Orientador: Jose Luiz Tatagiba Lamas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T11:29:52Z (GMT). No. of bitstreams: 1 Salvadori_AnitaModa_M.pdf: 2676870 bytes, checksum: 3fce7bde2fc549cdd3990fd9e89b48c9 (MD5) Previous issue date: 2007 / Resumo: No Brasil, o câncer é a segunda causa de morte por doença, sendo que o de pulmão tem uma elevada mortalidade, pois grande parte dos pacientes o descobre em um estágio avançado. Seu tratamento pode ser cirúrgico, quimioterápico, radioterápico ou uma combinação destes. O tratamento quimioterápico traz diversos efeitos colaterais para os pacientes. A enfermeira deve estar apta a lidar com essas angústias e efeitos dos medicamentos, de modo que o paciente consiga realizar seu autocuidado em casa. Para isso necessita de uma assistência de enfermagem individualizada e efetiva. A presente dissertação, inserida na linha de pesquisa Processo de Cuidar em Saúde e Enfermagem, teve os objetivos de elaborar um instrumento de coleta de dados para pacientes com câncer de pulmão em quimioterapia ambulatorial baseado na teoria de Dorothea Orem, avaliar o conteúdo do instrumento e avaliar a confiabilidade do instrumento. A elaboração do instrumento foi baseada na revisão da literatura, nas características clínicas e necessidades dos pacientes com câncer de pulmão e na teoria de Dorothea Orem. Os dados foram coletados no Hospital daS Clínicas da Universidade Estadual de Campinas, no ambulatório de quimioterapia. Inicialmente o instrumento foi analisado por cinco juizes, peritos no assunto e submetido ao coeficiente de Kappa, teste de Friedman e teste de concordância de Kendall. Uma vez modificado, em função dos resultado da análise estatítica, o instrumento foi. submetido ao pré-teste. Os resultados do pré-teste deram origem a nova reformulação, após a qual se procedeu à avaliação da confiabilidade pelo método da equivalência. A análise estatística destes dados foi realizada por meio do coeficiente Kappa e, teste de Wilcoxon. O instrumento foi dividido em duas partes: a primeira foi composta de dados pessoais e requisitos de autocuidado universais e a segunda parte pelo exame fisico, na qual se utilizou a concordância entre dois observadores para a coleta de dados. Pudemos observar que houve discordância em poucos itens, muitos deles relacionados à subjetividade do observador. A concordância entre observadores se mostrou alta. A. conclusão é que o instrumento se mostrou eficaz para a coleta de dados de pacientes com câncer de pulmão em quimioterapia ambulatorial / Abstract: In Brazil cancer is the second cause of death, if we consider only deathes caused by illnesses. Lung cancer, in particular, presents high mortality, beca.use most patients discover it in an advanced stage. The tteatment can be made by surgery, chemotherapy, radiotherapy or a combination. Chemotherapy has many side effects. Nurses must be able to face every side effect, giving to the patient conditions to perform self-care at home. Todo this, patients need an individual and effective nursing assistance. This study is inserted in the research line Process of Care in Hea1th and Nursing and its objectives were to develop a data collecting instrument to patients with lung cancer tteated by chemotherapy in ambulatory and to evaluate the contents and the reliability of the instrument. It was elaborated based on a literature review, on the clinical characteristics and the needs of the patients and on Dorothea Orem's theory. Data were collected in Hospital das Clínicas, Universidade Estadual de Campinas, in the ambulatory of chemotherapy. The instrument was evaluated by tive judges, experts in the area, and analised by Kappa, Friedman and Kendall agreement tests. Depending on the results, the instrument was modified and tested as a preliminar version. New results originated new moditications, and then the reliability was evaluated by the equivalence method. The statistical analysis was made by means of Kappa coeflicient and