Orientadores: Wu Feng Chung, Huei Diana Lee / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T17:40:33Z (GMT). No. of bitstreams: 1 Machado_RenatoBobsin_D.pdf: 21928006 bytes, checksum: efd4a25c4c6dd6e8c6a3f4f4426de95c (MD5) Previous issue date: 2013 / Resumo: A área computacional aplicada à medicina tem contribuído para aumentar a eficiência no armazenamento, na transmissão e na análise de dados referentes aos pacientes e, consequentemente, na precisão do diagnóstico. Nesse contexto, para ampliar ainda mais estas ações, tornam-se essenciais a formação e a consolidação de redes integradas e colaborativas de apoio à área médica à distância. Outro aspecto fundamental que deve ser considerado no trato de informações pertencentes aos pacientes e profissionais médicos é a segurança, contemplando critérios como integridade, confidencialidade e autenticidade dessas informações. Neste trabalho, desenvolveu-se um método original em telemedicina para o acompanhamento e a interação remota entre especialistas da área médica, em tempo real, durante a realização de exames videocolonoscópicos. Para a proteção de dados e para a transmissão segura e eficiente das informações referentes aos pacientes e aos exames, propôs-se um método de segurança específico. Esses métodos foram implementados em um sistema computacional aplicando tecnologia Web e ferramentas open source. Para aferir o desempenho desse sistema, avaliou-se a taxa Quadros por Segundo (QPS) durante a transmissão de vídeos sem compactação. Este processo se deu em dois ambientes distintos, com diferentes resoluções, sendo o primeiro caracterizado apenas pela rede local e, o segundo, pela rede local juntamente com a Internet, simulando ambientes reais de aplicação do método proposto. As análises dos resultados desse trabalho permitiram concluir que: 1. O método proposto, implementado no sistema computacional, cumpre os requisitos estabelecidos para transmissão de dados, segurança de informações e interação em tempo real entre os usuários; 2. O método proposto é aplicável para a realização de procedimentos videocolonoscópicos, em redes locais e na Internet. 3. O método de segurança definido neste trabalho prove privacidade para a transmissão de dados, de vídeos e de imagens, assim como para a interação entre os participantes locais e remotos / Abstract: Computational methods and tools applied to medicine have contributed to increase efficiency in storage, transmission and analysis of data related to patients and, consequently, the accuracy of diagnoses. In this context, to further expand these actions, it became essential the creation and consolidation of integrated and collaborative networks to support the medical area. Another fundamental aspect which must be considered in dealing with information about patients and medical professionals is security, considering criteria such as integrity, confidentiality and authenticity of this information. In this work, we have developed an original telemedicine method for monitoring and remotely interaction among medical experts, in real time, during the performance of video-colonoscopic procedures. For data protection, secure transmission and efficient use of information related to patients and their examinations, we have proposed a specific security method. Both methods were implemented in a computing system by applying Web technology and open source tools. In order to assess the performance of this system, we have evaluated the transmission rate in frames per second (FPS) during the streaming of an uncompressed video. We performed our experiments simulating real environments in two different scenarios with distinct resolutions, one being characterized only by the local network and the second considering the local network and the Internet. The analysis of the results has shown that: (1) the proposed method, implemented in the computational system, meets the requirements for data transmission, information security and real-time interaction among the users; (2) the proposed method is applicable for performing video-colonoscopic procedures, via local networks and the Internet, and; (3) the security method built for this system provides privacy during the transmission of the data, video and images, as well as the interaction between the local and remote participants / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

