. Linear regression with inference based on the generalized estimating equations (GEE) method was applied, followed by the post-hoc Bonferroni test considering P < 0.05 as significant. Results: On the 3rd postoperative day, POCD was diagnosed in 25.2% of patients receiving dexamethasone plus deep anesthesia, 15.3% of the dexamethasone plus superficial anesthesia group, 68.2% of the deep anesthesia group and 27.2% of the superficial anesthesia group (p < 0.0001). Neuropsychological tests showed that dexamethasone plus superficial anesthesia decreased the incidence of POCD, especially memory, attention and executive function. The administration of dexamethasone prevented the postoperative increase in S100? serum levels (p < 0.002) and it is also related with a significant decrease in serum levels of neuron specific enolase (p < 0.001). Immediate memory was different between patients with and without APOe4 allele (p = 0.025) independent of the moment of assessment. The Long-term memory was impaired over the evaluation periods in patients with and without the presence of APOe4 allele (p = 0.006 and p = 0.017 respectively). Patients with the APOe4 allele had higher percentage of dysfunction for Immediate memory (p = 0.003). Patients without the APOe4 allele showed a reduction of dysfunction for the process of Mental flexibility after 180 days compared to the other assessment phases (p < 0.05) and patients with APO?4 allele showed no statistically significant change (p > 0.999), and after 180 days the patients with the APOe4 allele had alterations in Executive function for mental flexibility when compared to patients without the allele (p < 0.001). Conclusion: Dexamethasone can minimize the incidence of POCD in elderly patients undergoing non-cardiac surgery, especially when associated with superficial anesthesia. The effect of dexamethasone on S100beta e NSE serum levels might be related with some degree of neuroprotection

O Transtorno Depressivo Maior (TDM) está entre as síndromes psiquiátricas que mais atingem a população em geral. A prevalência da depressão durante a vida é de 7 a 12% para homens e 20 a 25% para mulheres, independente de raça, educação, estado civil ou renda. Entre os idosos a prevalência é de aproximadamente 5%. Além do tratamento medicamentoso, as psicoterapias têm um papel importante durante a fase aguda e na fase de remissão. A Arteterapia é uma abordagem terapêutica primordialmente não verbal, e tem sido utilizada em diversos contextos, mas há carência de estudos quantitativos que comprovem sua eficácia. O objetivo deste trabalho foi avaliar a eficácia da Arteterapia para uma população de mulheres idosas com diagnóstico de TDM, segundo o DSM - 5 = Manual de Diagnóstico e Estatística dos Transtornos Mentais - 5º versão, medicadas. Participaram do estudo 66 idosas com diagnóstico de TDM em tratamento medicamentoso, sem mudança medicamentosa durante o estudo e intactas no ponto de vista da cognição. Essas idosas foram alocadas aleatoriamente em dois grupos: 33 constituíram o Grupo Experimental (GE), que constou de 20 oficinas de Arteterapia com duração de noventa minutos, semanalmente, e 33 participaram do Grupo Controle (GC) o qual não recebeu nenhuma intervenção. Ambos os grupos foram avaliados com as mesmas escalas no início e após 20 semanas. Foram utilizadas as seguintes escalas para avaliar aspectos cognitivos - Mini exame do Estado Mental (MEEM), o Teste do Desenho do Relógio (TDR), o teste de Fluência Verbal - categoria animal (FV), e o teste Trilhas A. Para a avaliação Visuoconstrutiva foi utilizada a Figura complexa de Rey - cópia e evocação. Para avaliar aspectos psiquiátricos foram utilizadas a Geriatric Depression Scale (GDS), a Escala de Beck para Depressão (BDI) e a Escala de Beck para Ansiedade (BAI). Para avaliar qualidade de vida - Functional Assessment Staging Test (FAST). No final do estudo 31 idosas completaram todas as oficinas do GE e 25 idosas do GC retornaram para as avaliações finais, apesar de todas terem sido contatadas. O GC diminuiu na GDS 0,6 ± 2,3 pontos, enquanto o GE diminuiu 3,2 ± 3,4 pontos, e esta diferença entre os grupos foi significante (p = 0,007). Na escala BDI, o GC diminuiu 1,6 ± 4,9 pontos e o GE diminuiu 8,6 ± 12,8 pontos (p = 0,025). Na escala BAI, o GC