Wilcoxon test. The instrument was divided in two parts: the first one consisted of personal data and universal self-care requisites; the second part was composed of physical exam, and this part was submitted to the reliability test. It was observed that there was disagreement in few itens, in most occasions due to observer' s subjectivity. Agreement between observers was high. The conclusion is that the instrument snowed to be eflicient to collect data from patients with lung cancer in ambulatorial chemotherapy / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O cÃncer de pulmÃo (CP) à uma agressÃo maligna com caracterÃsticas inflamatÃrias e muitas vezes ressecÃveis. A escolha do fibrinogÃnio e albumina deve ao fato de serem marcadores inflamatÃrios e se manifestarem em CP, muitas vezes associado à doenÃa obstrutiva crÃnica. As complicaÃÃes pulmonares ainda sÃo preocupaÃÃes nas ressecÃÃes pulmonares. O estudo avaliou o impacto da reabilitaÃÃo pulmonar nos marcadores inflamatÃrios prÃ-operatÃrios e nas complicaÃÃes pulmonares pÃs-operatÃrias de pacientes com CP. Ensaio clÃnico, controlado com 31 pacientes, com doenÃa obstrutiva de moderado a grave, estadiamento IA a IIIA, aleatorizados em: Grupo A (GA) submetido à RP e o controle Grupo B (GB) a fisioterapia respiratÃria (FR). Avaliados antes e apÃs 4 semanas do protocolo do estudo pela funÃÃo pulmonar, forÃa muscular respiratÃria, capacidade funcional, forÃa muscular de membros superiores (MMSS), capacidade mÃxima e submÃxima de exercÃcio, ansiedade e depressÃo (HADS), qualidade de vida pelo Short-Form36 (SF36), fibrinogÃnio e albumina. ApÃs a cirurgia foram analisadas as complicaÃÃes pulmonares. O GA realizou treinamento aerÃbico, de forÃa muscular perifÃrica e respiratÃria. O GB executou tÃcnicas para expansÃo pulmonar. Os grupos receberam aulas educativas e realizaram os protocolos com tempo equÃnime. O estudo foi aprovado pelo Comità de Ãtica do Hospital de Messejana. No GA houve melhora significativa da CVF passando de 65Â17 para 76Â15% previsto (p=0,003), da PImax de 78Â46 para 104Â42cmH2O (p=0,0003), da PEmax, de 78Â21 para 93Â25cmH2O (p=0,0009), aumento da distÃncia percorrida de 435Â70 para 491Â88m (p<0,0001), da carga mÃxima para MMSS de 1,0 para 2,0kg (p=0,008), da inclinaÃÃo do teste de MMII de 5Â3 para 8Â3% (p<0,0001) e velocidade de 4,9 [3,7-5,5] para 5,2 [4,4-6] (p=0,002), da capacidade submÃxima de MMII de 447Â179 para 718Â220s (p=0,002), da HADS-A de 9,9Â4,9 para 4,9Â2,7 (p<0,0001), do HADS-D de 9,05Â4,08 para 4,9Â2,1 (p<0,0001), da qualidade de vida com Coeficiente FÃsico Sumarizado (CFS) de 37,5Â9,07 para 46,15Â8,7% (p=0,004) e do fibrinogÃnio de 448,3Â129,9 para 321,6Â73,2mg/dl (p=0,0002). A albumina nÃo apresentou nenhum resultado significativo nos grupos (p>0,05). No GB houve aumento significativo da PImax 50Â22 para 70Â35(p=0,004) e reduÃÃo nÃo significante no fibrinogÃnio passando de 490,7Â199,7 para 453,3Â177,2 mg/dl(p=0,3). Nas demais variÃveis o GB nÃo apresentou resultados significantes. Quando comparados entre grupos houve diferenÃa significante nas variÃveis: teste da caminhada de 6min (p=0,0001), forÃa muscular de MMSS (p=0,009), inclinaÃÃo (p=0,0008), endurance (p=0,005), HADS-A (p=0,0002), HADS-D (p=0,04), CFS (p=0,03) e fibrinogÃnio (p=0,04). Dos 31 pacientes, 10 nÃo realizaram cirurgia. Nas complicaÃÃes pulmonares pÃs-cirÃrgicas o GA relacionados a morbidade de menor e maior relevÃncia apresentou menor percentual (p=0,002 e p=0,01 respectivamente), menor tempo de internaÃÃo hospitalar (p=0,004) e dreno torÃcico (p=0,03), percentual menor de fÃstula broncopleural (p=0,009) e menor presenÃa de broncoespasmo (p=0,002) quando comparado com GB. A RP prÃ-operatÃria teve impacto na diminuiÃÃo dos nÃveis sÃricos de fibrinogÃnio, melhora dos parÃmetros clÃnicos funcionais, qualidade de vida, ansiedade e depressÃo e reduziu o percentual de complicaÃÃes pulmonares no pÃs-operatÃrio. Na ausÃncia de RP a FR pode ser uma estratÃgia importante no