Introduction Patients with intestinal failure (IF) develop problems of malabsorption and malnutrition associated with short bowel syndrome (SBS). Home parenteral nutrition (HPN) became available to treat these patients since the 1970s. There is a paucity of qualitative research on patients’ experiences in the UK. The study aim was to generate theory that explains the experiences of adults living with HPN and complex medication regimens. Method The grounded theory methodology was used to explore the experiences and to generate theory about this health intervention. Twelve participants were interviewed. The interviews were recorded and transcribed verbatim. The joint process of data collection and analysis followed the principles of constant comparative approach. Results The core categories of stoma care and HPN treatment were supported by the subcategories of maintaining stoma output, access to toilets, maintaining HPN infusion routine, access to technical help to set up HPN infusion, and general health changes. Strategy used to manage living with loss was demonstrated by the subcategory of maintaining daily activities and social interactions. Discussion The theory of living with loss suggests that patients with a stoma receiving HPN experience the sense of loss at home and in social situations. Opportunities for professional practice development are detailed along with implications for future research. Conclusions The findings resonate with the Kubler-Ross Model of the five stages of grief (Kubler-Ross, 1970). The theory of living with loss was generated by the use of the grounded theory methodology. This study identified opportunities for changes and improvement in clinical practice.

Orientador: Alessandra Turini Bolsoni-Silva / Banca: Patrícia Alvarenga / Banca: Luciana Carla dos Santos Elias / Resumo: Problemas internalizantes, como ansiedade e depressão, tem sua origem e manutenção relacionados a diferentes tipos de variáveis, dentre elas as práticas parentais. Entretanto, raramente são pesquisas intervenções parentais para a prevenção e tratamento de problemas internalizantes. A presente pesquisa consiste em três estudos complementares sobre essa temática. Foi feita uma revisão de literatura pela qual foram mapeados preditores relacionados a manutenção e prevenção de problemas internalizantes com relação à variáveis relacionados à saúde mental dos pais e suas práticas parentais, bem como foram avaliadas intervenções que incluíssem os pais na prevenção de problemas internalizantes. O segundo estudo corresponde à avaliação dos efeitos de uma intervenção semi-estruturada conduzida exclusivamente com mães. Três casos clínicos foram conduzidos e analisados como sujeitos únicos, a partir do consentimento das participantes. A intervenção visava promover o desenvolvimento de práticas parentais indicadas como positivas pela literatura sobre problemas de comportamento, mas de modo contingente às dificuldades e demandas de cada caso. Foram usados diferentes instrumentos de relato validados nas avaliações de linha de base, pré-teste e seguimento para avaliação dos efeitos do procedimento. Os principais efeitos da intervenção incluem a remissão de problemas internalizantes, aumento na freqüencia de habilidades sociais infantis, aumento na freqüência de práticas parentais positivas e redução na variabilidade de práticas parentais negativas. O terceiro estudo teve por objetivo investigar variáveis do processo clínico que caracterizam os casos, a partir da categorização de queixas, conteúdo desenvolvido e comportamentos de interação terapeuta-cliente. As queixas mais frequentes foram práticas parentais negativas e os temas mais frequentemente desenvolvidos com relação aos filhos foram... / Abstract: Internalizing problems such as anxiety and depression are related and maintained to different types of variables, including parenting practices. However, rarely parent interventions to present and treat internalizing problems are studied. This research consists of three complementary studies on this topic. A literature review was was conducted, in review was conducted, in which there were identified predictors related to the maintenance and prevention of internalizing problems concerning parenting practices and parents psychopathology. Interventions which included parents in the prevention of internalizing problems were also assessed e discussed. The second study refers to the evaluation of the effects of a semi-structural intervention conducted exclusively with mothers of internalizing children. Three clinical cases were studied from the consent of the participants. The intervention aimed to promote the development of positive parenting practices as indicated by the literature on behavioral problems, but contingently to the dificulties and demands of each case. Different reporting instruments were used at baseline, posttest and follow-up to assess the effects of the intervention procedure. The main results include the remission of internalizing problems to non-clinical level, increased frequency of children's social skills, increased frequency of positive parenting practices and reduced variability of negative parenting practices. The third study aimed to investigate variables in the clinical process that could characterize the cases through the categorization of complaints, developed content and thrapist-client interaction behaviors. The most frequent complaints of mothers were their own negative parenting practices and the contents most often developed in concern to the children were the skillful expression of positive and negative emotions by the mothers. It was found that mothers complained of undiagnosed externalizing problems and... / Mestre

