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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
131

Inhibition of neutrophil migration and hypernociception by remote ischemic preconditioning: participation of the L-arginine-NO-cGMP-CHANNELS K + ATP / InibiÃÃo da migraÃÃo de neutrÃfilos e da hipernocic epÃÃo pelo prÃ-condicionamento isquÃmico remoto: participaÃÃo da via L-ARGININA-NO-GMPc-CANAIS K+ATP

Marcus VinÃcius Ponte de Sousa Filho 22 June 2005 (has links)
FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A lesÃo de reperfusÃo (LR) ocorre em diversos orgÃos e tecidos durante o restabelecimento do fluxo sangÃÃneo apÃs episÃdios de isquemia prolongada. Em diversas Ãreas clÃnicas esta lesÃo à temida pelas complicaÃÃes decorrentes da demora no restabelecimento do fluxo vascular. Nos transplantes de ÃrgÃos, nos retalhos microcirÃrgicos e nas cirurgias de revascularizaÃÃo miocÃrdica, a LR, dependendo de sua intensidade, pode prejudicar o benefÃcio destes procedimentos. Dentre as estratÃgias propostas para atenuar a LR, o prÃ-condicionamento isquÃmico (PCI) consiste na induÃÃo de pequenos perÃodos de isquemia seguidos de reperfusÃo, realizados antes da isquemia prolongada. Este estudo foi avaliar o efeito do PCI da pata posterior na sobrevida de retalhos cutÃneos randomizados em dorso (RCRD) e o efeito antiinflamatÃrio local e sistÃmico deste fenÃmeno. Para tanto o PCI foi induzido atravÃs da isquemia da pata posterior de ratos Wistar por 10 minutos seguida de 30 minutos de reperfusÃo. Diferentes grupos de ratos foram submetidos à confecÃÃo de RCRD, à induÃÃo de edema de pata (EP), ipsilateral (IPS) e contralateral (CON), por carragenina (Cg) ou dextran (Dx), cistite hemorrÃgica (CH) por ifosfamida (IFO) ou lesÃo gÃstrica (LG) por indometacina (INDO). Os grupos controles (C) receberam o mesmo tratamento, porÃm sem PCI. A Ãrea de sobrevida (AS) do RCRD foi calculada pela superfÃcie de tecido viÃvel (cm2), o EP atravÃs da variaÃÃo do volume das patas (ml), o edema vesical (EV) pelo peso Ãmido da bexiga (mg), o aumento da permeabilidade vascular (APV) pelo extravasamento de azul de Evans (&#61549;g), o Ãndice de lesÃo gÃstrica (ILG) pela soma das extensÃes das lesÃes encontradas na mucosa (mm), e a infiltraÃÃo neutrofÃlica (IN) pela atividade da mieloperoxidade (MPO) (U/mg). O PCI foi capaz de aumentar a AS do RCRD (C=4,16Â0,29 e PCI=6,42Â0,14, p<0,01). O EP e o APV induzidos por Cg (100&#61549;g, sc) ou Dx (200&#61549;g, sc), tanto na pata IPS quanto CON, foram reduzidos pelo PCI (EP IPS Cg â C=0,63+0,05 e PCI=0,26+0,02; APV IPS Cg â C=10,03+0,68 e PCI=5,82+1,18; EP IPS Dx â C=1,08+0,11 e PCI=0,54+0,06; APV IPS Dx â C= 24,38+3,02 e PCI=13,51+1,70; EP CON Cg â C=0,63+0,10 e PCI=0,30+0,05; APV CON Cg â C=16,16+2,18 e PCI=9,19+1,12; EP CON Dx â C=0,95+0,10 e PCI=0,49+0,10; APV CON Dx â C=24,09+2,97 e PCI=13,15+1,62; p<0,01). O PCI inibiu o EV e o APV da CH induzida por IFO (200mg/kg, ip) (EV â C=206,6+10,95 e PCI=126+5,66; APV â C=38,55+2,19 e PCI=17,74+2,18; p<0,001). Tanto a LG quanto a IN induzidas por INDO (20mg/kg, vo) foram bloqueadas pelo PCI (ILG â C=20,54+2,05 e PCI=2,00+0,93; IN â C=9,67+2,05 e PCI=3,49+0,83; p<0,001). Os resultados indicam que o PCI aumenta a sobrevida de RCRD e apresenta um efeito antiinflamatÃrio local e sistÃmico em modelos de inflamaÃÃo aguda. O esclarecimento do mecanismo atravÃs do qual o PCI atenua a lesÃo inflamatÃria poderà trazer importantes contribuiÃÃes em situaÃÃes clÃnicas onde esta lesÃo constitui um fator complicador, podendo propiciar o desenvolvimento de novas abordagens profilÃticas e/ou terapÃuticas. / The reperfusion injury (RI) occurs when there is delay in restoring blood flow to organs and tissues. Among the strategies proposed to attenuate the RI is the ischemic preconditioning (IPC), which consists of induction of brief ischemic periods followed by reperfusion performed before the sustained ischemic insult. In the first part, this study aimed to