Made available in DSpace on 2014-06-11T19:35:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-12-16Bitstream added on 2014-06-13T19:24:37Z : No. of bitstreams: 1 santos_pss_dr_botfm.pdf: 1256357 bytes, checksum: 4a195c65f3afc4f558db0dacf2c3985a (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A lesão renal aguda pode ter seu curso minimizado quando reconhecida e tratada adequadamente. NGAL surge como um novo biomarcador precoce desta lesão e poderá ser um marcador semelhante à troponina para o infarto agudo do miocárdio. O objetivo deste estudo foi quantificar a NGAL plasmática em ratos submetidos à isquemia renal sob anestesia venosa total (AVT) com reposição volêmica com cristalóide (RL) ou colóide (HES) e correlacionar com alterações histológicas renais. Trinta ratos, Wistar machos, foram distribuídos aleatoriamente em 3 grupos: G1 (AVT + RL + isquemia artéria renal esquerda), G2 (AVT + HES + isquemia artéria renal esquerda) e G3 (AVT + RL). A anestesia foi mantida com propofol na dose de 1 mg.kg-1.min-1 e remifentanil na dose de 0,05 a 0,1 μg.kg-1.min-1. Os valores plasmáticos da NGAL foram determinados a partir de coleta sanguínea estabelecidas em quatro momentos: M1, após a monitorização do animal; M2, após 30 minutos de isquemia; M3, após 30 minutos de reperfusão e M4, 12 horas após o início do experimento. Os atributos estudados foram pressão arterial média (PAM), temperatura retal (T), dosagem plasmática de NGAL e avaliação histológica. Todos os animais foram submetidos à laparotomia mediana para nefrectomia à direita e ao final do experimento procedeu-se nefrectomia à esquerda. A avaliação histológica foi realizada por meio de escala para avaliação de necrose tubular nos rins retirados dos grupos de estudo. As variáveis PAM, T, NGAL e escore de lesão histológica após análise, foram consideradas estatisticamente significativas quando p<0,05. Os valores da NGAL plasmática nos grupo G1 e G2 foram elevados alcançando 400 ng.mL-1 especificamente no M4, sendo esta diferença estatisticamente significativa quando comparado com G3; quando se comparou os diversos... / The course of acute renal injury can be minimized when it is adequately recognized and treated. NGAL arises as a new early biomarker for such injury, and it may be used similarly to troponin, which is a marker for acute myocardial infarction. This study aimed at quantifying plasma NGAL in rats submitted to renal ischemia under total venous anesthesia (TVA) with crystalloid (RL) or colloid (HES) volemic replacement and at correlating it with renal histological alterations. Thirty male Wistar rats were randomly distributed into three groups: G1 (TVA + RL + left renal arterial ischemia), G2 (TVA + HES + left renal arterial ischemia) and G3 (TVA + RL). Anesthesia was maintained with propofol at a dose of 1 mg.kg-1.min-1 and remifentanil at a dose of 0.05 to 0.1 μg.kg-1.min-1. NGAL plasma levels were determined from blood collections established at four moments: M1, after animal monitorization; M2, after 30 minutes of ischemia; M3, after 30 minutes of reperfusion and M4, twelve hours after commencement of the experiment. The studied attributes were mean arterial pressure (MAP), rectal temperature (T), plasma NGAL dosing and histological evaluation. All the animals were submitted to median laparotomy for right nephrectomy and, at the end of the experiment, left nephrectomy was performed. Histological evaluation was performed by means of a scale for assessment of tubular necrosis in the kidneys removed from the study groups. Variables MAP, T, NGAL and histological lesion scores were considered to be statistically significant when p<0.05. Plasma NGAL values in Groups G1 and G2 were high and reached 400 ng.mL-1 specifically at M4. Such difference was statistically significant when comparing with G3. When the various moments were compared within the same group, the difference was statistically significant only at M4 in relation to the other moments. As regards histological lesion... (Complete abstract click electronic access below)

