nÃo hà / INTRODUÃÃO: O acesso ao seguimento de crianÃas egressas de unidades de terapia intensiva neonatal (UTIN), deve iniciar na prÃpria unidade, tendo continuidade apÃs a alta hospitalar em ambulatÃrio especializado e de atenÃÃo primÃria, com avaliaÃÃes sistemÃticas do crescimento e desenvolvimento, prevenÃÃo de riscos e danos. OBJETIVO: Analisar o acesso da atenÃÃo à saÃde ofertada a crianÃas egressas de cuidados intensivos neonatais no municÃpio de Fortaleza-CE. METODOLOGIA: Estudo transversal, aninhado a um estudo de coorte de recÃm-nascidos admitidos em UTIN, integrante da Rede Norte-Nordeste de SaÃde Perinatal. A amostra do estudo constituiu-se de 193 crianÃas, residentes em Fortaleza-CE. As entrevistas foram realizadas no domicÃlio das crianÃas no perÃodo de marÃo de 2010 a junho de 2011. Para a anÃlise de acesso ao serviÃo de atenÃÃo primÃria e de Follow-up, foi utilizado o modelo hierarquizado dos componentes individuais de acesso: Componente Predisponente (CaracterÃsticas sociais, demogrÃficas e individuais), Componente Capacitante (CaracterÃsticas socioeconÃmicas) e Componente Necessidade de SaÃde (condiÃÃes de saÃde). RESULTADOS: A regressÃo logÃstica mÃltipla hierarquizada mostrou que apÃs ajuste das variÃveis do componente predisponente permaneceu no modelo de determinaÃÃo de acesso adequado ao serviÃo de atenÃÃo primÃria (puericultura): residir com o companheiro e profissional que realizou o prÃ-natal na categoria mÃdico/enfermeiro, quando ajustada as variÃveis do componente predisponente e capacitante a renda familiar per capita foi esvaziada do modelo. Na etapa final, as variÃveis do componente necessidades de saÃde foram ajustadas as do componente anterior permanecendo no modelo hierarquizado: residir com o companheiro OR=2,28 (IC95% 0,93-5,60, p=0,07), profissional que realizou o prÃ-natal na categoria mÃdico/enfermeiro OR=0,39 (IC95% 0,17-0,87, p=0,02), comportamento de risco OR=5,88 (IC95% 1,16-29,76), p=0,03) e prematuridade OR=2,03 (IC95% 0,88-4,68, p=0,09). Para o segundo desfecho de determinaÃÃo do acesso adequado ao serviÃo de Follow-up, a regressÃo logÃstica mÃltipla hierarquizada mostrou que, apÃs ajuste das variÃveis do componente predisponente permaneceram no modelo: idade materna e profissional que realizou o prÃ-natal na categoria enfermeiro, quando ajustada as variÃveis do componente predisponente e capacitante a renda per capita foi esvaziada do modelo.Na etapa final, apÃs ajuste das variÃveis do componente necessidade de saÃde com as do modelo anterior foram determinantes de acesso adequado ao serviÃo de Follow-up: idade materna OR=0,17 (IC95% 0,33-0,96), p=0,04), profissional que realizou o prÃ-natal na categoria enfermeiro OR=2,88 (IC95% 0,78-10,55, p=0,10), e recÃm-nascido de alto risco OR=4,37 (IC95% 1,10-17,28, p=0,03).Conclui-se que a idade materna, residir com o companheiro, os profissionais que realizam o prÃ-natal da mÃe da crianÃa, comportamento de risco da mÃe, prematuridade, e recÃm-nascido de alto risco sÃo determinantes de acesso aos serviÃos de atenÃÃo a saÃde.