evaluate the role of nitric oxide (NO), cyclic guanosine monophosphate (cGMP) and ATP-sensitive potassium channels (K+ATP) in the inhibitory effect of hind limb IPC on the mice peritoneal cavity neutrophil migration (NM). In the second part, the objective was to evaluate the potential systemic antinociceptive effect of IPC in mechanical plantar hypernociception test (MPH; Von Frey) in rats and to evaluate the involvement of NO, cGMP and K+ATP channels in this event. In the first part, the IPC was induced by hind limb ischemia for 10 min followed by 30 min of reperfusion in wild and knockout mice to inducible NO synthase (iNOS -/-). The leukocyte rolling (LR), leukocyte adhesion (LA) and NM were induced by ip administration of Carrageenan (Cg, 500 &#61549;g/cavity) and results expressed in number of leukocytes/min, number of adherent leukocytes/100 &#61549;m2 cells and number of neutrophils x 106/cavity, respectively. Different groups of animals were treated with saline (SAL), Aminoguanidine (AG, sc, 100mg/kg), ODQ (ip, 8 &#61549;mol/kg) or Glibenclamide (GBC, sc, 20 mg/kg) 30 min before IPC induction. Controls received the same treatment, but without IPC. In the second part, the IPC was induced by hind limb ischemia for 10 min followed by 30 min of reperfusion in male Wistar rats (180-200g). Cg (300 &#61549;g, intraplantar) or Prostaglandin E2 (PGE2 - 400 ng, intraplantar) were used as hypernociceptive stimulus on left paw immediately after induction of IPC in contralateral paw. Different groups of animals were treated 30 min before induction of IPC with AG (100 &#61549;g/kg, intraplantar), LNMMA (50 &#61549;g, intraplantar), ODQ (8 &#61549;g, intraplantar) or GBC (160 &#61549;g, intraplantar). Controls received the same treatments, but without IPC. The quantification of MPH was performed through subtraction strength/pressure (g) required to cause withdrawal of paw in contact with an apparatus of eletronic von Frey mensuread before hypernociceptive stimulus, by measure obtained 3h after administration of Cg or PGE2. The LR, LA and NM induced by Cg in the peritoneal cavity were significantly (p <0,01) inhibited by hind limb IPC of wild animals (LR= 75.94%, LA= 56.51%, NM= 79.01 %), but these effects were not observed in animals iNOS -/-. The treatment of wild animals with AG and ODQ, but not with GBC, abrogated the inhibitory effect of IPC on NM induced by Cg. Treatment of animals with AG, GBC or ODQ did not significantly alter the NM induced by Cg in the peritoneal cavity. We also observed that IPC did not alter the TNF-&#61537;, IL1-&#61538; and CXCL1 chemokine levels induced by Cg in the peritoneal cavity. The mechanical hypernociception induced by Cg or PGE2 in left hind paw was significantly reduced (p <0,01) when IPC was performed in the right paw (55% and 68%). The treatment of animals with AG, LNMMA, ODQ or GBC, before IPC, abrogated the antinociceptive effect of IPC. Treatment of animals with AG, LNMMA, ODQ or GBC did not significantly alter the hypernociception induced by noxious stimulation. Our results show that IPC has an inhibitory effect on remote NM, with NO an important mediator involved in this process, probably through the cGMP pathway. This inhibitory effect of IPC does not depend on the opening of K+ATP channels, or inhibition of synthesis and/or release of pro-inflammatory cytokines. The elucidation of the mechanism by which IPC inhibits the NM may make important contributions to clinical situations where neutrophil infiltration is a complicating factor. The IPC also has a potent inhibitory effect on inflammatory pain, with NO seems to be one important mediator involved in this protective effect of IPC, acting through the cGMP/K+ATP channel pathway. This is the first demonstration described in the literature of systemic antinociceptive effect of IPC, and the elucidation of the mechanisms involved in this process is fundamental for pain management induced by several inflammatory stimuli.
132

