The trend towards patient-and family-centered care (PFCC) invites families of critically ill patients to participate more fully in the care and recovery of their loved ones through partnerships with the medical team and personalized care that respects the values, beliefs and experiences of the individual. In response to the growing needs of families, healthcare institutions are re-designing the way patient and family care is delivered in terms of policy, culture and the physical environment. Despite the many benefits that come with closer collaboration, nurses report that "challenging" families are a key source of workplace stress. This exploratory case study documents some of these challenges as perceived by staff nurses at Emory University Hospital's Neuro ICU while examining the role the built environment plays in shaping such perceptions. Through a series of ethnographic interviews and observational methodologies, the study identifies some of the challenges and benefits that come with balancing patient and family needs. Nurse strategies developed to reassert spatial and temporal control over work environments are also identified. The second phase of research compares communication patterns generated from two different ICUs to explore the link between unit design and the frequency and quality of nurse-family interactions. Findings suggest that space plays a role in moderating the degree of nurse exposure to the often unstructured and unpredictable aspects of family interactions. These encounters, set within a highly charged critical care setting, may contribute to these perceived challenges. Healthcare stands at an important moment of transition in which attitudes, behaviors and expectations are changing. Together these results reinforce the need for adequate tools, training and education to further support nurses in the transition to this new care culture.

Η Μονάδα Εντατικής Θεραπείας – Μ.Ε.Θ. (Intensive Care Unit – ICU) προϋποθέτει ευρύ φάσμα γνώσεων από έναν επαγγελματία υγείας (νοσηλευτή ή ιατρό), που εργάζεται στον χώρο. Σε καθημερινή βάση έρχεται αντιμέτωπος µε απειλητικές καταστάσεις για τη ζωή του ασθενούς και η αντιμετώπιση των διαταραχών της οξεοβασικής ισορροπίας είναι το στοίχημα, που πρέπει να κερδηθεί. Η ορθή ερμηνεία της ανάλυσης των αερίων του αρτηριακού αίματος από έναν επαγγελματία υγείας αποτελεί το βασικό συστατικό για την προαγωγή της υγείας ενός ασθενή στη Μ.Ε.Θ. Όμως παρά την αλματώδη τεχνολογική εξέλιξη του εργαστηριακού τομέα διαπιστώνουμε μια πολύχρονη στασιμότητα στον διαγνωστικό τομέα. Αυτό έχει ως αποτέλεσμα την επιπλέον επιβάρυνση της υγείας του ασθενή, αλλά και επιπρόσθετο φορτίο στο οικονομικό σκέλος. Στη παρούσα διπλωματική εργασία περιγράφεται η δημιουργία ενός ευφυούς συστήματος υποστήριξης αποφάσεων, με σκοπό να αποτελέσει σύμβουλο λήψης αποφάσεων από μη εξειδικευμένους επαγγελματίες υγείας, όταν αυτοί αντιμετωπίζουν προβλήματα οξεοβασικών διαταραχών στις ΜΕΘ, αλλά και να συμβάλλει στην αποτελεσματικότερη και ταχύτερη υποστήριξη του νοσηλευτικού και ιατρικού προσωπικού γενικά. Επίσης στόχος της διπλωματικής αυτής εργασίας είναι να αξιολογηθούν και να συγκριθούν οι μέθοδοι, διά των οποίων δημιουργήθηκε το ευφυές σύστημα. Για να γίνει αυτό δημιουργήσαμε 4 διαφορετικά συστήματα. Στη δημιουργία του πρώτου συστήματος χρησιμοποιήθηκαν κανόνες ασαφούς λογικής(FuzzyClips) και στα επόμενα τρία, μέθοδοι εξόρυξης γνώσης με μηχανική μάθηση. Στο τέλος έγινε η σύγκριση αποτελεσματικότητάς τους, με βάση διεθνώς χρησιμοποιούμενες μετρικές.Τα συστήματα με τη βοήθεια μεθόδων εξόρυξης γνώσης του WEKA παρουσίασαν και τη μεγαλύτερη αποτελεσματικότητα. Τα συστήματα αυτά δεν έχουν σκοπό την αντικατάσταση ενός επαγγελματία υγείας. Έχουν ως κύριο στόχο να λειτουργήσουν επικουρικά, στην καλύτερη, ταχύτερη και πιο αξιόπιστη διάγνωση οξεοβασικών διαταραχών των ασθενών, που νοσηλεύονται σε Μονάδα Εντατικής Θεραπείας ενός νοσοκομείου, αλλά και να χρησιμοποιηθεί ως εργαλείο με εκπαιδευτικό χαρακτήρα σε αρχάριους επαγγελματίες υγείας . / -

No description available.

