Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 228-245).

Reliable access to the circulation is paramount in most medical and surgical emergencies. When venous access cannot be expediently established, intraosseous (IO) access is indicated. This method has a high success rate even in relatively inexperienced hands and there is considerable clinical experience of IO administration of drugs and fluids. There is however limited evidence on the use of IO samples for laboratory analysis. Also, uptake of drugs during shock has not been extensively studied. Further, there have been concerns that analysis of IO samples may damage laboratory equipment. We have studied, in a porcine model, the use of IO samples for point of care analysis of blood gases, acid base parameters and blood chemistries in stable circulation, in experimental septic shock, and in hypovolemia after major hemorrhage, comparing IO samples with arterial and venous samples, and comparing IO samples from different sites. We have also studied coagulation assays on IO samples in stable circulation and after major hemorrhage. Furthermore, we have compared IO and intravenous administration of antibiotics in experimental sepsis. Average differences between IO and arterial/venous samples varied between the studied analytes. During stable circulation, average IO levels of blood gases, acid-base parameters, hemoglobin/hematocrit and several blood chemistries approximated venous levels relatively well. Differences in acid-base and blood gas parameters, and lactate, were more pronounced in hypovolemia, as well as in sepsis. The dispersion of the differences was often relatively large, indicating limited precision. Average differences between two intraosseous sites were small. Intraosseous samples were clinically hypercoagulable with a strong tendency to clot in vitro, and thromboelastography demonstrated shortened reaction times compared with venous samples. Major bleeding and hemodilution moderately affected the studied coagulation parameters. In endotoxemic animals with circulatory instability, concentrations of cefotaxime and gentamicin in samples from the pulmonary artery were comparable at 5 minutes after intraosseous and intravenous administration, and during a 3 hour observation period. In summary, agreement between analytes in intraosseous and conventional blood samples was variable and often unpredictable, especially during circulatory compromise. Intraosseous samples clinically appeared hypercoagulable, and thromboelastography confirmed this. High and comparable concentrations of cefotaxime and gentamicin were found after intraosseous and intravenous administration of equivalent doses, suggesting that uptake is acceptable during septic instability.

The majority of Sickle Cell Disease (SCD) prevalence is found in Sub-Saharan Africa, where 80% of the world’s population who suffer from this disease are born. Due to a lack of diagnosis and early treatments, 50-90% of these children will die before they reach the age of five. Current methods used for diagnosing SCD are based on hemoglobin analysis such as capillary electrophoresis, ion-exchange high-performance liquid chromatography, and isoelectric focusing. They require expensive laboratory equipment and are not feasible in these low-resource countries. It is, therefore, imperative to develop an alternative and cost-effective method for diagnosing and monitoring of SCD. This thesis aims to address the development and evaluation of a smartphone-based optical setup for the detection of SCD. This innovative technique can potentially be applied for low cost and accurate diagnosis of SCD and improve disease management in resource-limited settings where the disease exhibits a high prevalence. This Point-of-Care (POC) based device offers the potential to improve SCD diagnosis and patient care by providing a portable and cost effective device that requires minimal training to operate and analyze. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

