Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 176-188). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (M.S.)--West Virginia University, 2005. / Title from document title page. Document formatted into pages; contains xiii, 177 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 147-154).

Thesis (M.S.)--University of Michigan, 1999. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1999. / Includes bibliographical references.

Thesis (Ph. D.)--West Virginia University, 2005. / Title from document title page. Document formatted into pages; contains xvii, 327 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 311-323).

OBJETIVO: Avaliar a responsividade da escala de avaliação funcional para pacientes com distrofia muscular de Duchenne (FES-DMD-D4), sentar e levantar do solo, no período de um ano. MÉTODO: Estudo observacional, longitudinal e retrospectivo. Foi estudada, utilizando o software FES-DMDDATA, uma amostra com 25 pacientes na atividade sentar no solo e 28 pacientes para a atividade levantar do solo. As avaliações ocorreram a cada três meses no período de um ano. Para análise estatística da capacidade de resposta foram utilizados índices de tamanho de efeito, como, effect size (ES) e Standardized Response Mean (SRM). RESULTADOS: A responsividade da atividade de sentar no solo foi considerada baixa a moderada em intervalos de três meses (ES de 0.28 a 0.54 e SRM de 0.38 a 0.71), moderada a alta em intervalos de seis meses (ES de 0.69 a 1.07 e SRM de 0.86 a 1.19), alta em intervalos de nove meses (ES de 1.3 a 1.17 e SRM de 1.26 a 1.55) e doze meses (ES de 1.9 e SRM de 1.72). Na atividade levantar do solo, a responsividade variou em baixa, moderada e alta em intervalos de três meses (ES de 0.21 a 0.33 e SRM de 0.45 a 0.83), baixa a alta em intervalos de seis meses (ES de 0.46 a 0.59 e SRM de 0.73 a 0.97), moderada a alta em intervalos de nove meses (ES de 0.76 a 0.88 e SRM de 1.03 a 1.22) e alta em doze meses (ES de 1.14 e SRM de 1.25). CONCLUSÃO: Para detectar alterações clinicamente significativas e consistentes nas atividades funcionais sentar e levantar do solo recomendamos a utilização da FES-DMD-D4 em intervalos a partir de seis meses, pois foi neste período de tempo que a capacidade de resposta variou de moderada a alta / OBJECTIVE: To evaluate responsiveness of functional scale for Duchenne muscular dystrophy - sitting and standing from the ground (FES-DMD - D4) in three months evaluation intervals in a one year follow up. METHODS: Observational, longitudinal and retrospective study. It was studied, using FESDMD- DATA software, films of sample of 25 patients performing sitting on the activity of soil and 28 patients performing the activity of from the ground. The evaluations were performed every three months within one year. The analysis for statistical responsiveness of the instrument we use effect size (ES) and Standardized Response Mean (SRM) tests. RESULTS: The responsiveness of the activity of sitting on the ground was considered low to moderate every three months (ES 0.28 to 0.54 and 0.38 to 0.71 SRM), moderate to high in intervals of six months (ES 0.69 the 1.07 and the 1.19 0.86 SRM), High at intervals of nine months (1,3 ES of the 1.17 and the 1.55 1.26 SRM), and twelve months (ES SRM 1.9 and 1.72). In raising from the ground activity, the responsiveness varied at low, moderate and high in intervals of three months (ES 0.21 to 0.33 and 0.45 to 0.83 SRM), low to high in intervals of six months (ES 0.46 to 0.59 and 0.73 to 0.97 SRM), moderate to high at intervals of nine months (ES 0.76 to 0.88 and 1.03 to 1.22 SRM ) and high in twelve months (ES 1.14 and SRM 1.25). CONCLUSION: To detect clinically significant changes and consistent in functional activities of sitting and standing from the ground we recommend using the FES-DMD-D4 at intervals from six months because it was at this time that the responsiveness was moderate to high