In the Canadian universal healthcare system, public access to care is not limited by monetary or social economic factors. Rather, waiting time is the dominant factor limiting public access to healthcare. Excessive waiting lowers quality of life while waiting, and worsening of condition during the delay, which could lower the effectiveness of the planned operation. Excessive waiting has also been shown to carry economic cost. At the core of the wait time problem is a resource scheduling and management issue. The scheduling of medical procedures is a complex and difficult task. The goal of research in this thesis is to develop the foundation models and algorithms for a resource optimization system. Such a system will help healthcare administrators intelligently schedule procedures to optimize resource utilization, identify bottlenecks and reduce patient wait times. This thesis develops a novel framework, the MPSP model, to model medical procedures. The MPSP model is designed to be general and versatile to model a variety of different procedures. The specific procedure modeled in detail in this thesis is the haemodialysis procedure. Solving the MPSP model exactly to obtain guaranteed optimal solutions is computationally expensive and not practical for real-time scheduling. A fast, high quality evolutionary heuristic, gMASH, is developed to quickly solve large problems. The MPSP model and the gMASH heuristic form a foundation for an intelligent medical procedures scheduling and optimization system.

In the Canadian universal healthcare system, public access to care is not limited by monetary or social economic factors. Rather, waiting time is the dominant factor limiting public access to healthcare. Excessive waiting lowers quality of life while waiting, and worsening of condition during the delay, which could lower the effectiveness of the planned operation. Excessive waiting has also been shown to carry economic cost. At the core of the wait time problem is a resource scheduling and management issue. The scheduling of medical procedures is a complex and difficult task. The goal of research in this thesis is to develop the foundation models and algorithms for a resource optimization system. Such a system will help healthcare administrators intelligently schedule procedures to optimize resource utilization, identify bottlenecks and reduce patient wait times. This thesis develops a novel framework, the MPSP model, to model medical procedures. The MPSP model is designed to be general and versatile to model a variety of different procedures. The specific procedure modeled in detail in this thesis is the haemodialysis procedure. Solving the MPSP model exactly to obtain guaranteed optimal solutions is computationally expensive and not practical for real-time scheduling. A fast, high quality evolutionary heuristic, gMASH, is developed to quickly solve large problems. The MPSP model and the gMASH heuristic form a foundation for an intelligent medical procedures scheduling and optimization system.

No description available.

Each year in the United States, approximately 81 million individuals receive surgeries in which .1% to .2% (20,000 to 40,000/20 million) experience Anesthesia Awareness (AA). More than 50% of the AA cases result in mental distress or Posttraumatic Stress Disorder (PTSD). Because the percentage of AA cases among surgeries makes it appear to be a rare occurrence, and because it has received rather limited research attention, I decided to undertake an interpretative phenomenological analysis to discover AA clients’ perceptions of their counseling experience, and encourage development of therapeutic interventions to meet their needs. The broad research question for my study was how do clients perceive their experience of counseling for trauma related to AA? The context was provided by a review of the literature which focused on trauma and PTSD, AA, clients’ perceptions of counseling, counseling for trauma, and counseling for PTSD. Semi-structured interviews were used to collect data which then was coded to identify emerging themes which were then clustered. The clustered themes were used to answer the broad and specific research questions. Based on the findings of my study, the theme of relational factors of counselors most often emerged as helpful to counseling (e.g., Rogerian- congruence, unconditional positive regard, accurate empathic understanding), whereas, the therapy process, external barriers, and PTSD symptoms most often emerged as hindering to counseling. Implications for counselors and counselor educators include increased understanding and insight regarding AA survivors and the role of relationship when counseling this population which may lead to more effective interventions and expanded professional roles to work with this population.

