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A aplicação da tecnologia da informação na Saúde tem dado um suporte à prestação do cuidado ao paciente com mais qualidade e propiciado a adesão de processos mais lineares, eficientes e seguros. Apresenta-se, nesta Tese, o desenvolvimento e a avaliação de um módulo, denominado Sistematização da Assistência de Enfermagem (Módulo SAE) que, incorporado ao Sistema de Informação Hospitalar (SIH) do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, seja capaz de automatizar as ações envolvidas no Processo de Enfermagem, identificando os benefícios e as limitações decorrentes da adoção de um sistema informatizado. A metodologia foi desenvolvida em duas etapas, uma para possibilitar o desenvolvimento e a implantação do Módulo SAE, outra para avaliar a contribuição para o enfermeiro e sua aplicabilidade no ponto de cuidado do paciente (PCP). A primeira etapa constou da organização das funcionalidades do Processo de Enfermagem no Módulo SAE. Como resultado, um conjunto de funcionalidades, estruturadas ou em texto livre, foi definido e compreende: coleta dos dados do paciente e exame físico, diagnóstico e evolução de enfermagem, intervenções e prescrição de enfermagem. O uso do Módulo SAE foi realizado em paralelo com a SAE manuscrita durante 6 meses e aprovado por 28 enfermeiros. Após esta fase, 50 outros enfermeiros foram treinados e utilizaram o Módulo SAE no seu trabalho diário, durante 15 meses, finalizando a primeira etapa com 78 enfermeiros treinados. A segunda etapa constou de uma pesquisa com os enfermeiros que responderam dois questionários para avaliar o uso do Módulo SAE, por meio de duas formas diferentes de acesso, uma delas por computador fixo no posto de enfermagem e a outra, um computador móvel desenvolvido no próprio hospital, para levar o sistema ao PCP. Para obter melhores resultados na pesquisa, as características pessoais desses enfermeiros foram analisadas e comparadas. Da homogeneidade dos resultados foram selecionados 42 profissionais aptos para usarem o computador móvel, dos quais, 25 participaram. Mediante os resultados analíticos e estatísticos, concluiu-se que o Módulo SAE incorporado no SIH contribuiu para o enfermeiro obter maior legibilidade e segurança no registro eletrônico, tanto por acesso fixo como por acesso móvel. A comparação entre as formas de acesso para a formulação do diagnóstico e da prescrição de enfermagem demonstrou resultado positivo a despeito das diferenças estatisticamente significantes (teste não paramétrico de Wilcoxon). Além disso, o registro eletrônico permitiu ao enfermeiro dispor de maior tempo para a assistência direta ao paciente (fixo 84% e móvel 60%). Quanto à facilidade do uso do computador móvel no PCP, as respostas positivas (84%) indicaram a diminuição do tempo gasto para a atualização da prescrição de enfermagem. / The application of information technology in health has given support to the patient care with more quality and provides more linear, efficient and safe processes. This thesis presents the development and evaluation of a module called Systematization of Nursing Care (SAE Module) that when incorporated into the Hospital Information System of the Heart Institute of the University of Sao Paulo Medical School is able to automate the actions involved in Nursing Process. The identification of the benefits and limitations resulting from the adoption of an information system are also described. The methodology was developed in two stages: the first involved the development and deployment of the SAE Module, and the second involved the assessment of the nursing computerized system to the nurse and its application at the point of patient care (PCP). The first step included the organization of the nursing process in the SAE Module. As a result, a set of features, structured or free texts were defined and comprised: collection of patient data and physical examination, nursing diagnosis and evolution, nursing interventions and prescription. The use of SAE Module was done in parallel with the SAE handwritten during 6 months and approved by 28 nurses. After this stage, 50 other nurses were trained and used it in their daily work for 15 months, finalizing the first step with 78 trained nurses. The second step involved the evaluation of nurses who replied two forms to evaluate SAE Module usage through two different ways of access, one using a fixed computer in the nursing counter and the other using a mobile computer, developed in the hospital in order to bring the system to the PCP. In order to obtain the best results from the evaluation, personal characteristics of these nurses were reviewed and compared. Fortytwo nurses were selected according to the homogeneity of the results, out of which 25 participated in the evaluation. The analytical and statistical results lead to the conclusion that the SAE Module incorporated into SIH contributed to the nurse to get more readability and security from patient electronic records for both fixed and mobile access. The comparison between the two forms of access to the formulation of nursing diagnosis and prescription has shown positive results despite statiscally significant differences (nonparametric Wilcoxon test). In addition, it was observed that the patient electronic record (fixed 84% and 60%) allowed an increase of the nurse´s time in the direct patient care. Regarding the use of a mobile computer in the PCP, the positive responses (84%) indicated a reduction in the time spent to update the nursing prescription.