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. / Made available in DSpace on 2012-10-19T02:22:06Z (GMT). No. of bitstreams: 0Bitstream added on 2016-01-09T04:38:27Z : No. of bitstreams: 1 176123.pdf: 8054370 bytes, checksum: cb15c36f8373b9afb0e89b5137ca82cb (MD5) / O sistema SANPANEO é um sistema especialista de apoio a nutrição parenteral, baseado em dados antropométricos, necessidades calóricas, hídricas, eletrolíticas, vitaminas, sais minerais e avaliação clínica, com a finalidade de recuperar e manter o metabolismo dos recém-nascidos enfermos ou de muito baixo peso, incapazes de suportarem a alimentação por via enteral exclusivamente. O sistema foi desenvolvido utilizando a metodologia KADS, recomendada para a construção de sistemas baseados em conhecimentos. Serão usuários do sistema os médicos e os residentes em Pediatria, que efetuarão a entrada dos dados do paciente, o serviço de farmácia, que elaborará a fórmula e o serviço de enfermagem que procederá a sua administração. O sistema SANPANEO conta com uma interface amigável, desenvolvida em Visual Basic, de fácil domínio, com todas as informações de entrada e saída sendo armazenados numa base de dados, permitindo consultas posteriores. Para tanto utilizou-se o gerenciador de banco de dados Access.

Made available in DSpace on 2018-07-27T18:26:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-14. Added 1 bitstream(s) on 2018-07-27T18:30:13Z : No. of bitstreams: 1 000864790.pdf: 480593 bytes, checksum: e04d21624043318d1ffaf6b9d31db37f (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Problemas internalizantes, como ansiedade e depressão, tem sua origem e manutenção relacionados a diferentes tipos de variáveis, dentre elas as práticas parentais. Entretanto, raramente são pesquisas intervenções parentais para a prevenção e tratamento de problemas internalizantes. A presente pesquisa consiste em três estudos complementares sobre essa temática. Foi feita uma revisão de literatura pela qual foram mapeados preditores relacionados a manutenção e prevenção de problemas internalizantes com relação à variáveis relacionados à saúde mental dos pais e suas práticas parentais, bem como foram avaliadas intervenções que incluíssem os pais na prevenção de problemas internalizantes. O segundo estudo corresponde à avaliação dos efeitos de uma intervenção semi-estruturada conduzida exclusivamente com mães. Três casos clínicos foram conduzidos e analisados como sujeitos únicos, a partir do consentimento das participantes. A intervenção visava promover o desenvolvimento de práticas parentais indicadas como positivas pela literatura sobre problemas de comportamento, mas de modo contingente às dificuldades e demandas de cada caso. Foram usados diferentes instrumentos de relato validados nas avaliações de linha de base, pré-teste e seguimento para avaliação dos efeitos do procedimento. Os principais efeitos da intervenção incluem a remissão de problemas internalizantes, aumento na freqüencia de habilidades sociais infantis, aumento na freqüência de práticas parentais positivas e redução na variabilidade de práticas parentais negativas. O terceiro estudo teve por objetivo investigar variáveis do processo clínico que caracterizam os casos, a partir da categorização de queixas, conteúdo desenvolvido e comportamentos de interação terapeuta-cliente. As queixas mais frequentes foram práticas parentais negativas e os temas mais frequentemente desenvolvidos com relação aos filhos foram... / Internalizing problems such as anxiety and depression are related and maintained to different types of variables, including parenting practices. However, rarely parent interventions to present and treat internalizing problems are studied. This research consists of three complementary studies on this topic. A literature review was was conducted, in review was conducted, in which there were identified predictors related to the maintenance and prevention of internalizing problems concerning parenting practices and parents psychopathology. Interventions which included parents in the prevention of internalizing problems were also assessed e discussed. The second study refers to the evaluation of the effects of a semi-structural intervention conducted exclusively with mothers of internalizing children. Three clinical cases were studied from the consent of the participants. The intervention aimed to promote the development of positive parenting practices as indicated by the literature on behavioral problems, but contingently to the dificulties and demands of each case. Different reporting instruments were used at baseline, posttest and follow-up to assess the effects of the intervention procedure. The main results include the remission of internalizing problems to non-clinical level, increased frequency of children's social skills, increased frequency of positive parenting practices and reduced variability of negative parenting practices. The third study aimed to investigate variables in the clinical process that could characterize the cases through the categorization of complaints, developed content and thrapist-client interaction behaviors. The most frequent complaints of mothers were their own negative parenting practices and the contents most often developed in concern to the children were the skillful expression of positive and negative emotions by the mothers. It was found that mothers complained of undiagnosed externalizing problems and...

