This thesis describes the management of patients treated with mechanical circulatory support devices for short- or long-term use. Twenty-four patients suffering from postcardiotomy heart failure were treated with a minimally invasive axial flow pump. The device was effective in unloading the failing left ventricle and in maintaining an adequate systemic circulation. The principles of perioperative monitoring, and pharmacological therapy are outlined. The pump was also used as an alternative to the heart-lung machine in conjunction with coronary artery bypass surgery. Together with a short-acting β-blocker, esmolol, the heart was decompressed and heart motion was reduced, facilitating bypass surgery on the beating heart. The anesthesiological considerations using this method are described. An implantable left ventricular assist device was used as a bridge to heart transplantation in 10 patients. We were interested in assessing the possibility to establish such a treatment program at a non-transplanting center. A multidisciplinary approach was enabled thanks to the organization of our Heart Center and due the close collaboration with our transplant center at Lund University. As one of the first centers in Europe, we established a well-functioning program with good results. Nine out of 10 of the bridge patients, with treatment times varying between 53 to 873 days, survived pump treatment and were eventually transplanted. The device proved to be powerful enough to support the failing heart and enable rehabilitation of the patients. Outpatient management became simpler when using the electrical device with belt-worn batteries. The uncertain durability and the high risk of device-related complications are shortcomings that limit its potential for more permanent treatment of heart failure. A new generation of small implantable axial blood flow pumps has therefore been developed. The principles of these pumps are based on the first generation axial flow pumps evaluated in this thesis. After several years of basic research and experimental studies, the first human implants have been performed. In the thesis, the hemodynamic effects of such a novel axial flow pump have been evaluated in an acute heart failure model. This technology holds great promise, both as a bridge to heart transplantation, and as a permanent circulatory support system. / On the day of the public defence the status of the article IV was: Submitted for publication.

Purpose: Patients living with advanced heart failure experience dyspnea, fatigue, poor quality of life, depression and cognitive impairment which may threaten their ability to provide informed consent to undergo heart transplant (HTx) or mechanical support (LVAD). Using qualitative and quantitative methods, we asked how patients with advanced heart failure make decisions regarding HTx and LVAD. The variables chosen to reflect the elements of consent included quality of life and symptom severity (voluntariness), depression and cognitive impairment (capacity) and treatment preferences (decision-making). Methods: 76 patients enrolled in the quantitative arm completed the Minnesota Living with Heart Failure Questionnaire; Visual Analog scales for dyspnea, fatigue and overall health; Beck Depression Inventory; Montreal Cognitive Assessment; Standard Gamble and Time Tradeoff. Qualitative methods were used to discover concepts, relationships and decision-making processes described by 17 of the 76 patients considering HTx and LVAD. Results: Patients reported poor quality of life and high symptom severity scores which compelled them to consider surgery as a way to relieve unpleasant symptoms and improve quality of life. Although 30% of patients had evidence of depression and/or cognitive impairment, no patient was deemed incapable of decision-making. Patients were willing to take considerable risk (35%) and trade considerable time (4months) to improve their health. While heart failure-related concepts were important to the decision, entrustment emerged as the meaningful process for decision-making. Conclusions: Patients who participated in this study were capable of decision-making and understood the risks associated with the surgery. Voluntariness was diminished by disease but not absent, and decisions were free of coercion. These results suggest the entrustment model of decision-making is the dominant process for patients considering high-risk surgical procedures and meets criteria for informed consent. Understanding the process of decision-making will help clinicians support and enable treatment decisions made by patients living with advanced heart failure.