Orientador: Marcos de Souza Queiroz / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T12:17:20Z (GMT). No. of bitstreams: 1 Combinato_DeniseStefanoni_M.pdf: 8438347 bytes, checksum: 96316422a0f5fa24327723cbbeaa24d7 (MD5) Previous issue date: 2005 / Resumo: A morte faz parte do processo de desenvolvimento humano e está presente no cotidiano do profissional da saúde que trabalha em Unidade de Terapia Intensiva.À partir do século xx, a morte foi escondida e negada pela cultura ocidental. Ela deixou de ser entendida como um fenômeno natural e tomou-se sinônimo de fracasso e impotência. Diante deste cenário, o objetivo desta pesquisa foi investigar a concepção de morte para profissionais da saúde que trabalham em Unidade de Terapia Intensiva, como essa concepção foi construída e como se manifesta na atuação prática, de maneira que possam ser identificados elementos, relacionados a esse tema, que dificultam o desenvolvimento da atividade ou que geram insatisfaçãono trabalhador. Participaram dessa pesquisa 13 profissionais da saúde com nível superior, sendo três médicas, três médicos, seis enfermeiras e um enfermeiro vinculados à Unidade de Terapia Intensiva (unidade adulto) de um hospital estadual de grande porte do interior do Estado de São Paulo. Os dados foram coletados através de entrevista individual semi-estruturada gravada em fita cassete. Foi realizada análise qualitativa dos dados, através da análise de conteúdo, de acordo com o método explicativo de Vigotski. Constituiu o eixo temático as categorias psicossociais representação social e consciência de acordo com a abordagem Sócio-Histórica. Como conclusão, destaca-se a ausência do processo de orientação Profissional e a deficiência na formação profissional - além da questão sócio-culturalmais ampla- como aspectos que não favorecem o desenvolvimento satisfatório da atividade, tendo o profissional dificuldade para lidar com o processo de morte. Ressalta-se a necessidade de mudança no paradigma da ciência do cuidado; a importância da orientação profissional e a priorização da educação sobre a morte e o mon-er no processo de formação profissional e no contexto organizacional / Abstract: Death is part of the process of human development and it is present in the every day life.of a health professionalworking in an Intensive Care Unit. This is due to the fact that ITomthe 20th Century, westem culture has considered the grieving process to be something which should be hidden and denied. Instead of being undestood as a natural phenomenon, grief has become synonymous of wea1mess and impotence. The objective of this research was to investigate the representation of death among health professionals who work in an Intensive Care Unit, how this perception was built and how it manifests itself in rea1ity.This was performance in order to identify culturals psychologica1 aspects related to the grieving process which could be identified as causing difficulties for health professionals in their day-to-day work and which could, in tum, cause worker dissatisfaction. Thirteen health professionals participated in this research - six doctors (3 men and 3 women) and seven nurses (1 man and 5 women) - alI of whom were linked to the adult section of an Intensive Care Unit in a large, hospital in the state of Sao Paulo. Data were collected through a semi-structured interview recorded on cassette. Qualitative data were analysied according to Vygotski's methodology and theory. The thematic aspects were divided into the following categories: psycho-social, social representation and conscience (according to the Socio-Historic Relevance). In conclusion, the lack of training to cope with death as part of the professional's orientation and training constitute crucial aspect which make it difficult for the professional to face death as a natural processo The need for change, the importance of professional orientation and the priority of education about death in the professional training process are self-evident / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Introduction: Patients with acute kidney injury (AKI) in developing countries are described in a profile of young age, with less comorbidities, with unifactorial, and with a lower mortality compared to patients in developed countries. Objective: To assess mortality in patients with acute kidney injury undergoing hemodialysis (HD) and its associated factors in a developing country setting. Methods: Retrospective study. Demographic, clinical, and mortality variables were collected from patients who presented AKI and underwent HD between January 2014 and December 2015 at a national reference hospital in Lima, Peru. Risk ratios (RR) and 95% confidence intervals (95%CI) were estimated through Poisson regressions. Results: Data from 72 patients with AKI that underwent HD were analyzed, 66.7% of them were < 64 years old, and 40.2% of all patients died undergoing HD. Crude analysis showed higher mortality among those who used vasopressors, but lower mortality among those with creatinine values > 8.9 mg/ dL. The adjusted analysis showed that having had a creatinine level of > 8.9 mg/ dL, compared to a creatinine level of < 5.2 mg/dL at the time of initiating HD, was associated with 74% less probability of death. Conclusion: Four out of every ten AKI patients undergoing HD die. Higher levels of creatinine were associated with lower probability of mortality.

D.Cur. (Intensive General Nursing) / Critical care nursing is cost-effective quality nursing to the critical ill patient. This nursing is inftuenced by certain expectations as well as the professional-ethical authorisation. The aim ofthis study is to describe and explore the expectations and the professional-ethical authorisation of the functions of the critical care nurse to enable the formulation ofguidelines for the scope of practice for the critical care nurse within South African context. Phase I was to determine the expectations of the critical care nurse, the nursing service managers and the doctors with regard to the functions of the critical care nurse. A focus group interview was held with a group of experts in the field of critical care. The results were used to compile a questionnaire. This questionnaire was sent to the critical care nurses, the nursing service managers and the doctors in South Africa for completion. From these results the functions of the critical care nurse were determined. Phase 2 is to analyse the expectations (Phase 1) according to the professional-ethical authorisation of the critical care nurse. Firstly, literature was explored and described to determine the professional ethicalauthorisation regarding the accountability ofthe critical care nurse. Secondly, the functions were analysed according to the professional-ethical authorisation. The analysis showed that except for prescribing medication, altering medication dosages and drawing blood samples from the critical ill patient, the critical care nurse is practicing within her professional-ethical authorisation. Phase 3 was to formulate guidelines for the scope of practice for the critical care nurse within a South African context. Through usage of the data (Phase I and 2) the scope of practice was formulated. Guidelines were formulated for the practise, education and research regarding the limitations of the professional-ethical authorization and the implementation of the scope of practice for the critical care nurse.

