A hipotermia ocorre em mais de 70% dos pacientes no período perioperatório tornando-se um evento adverso freqüente. O estudo teve como objetivo geral analisar a temperatura corporal do paciente submetido à cirurgia eletiva no período intra-operatório e como específicos: identificar as relações entre a temperatura corporal e as variáveis sócio-demográficas (idade e sexo) e clínicas (índice de massa corporal, transfusão sanguínea e doenças crônicas); identificar as relações entre temperatura corporal e as variáveis do procedimento anestésicocirúrgico (duração da anestesia, tipo de anestesia e duração da cirurgia); identificar a relação entre temperatura corporal e a temperatura da sala de operação; analisar a variância da medida da temperatura corporal média dos pacientes explicada pelas variáveis preditoras e identificar as medidas adotadas na sala de cirurgia para a prevenção de hipotermia. Para tanto, realizou-se uma pesquisa com abordagem metodológica quantitativa, delineamento não experimental, tipo de estudo correlacional, prospectivo em um hospital filantrópico situado no interior do Estado de São Paulo. Na amostra estudada foram incluídos 70 sujeitos com idade igual ou superior a 18 anos; submetidos à cirurgia eletiva, com duração da anestesia de, no mínimo, uma hora. Para a coleta de dados elaborou-se um instrumento que foi submetido à validação aparente e de conteúdo. Na coleta de dados, a pesquisadora realizou a mensuração da temperatura e umidade da sala de operação e da temperatura corporal do paciente em diferentes momentos. Por meio do coeficiente de correlação de Pearson verificou-se correlação estatisticamente significante e negativa entre a variável temperatura média corporal dos pacientes e a duração da anestesia e a duração da cirurgia. De forma positiva, o índice de massa corporal e a temperatura média da sala de operação apresentaram correlações estatisticamente significantes com a temperatura corporal média dos pacientes. Segundo o teste t Student a variável transfusão sanguínea apresentou diferença estatisticamente significante entre as temperaturas corporais médias do grupo submetido à transfusão e do grupo não submetido à transfusão. Em relação ao tipo de anestesia, a ANOVA mostrou diferença estatisticamente significante entre as temperaturas corporais médias e os grupos (geral, regional e combinada), sendo que o grupo submetido à anestesia combinada apresentou temperaturas médias corporais mais baixas. Na regressão linear multivariada, as variáveis tipo de anestesia, duração da anestesia, o índice de massa corporal e a temperatura da sala de operação estavam diretamente relacionadas à temperatura corporal média dos sujeitos investigados. As medidas adotadas na sala de cirurgia para a prevenção de hipotermia foram o uso de lençol de algodão e o enfaixamento dos membros inferiores que consistem em métodos passivos de aquecimento cutâneo; a utilização do sistema de ar forçado aquecido (método ativo de aquecimento cutâneo) ocorreu uma única vez. Conclui-se que apesar das limitações deste estudo, pode-se inferir que a realidade aqui demonstrada, deva ser igual ou similar a de muitos hospitais brasileiros. Compete ao enfermeiro perioperatório a adoção de postura crítica diante da realidade vivenciada, bem como a busca e a implementação de evidências que assegurem a melhoria do cuidado prestado ao paciente cirúrgico. / Hypthermia affects more than 70% of patients in the intraoperative period, turning into a frequent adverse event. The general aim of this study was to analyze the body temperature of patients submitted to elective surgery in the intraoperative period. Specific goals were: to identify the relations between body temperature and sociodemographic (age and gender) and clinical (body mass index, blood transfusion and chronic diseases); to identify the relations between body temperature and variables related to the anesthetic-surgical procedure (duration of anesthesia, type of anesthesia and duration of surgery); to identify the relation between body temperature and the temperature of the operating room; to analyze the variance in patients\' mean body temperature measures, explained by predictive variables, and to identify the measures adopted in the surgery room to prevent hypothermia. Therefore, a quantitative prospective correlation study with a nonexperimental design was carried out at a philanthropic hospital located in the interior of São Paulo State, Brazil. The study sample included 