<p>A uniaxial High-Velocity Compaction (HVC) process for polymer powder using a cylindrical, hardened steel die and a new technique with relaxation assist was tested with a focus on the compactibility characteristics and surface morphology of the compacted materials using various heights of relaxation assist device with different compacting profiles.</p><p>Relaxation assist device was presented as a new technique to reduce springback, pull-out phenomenon and to improve the compaction process.</p><p>The basic phenomena associated with HVC are explained and the general energy principle is introduced to explain pull-out phenomenon during the decompacting stage. In this study, polyamide-11 powders with different particle size distributions have been compacted with the application of different compaction profiles, e.g. different energies and velocities. It was found that the relative green density is influenced more by the pre-compacting (primary compaction step) than by the post-compacting (secondary compaction step).</p><p>Experimental results for different compaction profiles were presented showing the effect of varying the opposite velocity during the decompacting stage and how to improve the homogeneous densification between the upper and lower surface and the evenness of the upper surface of the compacted powder bed by using relaxation assists, and the influences of the relaxation assist device on the process characteristics. It was found that the relaxation assist improves the compaction of the polymer powder by locking the powder bed in the compacted form. In addition, the relative times of the compacting stage, decompacting stage and the reorganisation of the particles can be controlled by altering the height of the relaxation assist. It was found that the high-velocity compaction process is an interruption process and that the delay times between the pressure waves can be reduced by increasing the height of the relaxation assist device. Furthermore, the first gross instantaneous springback and the total elastic springback are reduced.</p><p>Two bonding strain gauges and a high-speed video camera system were used to investigate the springback phenomenon during the compaction process. Scanning electron microscopy (SEM) and image computer board Camera (IC-PCI Imaging Technology) were used to the study the morphological characteristics, the limit of plastic deformation and particle bonding by plastic flow at contact points, and pull-out phenomena.</p> / QC 20100506

Purpose: Patients living with advanced heart failure experience dyspnea, fatigue, poor quality of life, depression and cognitive impairment which may threaten their ability to provide informed consent to undergo heart transplant (HTx) or mechanical support (LVAD). Using qualitative and quantitative methods, we asked how patients with advanced heart failure make decisions regarding HTx and LVAD. The variables chosen to reflect the elements of consent included quality of life and symptom severity (voluntariness), depression and cognitive impairment (capacity) and treatment preferences (decision-making). Methods: 76 patients enrolled in the quantitative arm completed the Minnesota Living with Heart Failure Questionnaire; Visual Analog scales for dyspnea, fatigue and overall health; Beck Depression Inventory; Montreal Cognitive Assessment; Standard Gamble and Time Tradeoff. Qualitative methods were used to discover concepts, relationships and decision-making processes described by 17 of the 76 patients considering HTx and LVAD. Results: Patients reported poor quality of life and high symptom severity scores which compelled them to consider surgery as a way to relieve unpleasant symptoms and improve quality of life. Although 30% of patients had evidence of depression and/or cognitive impairment, no patient was deemed incapable of decision-making. Patients were willing to take considerable risk (35%) and trade considerable time (4months) to improve their health. While heart failure-related concepts were important to the decision, entrustment emerged as the meaningful process for decision-making. Conclusions: Patients who participated in this study were capable of decision-making and understood the risks associated with the surgery. Voluntariness was diminished by disease but not absent, and decisions were free of coercion. These results suggest the entrustment model of decision-making is the dominant process for patients considering high-risk surgical procedures and meets criteria for informed consent. Understanding the process of decision-making will help clinicians support and enable treatment decisions made by patients living with advanced heart failure.

