Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-05-30T13:57:02Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertação versão impressão 11.07.16.pdf: 2713868 bytes, checksum: 1b43ccd8bfdd9e87e9ee0dc36497b916 (MD5) / Made available in DSpace on 2017-05-30T13:57:02Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertação versão impressão 11.07.16.pdf: 2713868 bytes, checksum: 1b43ccd8bfdd9e87e9ee0dc36497b916 (MD5) Previous issue date: 2016-02-29 / O uso de ventilação artificial é indicado para indivíduos que apresentem, insuficiência ou falência respiratória, traumatismo crânio encefálico ou pacientes politraumatizados. As unidades de terapia intensiva (UTIs) são ambientes destinados ao atendimento de pacientes graves, com potencial risco de morte, que necessitam de atendimento ininterrupto, caracterizadas, muitas vezes, como um ambiente relacionado ao sofrimento e a morte. Sabe-se que nessas unidades é comum encontrar pacientes que necessitam de suporte ventilatório mecânico invasivo através de prótese traqueal. A pesquisa deve como objetivo desenvolver um equipamento específico para aferir e corrigir a pressão do balonete do tubo endotraqueal ou cânula de traqueostomia, e verificar o nível de conhecimento dos profissionais de saúde referente a pressão do balonete externo do tubo ou cânula traqueal. Trata-se de um estudo experimental, realizado no ano de 2015 no laboratório de instrumentação biomédica do Departamento de Engenharia Biomédica da Universidade Federal de Pernambuco (UFPE). O passo inicial para o desenvolvimento do equipamento foi a escolha do sensor de pressão de baixa intensidade, cuja a função primordial do sensor de pressão é transformar uma grandeza fisiológica (pressão) em uma grandeza elétrica (tensão). O equipamento desenvolvido é capaz de monitorar a pressão do cuff, em tempo real e de forma continua. O sistema de alarme sonoro e visual com três LEDs, cada uma com finalidades diferentes, sendo a LED verde responsável em informar que os valores estão dentro dos normais, a LED amarela indica que o valor da pressão se encontra fora dos limites máximo e mínimo estabelecidos como referência e a LED vermelha indicando pressão nula do cuff. O dispositivo criado nesta pesquisa pode monitorar de forma continua a pressão do cuff, e em tempo real sinalizar aos profissionais das UTIs que os valores pressóricos se encontram fora dos limites estabelecidos pelo profissional de saúde. A maioria dos profissionais das duas UTI utilizam técnica de mensuração da pressão do cuff de forma subjetiva com a palpação digital, ao mesmo tempo que realizam o ajuste de forma errada com a utilização da seringa, sem ter a precisão de ter corrigido a pressão para os valores correto / The use of artificial ventilation is indicated for individuals who have, failure or respiratory failure, cranial trauma or polytrauma patients. Intensive care units (ICUs) are environments used in the treatment of critically ill patients with potentially lifethreatening, which require uninterrupted service, characterized often as a related suffering and death environment. It is known that these units is common to find patients requiring invasive mechanical ventilation through tracheal prosthesis. Research should aim to develop specific equipment to measure and correct the pressure of the cuff of the endotracheal tube or tracheostomy tube, and check the level of knowledge of health professionals concerning the external pressure cuff tube or tracheal cannula. This is an experimental study carried out in 2015 in biomedical instrumentation laboratory of the Department of Biomedical Engineering at the Federal University of Pernambuco (UFPE). The initial step in the development of the equipment was the choice of low-level pressure sensor, whose primary function of the pressure sensor is to turn a physiological variable (pressure) into an electrical magnitude (voltage). The equipment developed is able to monitor the cuff pressure in real time and continuously. The audible and visual alarm system with three LEDs, each with different purposes, and the green LED charge to report that the values are within normal, the yellow LED indicates that the pressure value is outside the maximum and minimum limits as a reference and the red LED indicates zero pressure cuff. The device created in this research can monitor continuously the pressure of the cuff, and real-time signal to the ICU professionals that blood pressure values are outside the limits set by health professional. Most practitioners of the two ICUs use cuff pressure measurement technique subjectively by digital palpation while performing adjustment in the wrong way with the use of the syringe without having to precision have fixed pressure for correct values.

A satisfaction study investigates whether a more liberal ICU visitation policy satisfactorily meets visitors' and nurses' needs and expectations.