Efeito de exercícios motores orofaciais e laserterapia nos sintomas de desordem temporomandibular e funções orofaciais / Effect of orafacial motor exercises and lasertherapy in the symptoms of temporomandibular disorders and orofacial functions

Cusumano, Barbara Cristina Zanandréa Machado 28 January 2016 (has links)
Introdução: Baseado nos achados sobre o efeito analgésico do laser e no fato de que a reabilitação motora é sugerida para o tratamento de desordens de dor musculoesquelética, nossa hipótese foi que a laserterapia (LLLT) combinada com exercícios motores orofaciais potencializaria a reabilitação da desordem temporomandibular (DTM) e poderia promover maior redução dos sinais e sintomas e melhor reabilitação das funções motoras orofaciais do que a LLLT exclusiva ou o protocolo de terapia miofuncional orofacial (TMO) para DTM, previamente descrito. Objetivo: Analisar os efeitos da LLLT combinada com exercícios motores orofaciais (EMO) no tratamento de DTM. Verificar se esse programa de tratamento (LLLT + EMO) apresenta vantagens ou desvantagens em relação às seguintes modalidades: protocolo de TMO completo para DTM; LLLT exclusiva; e LLLT inativa (placebo) combinada com EMO. Verificar se as referidas modalidades de tratamento permitem a recuperação da normalidade no que diz respeito às variáveis envolvidas nesse estudo. Método: Participaram 104 pacientes com DTM, examinados segundo o Research Diagnostic Criteria for Temporomandibular Disorders RDC/DTM e classificados de acordo com o tipo de DTM seguindo o Diagnostic Criteria for Temporomandibular Disorder (DC/TMD). Participaram ainda 20 sujeitos sem DTM, equilibrados por gênero e idade com os grupos experimentais. Os pacientes com DTM foram divididos aleatoriamente em quatro grupos de tratamento com 26 participantes cada: Grupo II, no qual a TMO foi realizada de acordo com protocolo previamente publicado (Felício, 2009; Felício et al., 2010; Felício e Machado, 2012), composto por técnicas de alivio da dor e exercícios motores orofaciais e recuperação das funções; Grupo III que recebeu LLLT combinada com EMO, sendo a sessão iniciada com aplicação do laser de Arseneto de Gálio e Alumínio (AsGaAl) com uma dose de 60 J/cm², na região da ATM e sobre os locais doloridos na musculatura seguida dos EMO; Grupo IV que recebeu LLLT placebo associada a EMO, sendo os mesmos procedimentos do GIII, porém a aplicação do laser foi realizada com a ponta inativa; e Grupo V que recebeu laser de baixa intensidade exclusiva. As medidas de resultados foram: dor à palpação, limiar de dor à pressão, percepção da severidade dos sinais e sintomas de DTM, condição miofuncional orofacial e atividade eletromiográfica. Os grupos de tratamento foram comparados ao grupo controle em cada fase (FD, FF e FS) por meio do teste Kruskal-Wallis Anova by ranks. Também foram comparadas as fases do estudo somente entre os grupos tratados por meio do teste de Friedman. O post hoc teste foi aplicado para diferenças significantes (p < 0,01). Também foi realizada análise intragrupo para os grupos com DTM por meio do teste de Friedman (p < 0,05) e para as diferenças significantes foi calculado o índice Effect size (ES) para medir a magnitude do efeito do tratamento. Resultados: As modalidades com alguma estratégia de alívio da dor (LLLT ou relaxamento e massagens) e EMO combinados (GII e GIII) foram mais efetivas para a redução de sintomas de DTM, sensibilidade à palpação e dificuldade para mastigar, bem como para o aumento do limiar de dor à pressão e a recuperação das funções orofaciais. O GIII apresentou maior equilíbrio entre os músculos temporais e masseteres refletidos pelo índice ATTIV. Entre os outros dois grupos, o GIV (LLLT placebo+EMO) resultou em melhores condições miofuncionais orofaciais e maior redução de dificuldade para mastigar, enquanto o GV (LLLT) produziu maior decréscimo dos sintomas de DTM. A magnitude do efeito do tratamento para sensibilidade à palpação e limiar de dor à pressão foi similar entre estes dois grupos. Conclusão: As modalidades que incluíram estratégias de alívio da