Made available in DSpace on 2014-12-17T15:46:27Z (GMT). No. of bitstreams: 1 MariaLS_DISSERT.pdf: 3226194 bytes, checksum: 9dee30dde1674df8a94a8c2eb1a99501 (MD5) Previous issue date: 2012-12-27 / A disserta??o versa sobre a Pol?tica de Assist?ncia Estudantil e o processo de luta pela democratiza??o do acesso ? universidade, no contexto de expans?o do ensino superior em tempos de crise estrutural do capital. Apresenta como unidade de an?lise as particularidades da p?s-gradua??o em Servi?o Social da UFRN e tem como objetivo principal apreender e analisar as condi??es de perman?ncia disponibilizadas pela UFRN aos discentes de p?s-gradua??o no contexto de expans?o do Ensino Superior. O percurso te?rico-metodol?gico de an?lise adotado na pesquisa se fundamentou numa perspectiva cr?tica do objeto de estudo a partir de uma concep??o de totalidade, que pressup?e apreender as determina??es socioecon?micas e pol?ticas que incidem sobre a pol?tica de ensino superior e as condi??es de vida dos discentes do Programa de P?s-Gradua??o em Servi?o Social (PPGSS). As an?lises fundamentaram-se em pesquisa bibliogr?fica como base te?rico-metodol?gica da investiga??o, articulada com as reflex?es que resultaram dos dados emp?ricos da pesquisa de campo na perspectiva de apreens?o do objeto, em sua densidade hist?rica e num quadro de m?ltiplas determina??es. Do ponto de vista metodol?gico foram entrevistados 26 discentes e realizada an?lise documental referentes a leis e documentos da pol?tica educacional em n?vel federal e dos organismos internacionais. A luta por amplia??o do acesso ? universidade est? na agenda dos movimentos sociais no ?mbito da educa??o, no entanto na conjuntura dos governos de Luis In?cio Lula da Silva (2003 a 2010) e Dilma Rousseff (2011 a 2012) a tend?ncia tem sido seguir as orienta??es dos organismos internacionais e promover expans?o de vagas sem assegurar estrat?gias de perman?ncia compat?veis com as exig?ncias de excel?ncia acad?mica postas, por exemplo, na p?s-gradua??o. Discentes entrevistados acessam o ensino superior e os cursos de p?s-gradua??o e vivenciam dificuldades di?rias para atender com qualidade ?s exig?ncias acad?micas em face de suas condi??es materiais de vida e de trabalho e dos limites da pol?tica de assist?ncia estudantil que tem um perfil de programas e a??es localizadas

Made available in DSpace on 2014-12-17T15:46:29Z (GMT). No. of bitstreams: 1 NestorGDJ_DISSERT.pdf: 815149 bytes, checksum: 3535f029a2bde27c92cb3258eddb4466 (MD5) Previous issue date: 2013-11-25 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This paper discusses about the higher education in Brazilian society highlighting the struggle of the working class, as concerning the access to public universities, as well as highlights the contradictions implicit in social quotas adopted by Higher Education Institutions (HEIs) . The aim of this paper is on presenting the analysis of student assistance of the state universities in the Northeast that adopt quotas as social criteria of access for its students , presenting investigative locus as the following universities : UERN , UEPB , UPE and UNEAL . The paper presents the results of a qualitative study , based on a documentary analysis , based on dialectical and historical materialism in which she performed the reading of data from the following analytical categories: Higher Education, Social Quotas and Student Assistance. As main results, it is emphasized that the implementation of quotas as a means of access to higher education was not decisive for the form of planning and implementation of student assistance the university investigated; latent heterogeneity is that universities deal with actions to support student residence. And it is this heterogeneity and the variation in the conduct and understanding of student assistance , reflecting the lack of prioritization with the actions of the context of HEIs ; support programs are to stay focused on central campuses which are located the administrative offices of the universities, penalizing students enrolled in advanced units; also highlight that there is no link between the programs and projects related to student assistance with actions related to teaching, research and extension in universities investigated , which ultimately characterize the student assistance as an isolated action and punctual / O presente trabalho discorre acerca da educa??o superior na sociedade brasileira ressaltando a luta da classe trabalhadora, no que concernente ao acesso ? universidade p?blica, bem como destaca as contradi??es impl?citas nas cotas sociais adotadas pelas Institui??es de Ensino Superior (IES). O objetivo central deste trabalho constitui-se em apresentar a an?lise da assist?ncia estudantil das universidades estaduais do Nordeste que adotam as cotas sociais como crit?rio de acesso dos seus discentes, apresentando como l?cus investigativo as seguintes universidades: UERN, UEPB, UPE e UENAL. O trabalho apresenta os resultados de um estudo qualitativo, a partir de uma an?lise documental, baseado no materialismo hist?rico e dial?tico em que se realizou a leitura dos dados a partir das