Orientador: Daniela Ponce / Resumo: Introdução: Poucos trabalhos avaliaram a viabilidade e os resultados entre diálise peritoneal (DP) e hemodiálise (HD) no início urgente de terapia renal substitutiva (TRS). Objetivo: Comparar DP e HD como opções de início urgente de TRS, quanto à evolução, desfechos e complicações dos pacientes. Método: Estudo quasi experimental com pacientes incidentes em DP e HD em hospital universitário brasileiro, no período de julho/2014 a dezembro/2016. Incluídos indivíduos DRC estádio final que necessitaram de TRS imediata, ou seja, HD por meio de CVC ou DP cujo cateter foi implantado por nefrologista e utilizado em 72 horas, sem treinamento prévio. Pacientes em DP foram submetidos, inicialmente, a DP de alto volume (DPAV) para compensação metabólica. Após alta hospitalar, permaneciam em DP intermitente na unidade de diálise até efetivação do treinamento. Foram comparados: complicações mecânicas e infecciosas, recuperação de função renal e sobrevida. Resultados: Foram incluídos 93 pacientes em DP (G1) e 91, em HD (G2). Os grupos G1 e G2 foram semelhantes quanto à idade (58+17 vs 60+15; p=0,49), frequência de diabetes mellitus (37,6 vs 50,5%; p=0,10), outras comorbidades (74,1 vs 71,4%; p=0,67) e parâmetros bioquímicos ao início da TRS – creatinina (9,1+4,1 vs 8,0+2,8; p=0,09), albumina sérica (3,1+0,6 vs 3,3+0,6; p=0,06) e hemoglobina (9,5+1,8 vs 9,8+2,0; p=0,44). Após seguimento mínimo de 180 dias e máximo de dois anos, não houve diferença quanto a complicações mecânicas (24,7 vs 37,4... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Few studies have evaluated the feasibility and results of peritoneal dialysis (PD) and hemodialysis (HD) at the urgent-start of renal replacement therapy (RRT). Objective: We compared PD and HD as options for urgent-start of RRT regarding the evolution, complications and outcomes of patients. Method: End-stage renal disease (ESRD) patients who initiated dialysis urgently without a pre-established functional vascular acess or PD catheter were included in a period between July/2014 to December/2016, from a Brazilian single centre. In urgent-start PD, nephrologists performed the Tenckhoff catheter insertions. It was used high volume PD (HVPD) right after 72 hours PD catheter placement, and it was kept until metabolic and fluid control. After hospital discharge, patients were treated with intermittent PD on alternate days at the dialysis unit, until family training. Results: Ninety-three patients in PD (G1) and 91 in HD (G2) were included. Comparing the G1 group with G2, they were similar in age (58±17 vs 60±15; p= 0.49), frequency of diabetes mellitus (37.6 vs 50.5%; p= 0.10), others comorbidities (74.1 vs 71.4%; p= 0.67) and biochemical parameters to early RRT - creatinine (9.1+4.1 vs 8.0+2.8; p= 0.09), serum albumin (3.1+0.6 vs 3.3+0.6; p= 0.06) and hemoglobin (9.5+1.8 vs 9.8+2.0; p= 0.44). There was no difference between the groups in mechanical complications (24.7 vs 37.4%; p= 0.06) and bacteremia (15 vs 24%; p= 0.11). Exit site infection (ESI) (25.8 vs 39.5%; p ... (Complete abstract click electronic access below) / Doutor