Soft materials have gained increasing prominence in science and technology over the last few decades. This shift from traditional rigid materials to soft, compliant materials have led to the emergence of a new class of devices which can interact with humans safely, as well as reduce the disparity in mechanical compliance at the interface of soft human tissue and rigid devices.<br><br>One of the largest application of soft materials has been in the field of flexible electronics, especially in wearable sensors. While wearable sensors for physical attributes such as strain, temperature, etc. have been popular, they lack applications and significance from a healthcare perspective. Point-of-care (POC) devices, on the other hand, provide exceptional healthcare value, bringing useful diagnostic tests to the bedside of the patient. POC devices, however, have been developed for only a limited number of health attributes. In this dissertation I propose and demonstrate wireless, wearable POC devices to measure and communicate the level of various analytes in and the properties of multiple biofluids: blood, urine, wound exudate, and sweat.<br><br>Along with sensors, another prominent area of soft materials application has been in actuators and robots which mimic biological systems not only in their action but also in their soft structure and actuation mechanisms. In this dissertation I develop design strategies to improve upon current soft robots by programming the storage of elastic strain energy. This strategy enables us to fabricate soft actuators capable of programmable and low energy consuming, yet high speed motion. Collectively, this dissertation demonstrates the use of soft compliant materials as the foundation for developing new sensors and actuators for human use and interaction.

Paper-fluidic devices are a popular platform for point-of-care diagnostics due to their low cost, ease of use, and equipment-free detection of target molecules. The most common example is the lateral flow assay, in which samples are added to a paper membrane and a colorimetric indicator provides a binary signal indicating whether the molecule of interest is present. A novel lateral flow assay was developed to detect a protein biomarker for early stage cervical cancer. Cervical cancer can be cured if detected and treated at an early stage, but approximately 90% of cervical cancer deaths occur in low and middle-income countries due to lack of accessible testing. Methods for detecting the biomarker, valosin-containing protein (VCP), were optimized using enzymatic and gold nanoparticle dot blots, then lateral flow assays were developed and validated using purified VCP and cervical cancer HeLa cells. Future validation with patient tissue samples will permit translation of this device to testing clinics in low-resource areas. Despite advantages for use in resource limited settings, lateral flow assays are limited by their inability to perform more complex or multi-step processes, such as nucleic acid amplification or enzymatic signal enhancement. Thermally actuated wax valves are one mechanism that provides complete control over fluid obstruction and release. To better understand how wax valves can be used in fully automated, self-contained lateral flow assays, different sizes and geometries of valves were tested to investigate their effects on actuation time, flow rate, and flow pattern. Another limitation in the understanding of lateral flow assays is the lack of experimental data describing the microscale flow within the pores of the paper membrane that drives the biophysical reactions in the assay. Mathematical models can be designed to explain macroscopic phenomena, but so far, no literature has compared microfluidic models to microfluidic data. To quantify microfluidic properties within lateral flow assays, fluorescent nanoparticles were imaged flowing through different areas of the membrane and their velocity was quantified using micro-particle image velocimetry (µPIV). Scanning electron microscope images were used to verify that this experimental model was reasonable for describing microfluidic properties of the lateral flow assay. Altogether, this document investigates how developing lateral flow assays for cervical cancer detection can save lives by improving the accessibility of an early diagnosis, and how more robust lateral flow assay characterization can expand their applicability to a broad range of detection processes.

