Diss. (sammanfattning) Linköping : Univ., 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 6 uppsatser.

Dissertation (Ph.D.)--University of South Florida, 2006. / Title from PDF of title page. Document formatted into pages; contains 107 pages. Includes vita. Includes bibliographical references.

Objetivos A variação da pressão sistólica (VPS) é parâmetro de avaliação hemodinâmica em indivíduos ventilados mecanicamente. O objetivo deste estudo foi investigá-la em coelhos submetidos à hemorragia e pneumoperitônio. Método Estudou-se 11 coelhas sob 4 tratamentos: após 20 minutos de estabilização (T1); pneumoperitônio de 10mmHg por 30 minutos (T2); hemorragia de 20% da volemia estimada, realizada em 10 minutos, mais 10 minutos de estabilização, na vigência de pneumoperitônio (T3); após reposição do sangue retirado, em 10 minutos, mais 10 minutos de estabilização, sem pneumoperitônio (T4). Resultados Observou-se aumento de VPS significativo (p < 0,05) em T2 e T3, com maior valor em T3, em relação a T1 e que não houve diferença significativa entre T4 e T1. Delta Down tem maior participação na VPS nos tratamentos T1, T3 e T4. Em T2 a contribuição de ambas é equilibrada. Conclusões VPS mostrou ser preditora de hipovolemia durante hemorragia e pneumoperitônio / Systolic pressure variation (SPV) is a hemodynamic analysis parameter for mechanically ventilated individuals. The aim of this study was to investigate it in rabbits submitted to hemorrhage and pneumoperitoneum. Methods Eleven rabbits were studied under 4 treatments: after 20 minutes of stabilization (T1); 10 mmHg pneumoperitoneum for 30 minutes (T2); hemorrhage of 20% of the estimated volemia, performed in 10 minutes, followed by 10 minutes of stabilization, under pneumoperitoneum (T3); re-infusion in 10 minutes of the blood shed and more 10 minutes of stabilization, without pneumoperitoneum (T4). Results There was a significant increase in SPV (p < 0.05) in T2 and T3, with a higher value in T3, related to T1 and no difference between T4 and T1. Delta Down is the main component in T1, T3 and T4, while in T2 it is balanced with Delta Up. Conclusions SPV showed to be predictor of hypovolemia during hemorrhage and pneumoperitoneum

<p>Ciljevi: U kliničkoj praksi se rutinski upotrebljava vizuelna metoda evaluacije TOF testa, koja ne pruža u potpunosti precizne podatke u periodu oporavka neuromi&scaron;ićne blockade. Neophodno je ispitati mogućnost upotrebe specifičnije i preciznije metode u TOF monitoring, kao &scaron;to je kvantitativna TOF metoda. Određivanje razlike između vrednosti T1 i T4 mi&scaron;ićnih kontrakcija, dobijenih kvantitativnom TOF metodom, može biti precizan pokazatelj prisustva neuromi&scaron;ićne blokade na testiranom mi&scaron;iću. Takođe, aplikacijom kvantitativne TOF metode, neophodno je utvrditi da li kod različitih mi&scaron;ića postoji različit period oporavka od prisustva neuromi&scaron;ićne blokade. Upotreba kvantitativne TOF metode, i poređenje T4 / T1 odnosa između različitih mi&scaron;ića, može biti pokazatelj postojanja razlika u oporavku od prisustva neuromi&scaron;ićne blokade. Materijal i metode: U istraživanju je analiziran oporavak od prisustva neromi&scaron;ićne blokade na m.abductor hallucis i m. interosseus dorsalis primus aplikacijom kvantitativnog TOF testa u toku ortopedskih hirur&scaron;kih procedura na kičmenom stubu uz upotrebu intraoperativnog neurofiziolo&scaron;kog monitoring kod 147 bolesnika. T4/T1 odnos je određen na testiranom mi&scaron;iću stopala i &scaron;ake, obavljena je klasifikacija ispitanika u odnosu na dozu neuromi&scaron;ićnog blokatora i proteklo vreme od apilikacije. Poređenjem T4/T1 odnosa između testiranih mi&scaron;ića utvrđene su razlike u oporavku od prisustva neuromi&scaron;ićne blokade. Vizuelnom TOF metodom je vr&scaron;ena procena neuromi&scaron;ićne blokade od strane anesteziologa, stimulacijom n.ulnaris i praćenjem kontrakcije m.adductor pollicis. Rezultati dobijeni vizuelnom TOF metodom su upoređeni sa rezultatima dobijenim kvantitativnom TOF metodom na m. interosseus dorsalis primus. Rezultati: Postoje značajne razlike u T4/T1 odnosu između testiranih mi&scaron;ića na stopalu i &scaron;aci (p&lt;0.05). T4/T1 odnos određen na m.abductor hallucis ima niže vrednosti, odnosno brži oporavak, u odnosu na m. interosseus dorsalis primus (p&lt;0.05). Kvantitativnom TOF metodom dobijeni su pouzdani rezultati o proceni neuromi&scaron;ićne blokade kod svih testiranih bolesnika, dok su vizuelnom TOF metodom dobijeni kod 40 % testiranih bolesnika. Rezultati pokazuju da postoje značajne razlike u pouzdanosti i preciznosti između kvantitativne i vizuelne TOF metode. Zaključak: Kvantitativna TOF metoda je klinički prihvatljiva i pouzdana metoda u proceni prisustva neuromi&scaron;ićne blokade. Razlike u oporavku od neuromi&scaron;ićne blokade uočene kod različitih mi&scaron;ića, ukazuju da je TOF monitoring neophodan na određenoj mi&scaron;ićnoj regiji koja pruža pouzdane i precizne podatke o neuromi&scaron;ićnoj blokadi regije na kojoj se hirur&scaron;ka procedura obavlja. Kvantitativna TOF metoda pruža preciznije podatke o stepenu prisustva neuromi&scaron;ićne blokade u odnosu na vizuelnu subjektivnu TOF metodu.