prÃ-operatÃrio. / O cÃncer de pulmÃo (CP) à uma agressÃo maligna com caracterÃsticas inflamatÃrias e muitas vezes ressecÃveis. A escolha do fibrinogÃnio e albumina deve ao fato de serem marcadores inflamatÃrios e se manifestarem em CP, muitas vezes associado à doenÃa obstrutiva crÃnica. As complicaÃÃes pulmonares ainda sÃo preocupaÃÃes nas ressecÃÃes pulmonares. O estudo avaliou o impacto da reabilitaÃÃo pulmonar nos marcadores inflamatÃrios prÃ-operatÃrios e nas complicaÃÃes pulmonares pÃs-operatÃrias de pacientes com CP. Ensaio clÃnico, controlado com 31 pacientes, com doenÃa obstrutiva de moderado a grave, estadiamento IA a IIIA, aleatorizados em: Grupo A (GA) submetido à RP e o controle Grupo B (GB) a fisioterapia respiratÃria (FR). Avaliados antes e apÃs 4 semanas do protocolo do estudo pela funÃÃo pulmonar, forÃa muscular respiratÃria, capacidade funcional, forÃa muscular de membros superiores (MMSS), capacidade mÃxima e submÃxima de exercÃcio, ansiedade e depressÃo (HADS), qualidade de vida pelo Short-Form36 (SF36), fibrinogÃnio e albumina. ApÃs a cirurgia foram analisadas as complicaÃÃes pulmonares. O GA realizou treinamento aerÃbico, de forÃa muscular perifÃrica e respiratÃria. O GB executou tÃcnicas para expansÃo pulmonar. Os grupos receberam aulas educativas e realizaram os protocolos com tempo equÃnime. O estudo foi aprovado pelo Comità de Ãtica do Hospital de Messejana. No GA houve melhora significativa da CVF passando de 65Â17 para 76Â15% previsto (p=0,003), da PImax de 78Â46 para 104Â42cmH2O (p=0,0003), da PEmax, de 78Â21 para 93Â25cmH2O (p=0,0009), aumento da distÃncia percorrida de 435Â70 para 491Â88m (p<0,0001), da carga mÃxima para MMSS de 1,0 para 2,0kg (p=0,008), da inclinaÃÃo do teste de MMII de 5Â3 para 8Â3% (p<0,0001) e velocidade de 4,9 [3,7-5,5] para 5,2 [4,4-6] (p=0,002), da capacidade submÃxima de MMII de 447Â179 para 718Â220s (p=0,002), da HADS-A de 9,9Â4,9 para 4,9Â2,7 (p<0,0001), do HADS-D de 9,05Â4,08 para 4,9Â2,1 (p<0,0001), da qualidade de vida com Coeficiente FÃsico Sumarizado (CFS) de 37,5Â9,07 para 46,15Â8,7% (p=0,004) e do fibrinogÃnio de 448,3Â129,9 para 321,6Â73,2mg/dl (p=0,0002). A albumina nÃo apresentou nenhum resultado significativo nos grupos (p>0,05). No GB houve aumento significativo da PImax 50Â22 para 70Â35(p=0,004) e reduÃÃo nÃo significante no fibrinogÃnio passando de 490,7Â199,7 para 453,3Â177,2 mg/dl(p=0,3). Nas demais variÃveis o GB nÃo apresentou resultados significantes. Quando comparados entre grupos houve diferenÃa significante nas variÃveis: teste da caminhada de 6min (p=0,0001), forÃa muscular de MMSS (p=0,009), inclinaÃÃo (p=0,0008), endurance (p=0,005), HADS-A (p=0,0002), HADS-D (p=0,04), CFS (p=0,03) e fibrinogÃnio (p=0,04). Dos 31 pacientes, 10 nÃo realizaram cirurgia. Nas complicaÃÃes pulmonares pÃs-cirÃrgicas o GA relacionados a morbidade de menor e maior relevÃncia apresentou menor percentual (p=0,002 e p=0,01 respectivamente), menor tempo de internaÃÃo hospitalar (p=0,004) e dreno torÃcico (p=0,03), percentual menor de fÃstula broncopleural (p=0,009) e menor presenÃa de broncoespasmo (p=0,002) quando comparado com GB. A RP prÃ-operatÃria teve impacto na diminuiÃÃo dos nÃveis sÃricos de fibrinogÃnio, melhora dos parÃmetros clÃnicos funcionais, qualidade de vida, ansiedade e depressÃo e reduziu o percentual de complicaÃÃes pulmonares no pÃs-operatÃrio. Na ausÃncia de RP a FR pode ser uma estratÃgia importante no prÃ-operatÃrio. / O cÃncer de pulmÃo (CP) à uma agressÃo maligna com caracterÃsticas inflamatÃrias e muitas vezes ressecÃveis. A escolha do fibrinogÃnio e albumina deve ao fato de serem marcadores inflamatÃrios e se manifestarem em CP, muitas vezes associado à doenÃa obstrutiva crÃnica. As complicaÃÃes pulmonares ainda sÃo preocupaÃÃes nas ressecÃÃes pulmonares. O estudo avaliou o impacto da reabilitaÃÃo pulmonar nos marcadores inflamatÃrios prÃ-operatÃrios e nas complicaÃÃes pulmonares pÃs-operatÃrias de pacientes com CP. Ensaio clÃnico, controlado com 