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Introduction: Emergency department usage for non-urgent care has been identified as an issue worldwide. Many health professionals have an opinion as to why parents seek care for their children at an emergency department. In Australia, although it is known that there is increasing usage of paediatric emergency departments for non-urgent care; there is a paucity of research on the reasons for this high usage. Aim: This study aims to provide a better understanding of the motivations and actions of parents of children with non-urgent injury or illness who attend the emergency department (PED) at a tertiary paediatric hospital seeking care. Method: This study was designed as a cross sectional descriptive survey to ascertain information fiom parents about their care-giving and care-seeking behaviours prior to presenting with their child to the paediatric emergency department (PED) for professional assessment and treatment. Demographic characteristics were compared with those of the general population to ensure representativeness. Results: A total of 355 parents were surveyed in the three-month period between May and July 2005. This represented 8% of the parents/carers who had presented to the PED for nonurgent (Australian Triage Score Category 4 and 5) care of their child. Just over half of the children presenting were male (185 (53%)) with an overall mean age of 5.45 years (*SD 4.25). The factors the study identified as seminal as to why parents sought care for their child at the paediatric emergency department are that parents rated their child's condition as moderate to very serious (242 (68%)) and that two thirds of parents (234 (66%)) had sought advice prior to attending PED. Other pertinent factors identified were that 54% of children attended with an injury (137) presented promptly to PED (i-e. within four hours of injury) whereas of those presenting with illness (88 (41.3%)) presented within two to seven days of the onset of the illness. The majority of children attended with an illness (213 (60%)) and of these, 98% had medication administered prior to presentation to PED. The presenting child was most likely to be the youngest sibling. Conclusions: The results of the study highlight the accuracy of 'parental triage', that is that parents assess their child's health, and generally engage in appropriate care-giving and careseeking behaviours before presenting to paediatric PED. This study highlights the deficiencies in current primary care services available to families and the perception that not all cases deemed as non-urgent by the emergency department are able to be dealt with in a primary care setting. In recognising that presentation is multifactorial, an issue that needs to be addressed is that there will always be non-urgent presentations at the paediatric emergency department and service delivery and W i g models need further development to address the increasing paediatric requirements for care. In identifying these multiple factors, this study will provide a solid base for future planning within paediatric hospitals, the emergency department setting and in provision of care in the community.

Concussions are brain injuries--also called mild traumatic brain injuries--that affect the function of the brain temporarily or permanently. The purpose of this doctoral project was to develop an education module for staff at an urgent care center to address the lack of knowledge and low level of comfort regarding the care for patients with a head trauma. This project introduced and educated the clinical staff on an evidence-based protocol for the treatment and management of a patient with a concussion. The Rosswurm and Larrabee model for evidence-based change was used as a foundation for refining the practice question, gathering evidence, and translation of the protocol into the clinical setting. The Dreyfus model of the 5 stages of skill acquisition was used to measure the learners' level of achievement. A pretest and posttest were conducted to determine whether there was a gain in knowledge and confidence as a result of the project. There were 6 participants: 3 nonclinical staff and 3 nurses. Overall, there was a statistically significant improvement in confidence based on the Wilcoxon sign ranks test (z = -2.201; p = .028); however, a statistically significant increase in knowledge was not apparent, even though the scores did improve. All staff members were able to apply the practice guideline and make sound judgments using case studies. This project resulted in the translation of evidenced-based care into the urgent care setting, enhanced the confidence of the nursing staff, and has the potential to bring about positive social change by improving the quality of care that will be provided to patients with head injuries.

Till the present-day the problems of the professional pressure have been explored above all in the field of the EMS nevertheless the inquiry in the field of urgent reception was and still is the field much less explored. In the thesis three aims were specified: To evaluate the most stressing situations of the urgent reception. To compare the stressful aspects of the paramedics at the places of urgent reception with EMS. To suggest the ways of managing stress at the urgent reception. Two inquiry questions were asked to fulfill the aims of the work: Are the paramedics working at the urgent reception able to describe stressing factors? Are the stressing situations same when working at the urgent reception and at the EMS? The inquiry was realized by the collection and analyses of the data while the collection of the data was realized by the qualitative form, by the method of semi-structured dialogues. The dialogues were led with 14 middle medical workers who worked at the position of paramedics. The choice of the workers was random, some of them worked at the urgent reception in Prague, in the Motol Teaching Hospital, in the Střešovice Central Military Hospital and in Královské Vinohrady Teaching Hospital. The questions were ranked into four areas. The first area dealt with the stressing factors and their comparison with the EMS. The respondents were asked why they find their work more difficult and in which it is easier then working at the EMS. Futher which situations they perceive as the most difficult for their psychical balance, if they face some fear in their service or if they are afraid of anything. In the second area we tried to go back with the respondents to the subsequences of the situations they experienced during their service. We traced the situations with which they feel to be influenced at the urgent reception and what kind of situations they were. The third area regarded the professional intervention. Here we found out if the respondents needed the help of the professional psychologist. Consequently if they have a psychologist at their disposal within the framework of their workplace. Lastly the respondents should express their opinion about the professional psychologist in the context of their profession. In the last forth area we dealt with the managing of stress. In this area we found out if the respondents try to cope with the stress load during their service or if they go back to such situations. Then the respondents were to answer if they have some kind of active relaxation and how often they practise this kind of relaxation. Then there was time to answer questions regarding the problems of smoking, alcohol and drugs. Thanks to the determination supported by the inquiry that the most demanding situations at the urgent reception regard death or serious health condition of a young man or a child, it was possible to state the proposion that the paramedics working at the urgent reception were able to describe the stressing factors they deal with. From the results it was also possible to state that the stressing situations at the urgent reception and EMS vary. Also it is necessary to remark that although the stressing situations and their perception vary in specific details, the perception of the demandingness of the work at the urgent reception can be subjective.The results also showed that some respondents found their work easier than working at the EMS. But the paramedics of these two subjects agreed in perceiving the most stressing situation the serious heath condition and death of young people and children. This thesis could be used in praxis to create a conception of a preventive and intervention program as an instrument of managing stress coming out of these results and the mentioned points. It would be only necessary to modify them in the area of urgent reception and in the situations which the respondents find demanding.