seguintes categorias anal?ticas: Educa??o superior, Cotas sociais e Assist?ncia estudantil. Como principais resultados, destaca-se que a implanta??o das cotas como mecanismo de acesso ? educa??o superior n?o tem sido determinante para a forma de planejamento e execu??o da assist?ncia estudantil nas universidades investigadas; ? latente a heterogeneidade com que as universidades lidam com as a??es de apoio ? perman?ncia discente. E ? esta heterogeneidade e a varia??o na forma de condu??o e entendimento da assist?ncia estudantil, que refletem a falta de prioriza??o com as a??es de apoio ? perman?ncia discente no contexto das IES investigadas; os programas de apoio ? perman?ncia s?o concentrados nos campi centrais onde se situam as sedes administrativas das universidades, penalizando os estudantes matriculados nas unidades avan?adas; Ainda destacamos que n?o h? articula??o entre os programas e os projetos vinculados ? assist?ncia estudantil com as a??es vinculadas ao ensino, pesquisa e extens?o nas universidades investigadas, o que acaba por caracterizar a assist?ncia estudantil como uma a??o isolada e pontual

Made available in DSpace on 2014-12-17T15:46:31Z (GMT). No. of bitstreams: 1 DanielleDOM.pdf: 4785860 bytes, checksum: db3d79f21aa78adaf621d445bb916769 (MD5) Previous issue date: 2006-09-14 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This study is about the users' experiences of the services offered by League Against C?ncer that are in treatment of breast cancer, focusing on how the health/illness process develops. It is distinguished, in this context, the National Politics of Health, approaching the sprouting, implantation and consolidation process of the Unified Health System and its shocks on the installment of health services to the low-income population as a legit right from Citizen Constitution. It has as an objective to analyze how the social-economic extract of these women intervenes with such process, the aspects who involve the cancer while a pathology, approaching the signals, symptoms, forms of prevention, diagnosis, among other aspects that configure themselves as important points to the understanding of these experiences, since the diagnosis, treatment and control phases. The research was carried out with 25 women, between the months of January and February of year of 2005. The used technique was the scriptstructured interview, whose universe was defined through intentional sample. The following distinguishes as a result of the research: The majority of the women has its origins on the interior of the state, possesses a familiar income from one to three minimum wages and didn't make any kind of prevention before diagnosis, currently make treatment, beyond other aspects. It becomes necessary posterior studies on this social problematic, with respect to the personal, professional, familiar and social daily behavior of these women. It is worth mentioning that the role of the social assistant in the developed work with these women, understanding all the impediments associated with such experiences, as well as giving information about the rights of the patients with cancer, conquered through the years / Trata-se de um estudo sobre as viv?ncias das usu?rias dos servi?os da Liga Contra o C?ncer que est?o em tratamento de c?ncer de mama enfocando como se d? o processo sa?de/ doen?a. Destaca-se, neste contexto, a Pol?tica Nacional de Sa?de, abordando o surgimento, implanta??o e processo de consolida??o do Sistema ?nico de Sa?de e seus embates na presta??o dos servi?os de sa?de ? popula??o de baixa renda enquanto direito, a partir da Constitui??o Cidad?. Tem como objetivo analisar de que maneira o extrato s?cio-econ?mico dessas mulheres interfere em tal processo, os aspectos que envolvem o c?ncer, enquanto patologia, abordando os sinais, sintomas, formas de preven??o, diagn?stico, entre outros aspectos que se configuram como pontos importantes para o entendimento dessas experi?ncias, desde as fases de diagn?stico, tratamento e controle. A pesquisa foi realizada com 25 mulheres, entre os meses de janeiro e fevereiro de 2005. A t?cnica utilizada foi a entrevista estruturada a partir de um roteiro, cuja defini??o do universo se deu atrav?s da amostra intencional. Como resultados da pesquisa destacam-se: a maioria ? procedente do interior do estado, possuem o ensino fundamental incompleto, s?o casadas, tem mais de 62 anos, possuem renda familiar de1a 3 sal?rios m?nimos e n?o faziam nenhum tipo de preven??o antes do diagn?stico, atualmente fazem tratamento, al?m de outros aspectos. Fazem-se necess?rios estudos posteriores sobre esta problem?tica social, no que diz respeito ao cotidiano pessoal, profissional, familiar e social dessas mulheres. Vale ressaltar o papel do assistente social frente ao trabalho desenvolvido junto a essas mulheres, compreendendo todos os entraves associados a tais viv?ncias, bem como prestando informa??es acerca dos direitos dos pacientes com c?ncer, conquistados ao longo dos anos