O propósito desta investigação foi avaliar o desempenho funcional e a qualidade técnica de um Software-protótipo desenvolvido para a sistematização da assistência de enfermagem. Foi elaborada uma versão deste ambiente computacional específica para aplicação em dispositivo de mão móvel com interface de rede sem fio integrada possibilitando aos enfermeiros acessar e documentar dados acerca de sinais vitais, balanço hidroeletrolítrico, evolução e prescrição de enfermagem a beira do leito com transmissão de dados em tempo real. Este estudo está alicerçado no Modelo do Processo de Avaliação segundo a ISO/IEC 9126, Parte 1: Modelo de qualidade, que versa sobre qualidade externa e interna de software e a especifica em seis características denominadas: funcionalidade, confiabilidade, usabilidade, eficiência, manutenibilidade e portabilidade, as quais são subdivididas em subcaracterísticas. Foi utilizado subsídio da NBR ISO/IEC 14598 que apresenta uma visão geral do processo de avaliação de software, suas orientações e requisitos. Este estudo descritivo/exploratório foi realizado em uma instituição de ensino superior de enfermagem e duas instituições hospitalares de ensino localizadas no interior do estado de São Paulo. Os avaliadores totalizaram um número de vinte e sete e foram constituídos por oito especialistas em informática; oito enfermeiros docentes e 11 enfermeiros, sendo sete do Hospital A e quatro do Hospital B. Considerando-se a característica de modularidade e adotando o referencial proposto por Pressman (2006), realizaram-se duas etapas de avaliação: teste de unidade modular e de validação. Inicialmente, a verificação concentrou-se em cada uma das doze unidades modulares, em seguida foram avaliados na forma integrada para se proceder ao teste de validação. O desenvolvimento destas duas etapas contou com a participação individual de cada um dos especialistas e ocorreu na presença da pesquisadora. Foi elaborado um instrumento de avaliação (Anexo I) a fim de documentar os dados coletados no teste de unidade modular e com base nas características e subcaracterísticas de qualidade foram desenvolvidos instrumentos específicos para aplicação do teste de validação junto aos especialistas em informática (Anexo II a) e enfermeiros docentes e enfermeiros (Anexo II b). Os resultados demonstraram que a incorporação da tecnologia da computação móvel advinda de rede sem fio às atividades assistenciais de enfermagem proporcionou um ambiente com mobilidade para as ações e facilitou a comunicação e a documentação da assistência prestada. A avaliação dos atributos de qualidade do Software-protótipo em questão foi mensurada pelos especialistas em informática, enfermeiros docentes e enfermeiros destacando-se duas características: usabilidade e eficiência. A usabilidade foi avaliada com 100% de respostas positivas pelos docentes e enfermeiros e com 80,4% de aprovação pelos especialistas em informática evidenciando que o Software-protótipo para a sistematização da assistência de enfermagem (SAE) apresenta facilidade para inserir e obter informações e apresenta-se como um sistema dinâmico para documentar a assistência prestada. A eficiência foi aprovada com 92,3% e 87,5% de respostas positivas pelos enfermeiros docentes e especialistas em informática, respectivamente, demonstrando que uma das vantagens desta ferramenta é armazenar, processar e disponibilizar informações sobre a SAE de forma mais eficiente que a realizada manualmente. / The purpose of this investigation was to evaluate the functional performance and the technical quality of a software-prototype developed for the systematization of the nursing care. A version of this specific computational environment has been developed to be used in hand-mobile devices with integrated wireless network interface allowing the nurses to access and document data related to vital signals, hydroelectrolytic balance, evolution and nursing prescription at the point-of-care with transmission of data in real time. This study is based on Evaluation Process Model, according to ISO/IEC 9126, Part 1: Model of Quality which is versed in external and internal software quality and specifies it in six characteristics denominated: functionality, reliability, usability, efficiency, maintainability, and portability, which are subdivided in sub-characteristics. Subsidy of NBR ISO/IEC 14598 has been used, which presents a general overview of the software evaluation process, its orientations and requirements. This descriptive/exploratory study has been accomplished in a Nursing College and in two school hospital institutions in the interior of the state of Sao Paulo. It has been totaled 27 appraisers, and constituted by eight specialists on computer science; eight faculty members nurses; and 11 registered nurses - seven from Hospital A, and four from Hospital B. Considering the characteristic of modularity, and adopting the reference proposed by Pressman (2006), two stages of evaluation have been accomplished: modular unity test, and validation. Initially, the verification focused on each one of the 12 modular unities, and then they have been evaluated integrally in order to proceed the validation test. Each one of the specialists participated in the development of these two stages, which occurred in the presence of the researcher. An instrument of evaluation has been elaborated (Appendix I) in order to document the data collected in the modular unity test. Based on the characteristics and sub-characteristics of quality, specific instruments for application of the validation test have been developed along with the computer science specialists (Appendix II a), and the faculty members nurses and registered nurses (Appendix II b). The results demonstrated that the incorporation of the mobile computer technology originated from wireless network to the nursing care activities provided an environment with mobility for actions and became communication and documentation of the assistance easier. The evaluation of the quality attributes of the software-prototype was measured by the computer science specialists, faculty members nurses and registered nurses, highlighting two characteristics: usability and efficiency. The usability was evaluated, resulting 100% of positive approval among faculty members nurses, and 80.4% among computer science specialists, demonstrating that the software-prototype for the systematization of nursing care makes the action of inserting and obtaining information easy, and it is presented as a dynamic system to document the provided care. The efficiency was approved with 92.3% and 87.5% of positive answers by the faculty members nurses and computer science specialists, respectively, demonstrating that one of the advantages of this tool is to store, process, and make available information about the nursing process, more efficiently than the one made manually.