31 pacientes, com doenÃa obstrutiva de moderado a grave, estadiamento IA a IIIA, aleatorizados em: Grupo A (GA) submetido à RP e o controle Grupo B (GB) a fisioterapia respiratÃria (FR). Avaliados antes e apÃs 4 semanas do protocolo do estudo pela funÃÃo pulmonar, forÃa muscular respiratÃria, capacidade funcional, forÃa muscular de membros superiores (MMSS), capacidade mÃxima e submÃxima de exercÃcio, ansiedade e depressÃo (HADS), qualidade de vida pelo Short-Form36 (SF36), fibrinogÃnio e albumina. ApÃs a cirurgia foram analisadas as complicaÃÃes pulmonares. O GA realizou treinamento aerÃbico, de forÃa muscular perifÃrica e respiratÃria. O GB executou tÃcnicas para expansÃo pulmonar. Os grupos receberam aulas educativas e realizaram os protocolos com tempo equÃnime. O estudo foi aprovado pelo Comità de Ãtica do Hospital de Messejana. No GA houve melhora significativa da CVF passando de 65Â17 para 76Â15% previsto (p=0,003), da PImax de 78Â46 para 104Â42cmH2O (p=0,0003), da PEmax, de 78Â21 para 93Â25cmH2O (p=0,0009), aumento da distÃncia percorrida de 435Â70 para 491Â88m (p<0,0001), da carga mÃxima para MMSS de 1,0 para 2,0kg (p=0,008), da inclinaÃÃo do teste de MMII de 5Â3 para 8Â3% (p<0,0001) e velocidade de 4,9 [3,7-5,5] para 5,2 [4,4-6] (p=0,002), da capacidade submÃxima de MMII de 447Â179 para 718Â220s (p=0,002), da HADS-A de 9,9Â4,9 para 4,9Â2,7 (p<0,0001), do HADS-D de 9,05Â4,08 para 4,9Â2,1 (p<0,0001), da qualidade de vida com Coeficiente FÃsico Sumarizado (CFS) de 37,5Â9,07 para 46,15Â8,7% (p=0,004) e do fibrinogÃnio de 448,3Â129,9 para 321,6Â73,2mg/dl (p=0,0002). A albumina nÃo apresentou nenhum resultado significativo nos grupos (p>0,05). No GB houve aumento significativo da PImax 50Â22 para 70Â35(p=0,004) e reduÃÃo nÃo significante no fibrinogÃnio passando de 490,7Â199,7 para 453,3Â177,2 mg/dl(p=0,3). Nas demais variÃveis o GB nÃo apresentou resultados significantes. Quando comparados entre grupos houve diferenÃa significante nas variÃveis: teste da caminhada de 6min (p=0,0001), forÃa muscular de MMSS (p=0,009), inclinaÃÃo (p=0,0008), endurance (p=0,005), HADS-A (p=0,0002), HADS-D (p=0,04), CFS (p=0,03) e fibrinogÃnio (p=0,04). Dos 31 pacientes, 10 nÃo realizaram cirurgia. Nas complicaÃÃes pulmonares pÃs-cirÃrgicas o GA relacionados a morbidade de menor e maior relevÃncia apresentou menor percentual (p=0,002 e p=0,01 respectivamente), menor tempo de internaÃÃo hospitalar (p=0,004) e dreno torÃcico (p=0,03), percentual menor de fÃstula broncopleural (p=0,009) e menor presenÃa de broncoespasmo (p=0,002) quando comparado com GB. A RP prÃ-operatÃria teve impacto na diminuiÃÃo dos nÃveis sÃricos de fibrinogÃnio, melhora dos parÃmetros clÃnicos funcionais, qualidade de vida, ansiedade e depressÃo e reduziu o percentual de complicaÃÃes pulmonares no pÃs-operatÃrio. Na ausÃncia de RP a FR pode ser uma estratÃgia importante no prÃ-operatÃrio. / Lung cancer (LC) is a malignant aggression which can be also surgically treated characterized by inflammation and higher mortality rates. Pulmonary complications are still concerning. The choice of studying fibrinogen and albumin is due to the fact that they are active inflammatory markers in LC often associated with chronic obstructive pulmonary disease. Pulmonary complications subsequent to lung resection are still worrying. This study evaluated the impact of Pulmonary Rehabilitation (PR) on preoperative inflammatory markers and postoperative pulmonary complications of LC patients. Controlled clinical trial with 31 patients with moderate to severe obstructive disease, stages IA to IIIA, randomized into Group A (GA) undergone PR and the control group - Group B (GB) undergone respiratory therapy (RT). Pulmonary function, respiratory muscle strength, functional capacity, upper limbs muscle strength, maximum and submaximal exercise capacity, Hospital anxiety and depression scale (HADS), quality of life through Short-form36 (SF36), fibrinogen and albumin were evaluated before and