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-12-12T17:33:32Z No. of bitstreams: 1 ThalyneYuriAraujoFarias_TESE.pdf: 909519 bytes, checksum: 9bbecdd157280cdc04c52bdc00e0a52b (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-12-13T17:47:53Z (GMT) No. of bitstreams: 1 ThalyneYuriAraujoFarias_TESE.pdf: 909519 bytes, checksum: 9bbecdd157280cdc04c52bdc00e0a52b (MD5) / Made available in DSpace on 2017-12-13T17:47:53Z (GMT). No. of bitstreams: 1 ThalyneYuriAraujoFarias_TESE.pdf: 909519 bytes, checksum: 9bbecdd157280cdc04c52bdc00e0a52b (MD5) Previous issue date: 2017-08-30 / A ?lcera venosa (UV) ? caracterizada pela perda irregular e circunscrita da derme e epiderme, podendo acometer tecidos subcut?neos e subjacentes. Sua causa est? relacionada a disfun??o do sistema vascular venoso. ? considerado um grande problema de sa?de p?blica, gerando impacto na economia, dor permanente, incapacidade de realiza??o das atividades de vida di?ria, problemas biopsicossociais, isolamento social, al?m da diminui??o da qualidade de vida. O estudo objetiva avaliar a qualidade de vida de pessoas com ?lcera venosa atrav?s do ChronIc Venous Insufficiency quality of life Questionnaire (CIVIQ-20). Estudo transversal, quantitativo, com amostra n?o probabil?stica, composta por 30 pessoas com doen?a venosa, que tinham ?lcera ativa com classifica??o cl?nica 6, realizado no ambulat?rio de angiologia de um hospital universit?rio em Natal Rio Grande do Norte, entre os meses de mar?o e novembro de 2016, atrav?s de um formul?rio estruturado de entrevista com caracter?sticas sociodemogr?ficas e de sa?de e um instrumento de Qualidade de Vida Relacionada ? Sa?de, CIVIQ-20. Predominaram nesse estudo pessoas acima de 60 anos (66,7%), do g?nero feminino (86,7%), solteira vi?va ou divorciadas (66,7%), baixa escolaridade (83,3%). 40% tinha hist?ria familiar de doen?a venosa, 80% passaram por gesta??es, 76,7% apresentavam veias varicosas e 70% tinham hipertens?o arterial. 73,3% apresentaram tempo de tratamento da UV maior que seis meses e 70,0% n?o tinham orienta??o para o uso de terapia compressiva. Todas as dimens?es do CIVIQ (F?sica, Dor, Social e Psicol?gica) e escore total do instrumento obtiveram m?dias e medianas com valores que se aproximam dos escores de pior qualidade de vida, com varia??es estatisticamente significantes (p<0,001), com destaque para a dimens?o f?sica com m?dia de 71,0 e dor com m?dia de 67,0. Ao correlacionar as dimens?es de qualidade de vida do CIVIQ entre elas, a correla??o foi de moderada a forte, com p- valor significante para todas as correla??es entre as dimens?es. Com destaque para a correla??o entre a dimens?o f?sica e dimens?o dor, assim como dimens?o f?sica com o escore total do instrumento. Conclus?o: Os resultados demonstram um importante impacto das dimens?es do instrumento na qualidade de vida dos portadores de DVC participantes deste estudo, com destaque para a dor e dimens?o f?sica. / Venous ulcer is characterized by irregular and circumscribed loss of the dermis and epidermis, which can affect subcutaneous and underlying tissues. Its cause is related to dysfunction of the venous vascular system. It is considered a major public health problem, generating an impact on the economy, permanent pain, inability to perform activities of daily living, biopsychosocial problems, social isolation, and a decrease in quality of life. The study aims to evaluate the quality of life of people with venous ulcer through ChronIc Venous Insufficiency quality of life Questionnaire (CIVIQ-20). A cross-sectional, quantitative, non-probabilistic sample composed of 30 people with venous disease who had active ulcer, Clinical APC 6, performed at the angiology outpatient clinic of a university hospital in Natal, Rio Grande do Norte between March and November 2016, through a structured interview form with sociodemographic and health characteristics and a Health Related Quality of Life instrument, CIVIQ-20. Prevalence in this study was over 60 years old (66.7%), female (86.7%), single widowed or divorced (66.7%), low educational level (83.3%). 40% had a family history of venous disease, 80% had gestations, 76.7% had varicose veins, and 70% had arterial hypertension. 73.3% had a VU treatment time greater than six months and 70.0% had no guidance for the use of compressive therapy. All the dimensions of the CIVIQ (Physical, Pain, Social and Psychological) and total score of the instrument obtained means and medians with values that approximate the scores of worse quality of life, with statistically significant variations (p<0.001), Physical dimension with a mean of 71.0 and Pain with a mean of 67.0. When correlating the quality of life dimensions of CIVIQ between them, the correlation was moderate to strong, with a significant p-value for all correlations between dimensions. With emphasis on the correlation between the physical dimension and pain dimension, as well as physical dimension with the total score of the instrument. Conclusion: The results show a major impact on the dimensions of the instrument in the quality of life of patients with CVD study participants, highlighting the pain and physical dimension. It is confirmed that the CIVIQ is an instrument of high reliability to verify the quality of life of people with venous disease.

