Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-08-13T19:35:39Z No. of bitstreams: 1 473454 - Texto Parcial.pdf: 755327 bytes, checksum: 9e3264a8362ab0aeb4b4514a2de60490 (MD5) / Made available in DSpace on 2015-08-13T19:35:40Z (GMT). No. of bitstreams: 1 473454 - Texto Parcial.pdf: 755327 bytes, checksum: 9e3264a8362ab0aeb4b4514a2de60490 (MD5) Previous issue date: 2015-07-02 / Objective: To compare the effectiveness of single-dose intramuscular bromopride, metoclopramide, and ondansetron for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency department setting. department setting. department setting. department setting. department setting. department setting.department setting. Methods: Randomized controlled trial of children who presented with vomiting due to gastroenteritis at the pediatric emergency department of Hospital Universit?rio de Santa Maria from August 2013 to June 2014. Children aged 1 to 12 years were randomized to receive a single intramuscular dose of bromopride or metoclopramide (up to 10 mg) or ondansetron (up to 8 mg) 0.15 mg/kg. After administration of the antiemetic drug, children remained under observation for at least 1 hour. Children who were discharged after the observation period were subsequently monitored by their parents or caregivers at home for 24 hours and contacted via telephone for assessment of the results of antiemetic therapy. The following parameters were compared across treatment groups: time to cessation of vomiting within 1, 6, and 24 hours; acceptance of oral rehydration therapy; intravenous fluid replacement; return to hospital; and adverse effects attributable to the antiemetic. All parents or caregivers were given information on the antiemetic treatment that would be provided and signed an informed consent form authorizing the child's participation in the study. Results: Of 180 children randomized, 175 completed the trial. Within 1 hour of antiemetic administration, cessation of vomiting had been achieved in 96.6% of children given bromopride, 94.8% of those given metoclopramide, and 100% of those given ondansetron (p=0.312). Six hours after administration, bromopride was found to cease vomiting in 216?114 minutes, metoclopramide in 150?168 minutes, and ondansetron in 72?54 minutes (p=0.011). Cessation of vomiting at 24 hours was achieved in 67.8% of children given bromopride, 67.2% of those given metoclopramide, and 96.6% of those given ondansetron (p=0.002). Children in the ondansetron group accepted more fluid replenishment orally (200 ml) than those given bromopride or metoclopramide (150 ml and 100 ml respectively) (p=0.034). Eleven children ultimately required intravenous fluids: five in the bromopride group and six in the metoclopramide group. Within 1 hour of antiemetic administration, only 24.1% of children in the ondansetron group reported adverse effects (somnolence, diarrhea, fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) , whereas 42.4% and 44.8% of children in the bromopride and metoclopramide groups respectively reported somnolence (p=0.034). At 24 hours, there were no significant differences in adverse effects across the three groups (p=0.357). Conclusion: In a pediatric emergency department setting, ondansetron is superior to bromopride and metoclopramide for treatment of vomiting. Ondansetron was associated with cessation or reduction of vomiting both within 1 hour of administration and at 6 and 24 hours. Bromopride and metoclopramide were both effective, but were associated with somnolence, an adverse effect that can prolong observation time in the emergency department and thus increase hospital costs. / Objetivo: Avaliar os resultados dos antiem?ticos aplicados via intramuscular, bromoprida, metoclopramida e ondansetron em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto socorro socorro socorro pedi?trico. pedi?trico. pedi?trico. pedi?trico. M?todos: Ensaio cl?nico randomizado e controlado, envolvendo crian?as que consultaram por v?mitos, devido ? gastroenterite, no servi?o de Emerg?ncia Pedi?trica no Hospital Universit?rio de Santa Maria, no per?odo de agosto de 2013 a junho de 2014. Foram randomizadas crian?as com idades entre 1 a 12 anos, para receber dose ?nica de bromoprida via intramuscular ou metoclopramida via intramuscular (m?ximo 10mg); ou ondansetron (m?ximo 8mg) na dose de 0,15mg/kg via intramuscular. A crian?a ap?s receber o antiem?tico permanecia em observa??o por no m?mimo 1 hora. Ap?s a reavaliac?o cl?nica as crian?as que recebiam alta eram monitorizadas pelo familiar no domic?lio durante 24 horas, e