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Parenteral nutrition is the nutrients administration by intravenous mean in patients who cannot consume them for gastrointestinal way. Parenteral Nutrition Solutions are stored in glass and plastic containers, being the glass the most used due to its rigid structure, chemical resistance, sterilization easiness and transparency. Among glass constituents is the arsenic, in form of As2O3, used as refining agent to promote bubbles removal generated in the casting one. Arsenic is highly toxic. Its toxicity however is not dependent on its concentration only,but on its chemical form. Among inorganic species, arsine (AsH3) is more toxic than arsenite (As(III)) which is, more toxic than the arsenate (As(V)). Arsenic is methylated in the organism alternating the oxidation state of arsenic pentavalent the trivalent. The methilation is known as a detoxification mechanism, but studies have been shown that forms of MMA and DMA may be as mutagenic, carcinogenic and cytogenic as the forms of inorganic arsenic, or even more. Studies have been shown that most substances used in parenteral formulations, as: salts, amino acid, glucose and vitamins, can present Arsenic (As(III and As(V)) as contaminant. The species of Arsenic (As(III) and As(V)) can be present in the raw material or be leached from glass containers by different mechanisms, being the sterilization process the determinative factor for that this to occur. Despite toxicological implications around the presence of species of Arsenic in these formulations it important to investigate the possible transformation of the species of arsenic during the sterilization process of parenteral nutrition solutions. In this work, it was investigated the possibility of formation of organic arsenic species (DMA(V) and MMA(V)), due to methilation reaction of the arsenic inorganic species for reaction with the organic species of parenteral nutrition solutions. The arsenic species separation (DMA(V), MMA(V) and As(V)) was carried out by ionic chromatography, and the quantification by hydride generation atomic absorption spectrometry. Due to the complex nature of the matrix constituent the direct injection of the samples in the chromatographic system was not possible, being necessary, therefore, a "clean up" step was developed. The sterilization procedure was carried out with solutions of amino acids, glucose and vitamins, with addition of inorganic arsenic species. The comparison of the results between sterilized and not sterilized solutions showed that arsenic organic species (DMA(V) and MMA(V)) were not formed in solution. The arsenic speciation analysis (As(III), DMA(V), MMA(V) and As(V)) in commercial solutions of parenteral nutrition showed that if they contain organic arsenic, the concentration is very low, being lesser than the limit for arsenic allowed by pharmacopeias. / Nutrição Parenteral é a administração de nutrientes por meio intravenoso em pacientes que não podem consumi-los por via gastrointestinal. Soluções de Nutrição Parenteral são armazenadas em embalagens de plástico e de vidro, sendo o vidro o mais utilizado devido à sua estrutura rígida, resistência química, facilidade de esterilização e transparência. Entre os vários constituintes do vidro, está o arsênio, na forma de As2O3 usado como agente de refino para promover a remoção das bolhas geradas no fundido. O arsênio é altamente tóxico, contudo, sua toxicidade não é dependente apenas da sua concentração total, mas de suas formas químicas, pois das espécies inorgânicas, a arsina (AsH3) é mais tóxica que o arsenito (As(III)) e, este, mais tóxico que o arsenato (As(V)). O arsênio é metilado no organismo alternando de estado de oxidação de arsênio pentavalente a arsênio trivalente e adição do grupo metil através de S-adenosilmetionina. Glutationa, e outros tióis, servem como agentes redutores, formando primeiramente o ácido monometil arsênico (MMA) e logo a seguir o ácido dimetil arsínico (DMA). Por isso a metilação é conhecida como um mecanismo de desintoxicação, mas estudos mostram que o MMA e DMA podem ser tanto quanto ou mais mutagênicos, carcinogênicos e citogênicos que os arsênios inorgânicos. Estudos mostraram que quase todas as substâncias que fazem parte da constituição das formulações parenterais, como: soluções de aminoácidos, soluções salinas, glicose e heparinas, podem apresentar contaminação por arsênio (As(III e As(V)) sendo a embalagem de vidro a maior fonte de contaminação. As espécies de arsênio (As(III) e As(V)) podem ser lixiviados pela solução por diferentes mecanismos, sendo o processo de esterilização o fator determinante para que isso ocorra Devido às implicações toxicológicas em torno da presença de espécies de arsênio nos produtos é importante que se investigue possíveis transformações das espécies de arsênio durante o processo de esterilização das soluções de nutrição parenteral. Neste trabalho, investigou-se a possibilidade de formação de arsênio orgânico (DMA(V) e MMA(V)), devido à reação de metilação das espécies de arsênio inorgânico por reação com as espécies orgânicas dos constituintes de tais soluções. Para esta investigação foi necessária uma análise de especiação. A separação das espécies de arsênio (DMA(V), MMA(V) e As(V)) foi feita por cromatografia iônica, e a quantificação por espectrometria de absorção atômica com geração de hidretos. Devido à natureza complexa e à elevada concentração dos constituintes das matrizes a injeção direta das amostras no sistema cromatográfico não foi possível, sendo necessária, portanto, uma etapa prévia de clean up . Procedeu-se a esterilização em soluções de substâncias orgânicas que constituem as soluções de nutrição parenteral, como soluções de aminoácidos, glicose e vitaminas, com adição de arsênios inorgânicos e, através da comparação dos resultados entre as soluções esterilizadas e não esterilizadas não se observou a formação de espécies orgânicas de arsênio (DMA(V) e MMA(V)). Realizou-se, assim, a especiação das espécies de arsênio (As(III), DMA(V), MMA(V) e As(V)) em soluções comerciais constituintes das formulações parenterais e pode-se concluir que se há a formação de arsênio orgânico, as concentrações são muito baixas, sendo menores que os limites para arsênio permitidos pela farmacopéia.