70 subjects aged 18 years or older; submitted to elective surgery, who received anesthesia during at least one hour. For data collection, an instrument was elaborated and submitted to face and content validation. During the collection, the researcher measured the temperature and humidity of the operating room and the patient\'s body temperature at different times. Pearson\'s correlation coefficient was used to identify a statistically significant and negative correlation between three variables: patients\' mean body temperature, the duration of anesthesia and the duration of the surgery. In the positive sense, the body mass index and mean operating room temperature displayed statistically significant correlations with the patients\' mean body temperature. According to Student\'s t-test, the blood transfusion variable presented a statistically significant difference between the mean body temperatures of the group submitted to transfusion and the group that was not submitted to transfusion. As to the type of anesthesia, ANOVA showed a statistically significant difference between mean body temperatures and anesthesia groups (general, regional and combined), with the group submitted to combined anesthesia presenting lower mean body temperatures. In the multivariate linear regression, the variables type of anesthesia, duration of anesthesia, body mass index and operating room temperature were directly related with the research subjects\' mean body temperature. The measures adopted in the surgery room to prevent hypothermia were the use of cotton sheets and the wrapping of lower members, which are passive cutaneous warming methods; the forced-air warming system (active cutaneous warming method) was used once. It is concluded that, despite the study limitations, it can be inferred that the reality pictured here should be equal or similar to that of many Brazilian hospitals. Perioperative nurses should adopt a critical attitude towards this reality, and also look for and implement evidence that guarantees the improvement of care delivery to surgical patients.

O propósito deste estudo foi desenvolver e avaliar um software, que possibilite ao enfermeiro da unidade cirúrgica otimizar a assistência de enfermagem intraoperatória por meio do acesso eletrônico e sistemático às rotinas de trabalho de sua equipe. O percurso metodológico utilizado no desenvolvimento baseou-se na teoria de desenvolvimento de sistemas. A equipe multiprofissional envolvida no desenvolvimento do sistema foi constituída por dois enfermeiros pesquisadores, um analista de sistemas e um programador de computador da instituição coparticipante da pesquisa. Para avaliação do software utilizou-se o modelo proposto por Sperandio (2008), em conformidade com da norma ISO/IEC 25010 (2011), para cada característica. Participaram da avaliação dois grupos de avaliadores G1 (10 enfermeiros) e G2 (42 técnicos/auxiliares de enfermagem), também da instituição coparticipante da pesquisa. Atendento aos requisitos previamente levantados, o sistema foi desenvolvido em plataforma e linguagem Java com banco de dados IBM DB2 e servidor de aplicação JBoss, contendo seis módulos de fácil navegação. Na avaliação dos grupos G1 e G2 as características obtiveram as seguintes notas: \"funcionalidade\" (G1 - 100%; G2 - 99,60%), \"confiabilidade\" (G1 - 100%; G2-98,17%), \"usabilidade\" (G1 - 96,30%; G2 - 98,79%), \"eficiência de desenpenho\" (G1 - 96,67%; G2 - 100%), \"compatibilidade\" (G1 - 92,31%; G2 - 98,98%) e \"segurança\" (G1 - 100%; G2 - 99,85%). Considerando os resultados desta pesquisa, acredita-se que o software desenvolvido permitirá seus usuários enfermeiros, técnicos e auxiliares de enfermagem, da unidade cirúrgica, possam acessar suas rotinas de enfermagem intraoperatória de forma eficiente e sistemática, uma vez que o sistema desenvolvido permitiu concentrar todas as rotinas de enfermagem relacionadas à montagem, circulação e desmontagem de Sala Operatória, em um espaço seguro e acessível / The purpose of this study was to develop and evaluate a software that enables the surgical unit nurse to optimize intraoperative nursing care through electronic and systematic access to their team\'s work routines. The methodology applied in the development was based on the system development theory. The multi-professional team involved in the system development was composed of two research nurses, a systems analyst and a computer programmer from the co-participant institution in