O propósito desta investigação foi avaliar o desempenho funcional e a qualidade técnica de um Software-protótipo desenvolvido para a sistematização da assistência de enfermagem. Foi elaborada uma versão deste ambiente computacional específica para aplicação em dispositivo de mão móvel com interface de rede sem fio integrada possibilitando aos enfermeiros acessar e documentar dados acerca de sinais vitais, balanço hidroeletrolítrico, evolução e prescrição de enfermagem a beira do leito com transmissão de dados em tempo real. Este estudo está alicerçado no Modelo do Processo de Avaliação segundo a ISO/IEC 9126, Parte 1: Modelo de qualidade, que versa sobre qualidade externa e interna de software e a especifica em seis características denominadas: funcionalidade, confiabilidade, usabilidade, eficiência, manutenibilidade e portabilidade, as quais são subdivididas em subcaracterísticas. Foi utilizado subsídio da NBR ISO/IEC 14598 que apresenta uma visão geral do processo de avaliação de software, suas orientações e requisitos. Este estudo descritivo/exploratório foi realizado em uma instituição de ensino superior de enfermagem e duas instituições hospitalares de ensino localizadas no interior do estado de São Paulo. Os avaliadores totalizaram um número de vinte e sete e foram constituídos por oito especialistas em informática; oito enfermeiros docentes e 11 enfermeiros, sendo sete do Hospital A e quatro do Hospital B. Considerando-se a característica de modularidade e adotando o referencial proposto por Pressman (2006), realizaram-se duas etapas de avaliação: teste de unidade modular e de validação. Inicialmente, a verificação concentrou-se em cada uma das doze unidades modulares, em seguida foram avaliados na forma integrada para se proceder ao teste de validação. O desenvolvimento destas duas etapas contou com a participação individual de cada um dos especialistas e ocorreu na presença da pesquisadora. Foi elaborado um instrumento de avaliação (Anexo I) a fim de documentar os dados coletados no teste de unidade modular e com base nas características e subcaracterísticas de qualidade foram desenvolvidos instrumentos específicos para aplicação do teste de validação junto aos especialistas em informática (Anexo II a) e enfermeiros docentes e enfermeiros (Anexo II b). Os resultados demonstraram que a incorporação da tecnologia da computação móvel advinda de rede sem fio às atividades assistenciais de enfermagem proporcionou um ambiente com mobilidade para as ações e facilitou a comunicação e a documentação da assistência prestada. A avaliação dos atributos de qualidade do Software-protótipo em questão foi mensurada pelos especialistas em informática, enfermeiros docentes e enfermeiros destacando-se duas características: usabilidade e eficiência. A usabilidade foi avaliada com 100% de respostas positivas pelos docentes e enfermeiros e com 80,4% de aprovação pelos especialistas em informática evidenciando que o Software-protótipo para a sistematização da assistência de enfermagem (SAE) apresenta facilidade para inserir e obter informações e apresenta-se como um sistema dinâmico para documentar a assistência prestada. A eficiência foi aprovada com 92,3% e 87,5% de respostas positivas pelos enfermeiros docentes e especialistas em informática, respectivamente, demonstrando que uma das vantagens desta ferramenta é armazenar, processar e disponibilizar informações sobre a SAE de forma mais eficiente que a realizada manualmente. / The purpose of this investigation was to evaluate the functional performance and the technical quality of a software-prototype developed for the systematization of the nursing care. A version of this specific computational environment has been developed to be used in hand-mobile devices with integrated wireless network interface allowing the nurses to access and document data related to vital signals, hydroelectrolytic balance, evolution and nursing prescription at the point-of-care with transmission of data in real time. This study is based on Evaluation Process Model, according to ISO/IEC 9126, Part 1: Model of Quality which is versed in external and internal software quality and specifies it in six characteristics denominated: functionality, reliability, usability, efficiency, maintainability, and portability, which are subdivided in sub-characteristics. Subsidy of NBR ISO/IEC 14598 has been used, which presents a general overview of the software evaluation process, its orientations and requirements. This descriptive/exploratory study has been accomplished in a Nursing College and in two school hospital institutions in the interior of the state of Sao Paulo. It has been totaled 27 appraisers, and constituted by eight specialists on computer science; eight faculty members nurses; and 11 registered nurses - seven from Hospital A, and four from Hospital B. Considering the characteristic of modularity, and adopting the reference proposed by Pressman (2006), two stages of evaluation have been accomplished: modular unity test, and validation. Initially, the verification focused on each one of the 12 modular unities, and then they have been evaluated integrally in order to proceed the validation test. Each one of the specialists participated in the development of these two stages, which occurred in the presence of the researcher. An instrument of evaluation has been elaborated (Appendix I) in order to document the data collected in the modular unity test. Based on the characteristics and sub-characteristics of quality, specific instruments for application of the validation test have been developed along with the computer science specialists (Appendix II a), and the faculty members nurses and registered nurses (Appendix II b). The results demonstrated that the incorporation of the mobile computer technology originated from wireless network to the nursing care activities provided an environment with mobility for actions and became communication and documentation of the assistance easier. The evaluation of the quality attributes of the software-prototype was measured by the computer science specialists, faculty members nurses and registered nurses, highlighting two characteristics: usability and efficiency. The usability was evaluated, resulting 100% of positive approval among faculty members nurses, and 80.4% among computer science specialists, demonstrating that the software-prototype for the systematization of nursing care makes the action of inserting and obtaining information easy, and it is presented as a dynamic system to document the provided care. The efficiency was approved with 92.3% and 87.5% of positive answers by the faculty members nurses and computer science specialists, respectively, demonstrating that one of the advantages of this tool is to store, process, and make available information about the nursing process, more efficiently than the one made manually.