Made available in DSpace on 2014-12-17T14:46:39Z (GMT). No. of bitstreams: 1 FlavioCBS_DISSERT.pdf: 2052091 bytes, checksum: 63aa15d25bc19657919cea29649ce570 (MD5) Previous issue date: 2009-10-29 / This research aimed to understand pregnant general meaning about consort absence in prenatal care. It s an exploratory and descriptive qualitative approach, developed at Centro de Sa?de de Jardim Lola, S?o Gon?alo do Amarante / RN. Participated in investigation 20 pregnant enrolled in prenatal program, their aged over 18 years, guidance of mental faculties and who survive together her partner. Data were collected from March to May 2009, through semi-structured interview. The analysis was processed according to grounded theory and symbolic interactionism as theoretical and methodological references. To support discussions were used literature findings involving political aspects of women humanization in health care and gender relations within family. Following footsteps of points it were adopted derived following sub categories: ?Realizing involvement of consort during prenatal?, ?Expressing feelings during prenatal? and ?Manifesting attitudes during prenatal period?. These, when they had their properties and dimensions analyzed, resulted in the main category ? Experiencing absence of compeer in clinical prenatal?. The construction of this theory leads to conclusion that women understand absence of her partner, attributing this to even work at the moment prenatal care or does not like to attend health institutions. However, this does not mean that his presence is dismissed, because desire to be with him in prenatal care was mentioned by most interviewees. So, partner absent at time, leads women to experience desires, feelings, attitudes, perceptions and expectations about studied phenomenon. This reality, induce that absence of them partner in prenatal care predisposes women to strengthening of discomforts arising from pregnancy and therefore goes against wellbeing of pregnant, and ensure the possibility of marital discord. This requires professional nursing measures to get in inclusion of partner in daily pre-natal care in humanization perspective. / A pesquisa teve como objetivo geral compreender o significado atribu?do por gestantes acerca da aus?ncia do companheiro nas consultas de pr?-natal. Trata-se de um estudo explorat?rio e descritivo em uma abordagem qualitativa, desenvolvido no Centro de Sa?de de Jardim Lola no Munic?pio de S?o Gon?alo do Amarante/RN. Participaram da investiga??o 20 gestantes cadastradas no programa de pr?-natal, com idade igual ou superior a 18 anos, apresentando orienta??o das faculdades mentais e que conviviam sob o mesmo teto com o companheiro. Os dados foram coletados no per?odo de mar?o a maio de 2009, atrav?s de entrevista semiestruturada. A an?lise se processou segundo a teoria fundamentada nos dados (Grounded Theory) e o interacionismo simb?lico (Simbolic Interactionism), como referenciais te?rico-metodol?gicos. Para respaldar as discuss?es foram utilizados achados liter?rios envolvendo aspectos pol?ticos da humaniza??o na assist?ncia ? sa?de da mulher, bem como a rela??o de g?nero no contexto familiar. Seguindo o percurso dos referenciais adotados, foram originadas as seguintes categorias secund?rias: ?Percebendo a participa??o do companheiro durante o pr?-natal?, ?Expressando sentimentos durante o pr?-natal? e ?Revelando atitudes durante o pr?-natal?. Estas, quando tiveram suas propriedades e dimens?es analisadas, suscitaram na categoria central ?Experienciando a aus?ncia do companheiro nas consultas de pr?-natal?. A constru??o dessa teoria leva a considerar que as gestantes entendem a aus?ncia do companheiro, atribuindo esse fato ao mesmo trabalhar nos hor?rios dos atendimentos de pr?