<p>Scaphoid fracture is most common in young individuals of working age. Without adequate diagnosis and treatment, long-term results are poor. Operative treatment is being recommended increasingly often instead of a long time in cast, although there is no evidence-based support for its superiority.</p><p>The present thesis focuses on diagnostic problems and therapeutic consequences of acute scaphoid fractures and of scaphoid reconstruction when other treatments have failed.</p><p>Simultaneous plain radiographs and computed tomography were done in 97 injured wrists. Structural assessments of plain radiography images were highly predictive with respect to the risk of having a displaced or comminute fracture as diagnosed on computed tomography. Any finding of a gap or step-off > 0.5 mm, the presence of an intermediate fragment or a dorsal lunate tilt of ≥ 15° identified 81 % of fractures that were displaced or comminuted when investigated with computed tomography.</p><p>Eighty-three patients were randomly allocated to and received either nonoperative treatment in cast or operative treatment with the aim of assessing long-term outcome of the two treatment options. Fifty-two of the patients were occupationally active. From an occupational perspective with an early return to work, surgical treatment was superior in individuals with manual employment, and from a health economic perspective conservative treatment was superior in non-manual workers.</p><p>Patients treated for scaphoid fractures generally do well up to 13 years after the injury based on limb-specific outcome scores. No benefits were identified with operative treatment compared to non-operative treatment in cast. On the contrary, there was an increased risk for osteoarthritis in the scaphotrapezial joint in those who were operated.</p><p>The patient-rated long-term results of silicone implant arthroplasty were good, with pain relief and reasonable hand function in many patients up to 20 years after surgery.</p>

Les maladies cardio et cérébro-vasculaires représentent la première cause de mortalité et de handicap dans le monde. Du fait des progrès thérapeutiques dans la prise en charge de ces pathologies à la phase aigüe, le nombre de patients porteurs de formes chroniques de ces affections limitant leurs capacités d’effort est en augmentation constante. La problématique de ce travail de thèse s’articule autour de l’utilisation des tests de marche standardisés dans l’évaluation des capacités d’effort des patients porteurs de pathologies coronariennes. Nous avons dans un premier temps rappelé les notions de handicap et de qualité de vie appliqués aux maladies chroniques, et la nécessité d’évaluations fonctionnelles spécifiques pour en apprécier le retentissement et l’évolution. Puis nous avons fait le point sur les modalités actuelles de la réadaptation cardiaque, en développant plus particulièrement la place de l’activité physique. Nous avons entrepris ensuite l’étude des sollicitations physiologiques induites par un test de marche rapide de 200 mètres (TMR200) chez des sujets âgés sains, puis sur une population de patients coronariens. Ce test s’est avéré bien toléré, et correspond à une intensité d’exercice intermédiaire entre le premier seuil ventilatoire et les capacités maximales d’exercice. Il apparaît ainsi particulièrement intéressant pour apprécier les capacités à effectuer des efforts fréquents de la vie quotidienne, plus intenses que ceux correspondant à la marche à vitesse spontanément adoptée au cours du classique tes de marche de 6 minutes (correspondant à un effort essentiellement aérobie). Par la suite nous avons cherché à définir la différence minimale cliniquement pertinente du test de marche (MCID) de 6 minutes (TM6) et du TMR200, afin de mieux interpréter les progrès fonctionnels des patients intégrés dans les programmes de réadaptation cardiaque après un syndrome coronarien aigu. Cette dernière a été estimée à 25 mètres pour le TM6. Enfin, nous avons étudié l’intérêt de ces tests de marche dans l’aide à l’individualisation de la prescription de l’intensité du réentraînement chez les patients coronariens. Ces modalités permettent aux patients d’être plus souvent proches des intensités d’entraînement conventionnellement préconisées, en aboutissant à des résultats comparables, sans la nécessité de pratiquer un test d’effort maximal mobilisant des moyens significatifs en personnel et en matériel. Au total, ce travail apporte des arguments pour l’utilisation en pratique clinique courante de ces tests de marche standardisés. Ils apparaissent complémentaires dans le cadre de l’évaluation objective des capacités fonctionnelles et de la qualité de vie perçue des patients âgés et coronariens. Ces résultats ouvrent des perspectives pour poursuivre l’étude de leurs propriétés métrologiques et de leurs applications cliniques au cours des affections chroniques incapacitantes. / Cardiovascular and cerebrovascular diseases remain the first cause of mortality and handicap in the world. With the improvements in the management of the acute phase, the number of