dor (LLLT ou relaxamento e massagens) combinadas aos EMO foram mais eficazes. Assim sendo, a combinação de estratégias para o controle da dor e treinamento motor orofacial mostrou-se promissora como uma opção na reabilitação das DTMs crônicas / Introduction: Based on previous findings about the analgesic effect of lasertherapy (LLLT) and on fact that, motor rehabilitation is a potential approaches to treat musculoskeletal pain disorders, because altered motor performance may be a factor for the maintenance of pain, we raised the hypotheses that LLLT combined with orofacial motor exercises (OME) may potentiate temporomandibular disorder (TMD) rehabilitation better than either LLLT alone or OME associated with relaxation techniques and massage of the OMT protocol previously described. Objective: To analyze the effects of LLLT combined with OME for the treatment of TMD. To verify if this treatment program (LLLT + OME) has advantages and disadvantages regarding to the others modalities: complete protocol of orofacial myofunctional therapy (OMT) for DTM, only LLLT and inactive LLLT combined with OME. To verify if these treatment modalities allow the recovery of normality regarding to the variables involved in this study. Method: 104 patients with TMD were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders RDC/TMD and classified according to the type of TMD following the Diagnostic Criteria for Temporomandibular Disorder (DC/TMD). Also, 20 subjects without TMD participated, balanced by gender and age with the experimental groups. The TMD patients were randomly divided into four treatment groups with 26 participants in each one: Group II received the OMT performed according to previously published protocol (Felício, 2009; Felício et al., 2010; Felicio and Machado, 2012), consisting of pain relief techniques, OME and recovery functions; Group III was treated with LLLT combined with OME: the session was started with the laser application of gallium arsenide and aluminum (GaAlAs) at a dose of 60 J/cm², in the TMJ region and in painful muscles followed by the OME; Group IV that received LLLT placebo associated with OME and the procedures were the same as GIII, however, the laser application was performed with the inactive tip and; and Group V that received only laser therapy. The outcome measures were pain on palpation, pressure pain threshold, perception of severity of signs and symptoms of TMD, orofacial myofunctional condition and electromyographic activity. The treatment groups were compared to the control group in the phases FD, FF and FS, using Kruskal-Wallis ANOVA by ranks test. Also, the phases of the study were compared only between the treated groups by Friedman test. The post hoc test was applied for significant differences (p <0.01). Intra-group analysis was performed for the TMD groups using the Friedman test (p <0.05) and for significant differences was calculated the Effect size index (ES) to measure the magnitude of effect of treatment. Results: The therapeutic modalities involving some pain-relieving strategy (LLLT or relaxation and massage) and OME combined (GII and GIII) were more effective in reducing symptoms of TMD, tenderness on palpation and difficulty in chewing, as well as, the increase the pressure pain threshold and recovery of functions. The GIII group showed higher balance between temporal and masseter muscles represented by ATTIV index. Between the other two groups, the GIV (LLLT placebo + OME) resulted in better orofacial myofunctional conditions and reduction of difficulty chewing, while the GV (LLLT) produced a greater decrease in symptoms of TMD. The magnitude of the effect of treatment for tenderness on palpation and pressure pain threshold was similar between these two groups. Conclusion: The modalities of treatment that included pain relief strategies (LLLT or relaxation and massage) combined with OME were more effective. Therefore, the combination of strategies for the control pain and orofacial motor training proved to be promising as an option in the chronic TMD rehabilitation
133