Orientador: Silvia Cristina Mangini Bocchi / Banca: Magda Cristina Querioz Dell"Acqua / Banca: Janete Pessuto Simonetti / Banca: Sueli Moreira Pirolo / Banca: Antônio Carlos Siqueira Junior / Resumo: Trata-se de pesquisa na abordagem qualitativa realizada na cidade de Londrina, Paraná, Brasil, e teve como objetivos compreender a experiência interacional homem-processo saúde-doença de usuários de serviços de urgência e emergência atendidos com crise hipertensiva e propor um modelo teórico representativo dessa experiência. A saturação teórica se configurou mediante a análise da vigésima primeira entrevista do tipo não diretiva, tendo como pergunta de partida: "Conte-me sobre a sua experiência em relação aos cuidados com a sua saúde.". As entrevistas foram audiogravadas, transcritas na íntegra e analisadas segundo os passos da Teoria Fundamentada nos Dados, de junho de 2011 a junho de 2012. Da análise das experiências emergiram três subprocessos: concebendo o cuidado à saúde inerente ao feminino: uma fantasia do masculino; aprisionando-se ao papel de homem com superpoderes sobre sua saúde; vivenciando a materialidade da doença nas comorbidades. Do realinhamento dos componentes desses subprocessos originou a categoria central e modelo teórico, denominado "movendo-se entre o fortalecimento e a fragilização do poder como homem de saúde inabalável: o medo do diagnóstico médico imaginado como componente interveniente para a materialidade da doença.". Analisando-o à luz do interacionismo Simbólico, verificou-se a necessidade de o indivíduo reconfigurar o seu self, dando a si mesmo a oportunidade de romper com a concepção de homem com superpoderes sobre a sua saúde para poder (re)alinhar-se a comportamentos saudáveis e abandonar o autocontrole de sua saúde sem auxílio de serviços de saúde. A pesquisa corrobora resultados de estudos anteriores, porém o modelo teórico descoberto configura-se em grande contribuição se considerado protótipo tecnológico para profissionais da saúde ajudarem homens a refletirem e se auto-avaliarem, ao interagirem com ele durante ações educativas / Abstract: This is a qualitative study conducted in the city of Londrina, Paraná, Brazil, and it aimed at understanding the interactional experience man-health-disease process of users of urgency and emergency services attended to when facing a hypertensive crisis and at proposing a theoretical model of such experience. Theoretical saturation was configured by analyzing the twenty one non-directive interview with the starting request: "Tell me about your experience in relation to your health care". The interviews were audiotaped, fully transcribed and analyzed according to the steps of the Grounded Theory from June 2011 to June 2012.Three sub-processes emerged from the analysis of the experiences: conceiving health care as inherent to females: a male‟s fantasy; being trapped to the role of a man with superpowers over his health; experiencing the materiality of disease comorbidities. The realignment of these sub-components gave origin to the theoretical model and the core category denominated "moving between the strengthening and weakening of power as a man of unfailing health: the fear of medical diagnosis imagined as intervenient component for materiality of disease". When examined in light of Symbolic Interactionism, there was the need for the individual to reconfigure his self, giving himself the opportunity to break with the conception of a man with superpowers over his health in order to (re)align with healthy behaviors and abandon the self-control of his disease without help from health care services. The study confirms results from previous investigations, but the theoretical model discovered is configured as great contribution if considered as a technological prototype for health professionals to help men reflect and evaluate themselves when interacting with them during educational activities / Doutor

<p>Syftet med studien var att beskriva icke farmakologiska metoder för att reducera barns rädsla och smärta inför cancerrelaterade behandlingar och undersökningar. Studien genomfördes som en litteraturstudie med beskrivande design. 21 vetenskapliga artiklar inkluderades, analyserades och lades som grund för resultatet. Resultatet visade att distraktion var den vanligaste förekommande icke farmakologiska omvårdnadsåtgärden för att minska barns rädsla och smärta inför smärtsamma cancerrelaterade behandlingar och undersökningar. Distraktion i form av kommunikation, beröring och hjälpmedel distraherar, lugnar, ökar smärttoleransen, förbättrar vårdresultatet och ger positiva vårderfarenheter. Barn som själva fick välja distraktionsmedel visade mindre rädsla, smärta och obehag vid smärtsamma behandlingar och undersökningar. Som distraktion används kommunikation, beröring, elektroniska leksaker, såpbubblor, clowner, virtuell verklighet, filmer, musik och kalejdoskop. Kognitiv beteendeterapi (KBT) visade sig vara bra för att hjälpa barn att hantera rädslan inför provtagningar. Hypnos visade sig vara användbart till rädda och oroliga barn med tidigare vårderfarenhet för att inge trygghet och förebygga ångest. Slutsatsen är att kommunikation, åldersadekvata distraktionsmedel och mänsklig närvaro är ett billigt och effektivt komplement för sjuksköterskan att reducera barns smärta och rädsla under smärtsamma procedurer. Vidare forskning inom området behövs för att utvärdera sjuksköterskornas kunskaper om kommunikation och distraktion.</p> / <p>The aim with the study was to describe non pharmacologic methods in order to reduce children's dread and pain before cancer related treatments and surveys. The study was implemented as a literature study with descriptive design. In the study 21 scientific articles was analyzed for the result. The result showed that distraction was the most common non pharmacologic method in order to decrease children's dread and pain before painful cancer related treatments and surveys. Distraction in the form of communication, touch and accessibility distract, reassuring, increases pain tolerance, improve care results and provides positive care experience. Children who elect distracters funds showed less fear, pain and discomfort at painful treatments and surveys. As distraction was communication, contact, electronic toys, soft soap bubbles, clowns, virtual reality, films, musical and kaleidoscope used. Cognitive behavior therapy (KBT) was found to help children to handle the dread before treatments. Hypnos showed to be useful to cautious and anxious children with earlier care experience stem to submit safety and to prevent anxiety. The authors drew the conclusion that communication, age adequate distraction and human presence is a cheap and effective complements for the nurse to reduce children's pain and dread during painful procedures. Further research within the area is needed in order to evaluate the nurses' knowledge about communication and distraction.</p>