patients with limited exercise capacity due to chronic cardiovascular disease is increasing. The aim of this thesis was to conduct a thorough study of the use of standardized walk tests to assess exercise capacity in coronary artery disease patients. We first explain the concepts of handicap and quality of life in chronic diseases, and the need for functional evaluations in order to assess their impact and evolution. We then present the current modalities of cardiac rehabilitation, emphasizing the importance of physical activity. We studied the physiological demands of a 200-meter fast-walk test (200MFWT) in healthy elderly subjects, and in coronary artery disease patients. This test was well tolerated, and corresponds to an effort intensity lying between the ventilatory threshold and maximal exercise capacity. It therefore appears interesting to assess the capacities of an individual to perform activities encountered in daily life that are more intense than walking at a self-selected comfortable speed, as during the 6-minute walk test (6-MWT) (corresponding to a moderate submaximal intensity solicitation, mainly aerobic). We then investigated the minimal clinically important difference of the 6MWT and 200MFWT, in order to better appraise functional improvements in patients undergoing cardiac rehabilitation after an acute coronary syndrome. This difference has been estimated at 25 metres for the 6MWT. Finally, we studied the interest of using these walk tests to individualize training intensity prescription in these patients. These modalities bring patients closer to the recommended intensity, while leading to results comparable to those of more traditional training programs, without the need for repeated expensive tests. In conclusion, this work supports the use of these standardized walk tests in routine clinical setting. They bring complementary information in the assessment of functional capacity and perceived quality of life in elderly patients and those with coronary artery disease. These results are a basis for further investigations regarding their metrological properties and clinical applications in various chronic diseases that reduce exercise capacity.

Objetivos: Avaliar a capacidade funcional de pacientes vítimas de trauma um ano após alta hospitalar e verificar associação da capacidade funcional com fatores relacionados ao trauma e à internação hospitalar. Metodologia: Estudo de coorte prospectivo, com pacientes vítimas de trauma grave (Injury Severity Score - ISS >=16), internados entre Junho e Setembro de 2010 em unidade de terapia intensiva (UTI) cirúrgica especializada em paciente politraumatizado de um hospital público de grande porte na cidade de São Paulo, Brasil. Variáveis de interesse como idade, sexo, escore de Glasgow, Acute Physiology and Chronic Health Disease Classification System II (APACHE II), mecanismos de trauma, número de lesões, região corpórea afetada, número de cirurgias, duração da ventilação mecânica (VM) e tempo de internação hospitalar foram coletadas dos prontuários médicos. A capacidade funcional foi avaliada um ano após alta hospitalar utilizando as escalas Glasgow Outcome Scale (GOS) e Escala de Atividades Instrumentais de Vida Diária de Lawton (AIVDL). Os pacientes também foram questionados se haviam retornado ao trabalho ou estudo. Resultados: O seguimento um ano após trauma foi completo em 49 indivíduos, a maioria composta por jovens (36±11 anos), do sexo masculino (81,6%) e vítimas de acidentes de trânsito (71,5%). Cada indivíduo sofreu aproximadamente 4 lesões corporais, acarretando uma média no ISS de 31 ± 14,4. O traumatismo cranioencefálico foi o tipo de lesão mais comum (65,3%). De acordo com a GOS, a maioria dos pacientes apresentou disfunção moderada (43%) ou disfunção leve ou ausente (37%) um ano após o trauma. A escala AIVDL apresentou pontuação média de 12±4 com aproximadamente 60- 70% dos indivíduos capazes de realizar de forma independente a maioria das atividades avaliadas. Escore de Glasgow, APACHE II, duração da VM e tempo de internação hospitalar foram associadas com a capacidade funcional um ano após lesão. A regressão linear múltipla considerando todas as variáveis significativas revelou associação entre a pontuação da escala AIVDL e o tempo de internação hospitalar. Apenas 32,6% dos indivíduos retornaram ao trabalho ou estudo. Conclusões: A maioria dos pacientes vítimas de trauma grave foi capaz de realizar as atividades avaliadas com independência; apenas um terço deles retornou