Exposição, avaliação e manejo da dor aguda do recém-nascido em unidades neonatais de um hospital estadual / Exposition, evaluation and management of acute pain in neonates in neonates\' unities in a state hospital

Capellini, Verusca Kelly 17 December 2012 (has links)
Os recém-nascidos internados em unidades neonatais são expostos a inúmeros procedimentos potencialmente dolorosos durante sua hospitalização, e há desconhecimento de tal exposição e das práticas para o manejo da dor, na maioria dos serviços brasileiros de referência neonatal. Este estudo descritivo exploratório foi realizado em três etapas, com os objetivos de avaliar o conhecimento e as práticas dos profissionais de saúde que atuam em unidades neonatais de um hospital estadual do interior paulista quanto à avaliação e ao manejo da dor no recém-nascido (etapa 1), identificar os registros de avaliação da dor e de intervenções farmacológicas e não farmacológicas para o alívio da dor, feitos pelos profissionais em prontuários neonatais nesse hospital (etapa 2) e dimensionar a exposição dos neonatos a procedimentos de dor aguda, durante os primeiros sete dias de internação nessas unidades neonatais (etapa 3). Os 15 médicos, 8 enfermeiras e 34 auxiliares de enfermagem preencheram um questionário contendo dados relacionados ao conhecimento e às práticas de avaliação e manejo da dor neonatal. Na etapa 2, foi feito um estudo retrospectivo em fonte secundária, utilizando dados dos prontuários de 115 recém-nascidos internados nas unidades de cuidados intensivos e intermediários neonatais do hospital, no período de 12 meses. Na etapa 3, foi realizado registro à beira do leito de todos os eventos potencialmente dolorosos a que os recém-nascidos foram submetidos, durante a primeira semana de internação nessas unidades, no período de setembro a dezembro de 2011. Constatou-se que apenas uma auxiliar de enfermagem acredita que o neonato não sente dor. Todas as enfermeiras e a grande maioria dos médicos e auxiliares de enfermagem afirmaram que avaliam a dor no recém-nascido, tendo como parâmetros de avaliação mais frequentes o choro e a mímica facial; os parâmetros fisiológicos, especialmente o aumento da frequência cardíaca, foram os mais mencionados pelos médicos. Nenhum dos profissionais de saúde conhecia escalas para a avaliação de dor no recém-nascido. Entre as medidas não farmacológicas para o alívio da dor neonatal, citadas pelos profissionais de saúde, predominou o uso da glicose com ou sem a sucção não nutritiva, enquanto as medicações mais referidas como adequadas para o alívio da dor neonatal foram o fentanil e o paracetamol. Os registros sobre a avaliação e as intervenções para o alívio da dor neonatal constavam apenas nas prescrições médicas e nos diagnósticos, prescrições e anotações de enfermagem. Os recém-nascidos participantes da etapa 3 foram submetidos a 1.316 procedimentos potencialmente dolorosos, durante a primeira semana de internação; a média foi de 5,9 ± 4,7 procedimentos por dia, variando de 9,4 ± 6,2 no primeiro dia a 3,8 ± 3,2 procedimentos no sétimo dia de internação. Os procedimentos dolorosos mais frequentes foram as punções de calcâneo e venosa. Concluiu-se que há desconhecimento dos profissionais de saúde e sub-registro sobre a avaliação e o manejo adequados da dor aguda no recém- nascido e que os neonatos são submetidos a inúmeros procedimentos potencialmente dolorosos, durante sua hospitalização. Recomenda-se a capacitação profissional e a elaboração de protocolos de cuidado para a avaliação adequada e o tratamento efetivo da dor, nessas unidades neonatais. / The neonates hospitalized in neonates\' unities are exposed to a countless potentially painful procedures during hospitalization and there is no knowledge of this exposure and the practices to handling this pain in most cases of Brazilian neonates referring. This descriptive exploratory study was made in three stages, in purpose to evaluate the knowledge and the practices of the health professionals who work in neonates\' unities of a state hospital in the São Paulo interior that concerns to evaluation and handling of pain in neonates (stage 1), identify the evaluation records of pain and pharmacologic and non-pharmacologic interventions for pain relief done by the professionals in neonates\' records in this hospital (stage 2) and dimensioning the exposure of the neonates to acute pain procedures during the first seven days of hospitalization in these unities (stage 3). The 15 physicians, 8 nurses and 34 nursing assistants filled a questionnaire related to knowledge and practices of evaluation and handling of neonate pain. On stage 2 was made a retrospective study in secondary sources using data from records of 115 hospitalized neonates in intermediary and intensive and care unities in 12 months. On stage 3 was made a record on the bedside of all the potentially painful events that the neonates underwent during the first week of hospitalization from September to December of 2011. When It comes to believing that the neonates don\'t feel any pain, just one nursing assistant believed that. All the nurses and the most part of physicians asserted that they evaluate the pain taking into consideration the weeping and facial expressions; the physiologic parameters, like heart rate increasing, were mentioned specially by the physicians. None of the professionals knew the scale of evaluation of a pain in neonates. Among the mentioned non- pharmacologic procedures, the glucose use with or without non- nutritive suction, while the most mentioned adequate medicine were fentanyl and paracetamol. In the records about evaluation and intervention for pain relief were present only medical prescriptions and in diagnosis, prescriptions and nursing notes. The participating neonates from stage 3 were submitted to 1,316 potentially painful procedures during the first week of hospitalization; the mean was 5.9 ± 4.7 procedures per day, varying from 9.4 ± 6.2 in the first day to 3.8 ± 3.2 procedures in the seventh day of hospitalization. The more frequent painful procedures were calcaneus and venous puncture. We concluded that there is ignorance by the health professionals and under-register about the evaluation and handling of acute pain in neonates and that the neonates are submitted to a countless potentially painful procedures during their hospitalization. We recommend the professional capacitation and elaboration of care protocols for the evaluation and effective treatment of pain in these neonates\' unities.
134

Korrekt smärtbedömning – en mänsklig rättighet : Smärtbedömning hos personer med Alzheimers sjukdom / Proper pain assessment – a human right. : Pain assessment in people with Alzheimer's disease