-natal ou a n?o gostar de frequentar institui??es de sa?de. Entretanto, isto n?o significa dizer que a sua presen?a do mesmo esteja descartada, pois o desejo de t?-lo nas consultas de pr?-natal foi mencionado pela grande maioria das entrevistadas. Assim sendo, ter o companheiro ausente nesse momento leva as mulheres a experienciar anseios, sentimentos, atitudes, percep??es e expectativas frente ao fen?meno estudado. Diante dessa realidade, pode-se concluir que a aus?ncia do companheiro nas consultas de pr?-natal predisp?e as gestantes ao fortalecimento dos desconfortos advindos da gravidez e, consequentemente, vai de encontro ao bem-estar das gr?vidas, al?m de velar a possibilidade de desajuste conjugal. Essa situa??o requer dos profissionais de enfermagem medidas que viabilizem a inclus?o do parceiro no cotidiano do atendimento pr?-natal, na perspectiva da humaniza??o da assist?ncia

Made available in DSpace on 2014-12-17T14:46:44Z (GMT). No. of bitstreams: 1 DanieleVD_DISSERT.pdf: 1474768 bytes, checksum: 2c3fc77468bc489daec37da03412db3e (MD5) Previous issue date: 2010-09-03 / Universidade Federal do Rio Grande do Norte / Venous ulcers (VU), recurrent chronic wounds resulting from Chronic Venous Insufficiency (CVI), affect different age groups and would severely affect ambulation of patients. The lesions require treatment lasting and complex and are responsible for significant morbidity and mortality. Thus, this study aims to identify the important aspects covered in the scientific literature protocol for assisting patients with venous ulcers, identifying the issues to be proposed by the judges of the study (nurses, doctors and physiotherapists) to the protocol of care provided to patients venous ulcers and present the structure of protocol proposed by the judges of the study to assist patients with venous ulcers treated at a referral hospital of Rio Grande do Norte. This is a descriptive study using a quantitative approach, carried out at the dressings, located in the outpatient surgical clinic of the Hospital University Onofre Lopes (HUOL), located in East Sanitary District, Natal-RN. The sample consisted of 39 professionals, 30 nurses, seven doctors and two physical therapists, team members HUOL surgical clinic and other public and private institutions of Rio Grande do Norte and Jequi?/Bahia. These professionals were the judges responsible for selecting the guidelines already proposed in the literature on VU protocols. Approved by the Ethics in Research HUOL (Report n.o 081/07), began the first stage of the study which consisted of reviewing the scientific literature about the relevant aspects to be included in a protocol for assisting patients with VU. These aspects were organized into a proposed questionnaire to the judges of the study. Following examination, held on the content validation with application of the Kappa (K), accepting a score higher than 0.80 and the Likert Scale, whereas rates from 4.0 to 5.0. The data collected were organized in Microsoft Excel and exported into Statistical Package for Social Sciences (SPSS) 15.0. The literature review included national and international scientific articles, thesis, dissertation and institutional protocols. Regarding the characterization of professional nurses predominated (76.1%), between 34 and 45 years (41.0%), female (79.5%), married/consensual union (46.2%), with specialization in VU care (61.5%), working in the hospital network (46.1%), with up to 5 years experience in VU (69.2%) and claiming to feel prepared to care for these injuries (92.3 %). With regard to aspects that had very good agreement (K &#8805; 0.81), remained the items found in the literature with some modifications. In the analysis of the proposed evaluation items had very important, ranging from 4.1 (drug treatment) to 4.9 (patient assessment and care of the injury and the injured and perilesional skin). The proposition