diminuiu 2,9 ± 1,4 pontos e o GE diminuiu 8,9 ± 14,5 pontos (p = 0,032). Não foram encontradas diferenças nas demais escalas. Assim, houve diferença entre os grupos Controle e Experimental após as 20 semanas nos aspectos psiquiátricos de depressão e ansiedade. Não foram observadas mudanças na cognição. Desta forma, intervenções como a deste estudo parecem auxiliar no tratamento de sintomas depressivos e ansiosos de idosas com TDM / Major Depressive Disorder (MDD) is, among the psychiatric syndromes, that most affect the general population. The prevalence of depression during life is 7 to 12% for men and 20 to 25% for women, regardless of race, education, marital status or income. Among the elderly, the prevalence is approximately 5%. In addition to drug treatment, psychotherapies have an important role during the acute phase and in the remission phase. Art Therapy is a therapeutic approach primarily nonverbal, and has been used in several contexts, but there is a lack of quantitative studies that prove its efficacy. The objective of this study was to evaluate the efficacy of Art therapy for a population of elderly women diagnosed with MDD, according to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM - 5). A total of 66 elderly women with a diagnosis of MDD were enrolled in the drug treatment, without drug change during the study and intact from the point of view of cognition. These elderly women were randomly allocated into two groups: 33 were the Experimental Group (EG), which consisted of 20 Art therapy workshops lasting 90 minutes, weekly, and 33 participated in the Control Group (CG), which received no intervention. Both groups were evaluated with the same scales at baseline and after 20 weeks. The following scales were used to evaluate cognitive aspects - Mini Mental State Examination (MMSE), Clock Drawing Test, Verbal Fluency Test - Animal Category (VF), and Trail A. To evaluate psychiatric aspects, the Geriatric Depression Scale (GDS), the Beck Depression Scale (BDI) and the Beck Anxiety Scale (BAI) were used. For the Visuoconstructive evaluation, Rey\'s Complex Figure and Delayed Recall was used. And to evaluate quality of life - Functional Assessment Staging Test (FAST). At the end of the study, 31 elderly women completed all EG workshops and 25 elderly women of CG returned to the final evaluations, although all were contacted. The CG decreased in the GDS 0.6 ± 2.3 points, while the EG decreased by 3.2 ± 3.4 points, and this difference between the groups was significant (p = 0.007). On the BDI scale, the CG decreased by 1.6 ± 4.9 points and the EG decreased by 8.6 ± 12.8 points (p = 0.025). On the BAI scale, the CG decreased by 2.9 ± 1.4 points and the EG decreased by 8.9 ± 14.5 points (p = 0.032). No differences were found in the other scales. Thus, there was difference between the Control and Experimental groups after the 20 weeks in the psychiatric depression and anxiety aspects. No changes in cognition were observed. Thus, interventions such as this study seem to aid in the treatment of depressive and anxious symptoms of elderly patients with TDM

Tirti pasirinktiniai 193 pacientai, gydyti Vilniaus universiteto ligoninės Santariškių klinikų Kardiologijos reanimacijos ir intensyviosios terapijos skyriuje. Tyrime buvo nagrinėjami vyresnio amžiaus pacientų ūminio koronarinio sindromo klinikinės eigos ypatumai, ligonių išgyvenamumo ryšys su klinikinės eigos ypatumais bei gydymo būdais. Tuo tikslu buvo išanalizuotas vyresnio amžiaus pacientų, patyrusių ūminį koronarinį sindromą, išgyvenamumas bei didžiųjų nepageidaujamų kardiovaskulinių įvykių dažnis per 3 metus nuo ūminio koronarinio sindromo pasireiškimo pradžios. Buvo įvertintas pacientų grupių homogeniškumas pagal amžiaus grupes, ūminio koronarinio sindromo formas bei GRACE riziką. Buvo palyginti pacientų, kuriems taikytas ir netaikytas invazinis gydymas, ūminio koronarinio sindromo klinikinės eigos bei išeičių ypatumai. Tyrime buvo įvertintos išgyvenamumo sąsajos su pacientų anamnezės, klinikinės eigos bei gydymo veiksniais, taip pat bei palyginti išgyvenę ir neišgyvenę pacientai, patyrę ūminį koronarinį sindromą pagal anamnezės, klinikinės eigos bei gydymo veiksnius priklausomai nuo invazinio ar neinvazinio gydymo taikymo. Tokiu būdu buvo ieškoma