Sjölin, William, Bengtsson, Annika January 2011 (has links)
Bakgrund: svårigheter uppstår med kommunikationen mellan patient och sjuksköterskan vid insjuknande i Alzheimers sjukdom vilket leder till hinder i smärtbedömning av personer med Alzheimers sjukdom jämfört med bedömningen avpersoner utan kognitiv nedsättning. Syfte: syftet med litteraturstudien var att belysa vikten av korrekt smärtbedömning hos patienter med Alzheimers sjukdom. Metod: studien var en litteraturstudie, 12 artiklar samtliga kvantitativa som svarade mot studiens syfte har granskats och analyserats. Resultat och konklusion: bedömning av smärta hos patienter med Alzheimers sjukdom är komplex, slutsatsen är tvetydig då resultatet visar dels att personer med Alzheimers sjukdom har mer smärta respektive mindre smärta än personer utan kognitiv nedsättning. Bedömningsinstrumenten som undersöktes i studien visade sig vara relevanta men ansvar och kunskap från sjukvårdspersonalen som använder instrumentet var ett krav för att kunna utesluta felkällor av tecken på smärta så som onormala rörelser, beteende och ljud. Implikation: vidare forskning bör göras där fokus ligger på de enskilda diagnoserna istället för gruppen demenssjukdomar samt ökad kunskap hos sjukvårdspersonal på smärta i relation till Alzheimers sjukdom. / Background: difficulties with communication is shown in the progress of Alzheimer’s disease which leads to a difference in assessment of pain in persons with Alzheimer’s disease compared to persons without a cognitive impairment. Aim of the study: the aim of the study was to illuminate the importance of correct pain assessment in patients with Alzheimer’s disease. Method: the study was a literature review, 12 quantitative articles which met the study’s purpose was reviewed and analyzed. Results and conclusions: pain assessment in patients with Alzheimer’s disease is complex, the conclusion is ambiguous since the results show that people with Alzheimer’s disease has more in some studies and less pain in others in comparison with people without a cognitive impairment. The pain assessment tools that were examined in this study were shown to be relevant, but it was important that the staff using the instruments had to be able to rule out confounders of pain such as unusual movements, behaviour and sounds. Implication: further research should focus on the the separate diagnoses that are included in the dementia genre. Also an increased knowledge and awareness in the staff about pain in correlation with Alzheimer’s disease.
135

Resultatet av sjuksköterskans användande av smärtskattningsinstrument vid akut smärta : En litteraturstudie / The results of nurse's use of pain assessment tools in acute pain : A literature review

Brobeck, Daniel, Ingheden, Pernilla January 2012 (has links)
Bakgrund: Smärta är en av de vanligaste orsakerna till att människor söker akut vård. Adekvat smärtbedömning är förutsättningen för god smärtbehandling. Syfte: Att belysa resultatet av sjuksköterskans användande av smärtskattningsinstrument för bedömning av akut smärta hos vuxna patienter på akutmottagning. Metod: Litteraturstudie med ett systematiskt arbetssätt. Resultat: Val av smärtskattningsinstrument: VAS och NRS är tillförlitliga instrument för att bedöma akut smärta. Professionell smärtbehandling: Användandet av smärtskattningsinstrument förkortade tiden till smärtbehandling samtidigt som fler blev smärtbehandlade. Upplevd kontra tolkad smärta: Sjuksköterskor underskattade ofta patienters akuta smärtintensitet. Kontinuerligt dokumenterade smärtanalyser: För att tillgodose att patienter får en så bra smärtbehandling som möjligt krävs att smärtanalyser utförs och dokumenteras vid inskrivning och kontinuerligt till utskrivning. Med regelbunden smärtskattning och dokumentation kan patienters smärtutveckling och eventuella behandlingsresultat följas. Slutsats: Förutsättningen för en adekvat smärtbehandling är att en smärtanalys utförts med ett smärtskattningsinstrument. Användandet av smärtskattningsinstrument leder till att patienter får adekvat smärtbehandling fortare. Smärtskattningsskalor är goda redskap för att bedöma smärta. En metod för att förbättra smärtbehandlingen kan vara att ha tydliga riktlinjer och rutiner som förespråkar användandet av smärtskattningsinstrument. / Background: Pain is one of the most common reasons for seeking emergency care. Adequate pain assessment is a prerequisite for good pain management. Aim: To illustrate the results of the nurse's use of pain assessment tools for the assessment of acute pain in adult patients in the emergency department. Method: Literature study with a systematic approach. Results: Choice of pain assessment tool: VAS and NRS are reliable tools for the measurement of acute pain. Professional pain management: The use of pain assessment tools shortened the time to pain relief, while more patients received analgesics. Experienced versus interpreted pain: Nurses often underestimated the patients' pain intensity. Continuously documented pain assessments: To assure that patients get the best pain management possible, documented pain assessments at enrollment and continuously to discharge are required. With regular pain assessment and documentation patients' pain development and possible treatment outcomes can be followed. Conclusion: The prerequisite for adequate pain management is a pain analysis performed with a pain assessment tool. The use of pain assessment tools leads to more patients getting adequate pain relief more rapidly. Pain rating scales are excellent tools to assess pain. A method to improve pain treatment may be to have policies and guidelines that advocate the use of pain rating scales.
136

Effects of repetitive work on proprioception and of stretching on sensory mechanisms : implications for work-related neuromuscular disorders /

Björklund, Martin. January 2004 (has links)
Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 6 uppsatser.
137

Psychophysiological reactions to experimental stress : relations to pain sensitivity, position sense and stress perception /

Heiden, Marina, January 2006 (has links)
Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 4 uppsatser.
138

Cost-effectiveness of epidural steroid injections to treat lumbosacral radiculopathy in chronic pain patients managed under Workers' Compensation