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O presente estudo teve como meta desenvolver definiÃÃes conceituais e operacionais para o Resultado de Enfermagem Integridade Tissular direcionado a pacientes com Ãlcera venosa. O capÃtulo 1 descreve as etapas da revisÃo integrativa implementada para o desenvolvimento inicial das definiÃÃes conceituais e operacionais para os elementos do Resultado em questÃo aplicado à avaliaÃÃo de Ãlceras venosas. Nesta revisÃo,a busca foi realizada em bases de dados e no acervo do periÃdico International Journal of Nursing Terminologies and Classifications. Oito artigos compuseram a amostra. As informaÃÃes que se referiam aos conceitos do resultado Integridade Tissular e seus indicadores foram reunidas, comparada e agrupadas. Foram propostas definiÃÃes conceituais e operacionais para o Resultado Integridade Tissular, assim como inserido indicadores fictÃcios. O desenvolvimento das definiÃÃes do Resultado Integridade Tissular pÃde possibilitar melhor compreensÃo do seu uso segundo o contexto de Ãlceras venosas. No segundo capÃtulo, apresenta-se a construÃÃo das definiÃÃes conceituais e operacionais para apreciaÃÃo de 29 especialistas, realizando assim a validaÃÃo de conteÃdo. Para seleÃÃo dos especialistas utilizou-se os parÃmetros propostos por Fehring. A captaÃÃo dos participantes foi realizada por busca ativa na plataforma Lattes (CNPq). Foram remetidos dois instrumentos: um relativo ao perfil do especialista, e outro de anÃlise conceitual e operacional dos indicadores. A partir do valor atribuÃdo pelos especialistas, foi calculado o Ãndice de validade de conteÃdo (IVC) com ponto de corte de 0,8 e aplicado o teste binomial para anÃlise da proporÃÃo de adequaÃÃo das definiÃÃes por parte dos especialistas. O projeto foi aprovado pelo comità de Ãtica e pesquisa sob protocolo n097/10. Dos especialistas, 92,9% utilizam ou jà utilizaram o processo de enfermagem em sua prÃtica. A versÃo final do instrumento apresentou 18 indicadores, sendo trÃs fictÃcios. Foram excluÃdos trÃs indicadores propostos pela Nursing Outcomes Classifications (NOC), assim como o item Fadiga (fictÃcio). As colocaÃÃes e sugestÃes realizadas pelos especialistas foram analisadas e acatadas a maioria. Por fim, no capÃtulo 3, apresenta-se o processo de validaÃÃo clÃnica das definiÃÃes propostas com pacientes portadores de Ãlceras venosas. O estudo de validaÃÃo foi executado com 22 pacientes. Os instrumentos utilizados compreenderam dados clÃnicos e de identificaÃÃo, alÃm de indicadores com definiÃÃes operacionais. Dez enfermeiros aplicaram os instrumentos, metade com as definiÃÃes operacionais desenvolvidas e a outra metade nÃo. O teste de Friedman foi aplicado para verificar a diferenÃa de mediana entre os grupos de avaliadores. As anÃlises pos-hoc foram procedidas pelo mÃtodo da diferenÃa mÃnima significante (DMS). AlÃm disso, foi calculado o coeficiente de correlaÃÃo intraclasse para anÃlise da congruÃncia entre as avaliaÃÃes. Com exceÃÃo do indicador Textura, o teste de Friedman e mÃtodo DMS mostraram que os indicadores apresentaram diferenÃas estatÃsticas significantes entre os dois grupos de avaliadores (com e sem definiÃÃes operacionais). Entretanto, o mÃtodo da DMS mostrou nÃo haver diferenÃas estatisticamente significantes nas avaliaÃÃes realizadas pelos examinadores que utilizaram definiÃÃes operacionais denotando boa congruÃncia entre as mesmas. Observou-se que os valores de correlaÃÃo intraclasse do grupo sem definiÃÃes foram inferiores ao do grupo que utilizou tais definiÃÃes. As definiÃÃes operacionais construÃdas, com exceÃÃo do indicador Textura, possibilitaram maior uniformidade e similaridade entre avaliaÃÃes de pacientes com Ãlceras venosas. Diante disso, pode-se confirmar a tese de que o uso de definiÃÃes na avaliaÃÃo de pacientes com Ãlceras venosas possibilitou uma avaliaÃÃo mais acurada que a nÃo utilizaÃÃo das mesmas. / The present study aims at developing conceptual and operational definitions to the results from Tissue Integrity Nursing addressed to venous ulcers patients. In chapter 1, definitions to concepts related to the referred results applied to the evaluation of venous ulcers. In order to do so, an integrative review was made based on the data collection from the periodical International Journal of Nursing Terminologies and Classifications. The sample was composed of eight articles. The information regarding the concepts from Tissue Integrity Nursing and its indicators were gathered, compared, and grouped. Operational and conceptual definitions were proposed to Tissue Integrity Nursing, as well as fictitious indicators were added. The development of definitions from the Tissue Integrity Result enabled a better understanding of its use according to venous ulcers contexts. In chapter 2, the construction of the operational and conceptual definitions was presented to the appreciation of 29 experts, thus validating the content. The selection of the experts was made based on Fehringâs standards. The choice of the participants was made through search on Lattes plataform (CNPq). Two instruments were used: one related to the expertâs profile, and the other related to the analysis of the conceptual and operational indicators. The instrumentâs final version showed 18 indicators, and three of them were fictitious. Three indicators proposed by Nursing Outcomes Classifications NOC were excluded, as well as the item Fatigue (fictitious). The expertsâ suggestions and remarks were analyzed and most of them were also abided by. Finally, in chapter 3, we dealt with the execution of the clinical validation of the proposed definitions along with the patients afflicted with venous ulcers. The validation study was held with 22 patients. The instruments used were clinical and identification data, and also indicators with operational definitions. Ten nurses applied the instruments, some of them had operational definitions and the others did not. Friedmanâs test showed the average difference between the evaluatorsâ groups. The differences were calculated in at least one of the groups by the Minimal Detectable Change (MDC) method, besides the intraclass correlation coefficient. Except from the indicator âtextureâ, Friedmanâs test and the MDC method showed that the indicators presented significant statistical differences between the two groups (with or without operational definitions). However, the MDC method showed that the evaluation differences between the evaluators from the group that used the operational definitions was not significant. It was noticed that the intraclass correlation values from the group without the definitions were inferior to the one that used those definitions. The operational definitions built, except from the indicator âtextureâ, enabled greater uniformity and similarity between the evaluations of patients affected with venous ulcers. Bearing this in mind, the thesis that the use of definitions in the evaluation of patients afflicted with venous ulcers enables more accurate evaluation can be confirmed.