Dengue is a major public health problem that affects tens of millions of people annually in tropical and sub-tropical countries. This acute viral infection happens to be severe and even life threatening but there is still no available drug or vaccine. Previous studies have noted early higher viral burden in patients who develop more severe symptoms suggesting that administration of a potent and safe antiviral may prevent progression to severe dengue. To verify this hypothesis, we have conducted the first RCT directed towards reducing the viral burden in vivo by administrating chloroquine (CQ), a cheap and well-tolerated drug that inhibits DENV in vitro with concentrations achievable in vivo, to 307 Vietnamese adults with suspected dengue (257 of them were laboratory-confirmed cases). Unfortunately, we did not see an effect of CQ on the duration of infection. However in patients treated with CQ, we observed a trend towards a lower incidence of severe forms. We did not find any differences in the immune response that can explain this trend. We also found more adverse events, primarily vomiting, with CQ. In addition, we have explored the relationships between clinical features, antibody responses and virological markers in these patients. We found that the early magnitude of viremia is positively associated with disease severity and there are serotype dependent differences in infection kinetics. We found as well that DENV was cleared faster and earlier in patients with secondary infections. To complete this study, we have also evaluated 2 rapid lateral flow tests for the diagnosis of dengue in a panel of plasma samples from 245 RT-PCR confirmed dengue patients and 47 with other febrile illnesses. Our data suggest that the NS1 test component of these tests are highly specific and have similar levels of sensitivity (~60%). Both NS1 assays were significantly more sensitive for primary than secondary dengue. The IgM parameter in the SD Duo test improved overall test sensitivity without compromising specificity. All these findings are of major importance for further anti-viral drug testing.

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.