Class of 2005 Abstract / Objectives: To develop a decision analytic model to compare the clinical and economic outcomes of enteral nutrition (EN) and total parenteral nutritional (TPN) support in acute pancreatitis patients. Methods: All randomized clinical trials comparing EN and TPN in acute pancreatitis patients published in the medical and pharmacy literature were identified. Six trials were identified by searching MEDLINE, Web of Science, Cochrane Controlled Trials Register, International Pharmaceutical Abstracts, HealthStar, Cumulative Index to Nursing & Allied Health Literature, and citation review of applicable literature. The costs used for the decision tree were from the perspective of a hospital. A literature based decision tree was formed based from these costs and the probabilities of events from the six identified clinical trials. The TreeAge Pro computer program (TreeAge Software, Inc.; Williamstown, MA) was used to conduct the cost effectiveness analysis. Therapeutic success was considered, for the purposes of the trial, as having no complications. Results: EN was associated with a lower risk of infections, a reduced length of hospital stay, and fewer surgical interventions. There was no statistical difference in the risk of mortality, adult respiratory distress syndrome or multiple organ failure between groups treated with EN or TPN. The results found that EN dominated TPN by being both less costly and more effective. The average costs for EN and TPN were $46,345 and $73,878, respectively. The success rates were 0.652 and 0.358 for EN and TPN, respectively. Conclusion: Enteral nutrition was the dominant route of administration for nutritional support, when compared to total parenteral nutrition both clinically and economically for acute pancreatitis patients.