the research. To evaluate the software, the model proposed by Sperandio (2008) was used for each characteristic, according to ISO / IEC 25010 (2011). Two groups of G1 (10 nurses) and G2 evaluators (42 nursing technicians / auxiliaries) participated in the evaluation, also from the institution which cooperates with the research. In line with the requirements previously raised, the system was developed in Java platform and language with IBM DB2 database and JBoss application server, containing six easy-to-navigate modules. In the evaluation of groups G1 and G2, the following characteristics were obtained: \"functionality\" (G1 - 100%, G2 - 99.60%), \"reliability\" (G1 - 100%, G2-98,17% (G1 - 96.30%, G2 - 98.79%), \"performance efficiency\" (G1 - 96.67%, G2 - 100%), \"compatibility\" (G1 - 92.31%; , 98%) and \"safety\" (G1-100%, G2-99.85%). Considering this research results, the software developed will allow its users (nurses, technicians and nursing assistants from the surgical unit) to access their nursery routines in an efficient and systematic way, since the developed system permitted to concentrate all the nursing routines related to the Operating Room preparation and circulation, in a safe and accessible space

Submitted by Bianca de Fátima Pinheiro null (bih_pinheiro@hotmail.com) on 2017-03-25T00:39:00Z No. of bitstreams: 1 Defesa - Bianca Pinheiro - VERSÃO FINAL (1).pdf: 3735855 bytes, checksum: f6debe5602c92a8fb95b71a7c3ba52c9 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-03-29T18:26:16Z (GMT) No. of bitstreams: 1 pinheiro_bf_me_bot.pdf: 3735855 bytes, checksum: f6debe5602c92a8fb95b71a7c3ba52c9 (MD5) / Made available in DSpace on 2017-03-29T18:26:16Z (GMT). No. of bitstreams: 1 pinheiro_bf_me_bot.pdf: 3735855 bytes, checksum: f6debe5602c92a8fb95b71a7c3ba52c9 (MD5) Previous issue date: 2017-02-24 / Neste trabalho foram analisados os custos financeiros decorrentes da implantação de um serviço de radioterapia intraoperatória (IORT), considerando os valores gastos para a construção do centro cirúrgico e demais dependências necessárias anexas a um serviço de radioterapia pré-existente, bem como os valores de aquisição de acessórios específicos para IORT para uso em um acelerador linear clínico. Foi comparada a realização do procedimento de IORT com o acelerador linear fixo e com o equipamento irradiador móvel (INTRABEAM®). Os dados obtidos foram coletados por e-mail e telefone junto aos serviços de radioterapia cadastrados na Sociedade Brasileira de Radioterapia, e junto aos fornecedores do ramo de radioterapia (Medical Systems, Elekta Medical Systems e ZEISS), além disso, o ambiente destinado para IORT do Hospital das Clínicas de Botucatu foi avaliado nos aspectos sócios econômicos. Foram analisados artigos publicados por serviço de radioterapia que realizam IORT, e selecionados os 10 principais, ilustrando a eficiência do procedimento. A pesquisa com os centros de radioterapia apontou que dos participantes apenas 17,7% realizam o procedimento. Os custos apontados para a instalação do serviço de IORT no Hospital das Clínicas de Botucatu somam a quantia de R$290.000,00. Comparando o Acelerador Linear com o INTRABEAM®, ambos possuem um tempo total gasto no procedimento semelhante. A avaliação do CONITEC do Ministério da Saúde mostrou não ser favorável para a incorporação da IORT usando o INTRABEAM® no SUS. Avaliando os repasses financeiros para o procedimento de IORT, o SUS ainda não incorporou nas suas diretrizes, no entanto, de acordo com a esfera privada, o procedimento de IORT custaria em torno de R$11.000,00, levando em consideração os gastos do Hospital das Clínicas de Botucatu, são necessárias à realização de 27 procedimentos para a reposição do investimento inicial. São ilustrados os benefícios terapêuticos da técnica de IORT frente à radioterapia convencional. Também estão ilustrados os parâmetros físicos analisados no processo de controle de qualidade dos procedimentos de radioterapia intraoperatória. O trabalho aponta que a IORT pode contribuir para minimizar a concentração de pacientes em processo de espera pelo tratamento convencional fracionado, e assim proporcionar maior conforto aos doentes, além de reduzir os custos dos procedimentos radioterápicos atualmente reembolsados pelos sistemas de saúde. / In this study, the financial costs resulting from the implantation of an intraoperative radiotherapy service (IORT) were analyzed, considering the amounts spent for the construction of the