ao trabalho e/ou estudo um ano após alta hospitalar. O tempo de internação hospitalar foi revelado como preditor significativo para a recuperação da capacidade funcional um ano após lesão grave / Objectives: To investigate the functional capacity of trauma survivors at one year after hospital discharge and to verify the association between functional capacity and trauma-related aspects and hospital stay. Methods: This prospective cohort study included severe trauma patients (Injury Severity Score - ISS >= 16) admitted between June and September 2010 to a surgical intensive care unit (ICU) of a large public hospital in São Paulo, Brazil. Variables of interest such as age, gender, Acute Physiology and Chronic Health Disease Classification System II (APACHE II), trauma mechanisms, number of injuries, body region injured, number of surgeries, mechanical ventilation (MV) duration and hospital length of stay (LOS) were collected from patient records. Functional capacity was assessed one year after hospital discharge using the Glasgow Outcome Scale (GOS) and the Lawton Instrumental Activities of Daily Living Scale (LIADL). Patients were also asked if they had returned to work or school. Results: A total of 49 trauma survivors completed 1 year of follow-up. Most subjects were young (36±11 years), male (81.6%) and victims of traffic accidents (71.5%). Each patient suffered approximately 4 injuries, with a mean ISS of 31 ± 14.4. Traumatic brain injury was the most common type of injury (65.3%). According to the GOS, most patients were classified into two categories, indicating moderate dysfunction (43%) or mild or no dysfunction (37%) at one year after trauma. Additionally, the LIADL also showed favorable functional outcomes (average score 12 ± 4); approximately 60-70% of the subjects were able to perform most activities independently. Glasgow score, APACHE II score, MV duration and hospital LOS were factors related to the recovery of functional capacity one year after injury. Multiple linear regression analysis including all variables with statistical power revealed a significant association between the LIADL score and hospital LOS. Only 32.6% of the subjects had returned to work or school. Conclusions: Most severe trauma patients were able to perform the assessed activities independently, although only a third had returned to work or school one year after hospital discharge. Hospital LOS was identified as a significant predictor of functional capacity recovery one year after severe injury

O cuidado integral ao idoso pode ser garantido mediante a utilização do Processo de Enfermagem (PE), aliado a um referencial teórico como, por exemplo, o Modelo Multidimensional de Envelhecimento bem Sucedido (MMES), que possui uma proposta de avaliação do idoso. Há, contudo, uma lacuna para a sua utilização, uma vez que não há estudos que comprovem a sua eficácia na prática clínica da Enfermagem associado à aplicação de sistemas de classificação da disciplina como a NANDA-I, NIC e NOC. O objetivo deste estudo é construir um modelo multidimensional de cuidado ao idoso associado aos Sistemas de Linguagens Padronizadas de Enfermagem NANDA-I, NIC e NOC, aplicável à consulta de enfermagem. O estudo foi conduzido em duas etapas metodológicas distintas. A primeira compreendeu um estudo de validação de conteúdo enquanto a segunda uma pesquisa de resultados, que contemplou um estudo quase experimental. As amostras foram constituídas de 15 especialistas em Enfermagem Gerontológica e 28 idosos em primeira consulta na Cidade do Idoso, local do estudo, com idade igual ou superior a 60 anos, que apresentaram o diagnóstico de enfermagem Risco de Síndrome do Idoso Frágil (RSIF) ou Síndrome do Idoso Frágil (SIF), no período de maio a outubro de 2017. Após a validação do conteúdo do modelo multidimensional, com a opinião dos especialistas, efetuou-se a sua aplicação aos idosos em quatro consultas de enfermagem para cada um. Durante as consultas estabeleceram-se os diagnósticos, mensuraram-se os resultados e implementaram-se as intervenções de enfermagem, conforme o modelo e a avaliação clínica. Os especialistas validaram informações da anamnese e exame físico referentes às características definidoras, fatores relacionados e de risco dos dois diagnósticos e às dimensões fisiológica, psicológica e social, conforme propõe o MMES. A validação também confirmou que dos 13 diferentes resultados de enfermagem validados, 10 foram comuns em ambos os diagnósticos. Os resultados validados para