Mohammed, Sheila. January 2008 (has links)
Thesis (M.S.P.H.)--University of South Florida, 2008. / Title from PDF of title page. Document formatted into pages; contains 45 pages. Includes bibliographical references.
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Avalia??o da dor p?s-operat?ria: an?lise em pacientes submetidos a cirurgias abdominais em um hospital universit?rio de Natal/RN

Rufino, Fatima Haryanny Gomes 05 November 2010 (has links)
Made available in DSpace on 2014-12-17T14:46:44Z (GMT). No. of bitstreams: 1 FatimaHGRM_DISSERT.pdf: 2336964 bytes, checksum: 9165fe3152c282073444e29ba58e9306 (MD5) Previous issue date: 2010-11-05 / It is an exploratory and descriptive study made by a quantitative approach, developed among February and May 2010, aiming to assess the pain of patients underwent abdominal surgeries in a University Hospital, in Natal/RN; to identify the local and intensity of the pain based on Numerical Estimative Scale; to analyze the pain related to the sensorial-discriminative, motivational-affective and cognitive-assessment dimensions, using the McGill Questionnaire pain; to establish a relation between the pain process and age, gender, religion, and king of surgery; to identify the medicines efficiency used to control postoperative pain. The sample was composed by 253 patients underwent abdominal surgeries. The results showed a total of 63.63% females between 38 and 47 years of age (21.34%); illiterates (21.73%); married (64.03%), living in Natal and surroundings (67.97%) and Catholics (74.30%). In their first assessment, 84.19% showed postoperative pain; the pain was considered light in 18.97% of them, moderate in 21.74% and severe in 43.48%. The mean number of descriptors chosen through the McGill Questionnaire Pain was 10.78 (DP= 6.09) and pain rating 23.65 (DP= 15.93). The descriptors selected with higher frequency were: sickening pain (69.01%), tired (65.25%), thin (62.44%), bored (58.69%), ardor (46.48%), pointed (38.50%) and colic (35.21%). In their second assessment, 57.71% of patients didn t relate any postoperative pain and 42.29% were still complaining about the pain. After taking analgesic medication, just 41.90% of patients who had complete pain relief. The Pharmacological groups most used were: simple analgesic (37.86%), weak opioids (32.98%), AINES (19.85%) and strong opioid (9.31%). It was not found a significant postoperative pain variation related to the sexes, religion and kind of surgery. It was concluded there were a high level in the number of patients with postoperative pain, mainly in a severe scale. Less than half of patients had the pain relief. Then, it was observed there was not coherence between the pain intensity and the analgesic it was used. To solve or relieve this kind of problems is necessary a permanent education to the health professionals who works in this area / Estudo explorat?rio descritivo, com abordagem quantitativa, desenvolvido entre fevereiro e maio de 2010, com o objetivo de avaliar a dor dos pacientes submetidos a cirurgias abdominais em um Hospital Universit?rio, em Natal/RN; identificar a localiza??o e a intensidade dolorosa mensurada pela Escala de Estimativa Num?rica; analisar a dor nas dimens?es sensorial-discriminativa, motivacional-afetiva e a cognitivo-avaliativa, utilizando o Question?rio para dor McGill; relacionar o processo ?lgico com a idade, sexo, religi?o e tipo de abordagem cir?rgica; identificar a efetividade da medica??o utilizada no al?vio da dor p?s-operat?ria. A amostra constou de 253 pacientes submetidos a cirurgias abdominais. Os resultados mostraram que 63,63% eram mulheres, entre 38 e 47 anos (21,34%); n?o alfabetizados (21,73%), casadas (64,03%), procedentes da grande Natal (67,97%) e cat?licas (74,30%). Na primeira avalia??o, 84,19% apresentaram dor p?s-operat?ria; 18,97% apresentaram dor leve; 21,74% moderada e 43,48% severa. A m?dia do n?mero de descritores escolhidos atrav?s do Question?rio de Dor McGill foi 10,78 (DP= 6,09) e o ?ndice de dor 23,65 (DP= 15,93). Os descritores escolhidos com maior frequ?ncia foram: dor enjoada (69,01%), cansativa (65,25%), fina (62,44%), aborrecida (58,69%), ardor (46,48%), pontada (38,50%) e c?lica (35,21%). Na segunda avalia??o, 57,71% pacientes n?o referiram dor p?s-operat?ria e 42,29% continuaram com queixas de dor. Apenas 41,90% dos pacientes tiveram sua dor totalmente aliviada ap?s administra??o do analg?sico. Os grupos farmacol?gicos mais utilizados foram os analg?sicos simples 37,86%, opi?ides fracos 32,98%, AINES 19,85% e opi?ides fortes 9,31%. N?o encontramos rela??o significativa entre a vari?vel dor p?s-operat?ria com o sexo, religi?o e tipo de abordagem cir?rgica. Conclu?mos que houve uma alta preval?ncia de dor p?s-operat?ria, principalmente a de intensidade severa. A dor foi efetivamente aliviada em menos da metade dos pacientes. Dessa forma, percebemos que n?o existia coer?ncia entre a intensidade da dor do paciente e o analg?sico administrado para o seu al?vio. A educa??o permanente dos profissionais de sa?de dever? ser uma das a??es mais eficazes para evitar ou minimizar a ocorr?ncia desse evento
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Efetividade do tratamento da dor pós-operatória de pacientes submetidos a cirurgia abdominal de médio e grande porte em dois hospitais públicos de Brasília / Effectiveness of the treatment of postoperative pain in patients undergoing surgery abdominal medium and large sizes in two public hospitals in Brasilia