Introduction to the issue and the importance of the topic: Emergency Department (ED) is a new type of the health care service and these departments are organized in a different way in the Czech Republic so far. However, ED is an integral part of the acute care system, and the Emergency Deaprtment is capable to ensure the continuity of care between the field and the hospital despite of the increasing atomization of medical disciplines. In recent years, it is a model that is able to deal with all acute conditions of all severity, 24 hours a day, with an adequate level of safety for patients, because they can be briefly observed at the observation unit of the ED. Goal of the thesis and methodology: The main goal of the diploma thesis is a comprehensive analysis of the existing Emergency Departments in the Czech Republic. The first partial goal was to find out the disposition and organization of Emergency Departments in details, how many acute beds for emergency care are available and how is the work regime organized. The second partial goal was to find out staffing of the Emergency Departments. Whether a specialised emergency physician is continually present and whether there ais enough qualified non-medical medical staff. The third partial goal was the intention to find out how are Emergency...

Background: Involuntary exposure to secondhand smoke (SHSe) is an important cause of morbidity in children who present to the pediatric emergency department (PED) and urgent care (UC). SHSe interventions delivered in the PED and UC would benefit both the smoker and child, but there have been no large trials testing the efficacy of such interventions. The Healthy Families program is the first randomized controlled trial to test whether a screening, brief intervention, and referral to treatment (SBIRT) intervention delivered in the PED and UC will be effective in decreasing SHSe in children and increasing cessation in smokers. Methods/design: This trial uses a randomized, two-group design in which caregiver-smokers of children 0-17 years old are recruited from the PED and UC. Eligible caregiver-smokers are randomized to either the: 1) SBIRT Condition with face-to-face, tailored counseling that focuses on the child's illness, the importance of reducing child SHSe, caregiver smoking cessation, and the option to receive nicotine replacement therapy; or 2) Healthy Habits Control Condition which includes face-to-face, tailored attention control "5-2-1-0" counseling that focuses on improving the child's health. Dyadic assessments are conducted in-person at baseline, and via email, phone, or in-person at 6-weeks and 6-months. The primary outcomes are biochemically-verified, 7-day point prevalence and prolonged smoking abstinence. Secondary outcomes are cigarettes smoked per week, 24 h quit attempts, and biochemically validated child SHSe at each time point. The costs of this intervention will also be analyzed. Discussion: This study will test an innovative, multilevel intervention designed to reduce child SHSe and increase smoking cessation in caregivers. If effective and routinely used, this SBIRT model could reach at least one million smokers a year in the U.S., resulting in significant reductions in caregivers' tobacco use, SHSe-related pediatric illness, and healthcare costs in this population of children.