os dois diagnósticos avaliaram Equilíbrio (0202), Cognição (0900), Estado nutricional (1004), Autocontrole da doença crônica (3102), Conhecimento: controle da dor (1843), Participação em programa de exercício físico (1633), Conhecimento: controle da doença crônica (1847), Conhecimento: prevenção de quedas (1828), Conhecimento: controle do peso (1841) e Estado de conforto (2008). Apenas dois dos 13 resultados foram validados para o diagnóstico SIF, sendo eles: Nível de fadiga (0007) e Autocuidado: atividades da vida diária (0300), e um resultado, Conhecimento: medicamento (1808), foi validado apenas para o diagnóstico RSIF. As intervenções de enfermagem da NIC, validadas para os dois diagnósticos de enfermagem, foram praticamente iguais. Das oito diferentes intervenções validadas apenas a Assistência ao Autocuidado (1800) foi validada exclusivamente para o diagnóstico SIF e as outras sete foram validadas para os dois diagnósticos. As intervenções destacam a importância da Promoção do exercício (0200), Aconselhamento nutricional (5246), Controle de medicamentos (2380), Estimulação cognitiva (4720), Melhora na socialização (5100), Prevenção contra quedas (6490) e Ensino sobre o processo da doença (5602). A segunda etapa mostrou que dos 28 idosos a maioria era do sexo feminino (17 - 60,7%), com idade média de 65,6 ± 6,3 anos e, desses, 23 idosos foram diagnosticados com RSIF e cinco com SIF. Dos resultados de enfermagem utilizados para avaliar idosos com RSIF e SIF percebeu-se melhora significativa na média dos escores dos seus indicadores: Participação em programa de exercício físico; Autocontrole da doença crônica; 7 Conhecimento: controle da doença crônica; Conhecimento: controle do peso; Conhecimento: prevenção de quedas e Estado de conforto. Os resultados Estado nutricional e Conhecimento: controle da dor tiveram melhora significativa nos escores dos indicadores somente para idosos com RSIF, assim como a avaliação do Autocuidado: atividades da vida diária para idosos com SIF. As intervenções que apresentaram efetividade estatisticamente significativa na utilização de suas atividades em idosos, com ambos os diagnósticos, foram: Ensino: processo da doença e Promoção do exercício, enquanto a intervenção Prevenção contra quedas foi encontrada somente em idosos com RSIF. Conclui-se que as sete intervenções de enfermagem validadas pelos especialistas foram implementadas aos idosos com diagnóstico de enfermagem RSIF e foram consideradas efetivas, tendo como base a avaliação de nove resultados que apontaram melhora significativa na comparação entre as médias da primeira e quarta consultas. Dentre as oito intervenções de enfermagem implementadas aos idosos com diagnóstico de enfermagem SIF, sete foram consideradas efetivas, tendo como base a avaliação de 11 resultados que apontaram melhora significativa na comparação entre as médias da primeira e quarta consultas. Dessa forma, conclui-se ainda, que o modelo multidimensional de cuidado ao idoso associado aos SLP contribui para a prática assistencial do enfermeiro na consulta de enfermagem, com vistas ao envelhecimento bem sucedido. Dentre as importantes implicações e contribuições dos resultados desta pesquisa está a possibilidade de apoiar a ligação entre resultados e intervenções validados com os diagnósticos de enfermagem RSIF e SIF, facilitando a avaliação de enfermagem e os cuidados de enfermagem aos idosos na prática clínica. Além disso, recomenda-se a construção de definições operacionais para os indicadores dos resultados de enfermagem. Uma limitação do estudo foi o fato de realizarmos a pesquisa com especialistas do mesmo país. / Comprehensive care for the elderly can be guaranteed through the use of the Nursing Process (PE), together with a theoretical framework such as the Multidimensional Model of Successful Aging (MMSA), which has a proposal for the evaluation of the elderly. There is, however, a gap to its use, since there are no studies that prove its effectiveness in the clinical practice of Nursing associated with the application of discipline classification systems such as NANDA-I, NIC and NOC. The objective of this study is to build an elderly care multidimensional model associated with the standardized NANDA-I, NIC and NOC Nursing language systems, applicable to the nursing consultation. The study was conducted in two different methodological steps. The first comprised a content validation study while the second a results research, which included a quasi-experimental study. The samples