Abstract Point-of-care testing (POCT) is defined as laboratory tests performed outside the traditional clinical laboratory close to the patient at the time and place where care is received, such as hospitals and healthcare centers. The main reason for the use of POCT is that they provide rapid results and enable prompt interventions, with hopefully improved patient outcomes. All phases of laboratory procedure are included in POCT offering many opportunities for errors, which can influence on patients’ treatment. The measurements are more often performed by nurses than by laboratory professionals. These nurses have different kinds of professional backgrounds, e.g. public health nurses, registered and practical nurses, with minimal or no knowledge of laboratory procedures. The aim of the study was to develop a two-step training and management strategy for nurses to do POCT in hospital and primary healthcare center. In accordance with the strategy, with reasonable investment of laboratory resources, designated contact nurses were first trained in POCT by laboratory professionals, after which the contact nurses trained other nurses in POCT their respective units. Blood glucose, the most common point-of-care (POC) test, was chosen as an example to investigate the influence of training on the quality of the test performed by nurses. The quality of blood glucose measurements was studied by analyzing the control results obtained by nurses and biomedical laboratory scientists (BLSs). The study participants included nurses who were either untrained or trained to do POCT by using the developed interactive two-step training strategy. In conclusion, the nurses trained by using interactive two-step strategy achieved near-similar quality of blood glucose measurements as BLSs. The good quality of glucose measurements, once achieved by training, was also sustained in the long-term. / Tiivistelmä Määritelmän mukaan vieritutkimuksiksi kutsutaan laboratoriotutkimuksia, joita tehdään perinteisen laboratorion ulkopuolella, tarvittaessa lähellä potilasta sairaalassa ja perusterveydenhuollon alueella. Pääasiassa vieritutkimuksia tehdään silloin kun tulos halutaan saada nopeasti ennen hoitopäätöstä tai tulevaa toimenpidettä. Vieritutkimusten tekeminen sisältää kaikki laboratoriotyön vaiheet ja jokaisessa vaiheessa on mahdollisuus tehdä virheitä, jotka voivat vaikuttaa potilaiden hoitoon. Laboratorioammattilaisten sijaan määrityksiä tekevät yhä useammin hoitajat sairaalan eri yksiköissä ja perusterveydenhuollon alueella. Näillä hoitajilla on erilainen ammatillinen peruskoulutus, kuten perushoitajan tai sairaanhoitajan koulutus, ja heillä on vähän tai ei ollenkaan tietoa laboratoriomenetelmistä. Tämän tutkimuksen tarkoituksena oli kehittää hoitajien vieritutkimustoimintaan koulutus- ja hallintomalli, joka toimisi sekä sairaalassa että terveyskeskuksessa. Strategian perusteena oli käyttää suhteellisen vähän laboratorioresursseja ja päästä silti hyvään laadulliseen lopputulokseen. Strategiaksi valittiin kaksiportainen, vuorovaikutteinen koulutusmalli, jossa laboratorioammattilaiset kouluttivat sairaalan ja perusterveydenhuollon yksiköissä ns. yhdyshenkilöt, jotka puolestaan kouluttivat edelleen oman yksikkönsä muut hoitajat tekemään vieritutkimuksia. Veren glukoosimääritys, joka on yleisin vieritutkimus, valittiin esimerkkitutkimukseksi tutkittaessa koulutuksen vaikutusta hoitajien tekemien vieritutkimusten laatuun. Veren glukoosimääritysten laatutasoa tutkittiin analysoimalla hoitajien ja laboratoriohoitajien tekemien kontrollinäytteiden tuloksia. Tutkimukseen osallistui hoitajia, jotka oli koulutettu kehitetyllä vuorovaikutteisella kaksiportaisella koulutusstrategialla vieritutkimusten tekemiseen, sekä hoitajia, jotka eivät olleet saaneet vastaavaa koulutusta. Koulutusmallin avulla hoitajien suorittamien vieritutkimusten laatu parani ja he saavuttivat lähes saman laatutason kuin laboratoriohoitajat. Hyvä, kerran saavutettu glukoosimääritysten laatutaso säilyi myös pitkällä aikajaksolla.

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.

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.