Syftet med studien var att beskriva icke farmakologiska metoder för att reducera barns rädsla och smärta inför cancerrelaterade behandlingar och undersökningar. Studien genomfördes som en litteraturstudie med beskrivande design. 21 vetenskapliga artiklar inkluderades, analyserades och lades som grund för resultatet. Resultatet visade att distraktion var den vanligaste förekommande icke farmakologiska omvårdnadsåtgärden för att minska barns rädsla och smärta inför smärtsamma cancerrelaterade behandlingar och undersökningar. Distraktion i form av kommunikation, beröring och hjälpmedel distraherar, lugnar, ökar smärttoleransen, förbättrar vårdresultatet och ger positiva vårderfarenheter. Barn som själva fick välja distraktionsmedel visade mindre rädsla, smärta och obehag vid smärtsamma behandlingar och undersökningar. Som distraktion används kommunikation, beröring, elektroniska leksaker, såpbubblor, clowner, virtuell verklighet, filmer, musik och kalejdoskop. Kognitiv beteendeterapi (KBT) visade sig vara bra för att hjälpa barn att hantera rädslan inför provtagningar. Hypnos visade sig vara användbart till rädda och oroliga barn med tidigare vårderfarenhet för att inge trygghet och förebygga ångest. Slutsatsen är att kommunikation, åldersadekvata distraktionsmedel och mänsklig närvaro är ett billigt och effektivt komplement för sjuksköterskan att reducera barns smärta och rädsla under smärtsamma procedurer. Vidare forskning inom området behövs för att utvärdera sjuksköterskornas kunskaper om kommunikation och distraktion. / The aim with the study was to describe non pharmacologic methods in order to reduce children's dread and pain before cancer related treatments and surveys. The study was implemented as a literature study with descriptive design. In the study 21 scientific articles was analyzed for the result. The result showed that distraction was the most common non pharmacologic method in order to decrease children's dread and pain before painful cancer related treatments and surveys. Distraction in the form of communication, touch and accessibility distract, reassuring, increases pain tolerance, improve care results and provides positive care experience. Children who elect distracters funds showed less fear, pain and discomfort at painful treatments and surveys. As distraction was communication, contact, electronic toys, soft soap bubbles, clowns, virtual reality, films, musical and kaleidoscope used. Cognitive behavior therapy (KBT) was found to help children to handle the dread before treatments. Hypnos showed to be useful to cautious and anxious children with earlier care experience stem to submit safety and to prevent anxiety. The authors drew the conclusion that communication, age adequate distraction and human presence is a cheap and effective complements for the nurse to reduce children's pain and dread during painful procedures. Further research within the area is needed in order to evaluate the nurses' knowledge about communication and distraction.

