O trabalho de enfermagem oferece constantes perigos para o enfermeiro ao expô-lo às diversas cargas de trabalho que são geradoras de acidentes e doenças, com graves consequências pessoais, institucionais e sociais. O enfermeiro exerce suas atividades em um contexto que por suas próprias características é insalubre e possui muitos estressores, dada a forma de organização adotada, com trabalho em turnos, duplo emprego, carência de informações sobre seus riscos, falta de recursos e instalações inadequadas. Essas condições possibilitam os acidentes de trabalho e a contaminação por doenças e, em seu extremo, causam a morte do enfermeiro, subentendida pela gravidade da exposição no trabalho. Nesse sentido, esse estudo tem como objetivo identificar as melhores evidências sobre as causas de morte do enfermeiro, relacionadas às suas condições de trabalho e que permitam evidenciar o seu perfil de mortalidade. O estudo é de revisão sistemática, segundo o modelo do Instituto Joanna Briggs. Pauta-se na seguinte questão norteadora: Qual é a melhor evidência sobre as causas de morte dos enfermeiros, relacionadas ao trabalho? A população foi de estudos realizados com enfermeiros e escritos em português, inglês e espanhol; pesquisados até julho de 2011. As buscas foram realizadas nas bases de dados preconizadas pelo Instituto Joanna Briggs por meio dos seguintes descritores: mortalidade ocupacional; morbidade, câncer ocupacional, envelhecimento; suicídio; depressão; grupo de risco; riscos ocupacionais; compostos químicos; anormalidades induzidas por radiação; trabalho em turnos; morte súbita; tabaco; usuários de drogas; estresse fisiológico; trabalhadores; condições de trabalho; enfermagem do trabalho; esgotamento profissional; serviços de saúde do trabalhador; infecção; enfermeira, enfermeiro; enfermagem; profissionais da saúde; morte; pessoal de saúde. De acordo com a estratégia, foram selecionados oito artigos e sua análise permitiu identificar que as causas de mortalidade estão relacionadas aos diferentes tipos de cânceres e suicídios entre os enfermeiros e, ainda, avaliar as evidências apresentadas segundo o Instituto Joanna Briggs. Os resultados assinalam que a mortalidade dos enfermeiros relaciona-se, principalmente, à exposição às cargas químicas e psíquicas na vida profissional. Demonstram, ainda, a necessidade de novas pesquisas, dado o pequeno número de publicações existentes que abordam os prejuízos causados à saúde do enfermeiro nas funções exercidas no cotidiano de sua prática profissional / The nursing work offers constant dangers for nurses due to exposure to many workloads that generate accidents and diseases with serious personal consequences, institutional and social. The nurse carries out its activities in a context that by own characteristics has many unhealthy stressors, due form of organization adopted, with shift work, double job, lack of information about its risks, lack of resources and inadequate facilities. These conditions make it possible workplace accidents and contamination by disease and, in extreme cases, cause the death of the nurse by the severity of the exposure at work. Thus, this study aims identify the best evidence on the causes of death of the nurse related to their working conditions, and to evidence their profile of mortality. The study is a systematic review by model of the Joanna Briggs Institute. It is guided by the following question: \"What is the best evidence on the causes of death among nurses, work-related?\" The chosen population was studies about nurses, written in Portuguese, English and Spanish, searched by July 2011. The searches were conducted in the databases recommended by the Joanna Briggs Institute and identified the following key words: occupational mortality, morbidity, occupational cancer, aging, suicide, depression, risk group; occupational hazards, chemicals, radiation-induced abnormalities, shift work, sudden death, tobacco, drug users, physiological stress, workers, working conditions, occupational nursing, burnout, health care worker infection; nurse, nursing, occupational health, death, health personnel. According to the strategy, we selected eight articles and their analysis allowed identify that the causes of death are related to different types of cancers and suicide among nurses and also assess the evidence presented according to the Joanna Briggs Institute. The results show that the mortality of nurses is related mainly to exposure to chemical and psych workloads in professional life. Demonstrate the need for further research, given the small number of existing publications that approach the damage caused to the health of nurses in the roles played in the daily professional practice