consisted of 15 specialists in Gerontology Nursing and 28 elderly people in a first consultation in the City of the Elderly, place of study, with age equal to or greater than 60 years, of both sexes, who presented the diagnosis of Nursing Risk of Syndrome of the Elderly (RSIF) or Fragile Elderly Syndrome (SIF), from May to October 2017. After the validation of the multidimensional model content, with the opinion of the specialists, it was applied to the elderly in four every elderly person. During the consultations the diagnoses were established, the results were measured and the Nursing interventions were implemented, according to the multidimensional model and the clinical evaluation. The specialists validated information about the anamnesis and the physical examination referring to the defining characteristics, related and risk factors of the two diagnoses and the physiological, psychological and social dimensions, as proposed by the MMSA. Validation also confirmed that of the 13 different validated Nursing outcomes, 10 were common in both diagnoses. The results validated for the two diagnoses evaluated: Equilibrium (0202), Cognition (0900), Nutritional status (1004), Self-control of chronic disease (3102), Knowledge: pain control (1843), Knowledge: control of chronic disease (1847), Knowledge: prevention of falls (1828), Knowledge: weight control (1841) and Comfort state (2008). Only two of the 13 results were validated for SIF diagnosis, being: Fatigue level (0007) and Self-care: activities of daily living (0300), and a result, Knowledge: medicine (1808), was validated only for the diagnosis RSIF. The Nursing interventions of the NIC, validated for the two Nursing diagnoses, were practically the same. Of the eight different validated interventions, only Self-care Assistance (1800) was validated exclusively for SIF diagnosis and the other seven were validated for both diagnoses. The interventions emphasize the importance of Promoting Exercise (0200), Nutrition Counseling (5246), Medication Control (2380), Cognitive Stimulation (4720), Improving Socialization (5100), Fall Prevention (6490) and Teaching the Process of the disease (5602). The second stage showed that of the 28 elderly, the majority were female (17-60.7%), with a mean age of 65.6 ± 6.3 years, and of these, 23 elderly were diagnosed with RSIF and five with SIF. Nursing results used to evaluate the elderly with RSIF and SIF showed a significant improvement in the mean of the scores of their indicators: Knowledge: control of chronic disease; Self-control of chronic disease; Knowledge: prevention of falls; Weight control; State of comfort and Participation in physical exercise program. The results Knowledge: pain control and nutritional status had significant improvement in the scores of indicators only for the elderly with RSIF, as well as the self-care evaluation: daily life activities for elderly with 9 SIF. The interventions that presented a statistically significant reduction in the use of their activities in the elderly, with both diagnoses, were Teaching: disease process and Exercise promotion, while the intervention Prevention of falls was found only in the elderly with RSIF. It is concluded that the seven nursing interventions validated by the specialists were implemented to the elderly with a diagnosis of RSIF Nursing and were considered effective, based on the evaluation of nine results that indicated a significant improvement in the comparison between the means of the first and fourth visits. Among the eight Nursing interventions implemented to the elderly with SIF Nursing diagnosis, seven were considered effective, based on the evaluation of 11 results that indicated a significant improvement in the comparison between the means of the first and fourth visits. Thus, it can be concluded that the multidimensional model of elderly care associated with standardized Nursing language systems contributes to the nurses practice in the nursing consultation, with a view to successful aging. Among the important implications and contributions of the results of this research is the possibility of supporting the link between results and validated interventions with the RSIF and SIF, facilitating nursing assessment and nursing care for the elderly in clinical practice. In addition, it is recommended to construct operational definitions for indicators of nursing outcomes. One limitation of the study was the fact that we conducted the research with specialists from the same country.