contactados por via telef?nica para avaliar o resultado do tratamento antiem?tico recebido. Os grupos foram comparados em rela??o a tempo para cessar os v?mitos dentro de 1, 6 e 24 horas; aceita??o de l?quidos orais; reidrata??o endovenosa; retorno ao hospital e efeitos colaterais relacionados aos antiem?ticos. Os familiares ap?s devidamente informados sobre o tratamento antiem?tico que a crian?a seria submetida, assinaram o Termo de Consentimento Livre e Esclarecido, permitindo a participa??o do filho no estudo. Resultados: Das 180 crian?as randomizadas, 175 completaram o estudo. Na primeira hora ap?s medicar, a bromoprida teve 96,6% de efic?cia na cessa??o dos v?mitos, a metoclopramida, 94,8% e o ondansetron 100%, (p= 0,312). Em 6 horas, ? bromoprida cessou o v?mito em 216?114 minutos, ? metoclopramida em 150?168 minutos e o ondansetron 72?54 minutos, (p=0,011). Em 24 horas, a cessa??o dos v?mitos ocorreu em 67,8% com bromoprida, 67,2% com metoclopramida e 96,6% com ondansetron (p=0,002). O grupo ondansetron aceitou melhor os l?quidos orais, 200 ml, comparado ? bromoprida, 150 ml e ? metoclopramida, 100 ml (p=0,034). Onze crian?as necessitaram de hidrata??o endovenosa: 5 no grupo bromoprida e 6 no metoclopramida. Sessenta minutos ap?s medicar, apenas 24,1% do grupo ondansetron apresentaram efeitos colaterais (sonol?ncia, diarreia, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor) , enquanto que os grupos bromoprida e metoclopramida apresentaram associa??o com sonol?ncia, 42,4% e 44,8%, respectivamente, p=0,034. Os efeitos colaterais em 24hs n?o apresentaram diferen?a estat?stica significativa entre os tr?s grupos, p=0,357. Conclus?o: Existem benef?cios nos resultados para tratamento de v?mito em pronto socorro pedi?trico com o uso do ondansetron em rela??o ? bromoprida e ? metoclopramida. O ondansetron mostrou-se associado na cessa??o ou redu??o dos v?mitos ap?s medicar tanto na primeira hora, quanto nas pr?ximas 6 e 24 horas. A bromoprida e a metoclopramida foram consideradas eficazes, mas apresentava associa??o com sonol?ncia, efeito colateral que pode determinar um maior tempo de observa??o em sala de emerg?ncia e aumentar os custos hospitalares.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-08-01T14:46:42Z No. of bitstreams: 1 AlineSilvaDeOliveira_DISSERT.pdf: 937656 bytes, checksum: cb8808a256880fc9bb312eadf4546d72 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-08-08T14:41:00Z (GMT) No. of bitstreams: 1 AlineSilvaDeOliveira_DISSERT.pdf: 937656 bytes, checksum: cb8808a256880fc9bb312eadf4546d72 (MD5) / Made available in DSpace on 2017-08-08T14:41:00Z (GMT). No. of bitstreams: 1 AlineSilvaDeOliveira_DISSERT.pdf: 937656 bytes, checksum: cb8808a256880fc9bb312eadf4546d72 (MD5) Previous issue date: 2017-03-17 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / A educa??o permanente em sa?de vem sendo discutida desde que a Organiza??o Pan-Americana da Sa?de considerou-a importante para alcan?ar o desenvolvimento dos sistemas de sa?de. No Brasil, esse conceito torna-se evidente com a cria??o da Pol?tica Nacional de Educa??o Permanente em Sa?de no ano de 2004. Desde ent?o, poucos estudos tem sido realizados sobre o tema, especialmente nos servi?os de urg?ncia e emerg?ncia. A forma??o dos profissionais da ?rea de sa?de ainda ? um dos n?s cr?ticos para o fortalecimento do SUS, haja vista ainda estar fortemente ligada ao modelo de sa?de hegem?nico, ou seja, hospitaloc?ntrico. Portanto, o estudo objetivou analisar a concep??o dos profissionais sobre educa??o permanente no Servi?o de Atendimento M?vel de Urg?ncia de um munic?pio do Estado do Rio Grande do Norte. Trata-se de um estudo qualitativo que utilizou a an?lise tem?tica de conte?do para an?lise dos dados. A t?cnica de coleta de dados foi a entrevista semiestruturada. Do resultado das entrevistas com 29 profissionais, emergiram tr?s categorias: Concep??o sobre Educa??o permanente em Sa?de; Efetiva??o da Educa??o Permanente em Sa?de e Processos Educativos ofertados pelo N?cleo de Educa??o Permanente em Sa?de. As falas dos profissionais, em sua maioria, revelam que a Educa??o Permanente ? vista como sin?nimo de Educa??o Continuada. Al?m disso, os m?ltiplos v?nculos empregat?cios, associados a escassas reuni?es de equipe, entre outros foram apontados como dificuldades para efetiva??o da educa??o permanente. As facilidades relatadas foram a gratuidade dos cursos, boa infraestrutura e flexibilidade de dias e hor?rios dos processos educativos. No tocante aos processos educativos, observou-se que os profissionais mostraram-se satisfeitos