No description available.

Implementation strategies for the use of clinical practice guidelines are an integral component in bridging the gap between the best research evidence and clinical practice. However, despite some remarkable investments in health research regarding clinical practice guidelines implementation strategies, it is not yet known which of these are the most effective for intensive care units. The purpose of this research study was to systematically identify and /or search, appraise, extract and synthesize the best available evidence for clinical practice guidelines implementation strategies in intensive care units, in order to develop a draft guideline for clinical practice guidelines implementation strategies in the intensive care units. A systematic review design was used to systematically identify and /or search, appraise, extract and synthesize the best available evidence from the eligible included Level 2 studies (randomized controlled trials and quasi-experimental studies). Level 2 studies were applicable because they present robust evidence in the research results regarding effectiveness of clinical practice guideline implementation strategies. Furthermore, although other systematic reviews conducted in this area before, they included studies of In addition, no systematic review was identified that reviewed Level 2 studies and developed a guideline for clinical practice guideline implementation strategies in the intensive care units. Hence, including only Level 2 studies was distinctive to this research study. Databases searched included: CINAHL with full text, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials Issue 8 of 12, August 2013, and MEDLINE via PUBMED. Hand search in bound journals was also done. The search strategy identified 315 potentially relevant studies. After the process of critical appraisal, thirteen Level 2 studies were identified as relevant for the review. Of the 13 relevant studies, 10 were randomized controlled trials and three were quasi experimental studies. After the critical appraisal ten RCTs were included in the systematic review. Three studies (quasi-experimental) were excluded on the basis of methodological quality after the critical appraisal and agreement by the two independent reviewers. The Joanna Briggs Institute Critical Appraisal MASTARI Instrument for Randomized Controlled trials/ Experimental studies, and The Joanna Briggs Institute data extraction tools were used to critically appraise, and extract data from the ten included randomized controlled trials. The two reviewers who performed the critical appraisal were qualified critical care professional nurses and experts in research methodology. These reviewers conducted the critical appraisal independently to ensure the objectivity of the process. Appropriate ethical considerations were maintained throughout the process of the research study. The results indicated that 80 percent of the included studies were conducted in adult intensive care units while 20 percent were conducted in the neonatal intensive care units. Furthermore, 60 percent of the studies were conducted in the United States of America, 10 percent in France, a further 10 percent in Taiwan, another 10 percent in England and yet another 10 percfent was conducted in Australia and Newzealand. The included studies utilized more than one (multifaceted) implementation strategies to implement clinical practice guidelines in the intensive care units. The first most utilized were: printed educational materials; Information/ educational sessions/meetings; audit and feedback and champion/local opinion leaders; seconded by educational outreach visits; and computer or internet usage. Third most used were active/passive reminders; systems support; academic detailing/ one-on-one sessions teleconferences/videoconferences and workshops/in services. Fourth most used were ollaboration/interdisciplinary teams; slide shows, teleconferences/videoconferences and discussions. Fifth most used were practical training; monitoring visits and grand rounds. However all the strategies were of equal importance. Conclusively, the included studies utilized multifaceted implementation strategies. However, no study indicated the use of a guideline for the implementation strategies in the process of clinical practice guidelines implementation. The systematic review developed a draft guideline for clinical practice guideline implementation strategies in the intensive care units. The guideline will enhance effective implementation of clinical practice guidelines in such a complex environment.

Critically ill patients often require assistance by means of intubation and mechanical ventilation to support their spontaneous breathing if they are unable to maintain it. Mechanical ventilation is one of the most commonly used treatment modalities in the care of the critically ill patient and up to 90% of patients world-wide require mechanical ventilation during some or most parts of their stay in critical care units Management of a patient’s airway is a critical part of patient care both in and out of hospital. Although there are many methods used in verifying the correct placement of the endotracheal tube, the need and ability to verify placement of an endotracheal tube correctly is of utmost importance, because many complications can occur should the tube be incorrectly placed. Since unrecognized oesophageal intubation can have many disastrous effects on patients, various methods for verifying correct endotracheal tube placement have been developed and considered. Some of these methods include direct visualization, end-tidal carbon dioxide measurement and oesophageal detector devices. This research study aimed to explore and describe the existing literature on the verification of endotracheal tubes in the mechanically ventilated patient in the critical- care unit. A systematic review was done in order to operationalize the primary objective. Furthermore, based on the literature collected from the systematic review, recommendations for the verification of the endotracheal tube in the mechanically ventilated patient in the critical care unit were made. Ethical considerations were maintained throughout the study and the quality of the systematic review was ensured by performing a critical appraisal of the evidence found.

No description available.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24968号 / 医博第5022号 / 新制||医||1069(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 佐藤 俊哉, 教授 江木 盛時 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.