after a 4 weeks of the survey protocols. After surgery pulmonary complications were analyzed. GA performed aerobic physical training, peripheral and respiratory muscle strength training. GB performed lung expansion techniques. Both groups received educational classes and performed the protocols in similar time. The study was approved by the institutionâs ethic committee. There was in GA significant improvements in FVC from 65Â17 to 76 15% of its predicted (p=0.003 ), in maximal inspiratory pressure (MIP) from 78Â46 to 104 42cmH2O (p=0.0003 ), in maximal expiratory pressure (MEP) from 78Â21 to 93 25cmH2O (p=0.0009 ); in walked distance from 435Â70 to 491Â88 m (p<0.0001 ), upper limb maximum load from 1.0 to 2.0 kg (p=0.008 ), in treadmill inclination from 5Â3 to 8 3% (p<0.0001 ) and speed from 4.9 [3.7 -5.5] to 5.2 [4.4 -6] (p=0.002 ), submaximal exercise capacity from 447Â179 to 718 220s (p=0.002 ), in anxiety from 9.9 Â4.9 to 4.9 Â2.7 (p<0.0001 ), and depression from 9.05 Â4.08 to 4.9 Â2.1 (p<0.0001 ), in quality of life with Physical Component Summary (PCS) from 37.5 Â9.07 to 46.15  8.7 % (p=0.004 ) and fibrinogen to 448.3 Â129.9 to 321.6  73.2 mg/dl (p=0.0002 ). Albumin has not showed significant result in both groups. In GB there was significant increase in MIP 50Â22 to 70 35 (p=0.004) and reduction in fibrinogen from 490.7  199.7 to 453.3  177.2 mg/dl (p=0.3). Other variables GB did not show any significant results. When comparing results between groups there was significant difference in the walked distance (p=0,0001), in upper limb strength (p=0,009), in inclination (p=0,0008), in endurance (p=0,005), in anxiety (p=0,0002), in depression (p=0,04), in PCS (p=0,03) and fibrinogen (p=0,04). Out of 31 patients, 10 were not operated. In postoperative pulmonary complications, GA show less greater and lesser relevance morbidity (p=0,002 and p=0,01 respectively) shorter length of hospital stay (p=0,004), less chest tube days(p=0,03), lower percentage of bronchial fistula (p=0,009) and less bronchospasm (p=0,002). When compared to GB. PR had impact on the reduction of serum fibrinogen, on clinical improvements, health related quality of life, anxiety and depression, and also reduced postoperative pulmonary complications. In the absence of PR programs, RT can be an important preoperative strategy. / Lung cancer (LC) is a malignant aggression which can be also surgically treated characterized by inflammation and higher mortality rates. Pulmonary complications are still concerning. The choice of studying fibrinogen and albumin is due to the fact that they are active inflammatory markers in LC often associated with chronic obstructive pulmonary disease. Pulmonary complications subsequent to lung resection are still worrying. This study evaluated the impact of Pulmonary Rehabilitation (PR) on preoperative inflammatory markers and postoperative pulmonary complications of LC patients. Controlled clinical trial with 31 patients with moderate to severe obstructive disease, stages IA to IIIA, randomized into Group A (GA) undergone PR and the control group - Group B (GB) undergone respiratory therapy (RT). Pulmonary function, respiratory muscle strength, functional capacity, upper limbs muscle strength, maximum and submaximal exercise capacity, Hospital anxiety and depression scale (HADS), quality of life through Short-form36 (SF36), fibrinogen and albumin were evaluated before and after a 4 weeks of the survey protocols. After surgery pulmonary complications were analyzed. GA performed aerobic physical training, peripheral and respiratory muscle strength training. GB performed lung expansion techniques. Both groups received educational classes and performed the protocols in similar time. The study was approved by the institutionâs ethic committee. There was in GA significant improvements in FVC from 65Â17 to 76 15% of its predicted (p=0.003 ), in maximal inspiratory pressure (MIP) from 78Â46 to 104 42cmH2O (p=0.0003 ), in maximal