Gaudard, Ana Márcia Yunes Salles [UNIFESP] 27 October 2010 (has links) (PDF)
Made available in DSpace on 2015-07-22T20:50:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-10-27. Added 1 bitstream(s) on 2015-08-11T03:25:33Z : No. of bitstreams: 1 Publico-007.pdf: 442623 bytes, checksum: 0ebbfc5a4a59b57350c39d2be25bc5b6 (MD5) / Introdução: A dor de intensidade moderada a forte é prevalente após procedimentos cirúrgicos e está associada com aumento de morbidade e mortalidade pós-operatória. Objetivo: Avaliar a efetividade do controle e os fatores associados à percepção da intensidade da dor de pacientes submetidos a cirurgia abdominal internados nas clínicas cirúrgicas de dois hospitais públicos de Brasília. Métodos: Estudo descritivo e transversal, por meio de análise documental e entrevista de pacientes, realizado em dois hospitais públicos de Brasília. Foram coletados dados sobre características clínicas, procedimentos cirúrgicos e condutas no controle da dor de 342 pacientes. A dor foi avaliada pela escala visual analógica nas primeiras 48 horas do período pós-operatório. Os resultados foram comparados com os dados obtidos na revisão bibliográfica. Resultados: Em 100% dos pacientes a prescrição de analgésicos no pós-operatório não foi baseada nas melhores evidências científicas. Foi observada dor moderada a forte em 38,9% dos pacientes. O analgésico mais prescrito foi a dipirona (83,6%). Dos pacientes com uso isolado de dipirona, 29,2% dos pacientes relataram dor moderada a forte. Dor moderada a forte foi significativamente maior em mulheres do que em homens; em pacientes submetidos à anestesia geral e raquianestesia em comparação com a anestesia peridural; e em pacientes sob esquemas terapêuticos prescritos pelo staff, quando cotejados com tratamentos prescritos por residentes. Não houve diferença significativa em relação a idade e etnia. A maioria dos pacientes (50,9%) não recebeu informações prévias sobre a dor pós-operatória; 61% dos que sentiram dor não solicitaram alívio; e 80% tinham registros de avaliação da dor, mas sem uso de escalas e caracterização da dor. Conclusões: O controle da dor pós-operatória nos hospitais avaliados não seguiu as condutas baseadas nas melhores evidências. A dor pós-operatória foi mais intensa nos pacientes do sexo feminino e nos pacientes sob esquemas terapêuticos prescritos pelo staff. / Introduction: Moderate to intense pain is prevalent after surgical procedures and it is associated with increases in postoperative morbidity and mortality. Objective: Evaluate the effectiveness of control and the factors associated with perception of pain intensity in patients undergoing abdominal surgery in hospital surgical clinics of two public hospitals in Brasilia Methods: Transversal and descriptive study, through document analysis, and interviews with patients, performed at two public hospitals from Brasilia. Data were collected about clinical features, surgical procedures and pain management from 342 patients. Pain was evaluated using the visual analog scale on the first 48 postoperative hours. The results were compared with data encountered on the bibliographic review. Results: 100% of patients in the prescription of analgesics postoperative was not based on the best scientific evidence. Moderate to intense pain was observed in 38.9% of patients. The most prescribed analgesic drug was dipyrone (83.6%). Of the patients using dipyrone alone, 29.2% of patients reported moderate to intense pain. Moderate to intense pain was significantly associated with women, with the use of anesthetic procedures other than epidural and therapeutic plans prescribed by the attending doctor. The majority of patients (50.9%) didn’t receive previous information about postoperative pain, 61% of patients who were in pain didn’t ask for relief and 80% of them had records of pain assessment, but without the use of scales and pain characterization. Conclusions: Postoperative pain management in the evaluated hospitals does not follow conducts based on the best evidence. The postoperative pain was more severe in female patients and in patients under treatment regimens prescribed by staff / TEDE / BV UNIFESP: Teses e dissertações

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