</p> / <p>Purpose: In clinical practice routinely used method of TOF test is visual method of interpretation. This method does not provide completely reliable data in period of spontaneous recovery from neuromuscular blockade. It is necessary to investigate possibility of application of more specific and more accurate method in TOF monitoring, such as quantitative TOF method. Determination of difference between the values of T1 and T4 muscle contraction, obtained by quantitative TOF method, may indicate the presence of neuromuscular blockade on tested muscle. In addition to this, by application of quantitative TOF method, it is necessary to determine is there a difference in period of recovery from neuromuscular blockade between defferent muscles. Comparison of T4/T1 ratios between different muscles may indicate presence of different period of recovery from neuromuscular blockade. Methods: Study analyzed differences between recovery of foot - abductor hallucis muscle and hand - first dorsal interosseous muscle by application of quantitative TOF test on 147 patients undergoing lumbar spine surgery. T1 to T4 decrements on hand and foot TOF were determined and classified into different groups, depending of neuromuscular blocking agents (NMBA) dose and elapsed time after administration. T1 - T4 decrements were compared between hand and foot TOF and differences between muscle recovery were determined. Visual method of TOF test was performed by anesthesiologists, by using peripheral nerve stimulator and stimulating ulnar nerve. Quantitative TOF test was measured on first dorsal interosseous muscle, and compared with visual TOF results obtained on adductor pollicis muscle. Results: There are significant differences between T1 - T4 decrements obtained on tested muscles of hand and foot (p&lt;0.05). T1-T4 decrement determined on abductor hallucis muscle had lower values, respectively more rapid recovery, than first dorsal interosseous muscle (p&lt;0.05). Quantitative method of TOF test had reliable and correct results in all tested subjects, while visual interpretation of TOF method showed accurate results in 40 % of all cases. Results indicated that significant difference was present between quantitative and visual method of TOF interpretation. Conclusions: Difference between observed recovery of hand and foot muscles is indicating that quantitative TOF test should be performed on specific site for which accurate data about the level of neuromuscular blockade is needed. During lumbar spine surgery, in addition to hand TOF, foot TOF should be included as it provides more accurate data needed for neurophysiological intraoperative monitoring. Quantitative TOF method provides more accurate data about level of neuromuscular blockade if compared with subjective visual TOF method.</p>

Peng Zhiyong. / "December 2004." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 146-175) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Thesis (Ph. D.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Background. Diabetes requires significant disease management, patient-provider communication, and interaction between patients, family members, caregivers, and care teams. Emerging patient-facing technologies, such as cellular-enabled glucose meters, can facilitate additional care support and improve diabetes self-management. This study evaluated patient acceptability, feasibility, and efficacy of a diabetes care support program facilitated by cellular-enabled glucose meters. Methods. A two-phase study approach was taken. Get In Touch – Phase 1 (GIT-1) was a 1-month pilot involving patients with type 1 and type 2 diabetes. Get In Touch – Phase 2 (GIT-2) was a 12-month randomized controlled crossover trial involving patients with poorly-controlled type 2 diabetes. Results from GIT-1 and preliminary results from GIT-2 are presented. Results. GIT-1 participants with type 1 (n=6) and type 2 (n=10) diabetes reported the intervention and cellular-enabled glucose meter were easy to use and useful while identifying potential areas of improvement. GIT-2 participants in both the intervention (n=60) and control (n=60) groups saw significant improvements in treatment satisfaction and A1c change, with intervention participants experiencing slightly greater improvements in each after 6 months (p=0.09 and p=0.16, respectively) compared to control participants. Conclusions. Patients reported favorable acceptability of the intervention. Preliminary results from a randomized trial demonstrated potential of intervention to improve patient-reported and physiological health outcomes. Future studies should evaluate feasibility and efficacy over a longer period of time, with a greater number of participants, and targeting different populations of patients with diabetes. Provider perspectives and changes in provider behavior, clinical work flow, and caregiver burden should also be assessed.