O Atendimento pré-hospitalar (APH) móvel é uma modalidade de assistência recente no Brasil e, em especial, no município de Ribeirão Preto-SP, tendo sido criada em 1996, com a finalidade de atendimento a toda e qualquer solicitação de ajuda, fora do âmbito hospitalar, visando a manutenção da vida e/ou a minimização das seqüelas, podendo ser oriunda do próprio cidadão ou ainda de instituições de saúde. Tendo em vista a recente implantação deste serviço, os objetivos do presente estudo são descrever a epidemiologia do atendimento pré-hospitalar móvel primário e secundário de urgência e emergência, o fluxo de atendimento pré-hospitalar móvel secundário e o fluxo do atendimento pré-hospitalar móvel da unidade de suporte avançado no município de Ribeirão Preto. Nossa pesquisa trata-se de um estudo de natureza descritiva, em que utilizamos dados de fonte secundária com transcrição de informações específicas do Serviço de APH do Município em Ribeirão Preto-SP, quando da solicitação de atendimento em situações de agravos à saúde. Os dados referentes ao objeto de estudo, foram coletados junto ao Programa de Assistência Médica Emergencial da Secretaria Municipal da Saúde. A base de dados analisada permitiu delinear a caracterização da atenção pré-hospitalar móvel da Secretaria Municipal da Saúde. Os resultados da pesquisa revelam o perfil das solicitações de atendimento das urgências e emergências com análises importantes que poderão subsidiar futuras reorganizações do serviço de APH móvel primário e secundário. O estudo poderá subsidiar ainda decisões dos atores sociais envolvidos na promoção, prevenção, recuperação e reabilitação aos agravos à saúde, tais como: conselhos de saúde, gestores de saúde, prestadores de serviços, usuários, conselhos de classes, órgãos de educação, promoção social, segurança social, transporte e outros. / The pre-hospital mobile attendant is a recent modality of assistance in Brazil, in special, at the District of Ribeirão Preto – SP, created since 1996, with the intention of attending any help of solicitation of care outside the hospital environment, looking for a life maintenance and/or a sequel minimization, and still looking to be accepted for the health institutions or the own patient. Because of the this new system implementation of service, the goals for the recent studies are to describe the pre-hospital assistance mobile of Epidemology for the first and second degrees of emergency and urgent care, the overflowing of the system now settle at this district of Ribeirão Preto for this type of help/ work with patients. Our research is about a descriptive nature where we can use secondary sources of database with transcription of specified information of the APH Service in the District of Ribeirão Preto-SP, when in need of care the solicitation of worst problems for health at own. The database collected for the goals of this research were taken at the Emergency Medical Assistance Program of the Health Minister of Care. The base studied let us create a line of attention in characterization of the pre-hospital mobile assistance from the Health Municipal Secretary . The results of the research reveals the profile of each assistance solicitations of emergencies and urgent cases with very important analyses which can create future reorganizations of the first and secondary mobile APH service. This study will subside many important decisions of the social actors involved at this promotion, prevention, recover, rehabilitation of the worst problems in health care such as: health counseling, health managers, services, utilitarian, class counseling, education organism, social promotion, social security, transportation and others.

Introduction of the problematic: A burnout syndrome is largely presents among paramedics and has a negative impact on both work performance and life quality. The aim of this thesis was to analyse the incidence of burnout syndrome among male paramedics working in emergency care and to find out the effect the syndrome on their sexuality. The research was conducted by an internet survey. Methodology: Research was conceived as quantitative. Research was conducted paramedics working in emergency care by an internet survey that was in progress from 1.2.2019 to 30.4.2019 within facebook group ,,Ošetřovna od ošetřovatelství.info. The research group was consisted of 124 male paramedics working in emergency care. The measure of burnout syndrome was investigated using the Czech version of Shiron-Melamed burnout measure scale (SMBM questionnaire), the sexual life of respondents was examined using the questionnaire Sexual functions of man) in the extended Kroměříž's version (SFM/K). Results: Three of the five hypotheses were confirmed completely, two hypotheses were confirmed partially. The burnout syndrome has been shown to affect the need for sexual activity, the frequency of tries of sexual intercourse and the frequency of satisfying sexual intercourse, the sense of success in sexual life and also the...

Healthcare industry owners who have unsatisfactory customer care services may experience a financial risk and create dissatisfied patients. The purpose of this case study was to explore customer care strategies that managers of urgent care businesses used to improve customer care services and patient satisfaction. The target population consisted of 1 urgent care manager from 3 separate urgent care clinics with the highest customer satisfaction ratings in Alabama. The urgent care managers were knowledgeable about effective customer care strategies that improved customer care services and patient satisfaction. Customer loyalty theory with emphases on customer behavior, customer attitude, repeat patronage, and loyalty was the conceptual framework for the study. Semistructured interviews and patient survey forms were the data sources. Data were analyzed using thematic analysis which identified similar codes, patterns, and themes. The 3 primary themes that emerged from thematic analysis were patient-focused care, social media outreach, and employee engagement. The implications of this study for positive social change include the potential to enhance the quality of healthcare experiences, which may empower individuals to seek medical care. The patients might become trusting of healthcare providers and become collaborators in responding to medical care requests by medical staff to improve their quality of life.