surgical center and other necessary dependencies attached to a pre-existing radiotherapy service, as well as the acquisition values IORT-specific accessories for use in a clinical linear accelerator. The IORT procedure was compared with the fixed linear accelerator and with the mobile radiator device (INTRABEAM®). The data obtained were collected by e-mail and telephone with radiotherapy services registered at the Brazilian Society of Radiotherapy, and with radiotherapy providers (Medical Systems, Elekta Medical Systems and ZEISS), and the environment for IORT Of the Botucatu Clinic Hospital was evaluated in the socioeconomic aspects. We analyzed published articles by radiotherapy service that performed IORT, and selected the 10 main ones, illustrating the efficiency of the procedure. The research with the radiotherapy centers pointed out that of the participants only 17.5% performed the procedure. The costs indicated for the installation of the IORT service at Botucatu Clinic Hospital add up to the amount of R$ 290.000,00. Comparing the Linear Accelerator with INTRABEAM®, both have a total time spent in the similar procedure. The CONITEC evaluation of the Ministry of Health was not favorable for the incorporation of IORT using INTRABEAM® in the SUS. Evaluating the financial onlendings for the IORT procedure, the SUS has not yet incorporated into its guidelines, however, according to the private sphere, the IORT procedure would cost around R$ 11.000,00, taking into account the Botucatu Clinic Hospital, are necessary to carry out 27 procedures for the replacement of the initial investment. The therapeutic benefits of IORT versus conventional radiotherapy are illustrated. Also shown are the physical parameters analyzed in the quality control process of the intraoperative radiotherapy procedures. The study points out that IORT can contribute to minimizing the concentration of patients waiting for the conventional fractionated treatment, thus providing greater comfort to the patients, besides reducing the costs of the radiotherapy procedures currently reimbursed by the health systems.

Orientador: Marco Antônio Rodrigues Fernandes / Resumo: Neste trabalho foram analisados os custos financeiros decorrentes da implantação de um serviço de radioterapia intraoperatória (IORT), considerando os valores gastos para a construção do centro cirúrgico e demais dependências necessárias anexas a um serviço de radioterapia pré-existente, bem como os valores de aquisição de acessórios específicos para IORT para uso em um acelerador linear clínico. Foi comparada a realização do procedimento de IORT com o acelerador linear fixo e com o equipamento irradiador móvel (INTRABEAM®). Os dados obtidos foram coletados por e-mail e telefone junto aos serviços de radioterapia cadastrados na Sociedade Brasileira de Radioterapia, e junto aos fornecedores do ramo de radioterapia (Medical Systems, Elekta Medical Systems e ZEISS), além disso, o ambiente destinado para IORT do Hospital das Clínicas de Botucatu foi avaliado nos aspectos sócios econômicos. Foram analisados artigos publicados por serviço de radioterapia que realizam IORT, e selecionados os 10 principais, ilustrando a eficiência do procedimento. A pesquisa com os centros de radioterapia apontou que dos participantes apenas 17,7% realizam o procedimento. Os custos apontados para a instalação do serviço de IORT no Hospital das Clínicas de Botucatu somam a quantia de R$290.000,00. Comparando o Acelerador Linear com o INTRABEAM®, ambos possuem um tempo total gasto no procedimento semelhante. A avaliação do CONITEC do Ministério da Saúde mostrou não ser favorável para a incorporação da ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In this study, the financial costs resulting from the implantation of an intraoperative radiotherapy service (IORT) were analyzed, considering the amounts spent for the construction of the surgical center and other necessary dependencies attached to a pre-existing radiotherapy service, as well as the acquisition values IORT-specific accessories for use in a clinical linear accelerator. The IORT procedure was compared with the fixed linear accelerator and with the mobile radiator device (INTRABEAM®). The data obtained were collected by e-mail and telephone with radiotherapy services registered at the Brazilian Society of Radiotherapy, and with radiotherapy providers (Medical Systems, Elekta Medical Systems and ZEISS), and the environment for IORT Of the Botucatu