e que esses n?o s? contribuem, mas tamb?m s?o aplic?veis ? realidade do dia-a-dia de trabalho. Entretanto, identificou-se que a escolha dos processos educativos ? realizada de forma verticalizada, sem a participa??o direta dos trabalhadores. Al?m disso, diversas necessidades educacionais foram relatadas pelos profissionais. Assim, o estudo possibilitou identificar que a educa??o permanente deve estar presente neste cen?rio como uma estrat?gia de qualifica??o das pr?ticas nos servi?os de urg?ncia e emerg?ncia. Faz-se necess?ria n?o s? a compreens?o do conceito de educa??o permanente, bem como o aprimoramento de tal pr?tica no servi?o de sa?de em foco. / Continuing education in health has been discussed since the Pan American Health Organization considered it important to achieve the development of health systems. In Brazil, this concept becomes evident with the creation of the National Policy of Permanent Education in Health in the year 2004. Since then, few studies have been done on the subject, especially in the emergency and emergency services. The training of health professionals is still one of the critical nodes for SUS strengthening, since it is still strongly linked to the hegemonic health model, that is, hospital-centered. Therefore, the study aimed to analyze the perception of professionals about permanent education in the Mobile Emergency Care Service of a municipality in the State of Rio Grande do Norte. This is a qualitative study that used the thematic analysis of content for data analysis. The technique of data collection was the semistructured interview. From the results of the interviews with 29 professionals, three categories emerged: Perception on Permanent Education in Health; Effectiveness of Permanent Education and Educational Processes. The speeches of professionals, for the most part, reveal that Permanent Education is seen as synonymous with Continuing Education. In addition, the multiple employment links, associated with scarce staff meetings, among others, were identified as difficulties to implement permanent education. The reported facilities were the gratuity of the courses, good infrastructure and flexibility of days and times of educational processes. Regarding educational processes, it was observed that the professionals were satisfied and that these not only contribute, but also apply to the reality of the day to day work. However, it was identified that the choice of educational processes is carried out in a hierarchical way, without the direct participation of the workers. In addition, various educational needs were reported by practitioners. Thus, the study made it possible to identify that permanent education should be present in this scenario as a strategy for qualifying practices in emergency services. It is necessary not only the understanding of the concept of permanent education, as well as the improvement of such practice in the health service in question.

Made available in DSpace on 2015-04-14T13:32:40Z (GMT). No. of bitstreams: 1 417795.pdf: 1522667 bytes, checksum: 09ede2886e2366bb595d23bf1946feb3 (MD5) Previous issue date: 2009-03-30 / Introdu??o: As infec??es respirat?rias (IR) de vias a?reas inferiores s?o respons?veis por grande parte das hospitaliza??es de crian?as no sul do Brasil. Embora essas infec??es, em sua maioria sejam de origem preponderantemente viral, elas s?o reconhecidas como causa mundial de uso abusivo e err?neo de antibacterianos. De acordo com os crit?rios estabelecidos pela Organiza??o Pan-Americana da Sa?de (OPAS) atrav?s da identifica??o de alguns sinais e sintomas ? poss?vel prevenir e controlar as IR na inf?ncia, incluindo estrat?gias que simplificam o diagn?stico, afim de estabelecer o tratamento correto definindo o uso adequado de agentes microbianos. Objetivo: descrever os achados cl?nicos, hist?ria familiar e pregressa e tratamentos institu?dos a crian?as entre 1 e 36 meses de idade hospitalizadas por infec??o respirat?ria de vias a?reas inferiores. M?todos: foram inclu?das todas as crian?as hospitalizadas por pelo menos 6 horas, com diagn?stico de infec??o respirat?ria de vias a?reas inferiores, internadas no Hospital S?o Lucas da PUCRS, pelo per?odo de um ano. Foi feito o registro de sinais vitais e coletada hist?ria padronizada dos respons?veis. Ap?s a alta hospitalar, novo question?rio foi preenchido, com os dados da interna??o, pesquisa de v?rus respirat?rios, tratamentos institu?dos e plano de alta. Resultados: foram inclu?dos no estudo 298 pacientes que tiveram question?rios respondidos e foram acompanhados na interna??o.