veiksnių, kurie skirtingai reikšmingi pacientų, gydytų invaziniu ir neinvaziniu būdu, išgyvenamumui. / 193 consecutive patients older than 75 years with ACS were included in the study. Clinical process characteristics of acute coronary syndrome in elderly patients have been assessed in this study; the relation between patient survival and clinical process characteristics as well as treatment methods has been established. For this purpose the survival of elderly patients with acute coronary syndrome and, also, the frequency of MACE (major adverse cardiovascular events) during the 3 years after acute coronary syndrome has been analysed. The assessment of the patient group homogeneity according to the age group, acute coronary syndrome forms and GRACE risk has been performed. The analysis and comparison of the patients who received and those who did not receive invasive treatment, as well as the characteristics of their acute coronary syndrome clinical progress and outcomes have been presented in this study. The links between the patient survival and the factors of patient history, clinical progress and treatment have been established. The comparison of the patients with acute coronary syndrome who survived with the ones who did not survive based on the various factors of their history, clinical progress and treatment subject to the invasive or conservative treatment received has been provided. Thus, the study searched for the factors having various impacts on the patients survival depending on the treatment – invasive or conservative – received.

Antalet äldre människor ökar i samhället och står för en allt mer växande grupp patienter som behöver vård på akutmottagningen. Väntetiden på akutmottagningar runt om i landet blir allt längre. Det är ett välkänt faktum att äldre människor påverkas av att vänta länge på en akutmottagning, då deras allmäntillstånd lätt kan försämras på grund av det biologiska åldrandet och grundsjukdomar som gör dem skörare. Syftet med studien var att beskriva äldre patienters upplevelser av väntan vid besök på akutmottagningen. En litteraturstudie utfördes där resultatet baserades på tio vetenskapliga artiklar. Resultatet av denna litteraturöversikt delades in i fyra teman: att bli sedd, att bekräftas i sitt lidande, att vara delaktig som patient och att se patientens hela situation. Behovet hos den äldre att bli bekräftad, att få information och omvårdnad ökade när väntetiden blev lång på akutmottagningen. En ökad medvetenhet hos sjuksköterskan behövs kring den äldre akut sjuka patientens utsatta situation på akutmottagningen. Genom ökad kunskap och medvetenhet kan dessa patienternas behov av omsorg och omvårdnad mötas så deras lidande minskar under väntan på akutmottagningen. Behov av fortsatt forskning kring förbättringar avseende miljön och omhändertagandet av den äldre patienten på akutmottagningen finns vilket även behöver belysas inom grundutbildningen till sjuksköterska. / The number of elderly people is constantly increasing in the community and represents a growing group of patients who need care in the emergency department. The waiting time in the emergency deparments in Sweden tends to become longer. It’s a wellknown fact that older people are affected when they have to wait for a long time. Their general condition could easily detoriate as they are more vulnerable due to biological aging and medical conditions. The aim of the study was to describe older patient’s experiences of waiting in the emergency department. The study was conducted as a literature review and was based on ten scientific articles. The result of this literature review was divided into four themes: to be seen, to be acknowledged in their suffering, to participate as a patient and to see the patient’s entire situation. The older patient’s need to be acknowledged, information and care increased when the waiting time become long. For the nurse, an increased awareness of the older acutely ill patients situation in the emergency department is needed. With more knowledge and awareness, these patients’ needs could be taken care of and their suffering during the waiting time could be reduced. Continued research is needed to improve the environment and care of the older patient and should also be emphasized in nursing education.