Clinic Hospital was evaluated in the socioeconomic aspects. We analyzed published articles by radiotherapy service that performed IORT, and selected the 10 main ones, illustrating the efficiency of the procedure. The research with the radiotherapy centers pointed out that of the participants only 17.5% performed the procedure. The costs indicated for the installation of the IORT service at Botucatu Clinic Hospital add up to the amount of R$ 290.000,00. Comparing the Linear Accelerator with INTRABEAM®, both have a total time spent in the similar procedure. The CONITEC evaluation of the Ministry of Health was not favorable for the incorporation of IORT using INTRABEAM® in the SUS. Evaluating the financial onlendings for ... (Complete abstract click electronic access below) / Mestre

International Classification of Diseases the 10th Revision (ICD-10) was implemented October 1, 2015, and there was little knowledge how the transition to ICD-10 would impact the revenue cycle for intraoperative neurophysiological monitoring medical practices in Oklahoma. This correlational quantitative study examined the changes in dependent variables of reimbursements due to the change from ICD-9 to ICD-10 for independent variables of intraoperative neurophysiological monitoring procedure codes. The reimbursements from 2014 were compared to reimbursements from 2016. Prices were adjusted for inflation to 2016 dollar values. Annual reimbursements decreased for all intraoperative neurophysiological monitoring procedures examined except the remote monitoring code. The intraoperative neurophysiological monitoring procedure with the greatest mean annual decreases in reimbursement was the lower somatosensory evoked potentials. The intraoperative neurophysiological monitoring procedures with the least annual reimbursement decreases were transcranial electrical motor potential monitoring and electromyography. The findings of the budget-impact analysis and cost-effectiveness analysis indicated that reimbursement for procedures has steadily decreased from 2014 to 2016, causing a negative effect on practices' revenue cycle management. The findings of this study could benefit intraoperative neurophysiological monitoring companies in Oklahoma by supporting adjustments essential for healthcare leaders to maintain a financially sustainable intraoperative neurophysiological monitoring medical practice.

Die periprothetische Infektion nach endoprothetischen Operationen in der Orthopädie ist eine dramatische Komplikation, die nicht nur die Gesundheit des Patienten in hohem Maße kompromitiert und gefährdet, sondern auch in ökonomischer Hinsicht ein enormes Problem darstellt. Zahlreiche prophylaktische Maßnahmen, wie z.B. aseptische Techniken, präoperative Hautantiseptik und perioperative Antibiotikaprophylaxe tragen zur postoperativen Infektionsreduktion bei. Die Infektionsraten bewegen sich aber weiterhin zwischen 0,3% und 4,97%, je nach Implantatlokalisation. Hinzu kommt das Auftreten multiresistenter Erreger, die eine erfolgreiche Behandlung mit Antibiotika stark erschweren oder sogar unmöglich machen. Weltweit 58 zeichnet sich ein drastischer Anstieg von resistenten Erregern ab, die in Zukunft bisher wirksame Antibiotika womöglich gänzlich nutzlos werden lassen könnten. In Hinsicht auf amerikanische Studien, die den Bedarf an orthopädischer Endoprothetik hochgerechnet haben, ist bis 2030 allein in den USA eine nahezu Versiebenfachung von totaler Knieendoprothetik zu erwarten. Dies würde die Infektionsproblematik enorm verschärfen, wenn bis dahin keine neuen, wirksameren Prophylaxemaßnahmen zum Einsatz kämen. Es ist dringend notwendig alternative Substanzen zu erforschen, die vor allem bei aseptischen Operationen gute Wirksamkeit und Verträglichkeit vereinen, ohne Resistenzen zu fördern und somit postoperative Infektionen weiter zu senken oder zu verhindern. Studien mit Antiseptika, wie PVP-Iod, konnten bereits positive Ergebnisse liefern, die ein Lichtblick in der vorliegenden Problematik darstellen. Der Mangel an relevanten, hochwertigen Studien auf diesem Themengebiet lassen eine allgemeingültige klinische Empfehlung allerdings nur mit Vorsicht zu. Die intraoperative Wundspülung mit PVP-Iod als 0,35%ige Lösung und anschließendem Nachspülen mit steriler physiologischer Kochsalzlösung, kann zumindest bei Wirbelsäulenoperationen mit Instrumentierung als sinnvolle Infektionsprophylaxe angesehen werden. Die Resultate dieser Übersichtsarbeit rechtfertigen