Stress induced hyperglycaemia is prevalent in critical care. Since the landmark paper published by Van den Berghe et al. (2001) a great deal of attention has been paid to intensive insulin therapy in an ICU setting to combat the adverse effects of elevated glucose levels and poor glycaemic control. Glycaemic control protocols have been extensively developed, tested and validated within an ICU setting. However, little research has been conducted on the effects of a glycaemic control protocol in a less acute ward setting. There are many additional challenges presented in a ward setting, such as the variation in meals and levels of activity between patients, from day to day and throughout the day. A simple compartment model is used to describe the nature of insulin and glucose metabolism in patients of the Cardiothoracic Ward (CTW). A stochastic model of the fitted insulin sensitivity parameter is generated for this cohort and validated against cohorts of similar characteristics. The stochastic model is then used to run simulations of predictive control on 7 CTW patients, which shows significantly tighter glucose control than what is obtained with regular clinical procedures. However, the rate of severe hypoglycaemia is an unacceptably high 4.2%. The greatest challenge in maintaining tight glycaemic control in such patients is the consumption of meals at irregular times and of inconsistent quantities. Insulin sensitivity was compared to extensive hourly clinical data of 36 ICU patients. From this data a sepsis score of value 0-4 was generated as gold standard marker of sepsis. Comparing the sepsis score to insulin sensitivity found that insulin sensitivity provides a negative predictive diagnostic for sepsis. High insulin sensitivity of greater than Si = 8 x 10⁻⁵ L mU⁻¹ min⁻¹ rules out sepsis for the majority of patient hours and may be determined non-invasively in real-time from glycaemic control protocol data. Low insulin sensitivity is not an effective diagnostic, as it can equally mark the presence of sepsis or other conditions.

De senaste åren har forskning runt miljöns betydelse för patientens välbefinnande och tillfrisknande tagit fart. Medvetenhet om närståendes betydelse för den kritiskt sjuke har också ökat. Detta har gjort att de befintliga flerpatientrummen är i behov av renovering för att göra plats för närstående som är allt mer närvarande på rummet. Forskningen har visat att genom att vårdas i enpatientrum kan patienten få mera ro och förbättrad sömn. Förekomst av delirium minskar och smittspridningen blir lägre. Dock finns det negativa aspekter av enpatientrum som ger en ökad kostnad och kräver mer personal – något som kan bidra till att det inte byggs i lika stor utsträckning som behovet finns. Den aktuella studien är genomförd på en IVA som har byggts om till modulsystem, där två enpatientrum kopplas samman med hjälp av en skjutdörr. Syftet med studien var att beskriva sjuksköterskors upplevelser av att arbeta i en IVA-modul.  Information samlades in med hjälp av en kvalitativ forskningsintervju där tio sjuksköterskor intervjuades. Datamaterialet granskades med kvalitativ innehållsanalys. Samtliga sjuksköterskor var nöjda med att arbeta i modul. Rummens storlek och utformning uppskattades. De intervjuade upplevde dock att genom att vårda två patienter men i olika rum kunde de förlora kontroll vilket kunde skapa stress. Grundbemanningen där en sjuksköterska och en undersköterska ansvarar för två kritiskt sjuka patienter tycktes oftast inte räcka till då det kunde vara svårt att få hjälp av kollegor. Denna modullösning upplevdes som en bra kompromiss till flerpatientrum. En viktig slutsats är att modullösningar kräver mer personal och ställer högre krav på kommunikation samt samarbete personalen emellan.