No description available.

Background: Up to 40% of trauma patients die during the first 24 hours after injury due to massive hemorrhage. In patients who survive this critical time period, no information is available on rates of delayed major bleeding or factors associated with delayed major bleeding. Methods: A retrospective chart review of 150 critically ill adult trauma patients was used to determine the incidence of delayed major bleeding events. Cox proportional hazards multivariate analysis was performed to assess for risk factors associated with delayed major bleeding events. The anticipated rate of delayed major bleeding events was 10%. Results: The incidence of delayed major bleeding in this cohort of critically ill trauma patients was 44%. Predictors that were statistically significantly associated with delayed major bleeding included: male gender, pre-injury use of the antiplatelet agents aspirin and/or clopidogrel, presence of intracranial bleeding, higher injury severity scores, requirement of massive transfusion, and low pH values. Use of anticoagulant prophylaxis was not associated with delayed major bleeding. Conclusion: The rate of delayed major bleeding was higher than estimated. Larger retrospective and prospective cohorts are needed to confirm these findings.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Pharmacy Johannesburg 2001. i / The use of a low molecular weight heparin, enoxaparin was evaluated in the prevention and treatment of deep vein thrombosis. Patterns of use were analysed and measured against pre-determined criteria with a view to promoting optimal use and identifying those factors, which may contribute to safer use of the drug. / IT2018

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21621号 / 医博第4427号 / 新制||医||1033(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 湊谷 謙司, 教授 佐藤 俊哉, 教授 横出 正之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

No description available.

No / Activa Healthcare

The Relationship Between Central Venous Catheter and Post-operative Complications in Patients Undergoing Hepatic Resection David C. O’Connor, Ph.D., DNAP, CRNA A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University, 2018 Dissertation Chair: Clarence J. Biddle, Ph.D., CRNA Hepatic resection is indicated for primary and secondary malignancies. Use of a low central venous pressure technique is associated with decreased blood loss in these cases. This technique has evolved; central venous catheters and high dose morphine are no longer used, and patients are extubated earlier. The purpose of this study is to assess a relationship between these changes and outcomes. Central venous pressure has fallen out of favor as an accurate fluid measurement. Central venous catheters are associated with many complications. Outcomes in patients undergoing hepatic resection have improved over 20 years at one high volume institution. Guided by Donabedian’s theory of measuring outcomes, a non-randomized, non-experimental, retrospective, cohort design was conducted. The independent variables were intraoperative insertion of a central venous catheter, use of morphine, and time of extubation. The dependent variables were superficial and deep wound infections, number and severity of complications. The population sample is patients who submitted to partial hepatectomy at Memorial Sloan Kettering Cancer Center from 2007-2016. Data was obtained from hepatobiliary and anesthesia databases at Memorial Sloan Kettering Cancer Center. Data of 2518 from a possible 3903 patients were analyzed with chi square, univariate, Poisson and multivariate regressions. Univariate analysis for presence of CVC was significant for 90-day mortality (p 0.013). Use of morphine was significant for superficial wound infection (p 0.035), and a decrease in complications (p <.001). Amount of morphine was associated with fewer severe complications (p <.001). Incidental findings included a relationship between gender, total amount of fluids and number of segments resected. The significance of CVC with 90-day mortality was eliminated with stepwise multivariate regression. The findings support the change in anesthetic practice with clinical significance. Incidental findings regarding fluids and segments are supported in the literature. Future research should include goal directed fluid therapy and investigation of the relationship between gender and outcomes.