Capítulo 1. Objetivo: Acessar a literatura científica para determinar o nível de evidência científica que suporta a associação da reabsorção radicular inflamatória induzida ortodonticamente (RRIIO) com diferentes sistemas de força ortodôntica. Material e Método: A busca sistemática computadorizada foi realizada nas bases de dados PubMed, Cochrane e Embase, sem restrições quanto ao ano, status ou idioma de publicação. Os critérios de seleção incluíram estudos conduzidos em no mínimo 10 pacientes submetidos ao tratamento ortodôntico com aparelhos fixos ou termoplásticos removíveis, e que apresentaram descrição do sistema de forças utilizado. Resultados: A busca eletrônica inicial das bases de dados identificou 259 artigos. Após o processo de revisão, 21 artigos preencheram os critérios de inclusão. O tamanho da amostra variou entre 10 e 73 pacientes. A maioria dos artigos foi classificada como alto nível de evidência científica e baixo risco de viés. Conclusões: A análise da literatura disponível revelou que parece existir correlação positiva entre o aumento dos níveis de força e o aumento da reabsorção radicular, bem como entre o aumento do tempo de tratamento e o aumento da reabsorção radicular. Além disso, uma pausa na movimentação ortodôntica parece ser benéfica na redução da reabsorção radicular, por facilitar o processo de reparo do cemento. A ausência de um grupo controle, de critérios de seleção dos pacientes, e de exames adequados antes e após o tratamento constituem as falhas de metodologia mais comuns no estudo da RRIIO. Capítulo 2. Objetivos: Verificar por meio da análise de elementos finitos: (1) a influência do aumento da força (25 cN e 225 cN) em três diferentes movimentos ortodônticos (intrusão, inclinação para vestibular e combinação de intrusão e inclinação) na geração de tensões críticas no ligamento periodontal (LP), considerando sua não linearidade, (2) quais tensões podem ser utilizadas como indicadores do risco à RRIIO. Material e Método: Modelo tridimensional de elementos finitos foi construído com geometria axissimétrica para simular um pré-molar inferior unirradicular e seus tecidos circundantes: cemento, LP, osso alveolar cortical e trabecular. Com exceção do LP, os demais materiais foram considerados elásticos, isotrópicos, lineares e homogêneos. Foram simulados três tipos de carregamento: intrusão pura (IP), inclinação para vestibular (IV) e combinação de forças de intrusão e inclinação (CF), e duas magnitudes de força: 25 cN e 225 cN. O deslocamento foi restrito nos nós localizados na base e na lateral do osso cortical. Quatro variáveis respostas foram analisadas: tensão de von Mises (?VM), mínima tensão principal (?3), tensão hidrostática (?H) e tensão radial (?rr). Para cada tensão foi calculado o valor nodal obtido na interface LP-cemento e a média da variável de acordo com a sua localização: lingo-cervical (LC), lingo-média (LM), lingo-apical (LA), vestíbulo-apical (VA), vestíbulo-média (VM), vestíbulo-cervical (VC). Resultados: A distribuição e os picos de ?VM (terço cervical para a intrusão e regiões LC e VA para inclinação e movimento combinado) não foram correspondentes com os locais de maior risco de RRIIO encontrados clinicamente. Maiores valores de ?3 foram obtidos: no terço apical para forças de intrusão de 25 cN e no terço cervical para 225 cN; na região VC para a inclinação e na região VA para o movimento combinado. O perfil de distribuição de ?H e ?rr foi bastante similar: os maiores valores de tensão de compressão foram encontrados no terço apical para a intrusão e nas regiões VC e LA para o movimento de inclinação e combinado. Conclusões: A tensão radial negativa foi considerada o melhor indicador do risco de RRIIO, baseado na coerência com o mecanismo biológico e nas regiões de maior risco de reabsorção para cada tipo de movimento ortodôntico. Devido ao comportamento não linear do LP, o aumento da força provocou um aumento não proporcional das tensões. Na intrusão, o aumento da tensão radial compressiva foi mais significativo para o terço apical, enquanto na inclinação e no movimento combinado para as regiões VC e LA. / Chapter 1. Objective: Assess the literature to determine which evidence level supports the association of orthodontic force system and orthodontically induced inflammatory root resorption (OIIRR). Methods: PubMed, Cochrane, and Embase databases were searched with no restrictions on year, publication status, or language. Selection criteria included human studies conducted with fixed orthodontic appliances or aligners, with at least 10 patients, and the force system well described. Results: A total of 259 articles were retrieved in the initial search. After the review process, 21 full-text articles met the inclusion criteria. Sample sizes ranged from 10 to 73 patients. Most articles were classified as having high evidence levels and low risks of bias. Conclusions: Although a meta-analysis was not performed, from the available literature, it seems that positive correlations exist between increased force levels and increased root resorption, as well as between increased treatment time and increased root resorption. Moreover, a pause in tooth movement seems to be beneficial in reducing root resorption because it allows the resorbed cementum to heal. The absence of a control group, selection criteria of patients, and adequate examinations before and after treatment are the most common methodology flaws in studies of OIIRR. Chapter 2. Objectives: Verify by the finite element analysis: (1) The influence of the loading magnitude (25 cN and 225 cN) in three different orthodontic movements (intrusion, tipping and combination of both) on the stresses generation within the periodontal ligament (PDL) considering its nonlinearity. (2) Which stress criteria can be used as indicators of root resorption risk. Material and Method: Three-dimensional finite element model was constructed with axisymmetric geometry to simulate a single-rooted lower premolar and its surrounding tissues: cementum, PDL, cortical and trabecular alveolar bone. Except for the PDL, the remaining materials were considered elastic, isotropic, linear and homogeneous. Pure intrusion (PI), buccal tipping (BT) and combination of intrusion and tipping forces (CF), applied with two force magnitudes (25 cN and 225 cN), were simulated. The model displacement was restricted at the base and the lateral of cortical bone. Four stress criteria were analyzed: von Mises (?VM), minimum principal stress (?3), hydrostatic stress (?H) and radial stress (?rr). For each criteria it was calculated the nodal stress obtained at the PDL-cementum interface and its average value according to the location: lingual-cervical (LC), lingual-middle (LM), lingual-apical (LA), buccal-apical (BA), buccal-middle (BM), and buccocervical (BC). Results: The distribution and peak of ?VM (cervical third for intrusion, LC and BA regions for buccal tipping and combined movements) did not correspond to the zones where resorption occurs clinically. The highest average values of ?3 were obtained: at the apical third under 25 cN and at the cervical third under 225 cN of intrusion forces; at the BC region under tipping forces, and at the BA region under combined forces. The distribution pattern of ?H and ?rr was very similar: the highest compressive stress values was found at the apical third under intrusion forces and at the BC and LA regions under tipping and combined forces. Conclusions: The radial stress can be considered as the best indicator to predict the OIIRR risk, based on its consistency with the biological mechanism and according to the zones where resorption occurs clinically depending on the type of orthodontic movement. Due to the PDL nonlinearity, the increase of force magnitude caused a non-linear increase of the stress values. For intrusion, the increase of radial stresses was more significant at the apical third, while for buccal tipping and combined movement it was more significant for the BC and LA regions.