No description available.

The Intensive Care Unit (ICU) is a unit that manages the most critically ill, complex and unstable patients in the hospital. As a result, the ICU is characterised by a high degree of clinical and organisational unpredictability and uncertainty. In Western discourse, uncertainty is often portrayed as problematic, and as something to be controlled and reduced. This research challenges this discourse by examining the productive relationship between certainty and uncertainty in the work practices of ICU clinicians, and subsequently, how intensive care clinicians utilise uncertainty to construct order in a highly unpredictable work environment. To understand how order can coexist with ICU’s unremitting unpredictability, complexity theory is used to frame this investigation. This research engaged an emergent, interventionist methodology, deploying multiple methods. Using ethnography, video-ethnography, and video-reflexivity, this research relied on clinicians’ participation in the construction and analysis of video data of the ICU clinicians’ work practices. This resulted in clinician-led practice change in the ICU. This research suggests that methods need to be deployed adaptively in order to deal with the complexity of ICU, in addition to the moment-to-moment emergence of events that require the researcher’s own work plans to be revisited. Moreover, in order to gain traction with, and understand highly complex and changeable environments, the researcher needs to also enter and experience uncertainty herself. Using complexity theory as its analytical tool, this research shows an inseparability of uncertainty and certainty in the ICU which is labeled ‘un/certainty’. Three main conclusions emerge from this research. First, un/certainty predominates in intensive care, and due to this, ordering is a process rather than a final state. Un/certainty is at the heart of the adaptive practices that clinicians enact. These adaptive practices are highly interconnected to the changes that the ICU environment may require, and thus produce a dynamic order in the unit. Second, the researcher herself, in order to come to terms with the complexity and un/certainty of the ICU environment must also enter un/certainty in order to gain traction with the ICU environment: unpredictability and complexity cannot be studied from a neat and disengaged distance. Third, the presence of un/certainty in the ICU can be significant and enabling rather than disabling for clinicians in their ongoing pursuit of dynamically ordering practice. The contribution of un/certainty to frontline practice is as a central driver to managing change and complexity. Therefore it should be positively revalued by health services researchers, policy makers and clinicians alike.

Bakgrund: Patienter som drabbas av svår sjukdom och vårdas på intensivvårdsavdelning upplever känslor av total förlust av kontroll, förstärkt av oförmågan att kommunicera. Att få kunskap, kontroll och inflytande över sin vård leder till mindre smärtlindring och kortare vårdtid. Patientcentrering i vården brister dock, vilket kan leda till ökade kostnader för såväl samhället som patienter. Syfte: Att identifiera och beskriva hinder mot empowerment till patienter inom intensivvård samt vilka möjligheter som finns för att överbrygga dessa hinder.  Metod: En systematisk litteraturstudie analyserad i två steg med meta-syntes enligt Evans samt meta-aggregation, inspirerad av Joanna Briggs’ Institute. Resultat: Både hinder och lösningar för empowerment till intensivvårdspatienten finns på flera plan. Sjukdomen gör att patienten förlorar förmåga till empowerment, vårdmiljön känns skrämmande, vårdpersonal upplevs vara avvisande och brister i arbetsmiljön leder till sämre möjlighet till delaktighet. Specialistsjuksköterskan inom intensivvård behöver ge patienten indirekt delaktighet, förklara vårdmiljön, skapa en ömsesidig relation och uppmuntra delaktighet. Ett stödjande ledarskap och goda arbetsvillkor är andra nödvändiga förutsättningar för detta.  