Accidents related to medical devices are a worldwide problem and result in many deaths each year. It affects patients, relatives, health care workers and society. Due to the complexity of intensive care units (ICUs), such accidents lead to particularly serious consequences. The aim of this thesis was to identify patient safety aspects at ICUs in public and private hospitals in Bangladesh, in order to provide a basis for improving the quality of performance of devices as well as personnel, care and cost effectiveness. The objectives were to a)      compare the conditions of medical devices at ICUs in private and public hospitals, b)      increase understanding of errors, risks and accidents related to medical devices, c)      study reporting systems and communication between staff at ICUs and d)      find ways to minimize hazards related to medical equipment to ensure effective and safe use of devices. Data was collected through interviews during field visits to six hospitals in Dhaka, Bangladesh. Interviews were held with the chiefs of the ICUs, physicians, nurses and technicians. It was noticed that the admission fees to the public hospitals were lower and had more limited resources. Differences between public and private hospitals could be seen in the aspects of finance, the existence of a Biomedical Engineering Department, maintenance and calibration of medical equipment, further education of staff, working environment and infection control. The reporting systems for adverse events and communication about patients’ conditions between coworkers were weak at all hospitals. The procurement process was lengthy at all hospitals. Access to disposable items was limited at several hospitals. The lower admission fee at the government hospitals results in the patients of these hospitals often having a lower income and status, thus less inclined to be critical of the received care. A number of suggestions have been proposed in order to improve the work in the ICU. These include a)      following up rules made by the authorities to ensure they are implemented at each hospital, b)      increasing documentation of malfunctioning devices and adverse events, c)      nurses and physicians taking part in the procurement process, d)      establishing a Biomedical Engineering Department at all hospitals, e)      organizing workshops for health care workers, f)       developing biomedical products adapted for multiple time use and with less need for calibration, g)      providing more education for health care workers in infection control, management of specific devices, solutions to common technical problems, patient safety and user safety, for example using Information and Communication Technology tools (audio and audiovisual material) and discussion platforms as well as h)      constructing an internet forum for consultation on the abovementioned subjects for technicians. / Olyckor relaterade till medicinteknisk utrustning är ett globalt problem som leder till många dödsfall varje år. Det påverkar patienter, anhöriga, sjukvårdspersonal och samhället. Den komplexa miljön på intensivvårdsavdelningar gör att olyckorna leder till allvarliga konsekvenser. Uppsatsen syftade till att identifiera patientsäkerhetsaspekter på intensivvårdsavdelningar i Bangladesh för att skapa en grund för prestandaförbättring, både gällande utrustning och gällande personal. Det ska också öka vård- och konstandseffektiviteten. Målet uppnåddes genom att a)      jämföra användandemiljön för medicinteknisk utrustning på intensivvårdsavdelningar på statliga och privata sjukhus, b)      öka förståelsen för fel, risker och olyckor relaterade till medicinteknisk utrustning, c)      studera rapporteringssystem samt kommunikation mellan personal på intensivvårdsavdelningar och d)      hitta sätt att minimera faror relaterade till medicinteknisk utrustning för att försäkra en effektiv och säker användning av utrustningen. Data samlades in genom intervjuer under en fältstudie på sex sjukhus i Dhaka, Bangladesh. Intervjuer hölls med cheferna på intensivvårdsavdelningarna, läkare, sjuksköterskor och tekniker. Det upptäcktes att patientavgiften på de statliga sjukhusen var lägre och resurserna var mer begränsade. Skillnader mellan statliga och privata sjukhus kunde ses inom ekonomiska resurser, förekomsten av medicintekniskavdelning, underhåll och kalibrering av medicinteknisk utrustning, vidareutbildning av personal, arbetsmiljö och infektionskontroll. Rapporteringssystemen för olyckor samt kommunikationen om patienters tillstånd mellan medarbetare var bristfällig på alla sjukhus. Upphandlingsprocesserna av ny medicintekniskutrustning var lång på alla sjukhus. Tillgången på engångsartiklar var begränsad på flera utav sjukhusen. Den lägre avgiften på de statliga sjukhusen resulterar i att patienterna på dessa sjukhus ofta har lägre inkomst samt status i samhället och är därför mindre benägna att vara kritiska till den mottagna vården. Ett antal ändringar föreslogs för att förbättra arbetet på intensivvårdsavdelningarna. Dessa inkluderar att a)      följa upp de av myndigheterna satta reglerna för att försäkra att de är implementerade på varje sjukhus, b)      öka dokumentationen av icke fungerande utrustning tillika olyckor, c)      sjuksköterskor och läkare skall delta i