expiratory pressure (MEP) from 78Â21 to 93 25cmH2O (p=0.0009 ); in walked distance from 435Â70 to 491Â88 m (p<0.0001 ), upper limb maximum load from 1.0 to 2.0 kg (p=0.008 ), in treadmill inclination from 5Â3 to 8 3% (p<0.0001 ) and speed from 4.9 [3.7 -5.5] to 5.2 [4.4 -6] (p=0.002 ), submaximal exercise capacity from 447Â179 to 718 220s (p=0.002 ), in anxiety from 9.9 Â4.9 to 4.9 Â2.7 (p<0.0001 ), and depression from 9.05 Â4.08 to 4.9 Â2.1 (p<0.0001 ), in quality of life with Physical Component Summary (PCS) from 37.5 Â9.07 to 46.15  8.7 % (p=0.004 ) and fibrinogen to 448.3 Â129.9 to 321.6  73.2 mg/dl (p=0.0002 ). Albumin has not showed significant result in both groups. In GB there was significant increase in MIP 50Â22 to 70 35 (p=0.004) and reduction in fibrinogen from 490.7  199.7 to 453.3  177.2 mg/dl (p=0.3). Other variables GB did not show any significant results. When comparing results between groups there was significant difference in the walked distance (p=0,0001), in upper limb strength (p=0,009), in inclination (p=0,0008), in endurance (p=0,005), in anxiety (p=0,0002), in depression (p=0,04), in PCS (p=0,03) and fibrinogen (p=0,04). Out of 31 patients, 10 were not operated. In postoperative pulmonary complications, GA show less greater and lesser relevance morbidity (p=0,002 and p=0,01 respectively) shorter length of hospital stay (p=0,004), less chest tube days(p=0,03), lower percentage of bronchial fistula (p=0,009) and less bronchospasm (p=0,002). When compared to GB. PR had impact on the reduction of serum fibrinogen, on clinical improvements, health related quality of life, anxiety and depression, and also reduced postoperative pulmonary complications. In the absence of PR programs, RT can be an important preoperative strategy. / Lung cancer (LC) is a malignant aggression which can be also surgically treated characterized by inflammation and higher mortality rates. Pulmonary complications are still concerning. The choice of studying fibrinogen and albumin is due to the fact that they are active inflammatory markers in LC often associated with chronic obstructive pulmonary disease. Pulmonary complications subsequent to lung resection are still worrying. This study evaluated the impact of Pulmonary Rehabilitation (PR) on preoperative inflammatory markers and postoperative pulmonary complications of LC patients. Controlled clinical trial with 31 patients with moderate to severe obstructive disease, stages IA to IIIA, randomized into Group A (GA) undergone PR and the control group - Group B (GB) undergone respiratory therapy (RT). Pulmonary function, respiratory muscle strength, functional capacity, upper limbs muscle strength, maximum and submaximal exercise capacity, Hospital anxiety and depression scale (HADS), quality of life through Short-form36 (SF36), fibrinogen and albumin were evaluated before and after a 4 weeks of the survey protocols. After surgery pulmonary complications were analyzed. GA performed aerobic physical training, peripheral and respiratory muscle strength training. GB performed lung expansion techniques. Both groups received educational classes and performed the protocols in similar time. The study was approved by the institutionâs ethic committee. There was in GA significant improvements in FVC from 65Â17 to 76 15% of its predicted (p=0.003 ), in maximal inspiratory pressure (MIP) from 78Â46 to 104 42cmH2O (p=0.0003 ), in maximal expiratory pressure (MEP) from 78Â21 to 93 25cmH2O (p=0.0009 ); in walked distance from 435Â70 to 491Â88 m (p<0.0001 ), upper limb maximum load from 1.0 to 2.0 kg (p=0.008 ), in treadmill inclination from 5Â3 to 8 3% (p<0.0001 ) and speed from 4.9 [3.7 -5.5] to 5.2 [4.4 -6] (p=0.002 ), submaximal exercise capacity from 447Â179 to 718 220s (p=0.002 ), in anxiety from 9.9 Â4.9 to 4.9 Â2.7 (p<0.0001 ), and depression from 9.05 Â4.08 to 4.9 Â2.1 (p<0.0001 ), in quality of life with Physical Component Summary (PCS) from 37.5 Â9.07 to 46.15  8.7 % (p=0.004 ) and