A fisioterapia respiratória vem merecendo especial atenção por parte dos pesquisadores, em virtude de seu crescente aumento nos últimos anos. Entretanto, o conceito de que a fisioterapia respiratória além de ser benéfica, não apresenta efeitos deletérios para o recém-nascido (RN) ainda não é consenso. O objetivo deste estudo foi avaliar as repercussões da fisioterapia respiratória sobre a função cárdio-pulmonar em recém-nascidos pré-termo (RNPT) submetidos à ventilação mecânica. Realizou-se, então, um estudo prospectivo, incluindo RNPT com peso de nascimento inferior a 1500 gramas, submetidos à ventilação mecânica durante a primeira semana de vida. Os RN foram divididos em 2 grupos conforme o peso de nascimento: grupo MBP: peso entre 1000 e 1499 gramas e, grupo MMBP: peso inferior a 999 gramas. Foram excluídas as malformações congênitas graves, as síndromes genéticas e as situações clínicas em que a fisioterapia respiratória estava contra-indicada. A fisioterapia foi iniciada após a estabilidade clínica do RN, compreendendo o posicionamento, a vibração manual, os exercícios respiratórios e a aspiração endotraqueal. O estudo consistiu na determinação dos valores da freqüência cardíaca (FC-bpm), da saturação de oxigênio (SatO2 -%), da freqüência respiratória (FR-rpm) e da pressão arterial sistêmica (PA-mmHg), coletados entre o 3o e o 7o dia de vida, em 5 momentos diferentes: antes dos procedimentos de fisioterapia respiratória (T0), imediatamente após (T1), 5 minutos após os procedimentos fisioterapêuticos (T2), imediatamente após a aspiração endotraqueal (T3) e 5 minutos após a aspiração (T4). A análise dos resultados foi realizada através dos testes t- Student e medidas repetidas ANOVA one-way, sendo considerado diferença p<0,05. Foram estudados 21RNPT no grupo MBP e, 21 RNPT no grupo MMBP. Na população estudada as freqüências cardíaca e respiratória, a saturação de oxigênio e a pressão arterial sistêmica (sistólica, diastólica e média) permaneceram dentro dos valores fisiológicos após os procedimentos fisioterapêuticos e de aspiração endotraqueal, embora tenham havido algumas diferenças significativas. O procedimento de aspiração endotraqueal teve maior influência na função cárdiopulmonar do que os procedimentos fisioterapêuticos, sugerindo ser a aspiração um fator determinante das repercussões deletérias da função cárdio-pulmonar em RNPT, devendo ser empregada cautelosamente. / Respiratory physiotherapy has deserved special attention of the researchers due to its increasing practice. However, the concept that besides being effective, the respiratory physiotherapy brings no deleterious effects to the newborn (NB) is not a consensus yet. This study aims to evaluate the repercussions of respiratory physiotherapy on the cardiopulmonary function of preterm newborns (PTNB), subjected to mechanical ventilation. A prospective study was carried out, including PTNB of birth weight lower than 1500g subjected to mechanical ventilation along their first week of life. The NIs were divided into 2 groups, according to their birth weight: VLBW group: weight between 1000 and 1499g and VVLBW group, birth weight lower that 999g. The severe congenital malformations, the genetic syndromes and the clinical situations where the respiratory physiotherapy was not-advisable, were excluded. Physiotherapy was started after the NI?s clinical stability, including positioning, manual vibration, respiratory exercises and endotracheal aspiration.This study consisted of the determination of the heart rate values (HR-bpm), the oxygen saturation (SatO2 -%), of the respiratory frequency (RF-bpm) and of the systemic arterial pressure (SAP-mmHg), collected between the third and the seventh days of the infant?s life in five different moments: before the procedures of respiratory physiotherapy (T0), immediately after (T1), five minutes after the physiotherapeutic procedures (T2), immediately after the endotracheal aspiration (T3) and five minutes after aspiration (T4). The analysis of the results was carried out by means of t-Student?s tests and one-way ANOVA repeated measures, being considered a difference of p<0.05. 21 PTNB in group VLBW and 21 PTNB in group VVLBW have been studied. In the studied population, the heart rate and respiratory frequencies, the oxygen saturation and the systemic arterial pressure (systolic, diastolic and mean) remained within the physiological values after the physiotherapeutic procedures and endotracheal aspiration, though there have been some significant differences. The endotracheal aspiration procedure has shown more influence on the cardiopulmonary function than the physiotherapeutic procedures, suggesting that aspiration is a determining factor of the deleterious repercussions on the cardiopulmonary function of PTNB, therefore, having to be used cautiously