zudem weitere hochwertige Studien mit PVP-Iod, die nötig sind, um die bisherigen positiven Ergebnisse zu verifizieren und die letztendlich zu einer medizinischen Evidenz für endoprothetische Operationen in der Orthopädie führen könnten. Aber auch alternative Antiseptika sollten weiter erforscht werden, um bei speziellen Problematiken auf möglichst viele Alternativen zurückgreifen zu können. / Periprosthetic Infections after endoprosthetic operations in orthopedics is a dramatic complication, which compromises the health of patients and poses a huge economic problem. Several prophylactic actions, e.g. aseptic techniques, preoperative skin antiseptic and perioperative antibiotic prophylaxis, provides reduction of postoperative infections. However, the rate of infections still occurs with a prevalence of 0,3 - 4,97%, depending on implant localization. In addition, prevalence of multidrug resistant germs is rising, which complicates an antibiotic treatment. Worldwide there is a dramatic increase of resistant pathogenic germs, which could lead to ineffective antibiotics in the near future. Studies have predicted a demand of total knee arthroplastics, which will be nearly seven times higher by 2030 in the USA. Thus, result in an enormous increase of postoperative infections without advances in effective prophylactic strategies. It is urgently necessary to explore substances, especially for aseptic operations, which unite effectiveness and compatibility without provoking resistant germs and decrease or avert postoperative infections. Studies with Povidoneiodine showed positive results for the evaluated special field of endoprosthetics. However, there is a lack of relevant high-quality studies. The irrigation of surgical wounds in spine surgery with instrumentation with a dilute solution of 0,35% Povidoneiodine and following rinsing with isotonic sodium chloride solution could constitute an effective infection prophylaxis. In addition, the results of this systematic review justify further high-quality studies with Povidoneiodine to verify the existing positive results, which could lead to medical evidence for endoprosthetic operations in orthopaedics. Moreover, other substances should be explored to ensure alternatives in cases of special complications.

Staging is critical in the management of cancer. Sentinel lymph node (SLN) biopsy is one method used in the assessment of cancer spread. SLN procedures are standard practice in the management of some cancers although; these procedures have only recently been developed and refined. SLN procedures are commonly used in the management of melanomas and breast cancers in patients with no evidence of metastatic disease on clinical exam. SLN procedures include detection, localization, and assessment of SLNs. The detection/localization components vary in technique and rates of success. The procedures with the least number of detection/localization techniques generally include the use of blue dye or the use of a radiotracer with intraoperative gamma counting. The most complex procedures involve the use of blue dye, the use of a radiotracer with preoperative gamma imaging and preoperative gamma counting, intraoperative gamma counting, or some combination of these techniques. The ideal procedure for SLN would include all the listed techniques however; all facilities do not incorporate the most complete procedure, for different reasons. An investigation using a small FOV (5 in x 5 in) gamma camera intraoperatively for SLN procedures in melanoma and breast cancer patients was performed. A smaller FOV camera is capable of obtaining some of the same information as a conventional gamma camera. It is possible that centers, which do not or are not able to take advantage of preoperative imaging, may find the use of a smaller FOV gamma camera in the operating room useful. The investigation consisted of a total of 41 patients; it was split into two studies, Study 1: melanoma and study 2: breast cancer. The melanoma study found the added use of a smaller FOV camera under the parameters of this study to be minimal. Study 2 was broken into two branches; branch 1: camera/probe/dye and branch 2: probe/dye, for a comparison study. Comparing the two branches did not show the smaller FOV camera to reduce the time spent in the operating room versus using the probe and blue dye.

No description available.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.

Habilitation - Universität, Heidelberg, 1999.