Background: Pain associated with the spine (PAWS) refers to pain in the neck, thorax, lower back or sacrum. It impacts on patients' Quality of Life (QoL), including working ability, daily functioning, sleep and psychological well-being. A number of clinical trials have demonstrated that acupuncture was beneficial for patients with PAWS. However the overall effect of acupuncture on these patients' QoL is unknown. Aims: The current study aimed to conduct a systematic review (SR) of clinical trials to determine the effect of acupuncture on QoL and pain for patients with PAWS. In addition, a narrative review (NR) was conducted to compare patients' perceived changes (PCC) with the standard QoL instruments used in acupuncture clinical trials for pain. Methods: For the SR, PubMed, Embase (via ScienceDirect), CINAHL (Via EBSCO) and Cochrane Central Register of Controlled Trials were searched. Randomised controlled trials (RCTs) of acupuncture for PAWS condition(s) that include both QoL and pain assessments with a Jadad score of three or greater were included. For the NR, PubMed was searched to identify studies reporting PPC after acupuncture and/or traditional Chinese medicine. Extracted data were grouped and compared with domains of the QoL instruments. Results: In total, 21 RCTs were included and 17 of them had sufficient data for analysis. QoL was measured using 15 different instruments. Randomisation procedures and dropouts were adequately reported in all 17 studies. Four studies compared acupuncture with wait-list or usual-care. Two demonstrated that acupuncture had a superior effect on improving physical and mental components of QoL measured by Short Form-36 health survey questionnaire and pain at the three month follow-up. Studies comparing acupuncture with sham/placebo acupuncture or placebo-TENS found either no difference between the treatments or conflicting results. When acupuncture was compared with active interventions, there was no difference except that at the intermediate-term follow-up massage was better for disability and pain and physiotherapy was better for Northwick Park Neck Pain Questionnaire. Acupuncture was also better than TENS for pain. The combined therapy of acupuncture and an active intervention showed a superior result than the latter alone in the short-term. Six studies were identified for the NR. Patients reported 11 categories of changes after acupuncture, such as reduced reliance on other therapies, enhanced spirituality, prevention of disease. However, these clinical outcomes were not included in any of the QoL instruments used in the included RCTs. Conclusion: There is moderate to strong evidence that acupuncture is more effective than wait-list or usual-care at the short-term follow-up in improving QoL of patients with PAWS. When acupuncture is combined with another therapy, the combined therapy seems to produce a better outcome. Acupuncture is not better than sham/placebo acupuncture or placebo-TENS. Surprisingly, the commonly used QoL instruments do not measure all the changes perceived by patients as a result of acupuncture and/or traditional Chinese medicine. There is a pressing need to design QoL assessments that are suitable for acupuncture research. Further studies should have larger sample sizes and additional validated outcome assessments are required to detect effects of acupuncture.