fibrinogen to 448.3 Â129.9 to 321.6  73.2 mg/dl (p=0.0002 ). Albumin has not showed significant result in both groups. In GB there was significant increase in MIP 50Â22 to 70 35 (p=0.004) and reduction in fibrinogen from 490.7  199.7 to 453.3  177.2 mg/dl (p=0.3). Other variables GB did not show any significant results. When comparing results between groups there was significant difference in the walked distance (p=0,0001), in upper limb strength (p=0,009), in inclination (p=0,0008), in endurance (p=0,005), in anxiety (p=0,0002), in depression (p=0,04), in PCS (p=0,03) and fibrinogen (p=0,04). Out of 31 patients, 10 were not operated. In postoperative pulmonary complications, GA show less greater and lesser relevance morbidity (p=0,002 and p=0,01 respectively) shorter length of hospital stay (p=0,004), less chest tube days(p=0,03), lower percentage of bronchial fistula (p=0,009) and less bronchospasm (p=0,002). When compared to GB. PR had impact on the reduction of serum fibrinogen, on clinical improvements, health related quality of life, anxiety and depression, and also reduced postoperative pulmonary complications. In the absence of PR programs, RT can be an important preoperative strategy.

<p><strong>Introduction:</strong> In Ontario alone, an estimated 6,700 people (3,000 women; 3,700 men) will die of lung cancer in 2011 (Canadian Cancer Society, 2011). A diagnosis of cancer is associated with complex decisions; the array of choices of cancer treatments brings about hope, but also anxiety over which treatment is best suited for the individual patient (Blank, Graves, Sepucha et al., 2006). The overall cancer experience depends on the quality of this decision (Blank et al., 2006). Clinical practice guidelines are knowledge translation tools to facilitate treatment decision-making. In Ontario, guidelines have been developed and disseminated with the purpose to inform clinical decisions, improve evidence based practice, and to reduce unwanted practice variation in the province. But has this been achieved? To study this issue, the purpose of the current study was to gain an in-depth understanding and develop a theoretical framework of how Ontario physicians are making treatment decisions with their non-small cell lung cancer patients. The following research questions guided the study: (a) How do physicians make treatment decisions with their stage II, stage IIIA and stage IIIB non-small cell lung cancer patients in Ontario? (b) How do knowledge translation tools, such as Cancer Care Ontario guidelines, influence the decision-making process?</p> <p><strong>Methods:</strong> A qualitative approach of grounded theory, following a social constructivist paradigm outlined by Kathy Charmaz (2006), was used in this study. 21 semi-structured interviews were conducted; 16 interviews with physicians and 5 with health care administrators. The method of analysis integrated grounded theory philosophy to identify the treatment decision-making process in non-small cell lung cancer, from the physician perspective.</p> <p><strong>Findings:</strong> The theory depicts the treatment decision-making process to involve five key “guides” (or factors) to inform the treatment-decision making process: the unique patient, the unique physician, the family, the clinical team, and the clinical evidence.</p> <p><strong>Conclusion:</strong> Decision-making roles in lung cancer are complex and nuanced. The use of evidence, such as, clinical practice guidelines, is one of many considerations. Information from a large number of sources and a wide array of factors, people, emotions, preferences, clinical expertise, experiences, and clinical evidence informs the dynamic process of treatment decision-making. This theory of the treatment decision-making process (from the physician perspective) has implications relevant to treatment decision-making research, theory development, and guideline development for non-small cell lung cancer.</p> / Master of Science (MSc)