Background: Vagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation. Materials and methods: Branching of the cervical vagus nerve was investigated macroscopically in 35 body donors (66 cervical sides) in the carotid sheath. After X-ray imaging for determining the vertebral levels of cervical vagus nerve branching, samples were removed to confirm histologically the nerve and to calculate cervical vagus nerve diameters and cross-sections. Results: Cervical vagus nerve branching was observed in 29%of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79mm vs. 3.78mm) and cross-sections (7.24 mm2 vs. 5.28mm2). Discussion: Cervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation.

Syftet med denna avhandling är att skapa kunskap om vad det innebär för yngre barn att genomgå nålrelaterade medicinska procedurer. Dessutom vad vårdande stöd i samband med dessa procedurer innebär utifrån barns, föräldrars och sjuksköterskors perspektiv. Nålrelaterade medicinska procedurer är undersökningar som barn behöver vara med om i vården för att motverka sjukdom, för att ta reda på varför barnet är sjukt och för att ge barnet behandling. Dessa åtgärder innebär att barn behöver vara med om nålstick. Med hjälp av deltagande observationer och livsvärldsintervjuer, som har dokumenterats genom videoobservationer, fältanteckningar och ljudinspelningar, har datainsamlingen genomförts i vården med yngre barn, 3-7 år, deras föräldrar och sjuksköterskor. Barnen har berättat om konsekvenser som de har upplevt av nålprocedurer och om att få stöd vid dessa åtgärder. Föräldrar och sjuksköterskor har berättat om sina erfarenheter av att ge stöd till barnen. Avhandlingens resultat visar att en framträdande konsekvens för barn under nålprocedurer är upplevelse av rädsla. Hur föräldrar och sjuksköterskor svarar an mot detta har en avgörande betydelse för om barnets rädsla ökar eller minskar. Denna avhandling bidrar med kunskap om barns upplevelser av nålprocedurer och behov av stöd samt hur stödet kan utformas vid dessa åtgärder. Emellertid, forskning inom området ärfortfarande otillräcklig och ytterligare forskning behövs där barns perspektiv lyfts fram i vården. / Aim: The overall aim of the thesis is to create knowledge about what it means for younger children to undergo needle-related medical procedures (NRMPs), and what caring support in relation to this means based on nurses’, parents’, and younger children's perspectives. Methods: The first and second papers used descriptive phenomenological analysis to describe the meanings of supporting younger children during NRMPs from the perspective of nurses (Ι) and parents(ΙΙ). The third and fourth papers used lifeworld hermeneutic analysis to explain and understand the consequences related to NRMPs (ΙΙΙ) and support (ΙV) during these procedures from younger children’s perspectives. Data has been collected by participant observations and lifeworld interviews documented by video-recorded observations, field notes, and audio-recorded interviews. In total 60 people participated, fourteen nurses, twenty-five parents, and twenty-one children. Main results: The results show that an important consequence for children of procedures with needles is experiences of fear. The child's fear affects how the child is able to manage the procedure and the support the child gets from adults is crucial to whether the child's fear increases or decreases. The support consists of giving support or receiving support. Parents support the child by safeguarding and protecting the child during the needle-related procedure; they “keep the child under the protection of their wings,” sometimes very close and sometimes a little further out under the wingtips. Nurses support the child by starting from individual child’s experiences and needs; they "balance on a tightrope" in an unpredictable situation. In the meeting between the child, the parents, and the nurses, the adults are guided by the child in what forms of support are provided. This continues until the needle-related medical procedure is completed and the child can walk proud and strong from the procedure with a feeling that "I can handle this.” Conclusions: Children’s need for support during needle-related medical procedures is primarily tied to children’s experiences of fear. For the child to experience a caring support, adults need to understand children’s experiences of fear as well as children’s need for support and what form the support should take. A caring support develops dialectically between children and adults in a circular movement. In such a dialectic, the child guides the adult and vice versa. That children have the capability of guiding adults during needle-related medical procedures shows that they are active and participating. Here it becomes clear that there is no objective location of the phenomenon of support. Support can therefore only be studied as a lived experience of those who need it.