Slutsats: Genom en ökad medvetenhet om de hinder som finns för empowerment till intensivvårdspatienten kan specialistsjuksköterskor och arbetsgivare aktivt arbeta för att komma över hindren och istället stärka patientens möjligheter att bli en del av vårdteamet. / Background: To become critically ill and be cared for at an ICU involves feelings of total loss of control, reinforced by the inability to communicate. Gaining knowledge, control and influence over the nursing care results in reduced need for pain relief and shorter stay in hospital. Patient centered care is however lacking. This might incur a higher cost for society, as well as the patient in the form of suffering.Aim: To identify and describe barriers to patient empowerment in critical care and what means there are to overcome these barriers. Method: Systematic literature review, analysed in two steps with meta synthesis according to Evans and meta aggregation, inspired by the Joanna Briggs’ Institute. Results: Barriers as well as possibilities for patient empowerment in ICU were found on various levels. Being critically ill disables the patient from feeling or receiving empowerment, the nursing environment is frightening, staff is perceived as dismissive and working conditions impede patient participation. The specialist nurse in intensive care needs to give the patient indirect participation, explain the nursing environment, create a mutual relationship and encourage participation. Good working conditions and a supportive workplace leadership are also required.  Conclusion: By being aware of what the barriers to patient empowerment in the ICU are, specialist nurses and employers can actively engage in the work to overcome them, as well as engaging in the support of the patient to become part of the care team.

The fungi are being opportunistic, with wide distribution in nature, including the hospital environment, where it is frequent the presence of microorganisms that cause hospital infection, especially in immunocompromised patients. To identify and quantify the fungal microbiota in air, the filters of air-conditioners and samples of newborns from the neonatal ICU at University Hospital / HUPA, Maceió, Alagoas. Were held 20 exhibitions of collections totaling 400 disposable Petri dishes containing Sabouraud agar medium plus antibiotic. The plates were placed randomly inside and open the two neonatal ICUs (A and B) for 20 minutes. Also, there were 20 samples of the filters of air-conditioners of neonatal ICUs and conducted the direct examination and culture of clinical samples from newborns. CFU were isolated in 1209, these 675 (55.8%) were isolated CFU before cleaning to be done in the neonatal ICU and 534 (44.2%) CFU obtained after cleaning. Of 697 CFU of the environment of the NICU, 372 were isolated before and 325 after cleaning. Environment B, were obtained of 512 CFU and 303 CFU were obtained before cleaning and 209 after UFC. During the study species of Cladosporium was the most representative in the air and in the filters of air-conditioners. The clinical sample was more representative urine with 79.5%. Among the identified yeast Candida parapsilosis was present in 38.9% of environmental isolates of yeast and Candida albicans was isolated in 20% of clinical samples of newborns. The presence of pathogenic fungi in the two environments of the neonatal ICU and clinical samples of infants, demonstrating the need for constant monitoring to take control of microorganisms in hospital environments, especially in intensive care units where there is the presence of immunocompromised patients prone to develop fungal infections. / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Os fungos que são dispersos pelo ar atmosférico são denominados de fungos anemófilos e são importantes por causar patologias em pacientes imunocomprometidos. Com o objetivo de monitorar a microbiota fúngica do ar, dos filtros dos condicionadores de ar e das amostras clínicas dos recémnascidos internados na UTI neonatal do Hospital Universitário de Maceió - AL foram realizadas coletas de amostras do ar através da técnica de exposição de placas de Petri contendo o meio ágar Sabouraud acrescido de antibiótico. O material sólido dos filtros dos condicionadores de ar foi coletado utilizando um swab esterilizado. E das amostras clínicas dos recém-nascidos foram realizados o exame direto e cultura. Para identificação dos fungos filamentos foram comparadas as características macro e microscópicas e as leveduras foram identificados através da técnica de PCR. Entre as 400 exposições de placas realizadas foram isoladas 1029 UFC, sendo 675 (55,8%) UFC obtidas antes e 534 (44,2%) após a limpeza. Das 40 amostras analisadas dos filtros dos condicionadores de ar foram obtidas 303 UFC, sendo o fungo Cladosporium cladosporioides com maior frequência tanto no ar com 186 (15,4%) UFC como nos filtros dos condicionadores de ar com 77 (37,7%). Não foram isolados fungos filamentosos das amostras clínicas dos recém-nascidos. Entretanto as leveduras Candida albicans, C. tropicalis e C. parapsilosis foram obtidas tanto das amostras do ar como dos recém-nascidos com exceção de C. guilliermondii que foi isolada apenas das amostras do ar.