Publicación a texto completo no autorizada por el autor / Determina los conocimientos sobre medidas de bioseguridad que aplican las enfermeras en la administración de la NPT y la NET en pacientes del Servicio de UCI – Hospital Nacional Daniel Alcides Carrión - 2014 y determinar las prácticas sobre medidas de bioseguridad que aplican las enfermeras en la administración de la NPT y la NET en pacientes del Servicio de UCI – Hospital Nacional Daniel Alcides Carrión - 2014. El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por 22 enfermeras. La técnica fue la observación y la encuesta, y los instrumentos una lista de cotejo y un cuestionario, los cuales fueron aplicados previo consentimiento informado. Del 100% (22) enfermeras, 45,5% (10) conocen y 54,5% (12) no conocen sobre las medidas de bioseguridad en la administración de la NPT y la NET. Respecto a las prácticas de medidas de bioseguridad 27,3% (6) tienen prácticas inadecuadas y 72,7% (16) prácticas adecuadas. Respecto a los conocimientos de las enfermeras sobre medidas de bioseguridad en la administración de la NPT y la NET, el mayor porcentaje no conoce, mientras la mayoría no conoce sobre generalidades sin embargo conocen la aplicación de la bioseguridad. / Trabajo de investigación

The aim of this thesis was to identify and assess the nitrogen balance due to the field of nutritional support, body composition, energy expenditure, utilization of nutritional substrates and their changes during the hospitalization. Nitrogen balance was determined in 12 men and one woman (age 44 ± 16,4 years) with multiple injuries (ISS 40 ± 11) in the ICU based on 2 measurements in the time interval of 1-7 days, as the difference between the received and the ecrected nitrogen. The energy expenditure and nutritional substrate utilization nutritional indirect calorimetry, body composition analysis and blood chemistry laboratory were examined at patients. Correlation analysis revealed dependence between nitrogen balance and other monitored parameters and also dependence on the length of their trauma. Total protein intake averaged 1,40 ± 0,69 g.kg-1 .d-1 . At this dose were recorded negative values of nitrogen balance in the first measurement of the 9-patients and in the second measurement of the whole group. In this work also the results of uptake of parenteral and enteral route were compared. In practice, significant correlations were found between total uptake and energy expenditure (p = 6,31.10-3 ; r = 0,6) in the first measurement, and on the other hand negative correlation during the second...

The purpose of this research was to investigate home intravenous antibiotic therapy (HIVAT) in a multicenter, retrospective study in 1986 and 1987. The stability of reconstituted ceftizoxime and cefonicid in normal saline were evaluated by HPLC to investigate their usability for HIVAT. Using the three HHCPs' records, 457 patients were screened, and 30 patients were randomly selected/HHCP/year using the study's inclusion criteria (n = 180). Outcomes of HIVAT for osteomyelitis patients (n = 90) were compared with that for osteomyelitis inpatients (n = 13) discharged to HHCP1 from the referral hospital. Outcomes were classified as "success", "complication", and "failure". Types and frequency of problems were categorized as problems with antibiotics, and problems with administration procedures. Demographic data were analyzed to test the homogeneity of each group of patients. Data were analyzed using ANOVA, chi-square test, Kruskal-Wallis test, and multiple comparisons among proportions. (Abstract shortened with permission of author.)

Background and aims: Chronic intestinal failure (CIF) has been long-recognized, however the underlying etiology and risk factors have not been historically well-studied. We aim to study the underlying etiologies of CIF and predictive factors for long-term parenteral support (PS). Methods: We retrospectively identified patients with newly diagnosed CIF who received PS to maintain nutrition at the Cleveland Clinic between 2000 and 2017. Long-term PS was defined as a duration of more than 3 months. Univariable and multivariable logistic regression analyses were performed to identify the predictors of the need for long-term PS. Results: We identified 350 patients with CIF, 150 (43%) and 200 (57%) were diagnosed before and after 2010, respectively. The most common etiology was Crohn's disease (CD) in both cohorts (34.7% versus 30.5%, p = 0.41). Graft-versus-host-disease (GVHD) was a less frequent cause of CIF after 2010 (12.7% versus 2.5%, p = 0.0002). The type of PS was mostly total parenteral nutrition before and after 2010, 95% and 96%, respectively (p = 0.55). On univariable analysis, absence of ileocecal valve (p < 0.0001), ischemic bowel disease (p = 0.009), and whole colon resection (p = 0.033) were associated with the need for long-term PS. On multivariable analysis, absence of ileocecal valve (OR 2.19, p = 0.011) and ischemic bowel disease (OR 3.04, p = 0.003) remained statistically significant predictors of long-term PS. Conclusion: In our cohort of patients with CIF, CD remains the leading etiology over the last 20 years, whereas GVHD is less common after 2010. The absence of ileocecal valve and ischemic bowel disease were reliable predictive factors for requiring long-term PS.