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Mit dieser Arbeit wurde erstmalig eine qualitative und quantitative Analyse zum Status quo der studentischen US-Ausbildung im deutschsprachigen Raum durchgeführt. Eingeschlossen wurden alle medizinischen Fakultäten (n=44) Deutschlands, Österreichs und der deutschsprachigen Schweiz, die im Dezember 2015 auf den Webseiten des MFT und Thieme.de verzeichnet waren [3, 70]. Ein standardisierter Fragebogen mit insgesamt 32 Fragen beleuchtete folgende Aspekte der studentischen US-Ausbildung: 1. Allgemeine Angaben 2. Organisation 3. Ressourcen 4. Überprüfung des Lernerfolgs 5. Evaluation Der Fragebogen wurde an alle LeiterInnen der jeweiligen fakultätseigenen Skillslabs verschickt mit der Bitte nach Beantwortung bzw. Weiterleitung an die US-Verantwortlichen der Fakultät. Die Befragung begann im Dezember 2015 und endete im Mai 2016. Die finale Rücklaufquote betrug 64% (28/44). Die statistische Auswertung erfolgte mit SPSS® 20, IBM Chicago. Die Mehrzahl der medizinischen Fakultäten im deutschsprachigen Raum bieten US-Kurse an. Allerdings ist die studentische US-Ausbildung vielerorts heterogen organisiert mit eher zu kurzer praktischer Übungszeit und zu hohem Studierenden-Lehrenden-Verhältnis. Damit US als bereicherndes Lehrmittel sinnvoll in das bereits überfüllte Curriculum des Humanmedizinstudiums integriert werden kann, sind minimale Standards notwendig. Basierend auf den Ergebnissen dieser Studie und einer Literaturrecherche schlagen der Autor und die Koautoren ein mögliches Rahmenwerk und Meilensteine auf dem Weg zu einem longitudinalen US-Curriculum im Humanmedizinstudium vor.:A Abkürzungsverzeichnis 3 B Einführung 4 1 Ultraschall als Grundkompetenz zukünftiger ÄrztInnen 4 2 Ultraschall als integraler Bestandteil des Humanmedizinstudiums 7 2.1 Ultraschall als Lehrmethode in der Makroanatomie und Physiologie 7 2.2 Ultraschall als Erweiterung der körperlichen Untersuchung 7 2.3 Wesentliche Inhalte publizierter Ultraschall-Curricula 8 2.4 Peer-Teaching und Studierendeninitiativen 10 2.5 Rahmencurriculum für die studentische Ultraschallausbildung 11 3 Ableitung der Rationale für die publizierte Studie 13 C Originalpublikation 14 1 Allgemeine Angaben 14 2 Skizzierung der publizierten Studie 15 3 Formatierte Originalpublikation 16 D Zusammenfassung 28 1 Hintergrund und Durchführung 28 2 Ergebnisse und Auswertung 29 E Literaturverzeichnis 33 F Anlagen 41 1 Anschreiben 41 2 Fragebogen 42 G Darstellung des eigenen Beitrags 52 H Verzeichnis über die wissenschaftlichen Veröffentlichungen und Vorträge 53 I Lebenslauf 54 J Erklärung über die eigenständige Abfassung der Arbeit 56 K Danksagung 57

Trauma-induced coagulopathy (TIC) is a recently described condition which traditionally has been diagnosed by the common coagulation tests (CCTs) such as prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), platelet count, and fibrinogen levels. The varying sensitivity and specificity of these CCTs have led trauma coagulation researchers and clinicians to use Viscoelastic Tests (VET) such as Thromboelastography (TEG) to provide Targeted Thromboelastographic Hemostatic and Adjunctive Therapy (TTHAT) in a goal directed fashion to those trauma patients in need of hemostatic resuscitation. This review describes the utility of VETs, in particular, TEG, to provide TTHAT in trauma and acquired non-trauma-induced coagulopathy.

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.

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<p>In 2021, an estimated 1.5 million people were diagnosed with HIV globally, increasing the total to 38.4 million people. Approximately 16% of this population were unaware of their infected status and required HIV testing, which is a critical first step in HIV prevention, treatment, and care. Hence, there is a need to develop a rapid, user-friendly, and cost-effective point-of-care test for HIV detection. The time between HIV infection and a detectable host HIV antibody concentration can extend up to 90 days. By incorporating more sensitive testing for the HIV p24 antigen on the virus, the diagnosis lag can be reduced to 17 days. This window could be further shortened by using horseradish peroxidase (HRP) enzyme as a signal enhancement technique. The work herein focuses on developing an enzymatically signal-enhanced lateral flow assay test for the p24 antigen to detect HIV during the acute phase of infection. Conjugation chemistry for the sandwich assay was characterized using DLS and UV-Vis. Dot blots were then used to assess and enhance the functionality of the individual components via a visual color gradient formed by the protein coupled with antibody-conjugated gold nanoparticles. A quantitative analysis was performed using ImageJ software through signal pixel intensity analysis. A limit of detection (LoD) of 6 ng/mL was obtained for the detection of the p24 antigen. This LoD was improved to 0.2 ng/mL by incorporating HRP signal enhancement with the diaminobenzidine substrate. This 30x signal improvement could drive down the LoD even further to improve the sensitivity of the commercial p24 antigen tests. Different fabrication and scalability studies were performed to produce a cost- efficient, fully functional prototype of a paper-based lateral flow device incorporating the signal- enhanced p24 assay. This study serves as a solid foundation to research focused on creating more efficient point-of-care tests that can be used in resource-limited settings to provide early detection of HIV for the 6 million individuals who are currently unaware of their HIV status. </p>