PEREIRA, Mário Wilson Paiva. Arquitetura de hardware para monitor de UTI segundo padrão IEEE 1451: uma prova de conceito. 2017. 125 f. Dissertação (Mestrado em Engenharia de Teleinformática)–Centro de Tecnologia, Universidade Federal do Ceará, Fortaleza, 2017. / Submitted by Renato Vasconcelos (ppgeti@ufc.br) on 2017-11-17T18:30:25Z No. of bitstreams: 1 2017_dis_mwppereira.pdf: 12636405 bytes, checksum: 9101596c0294db74704566e056987670 (MD5) / Rejected by Marlene Sousa (mmarlene@ufc.br), reason: Prezado Mário Wilson: Existe uma orientação para que normalizemos as dissertações e teses da UFC, em suas paginas pré-textuais e lista de referencias, pelas regras da ABNT. Por esse motivo, sugerimos consultar o modelo de template, para ajudar nesta tarefa, disponível em: http://www.biblioteca.ufc.br/educacao-de-usuarios/templates/ Vamos agora as correções sempre de acordo com o template: 1. Na capa inicia-se na margem superior da folha/página com todas as informações centralizadas, em letras maiúsculas, em negrito, fonte tamanho 12 e espaço 1,5 entre linhas. Falta colocar o Centro de Tecnologia no alto da folha 2. Na folha de rosto (que segue a capa) nenhuma informação fica em negrito e o título deve ser todo em maiúsculo. O texto que apresenta a submissão de sua dissertação está transcrito no template. Favor alterar. 3. Na folha de aprovação o tamanho da fonte do titulo está maior que 12, nenhuma informação fica em negrito. Nessa folha não deve constar nem local, nem data. 4. A dedicatória deve iniciar abaixo do meio da folha com recuo de 8 cm da margem esquerda. O texto deve ser apresentado em tamanho 12, justificado, espaço entre linhas 1,5. 5. A palavra AGRADECIMENTOS deve ficar em negrito. 6. Epígrafe: Elemento opcional. Citação, seguida da indicação de autoria, relacionada com o tema do trabalho, expressa em folha/página distinta. Inicia-se abaixo do meio da folha, com recuo de 8 cm da margem esquerda. O texto deve ser digitado em tamanho 12, espaço 1,5 entre linhas, justificado, e entre aspas. 7. Troque a palavra Lista de ilustrações por LISTA DE FIGURAS (use maiúscula e negrito), já que vc optou em utilizar as tabelas separadas. O termo Lista de Ilustrações só deve ser usado quando juntar todas as tabelas em uma só. 8. As LISTAS DE TABELAS, ABREVIATURAS E SÍMBOLOS devem ficar em negrito. 9. No sumário os APÊNDICES e ANEXOS não são numerados, do mesmo modo que as REFERÊNCIAS. 10 Na lista de referencias, retire a informação, que está no final de cada obra citada, do numero de vezes que o autor foi citado em seu trabalho. Quando citar documentos consultados online, colocar autor. título. disponível em: <endereço eletrônico> Acesso em: data (dia, mes e ano). Corrigir em toda a lista. on 2017-11-20T13:21:38Z (GMT) / Submitted by Renato Vasconcelos (ppgeti@ufc.br) on 2017-11-29T12:30:37Z No. of bitstreams: 1 2017_dis_mwppereira.pdf: 13047402 bytes, checksum: f3860047ffbca14a78358f0c384dfb3d (MD5) / Rejected by Marlene Sousa (mmarlene@ufc.br), reason: Prezado Mário Wilson: Vc realizou quase todas as alterações, mas falta ainda, sempre de acordo com template disponível em: http://www.biblioteca.ufc.br/educacao-de-usuarios/templates/ 3. Na folha de aprovação os membros da banca não podem ir para a outra folha. Você pode fazer a opção de dividir um lado do outro. Ex. ________________________________ ________________________________ _________________________________ _______________________________ _________________________________ _______________________________ 10. Na lista de referencias, o título não fica em caixa alta, apenas a primeira letra e siglas se houver. Ex. ANAHP. Observatório 2015. GARCIA, W. L. C. Teds-easy - descricão automática de transducer electronic data sheet MARCONDES, A. Desenvolvimento de protótipo de gravador de TEDS e de etiqueta eletrônica TEDS PRIYA, M. et al. Embedded based wireless ICU monitoring system ROSSI, S. R.; RODRIGUES DA SILVA, A. C.; SANTOS FILHO, T. A. D. IEEE 1451.2- based sensor system with JAVA-TEDS software Tool TESTER, S. N. C. et al. An IEEE 1451 TEDS compiler and serial network compliance tester. Att. Marlene 3366-9620 on 2017-11-29T17:00:56Z (GMT) / Submitted by Renato Vasconcelos (ppgeti@ufc.br) on 2017-12-01T14:14:36Z No. of bitstreams: 1 2017_dis_mwppereira.pdf: 13128245 bytes, checksum: f6b50d91d6917b0407cfdedeba21bf03 (MD5) / Approved for entry into archive by Marlene Sousa (mmarlene@ufc.br) on 2017-12-01T16:28:19Z (GMT) No. of bitstreams: 1 2017_dis_mwppereira.pdf: 13128245 bytes, checksum: f6b50d91d6917b0407cfdedeba21bf03 (MD5) / Made available in DSpace on 2017-12-01T16:28:19Z (GMT). No. of bitstreams: 1 2017_dis_mwppereira.pdf: 13128245 bytes, checksum: f6b50d91d6917b0407cfdedeba21bf03 (MD5) Previous issue date: 2017-07-28 / This work presents the development of a hardware architecture for ICU monitors, combining design stages of embedded systems, biomedical instrumentation, intelligent sensors and the IEEE 1451 protocol. The method used defines operational requirements, system decomposition into modules, architecture definition and implementation using commercial development platforms. The entire process is based on national and international standards and protocols, seeking to design the system within the constraints of a product and validate the concept through printed circuit board prototypes. The proposed architecture establishes a network of intelligent biomedical sensors, called STIM, controlled by a central node, called NCAP. The use of this architecture provides modular, self-configuring, easy-to-maintain, plug and play sensors with standardized communication and data interface. The work also describes the process of creating electronic data sheets of the STIMs, called TEDS, which contain the operation characteristics of each smart sensor. / Este trabalho apresenta o desenvolvimento de uma arquitetura de hardware para moni- tores de UTI combinando etapas do projeto de sistemas embarcados, instrumentação biomédica, sensores inteligentes e o protocolo IEEE 1451. A metodologia empregada define requisitos operacionais, decomposição do sistema em módulos, definição da arquitetura e implementação utilizando plataformas de desenvolvimento comerciais. Todo o processo é baseado em normas e protocolos de órgãos nacionais e internacionais procurando projetar o sistema dentro das restrições de um produto e validar o conceito por meio de protótipos em placas de circuito impresso. A arquitetura proposta estabelece uma rede de sensores biomédicos inteligentes, denominados STIM, controlados por um elemento cental, denominado NCAP. A utilização desta arquitetura proporciona sensores modulares, autoconfiguráveis, de fácil manutenção, plug and play, com interface de comunicação e dados padronizados. O trabalho também descreve o processo de criação de folhas de dados eletrônicas dos STIMs, denominadas TEDS, que contêm as características de operação de cada sensor inteligente.