upphandlingsprocesserna, d)      starta medicintekniska avdelningar på alla sjukhus, e)      organisera workshops för vårdpersonal, f)       utveckla medicintekniska produkter som är anpassade för att användas flera gånger och som behöver kalibreras mer sällan, g)      ge mer utbildning till sjukvårdspersonal om infektionskontroll, hantering av specifika maskiner, lösningar till vanligt förekommande tekniska problem, patientsäkerhet och användarsäkerhet till exempel genom att använda information- och kommunikationsteknik-verktyg (audio och audiovisuellt material) och diskussionsplattformar samt h)      konstruera ett internetforum där tekniker kan få konsultation angående ovannämnda ämnen. / To develop patient safety system to improve the safety and quality of patient care at the Intensive Care Units

Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-10-16T17:10:00Z No. of bitstreams: 1 ALBERTO BRANDÃO TORRES NETO - DISSERTAÇÃO PPGEA 2009..pdf: 8942773 bytes, checksum: 5e58ef74c4a8c8c72d4700726c6be397 (MD5) / Made available in DSpace on 2018-10-16T17:10:00Z (GMT). No. of bitstreams: 1 ALBERTO BRANDÃO TORRES NETO - DISSERTAÇÃO PPGEA 2009..pdf: 8942773 bytes, checksum: 5e58ef74c4a8c8c72d4700726c6be397 (MD5) Previous issue date: 2009-09 / Desde a primeira crise do petróleo, em 1973, o álcool etílico vem despertando um crescente interesse do Governo Federal do Brasil e dos pesquisadores do mundo, e atualmente dos governos dos países desenvolvidos, como os Estados Unidos, Alemanha, França e países em desenvolvimento, como a índia e a China. Este fato se deve às pressões do esgotamento das fontes não-renováveis de combustíveis fósseis, como também à geopolítica do mundo (maiores reservas de petróleo em países com problemas de conflitos e instabilidade política). Surge, também, a busca por novas fontes de obtenção do álcool, os materiais lignocelulósicos. A palma forrageira foi introduzida no Brasil para dar suporte à criação de um inseto conhecido como cochonilha, este responsável pela produção de um corante de alto valor comercial na época. Com o passar dos anos o uso da palma passou a ser bastante diversificado pois, além de servir como forragem, ela produz frutas e verduras para consumo humano, biomassa para fins energéticos (combustível e biogás) e inúmeros produtos como bebidas, queijo vegetariano, remédios e cosméticos; elas servem, ainda, para abrigar e alimentar diversas espécies selvagens que vivem em ambientes áridos. A palma forrageira vem despertando interesse de muitos pesquisadores por se tratar de uma cultura bastante difundida e apresentar, em sua composição, celulose e hemicelulose, substâncias que podem ser utilizadas para obtenção de açúcares fermentescíveis; ela é, também, uma cultura bastante resistente à seca e produzida o ano inteiro. O objetivo deste trabalho foi estudar o processo de pré-hidrólise ácida da palma para obtenção de um licor pré-hidrolisado rico em pentoses diminuindo, assim, suas concentrações na matéria-prima, sendo esta o cladódio da palma forrageira do tipo gigante. O cladódio da palma foi recepcionado no Laboratório de Engenharia Bioquímica, onde se determinou sua umidade e se obteve a matéria seca. Fez-se a caracterização desta matéria (pH, açúcares redutores totais, sólidos solúveis, cinzas, hemicelulose, celulose, lignina e concentração de pentoses e hexoses). Foram realizados dois planejamentos experimentais 23 da pré-hidrólise para verificar a influência das variáveis temperatura, concentração de ácido e razão matéria seca/ácido sobre as respostas soma de pentoses e percentual de aumento de pentoses e, em seguida, foi realizada uma hidrólise preliminar acompanhada de uma fermentação. Com os resultados do planejamento fatorial experimental 23 verificou-se que apenas o segundo planejamento foi estatisticamente significativo ao nível de 95% de confiança para a média e a variável razão. Operando-se com razão abaixo de 1/10, para quaisquer valores de temperatura e concentração de ácido, obtém-se soma e percentual de aumento de pentoses acima de 8 g/L e 8000%, respectivamente. Durante a fermentação não houve produção de álcool etílico, devido, provavelmente, à formação de inibidores no processo de hidrólise, que se demonstrou através da forte coloração no licor hidrolisado. / Since the first petroleum crisis in 1973, ethylic alcohol has been arousing a growing interest by the Federal Government in Brazil and by researchers worldwide, and nowadays by governments of developed countries, such as the United States, Germany, and France, and by developing countries, such as índia and China. This is due to the pressure caused by the depletion of non-renewable sources of fóssil fuels, as well as to world geopolitics (greater reserves of petroleum in countries with problems of conflicts and politicai instability). The search for new sources for obtaining alcohol, such as lignocelluloses materiais, is also arising. Forage cactus was introduced in Brazil to support the raising of an insect known as cochonilha, which is responsible for the production of a dye that was of high commercial value at that time. Throughout the years, the use of this cactus has become very diversified, because aside from being used as forage, it produces fruit and greens for human consumption, biomass for energy reasons (fuels and biogas) and countless other products, such and beverages, vegetarian cheese, medicines and cosmetics. Furthermore, it is useful to shelter and feed various wild species that live in arid environments. Forage cactus has been arousing interest among many researchers because it is not only a greatly diffused culture and presents cellulose and hemicelluloses in its composition, and these substances can be used for obtaining fermentable sugars, but it is also a culture which is resistant to drought and can be produced ali year long. The purpose of this paper was to study the process of acid pre-hydrolysis of the cactus to obtain a prehydrolyzed liquor, high in pentose, thus diminishing the concentration in this raw material, which is the cladode of the giant forage cactus. The cactus cladode was received at the Biochemistry Engineering Laboratory, where its moisture content was determined and a dry matter was obtained. This matter was characterized (pH, total reducing sugars, soluble solids, ashes, hemicelluloses, cellulose, lignin, and the concentration of pentose and hexoses). Two factorial designs 23 of pre-hydrolysis were performed to verify the influence of the variables of temperature, acid concentration and dry matter/acid ratio over the responses to the sum of pentose and the percentile of pentose increase, and then a preliminary hydrolysis followed by fermentation was performed. With the results to the factorial design 23, it was verified that only the second design was statistically significant to a 95% levei of confidence for the mean and the variable ratio. Operating with the ratio below 1/10, for any value of temperature and acid concentration the sum and percentile increase in pentose is obtained above 8 g/L and 8000%, respectively. During fermentation, there wasn't production of ethylic acid, probably due to the formation of inhibitors in the hydrolysis process that was demonstrated through the strong color of the hydrolyzed liquor.

BACKGROUND: Clinical facilities are essential components not only for health care delivery systems but also for health care education programs. The clinical learning environment is important in training the future workforce in healthcare. Respiratory therapy education programs face several issues with the need to prepare a proper learning environment in different clinical settings. PURPOSE: The purpose of this study was to determine the perceptions of respiratory therapy students on the learning environment of clinical facilities affiliated with a respiratory therapy program at an urban state university. METHODS: This study used an exploratory research design to evaluate the essential aspects of a clinical learning environment in respiratory therapy education. A self-reporting survey was utilized to gather data from 34 respiratory therapy students regarding their perception about the effectiveness of clinical facilities in respiratory therapy education. The researcher utilized The Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale that was developed by Sarrikoski et al. (2008). The CLES+T evaluation scale was adapted and modified after a written agreement from the author. The survey included three main domains, which are the clinical learning environment (18 items), the supervision relationship (15 items), and the role of clinical instructors (9 items). Thirty-two students participated in the survey with a response rate of 94.1%. RESULTS: Responses included two groups of students: the second year undergraduate (68.8%) and graduate students (31.3%), with 75% being female participants. The results obtained from the study indicated that both graduate and undergraduate respiratory therapy students gave high mean scores to the learning environment of the clinical facilities, supervisory relationship and the roles of clinical instructors. A statistically significant data was obtained pertaining to the difference of perceptions regarding the multi-dimensional learning between the graduate and undergraduate students. The graduate students evaluated that “the learning situation are multi-dimensional” more than the undergraduate students (p = 0.03). Findings of this study showed that female students had higher ratings than male students in all evaluations of clinical facilities. However, only one dimension of leadership style stating that “the effort of individual employees was appreciated” was statistically significant (p=0.03). The results stating, the presence of a significant percentage of the students with lack of successful private supervision and high percentage of failed supervisory relationship, are in contrast with the fact that clinical learning plays a vital role in the respiratory therapy education. It is also contrasting that majority of the students experienced team supervision, which is against the philosophy and principles of individualization. CONCLUSION: Since respiratory therapy is a practice-based profession, it is essential to integrate clinical education to respiratory care education. Gender and education level may impact students’ perceptions about the learning environment of clinical facilities. This study provides information about areas for improvement in clinical facilities affiliated with a respiratory care education program at an urban university.