A fisioterapia respiratória vem merecendo especial atenção por parte dos pesquisadores, em virtude de seu crescente aumento nos últimos anos. Entretanto, o conceito de que a fisioterapia respiratória além de ser benéfica, não apresenta efeitos deletérios para o recém-nascido (RN) ainda não é consenso. O objetivo deste estudo foi avaliar as repercussões da fisioterapia respiratória sobre a função cárdio-pulmonar em recém-nascidos pré-termo (RNPT) submetidos à ventilação mecânica. Realizou-se, então, um estudo prospectivo, incluindo RNPT com peso de nascimento inferior a 1500 gramas, submetidos à ventilação mecânica durante a primeira semana de vida. Os RN foram divididos em 2 grupos conforme o peso de nascimento: grupo MBP: peso entre 1000 e 1499 gramas e, grupo MMBP: peso inferior a 999 gramas. Foram excluídas as malformações congênitas graves, as síndromes genéticas e as situações clínicas em que a fisioterapia respiratória estava contra-indicada. A fisioterapia foi iniciada após a estabilidade clínica do RN, compreendendo o posicionamento, a vibração manual, os exercícios respiratórios e a aspiração endotraqueal. O estudo consistiu na determinação dos valores da freqüência cardíaca (FC-bpm), da saturação de oxigênio (SatO2 -%), da freqüência respiratória (FR-rpm) e da pressão arterial sistêmica (PA-mmHg), coletados entre o 3o e o 7o dia de vida, em 5 momentos diferentes: antes dos procedimentos de fisioterapia respiratória (T0), imediatamente após (T1), 5 minutos após os procedimentos fisioterapêuticos (T2), imediatamente após a aspiração endotraqueal (T3) e 5 minutos após a aspiração (T4). A análise dos resultados foi realizada através dos testes t- Student e medidas repetidas ANOVA one-way, sendo considerado diferença p<0,05. Foram estudados 21RNPT no grupo MBP e, 21 RNPT no grupo MMBP. Na população estudada as freqüências cardíaca e respiratória, a saturação de oxigênio e a pressão arterial sistêmica (sistólica, diastólica e média) permaneceram dentro dos valores fisiológicos após os procedimentos fisioterapêuticos e de aspiração endotraqueal, embora tenham havido algumas diferenças significativas. O procedimento de aspiração endotraqueal teve maior influência na função cárdiopulmonar do que os procedimentos fisioterapêuticos, sugerindo ser a aspiração um fator determinante das repercussões deletérias da função cárdio-pulmonar em RNPT, devendo ser empregada cautelosamente. / Respiratory physiotherapy has deserved special attention of the researchers due to its increasing practice. However, the concept that besides being effective, the respiratory physiotherapy brings no deleterious effects to the newborn (NB) is not a consensus yet. This study aims to evaluate the repercussions of respiratory physiotherapy on the cardiopulmonary function of preterm newborns (PTNB), subjected to mechanical ventilation. A prospective study was carried out, including PTNB of birth weight lower than 1500g subjected to mechanical ventilation along their first week of life. The NIs were divided into 2 groups, according to their birth weight: VLBW group: weight between 1000 and 1499g and VVLBW group, birth weight lower that 999g. The severe congenital malformations, the genetic syndromes and the clinical situations where the respiratory physiotherapy was not-advisable, were excluded. Physiotherapy was started after the NI?s clinical stability, including positioning, manual vibration, respiratory exercises and endotracheal aspiration.This study consisted of the determination of the heart rate values (HR-bpm), the oxygen saturation (SatO2 -%), of the respiratory frequency (RF-bpm) and of the systemic arterial pressure (SAP-mmHg), collected between the third and the seventh days of the infant?s life in five different moments: before the procedures of respiratory physiotherapy (T0), immediately after (T1), five minutes after the physiotherapeutic procedures (T2), immediately after the endotracheal aspiration (T3) and five minutes after aspiration (T4). The analysis of the results was carried out by means of t-Student?s tests and one-way ANOVA repeated measures, being considered a difference of p<0.05. 21 PTNB in group VLBW and 21 PTNB in group VVLBW have been studied. In the studied population, the heart rate and respiratory frequencies, the oxygen saturation and the systemic arterial pressure (systolic, diastolic and mean) remained within the physiological values after the physiotherapeutic procedures and endotracheal aspiration, though there have been some significant differences. The endotracheal aspiration procedure has shown more influence on the cardiopulmonary function than the physiotherapeutic procedures, suggesting that aspiration is a determining factor of the deleterious repercussions on the cardiopulmonary function of PTNB, therefore, having to be used cautiously