of the protocol is arranged in eleven items: A) Evaluation of patient and lesion, B) Registration and documentation, C) the wound and perilesional skin, D) an indication of coverage, E) Use of antibiotic and pain treatment, F) Surgical treatment of CVI, G) Drug treatment, H) Improving venous return and prevetion of recurrence, I) Referral of patients, J) Training and K) Reference and counter reference / As ?lceras venosas (UV), feridas cr?nicas recidivantes que resultam da Insufici?ncia Venosa Cr?nica (IVC), acometem diferentes faixas et?rias e repercutem de forma severa na deambula??o dos portadores. As les?es requerem tratamento duradouro e complexo e s?o respons?veis por morbi-mortalidade significativas. Diante disso, este estudo tem como objetivos identificar os aspectos relevantes da literatura cient?fica contemplados em protocolo para assist?ncia aos portadores de ?lceras venosas; identificar os aspectos a serem propostos pelos ju?zes do estudo (enfermeiros, m?dicos e fisioterapeutas) para o protocolo de assist?ncia aos portadores de ?lceras venosas e apresentar a estrutura de protocolo proposta pelos ju?zes do estudo para assist?ncia aos portadores de ?lceras venosas atendidos em um hospital de refer?ncia do Rio Grande do Norte. Trata-se de um estudo descritivo, com abordagem quantitativa, realizado no setor de curativos, situado no ambulat?rio de cl?nica cir?rgica do Hospital Universit?rio Onofre Lopes (HUOL), localizado no Distrito Sanit?rio Leste, em Natal-RN. A amostra foi composta por 39 profissionais, sendo 30 enfermeiros, 7 m?dicos e 2 fisioterapeutas, integrantes da equipe de cl?nica cir?rgica do HUOL e de outras institui??es p?blicas e privadas do Rio Grande do Norte e de Jequi?/Bahia. Esses profissionais foram os ju?zes respons?veis por selecionar as diretrizes j? propostas na literatura sobre protocolos de UV. Aprovado pelo Comit? de ?tica em Pesquisa do HUOL (Parecer n.o 081/07), iniciou-se a primeira etapa do estudo que consistiu na realiza??o de revis?o de literatura cient?fica acerca dos aspectos relevantes a serem contemplados em um protocolo para assist?ncia aos portadores de UV. Esses aspectos foram organizados em um question?rio proposto aos ju?zes do estudo. Ap?s aprecia??o, realizou-se a valida??o de conte?do com aplica??o do ?ndice Kappa (K), aceitando-se escore superior a 0,80 e da Escala de Likert, considerando ?ndices de 4,0 a 5,0. Os dados coletados foram organizados no Microsoft Excel e exportados para Statistical Package for Social Science (SPSS) 15.0. O levantamento da literatura contemplou artigos cient?ficos nacionais e internacionais, tese, disserta??es e protocolos institucionais. Quanto a caracteriza??o dos profissionais predominaram enfermeiros (76,1%), entre 34 e 45 anos (41,0%), sexo feminino (79,5%), casados/uni?o consensual (46,2%), com especializa??o na ?rea de cuidado a UV (61,5%), atuando na rede hospitalar (46,1%), com at? 5 anos de experi?ncia em UV (69,2%) e alegando sentir-se preparado para cuidar dessas les?es (92,3%). No que diz respeito aos aspectos que obtiveram concord?ncia ?tima (K &#8805; 0,81), permaneceram os itens encontrados na literatura com algumas modifica??es. Na an?lise dos aspectos propostos, os itens obtiveram avalia??o muito importante, variando de 4,1 (tratamento medicamentoso) a 4,9 (avalia??o do paciente e da les?o e cuidado com a ferida e a pele perilesional). A proposi??o do protocolo est? disposta em onze itens: A) Avalia??o do paciente e da les?o, B) Registro e documenta??o, C) Cuidado com a ferida e a pele perilesional, D) Indica??o de cobertura, E) Uso de antibi?tico e tratamento da dor, F) Tratamento cir?rgico da IVC, G) Tratamento medicamentoso, H) Melhoria do retorno venoso e preven??o de recidiva, I) Encaminhamento dos pacientes, J) Capacita??o profissional e K) Refer?ncia e contra-refer?ncia