Anterior knee pain (AKP) is a common, chronic lower limb musculoskeletal overuse condition that represents substantial morbidity to those affected, and has a significant impact on the health care industry. Health practitioners frequently prescribe foot orthoses in the management of AKP as an alternative or adjunct to multimodal physiotherapy. The primary aim of this thesis was to investigate the clinical efficacy of foot orthoses in AKP, utilising high-quality research methodologies. The two systematic reviews conducted have identified a significant gap in the literature regarding evidence from randomised clinical trials (RCTs) for foot orthoses in AKP and other lower limb overuse conditions. While the best evidence for AKP management was for multimodal physiotherapy, there was insufficient evidence to support or refute the use of foot orthoses in the treatment of lower limb overuse conditions, including AKP. Meta-analysis provided evidence to support the use of foot orthoses in the prevention of the first incidence of lower limb overuse conditions. An interesting finding was evidence from pooled and individual study data of no difference between custom and prefabricated foot orthoses in both treatment and prevention of lower limb overuse conditions, inferring that either type of orthosis may be utilised. Both systematic reviews highlighted substantial methodological flaws of the included studies, and recommended that future studies include larger participant numbers, longer participant follow-up, more consistent use of reliable and valid outcome measures and reporting of outcome data, and utilisation of the CONSORT guidelines in the design and reporting of RCTs. A 12-month prospective RCT investigated the short- and long-term clinical efficacy of prefabricated foot orthoses in the treatment of 179 participants with AKP. Foot orthoses were more effective than flat shoe inserts in the short term, implying that their contoured form has some therapeutic effect. Foot orthoses were not significantly different to multimodal physiotherapy over 12 months, nor was there any benefit in adding foot orthoses to physiotherapy. Considering that all groups experienced clinically meaningful long-term improvements in pain and function, clinicians may prescribe foot orthoses for AKP to hasten recovery. Findings of post-hoc analyses to develop a clinical prediction rule indicate that those of older age and shorter height, who have a lower severity of AKP and a more mobile midfoot, are more than twice as likely to experience a successful outcome with foot orthoses. As a secondary aim, this thesis has provided a more comprehensive profile of AKP as a condition. Baseline data from the RCT participants confirms previous reports of higher rates of AKP in females, and a tendency towards bilaterality and chronicity. This AKP sample did not differ from asymptomatic individuals in terms of body mass index, physical activity level, general and mental health, and foot posture, although they tended to have a more mobile foot under load. These characteristics tend to be homogenous across a number of published RCTs, indicating that the findings of the RCT described above are likely to be generalisable to the broader population with AKP. An additional finding in this group was that those with AKP of long duration, higher pain levels, lower functional levels, and an overall lower score on a specific measure of AKP have a poorer prognosis over 12 months, irrespective of their age, gender or morphometry. These findings suggest that, in order to improve prognosis and the chance of a successful outcome, the primary goals of intervention should be to reduce the severity and duration of AKP, through the use of early intervention with foot orthoses, multimodal physiotherapy, or a combination of the two.

Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

The increasing popularity of traditional Chinese medicine (TCM) therapies as health care options warrants thorough examination of the efficacy and safety evidence around these therapies. This thesis explores the intersection of TCM and fatigue using two rigorous methodologies: systematic reviews (SRs) and a randomized controlled clinical trial (RCT). In order to inform the development of an RCT of acupuncture for infectious mononucleosis (mono), a common condition with no known cure, characterized by profound fatigue, we examined the literature on TCM treatment of mono as well as another fatigue condition, idiopathic chronic fatigue (ICF). Additionally, we investigated the literature on the safety of pediatric acupuncture. SRs of TCM efficacy in mono and ICF determined that although clinical trials exist, methodological flaws compromised their validity. In particular, studies published as RCTs were found to lack proper randomization. Inclusion of these studies in the SRs would have been inappropriate and demonstrates the importance of verifying RCT methods. We also present the results of the first known SR of pediatric acupuncture safety. This review was comprehensive, including a large number of databases and publications in any language. Synthesis of the results from those studies that included a denominator produced mild adverse event estimates of 16.3/100 (95% CI 11.221.5) per patient, for RCTs, and 6.3/100 (95% CI 4.97.7) per patient, for cohort studies, with a combined estimate of 7.8/100 (95% CI 6.49.2) per patient. We developed and conducted an RCT of acupuncture for mono, although limitations to recruitment resulted in the enrolment of only three participants. The primary result of the small sample size was to restrict the determination of treatment effect, however, successful implementation of other elements is informative to further research in this area. In addition, we determined the local 5-year Monospot positive incidence rate to be 1.11/1000 (95% CI 0.953.2) for all ages and 5.46/1000 (95% CI 0.8910.0) for the 15-25 year old group. This dissertation examined the evidence around TCM and fatigue and provides recommendations that are aimed at increasing the value of research and the safety and efficacy of practice in this area.

Background: Laparoscopic surgery for colorectal cancer is a novel healthcare technology, for which much research evidence has been published. The objectives of this work were to compare the oncologic outcomes of this technology across different study types, and to define patterns of adoption on the basis of the literature. Methods: A comprehensive systematic review of the literature was conducted using 1) existing systematic reviews, 2) randomized controlled trials (RCTs), and 3) observational studies. Outcomes of interest were overall survival, and total lymph node harvest. Outcomes were compared for congruence. Adoption was evaluated by means of summary expert opinions in the literature. Results: 1) Existing systematic reviews were of low to moderate quality and displayed evidence of overlap and duplication. 2) Laparoscopy was not inferior to open surgery in terms of oncologic outcomes in any study type. 3) Oncologic outcomes from RCTs and observational studies were congruent. 4) Expert opinion in the literature has been supportive of this technology, paralleling the publication of large RCTs. Conclusions: The evaluation of laparoscopic surgery for colorectal cancer in RCTs and observational studies suggests that it is not inferior to open surgery. Adoption of this technology has paralleled RCT evidence.

Patients with mechanical heart valves who present with intracranial haemorrhage are initially treated by reversing their coagulopathy. However, these patients will ultimately require that their oral anticoagulant be restarted. The time at which oral anticoagulants are restarted is critical since restarting too early may increase the risk of recurrent bleeding, while withholding anticoagulants increases the patient’s risk of thromboembolic events. The ideal time to restart patients on their oral anticoagulant medication is defined as the time at which all these risks are minimized. This thesis includes a systematic review and meta-analysis of the literature. The main outcomes were recurrent haematoma, valve thrombosis, stroke and peripheral emboli. Results were stratified by types of intracranial haemorrhage. We also conducted a survey to gain insight into current practices of neurosurgeons and thrombosis experts in Canada and USA when they are faced with deciding on anticoagulant restart times in patients with ICH. Results were stratified by type of intracranial bleed and participants’ characteristics and demographics. The systematic review identified that the ideal time for restarting anticoagulant therapy in patients following an ICH is unknown. Meta-analysis was limited by the heterogeneity of the studies. The survey results indicated that physicians had a wide range of practice and that their practice was dependent on the patient’s clinical features, but many physicians would restart oral anticoagulants between 4 and 14 days after the haemorrhage. For this reason we have proposed a multi centre cohort study to investigate the safety and efficacy of restarting patients on anticoagulation therapy between day 5 and 9 post haemorrhage. A full study protocol is presented in this thesis.

Background: Laparoscopic surgery for colorectal cancer is a novel healthcare technology, for which much research evidence has been published. The objectives of this work were to compare the oncologic outcomes of this technology across different study types, and to define patterns of adoption on the basis of the literature. Methods: A comprehensive systematic review of the literature was conducted using 1) existing systematic reviews, 2) randomized controlled trials (RCTs), and 3) observational studies. Outcomes of interest were overall survival, and total lymph node harvest. Outcomes were compared for congruence. Adoption was evaluated by means of summary expert opinions in the literature. Results: 1) Existing systematic reviews were of low to moderate quality and displayed evidence of overlap and duplication. 2) Laparoscopy was not inferior to open surgery in terms of oncologic outcomes in any study type. 3) Oncologic outcomes from RCTs and observational studies were congruent. 4) Expert opinion in the literature has been supportive of this technology, paralleling the publication of large RCTs. Conclusions: The evaluation of laparoscopic surgery for colorectal cancer in RCTs and observational studies suggests that it is not inferior to open surgery. Adoption of this technology has paralleled RCT evidence.

No description available.