People with diabetes are at a greater risk of burn injuries than those without diabetes. This stems from the epidemiological profiles of the conditions and the effects of morbidities associated with diabetes. Both conditions share some similarities in terms of metabolic alterations and suboptimal immune functions which may result in poor outcomes for patients. For that reason, it is reasonable to deduce that patients with diabetes are a challenging group to manage in burns units. However, this deduction should be taken cautiously because of lack of supporting evidence. Accordingly and after consulting with clinical experts, the research in this portfolio investigated the association between diabetes and burn injuries. In particular, two different aspects of this association were investigated in two individual quantitative and descriptive inquiries. The first was a case note review of patients hospitalised with a principal diagnosis of a foot burn injury in a large tertiary hospital in South Australia from 1999 to 2004. The second study investigated management of diabetes in burns units treating adults. This study is an e-mail survey of clinical leaders of burns units in Australia, New Zealand, Hong Kong and the United Kingdom. The clinical leaders were approached indirectly through key liaison persons in each identified unit. In the first study, outcomes for twelve subjects with and fifty-two without diabetes were described using descriptive and non-parametric statistics. In the second study, descriptive frequencies and content analysis were adopted to analyse twenty-nine responses from seventeen out of thirty burns units which participated in the study. Supporting findings in the literature, the first study showed that burn injuries among subjects with diabetes were mainly resulted from household devices. There were no statistically significant differences between subjects with and without diabetes in terms of size and depth of burn injuries and treatment received. In spite of this, there was a statistically significant association between diabetes and the experience of local post-burn complications and longer duration of hospitalisation. The second study indicated that more than twenty-five percent of the respondents believed that multidisciplinary centres should only occasionally be involved in the process of care. Participants reported that the individual profile of each patient plays a major role in determining the management of diabetes. Additionally, it was found that the insulin sliding scale was commonly used in the management of diabetes in burns units. The association between diabetes and a burn injury is a serious issue in terms of health and cost. This association need be addressed firstly and most importantly at the prevention level; secondly through proper management of both diabetes and burns. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1285462 / Thesis (D.Nurs.)--Population Health and Clinical Practice, 2007.

Doctor of Philosophy / ABSTRACT The notion of theatricality has, in recent years, emerged as a key term in the fields of Theatre and Performance Studies. Unlike most writings dealing with theatricality, this thesis presents theatricality as a rubric for a particular discourse. Beginning with a case-study of a theatre review, I read an anti-theatricalist bias in the writer’s genre distinctions of “theatre” and “performance”. I do not, however, test the truth of these claims; rather, by deploying Foucauldian discourse analysis, I interpret the review as a “statement” and analyse how the reviewer activates notions of “theatricality” and “performance” as objects created by an already existing discourse. Following this introduction, the body of thesis is divided into two parts. The first, “Mapping the Discursive Field”, begins by surveying a body of literature in which a struggle for interpretive dominance between contesting stakeholders in the fields of Theatre and Performance Studies is fought. Using Samuel Weber’s reframing of Derrida’s analysis of interpretation of interpretation, in Chapter 2, I argue that the discourse of the field is marked by the struggle between “nostalgic” and “affirmative” interpretation, and that in the discourse that emerges, certain inconsistencies arise. The disciplines of Theatre, and later, Performance Studies in the twentieth century are characterised, as Alan Woods (1989) notes, by a fetishisation of avant-gardist practices. It is not surprising, therefore, that the values and concerns of the avant-garde emerge in the discourse of Theatre and Performance Studies. In Chapter 3, I analyse how key avant-gardist themes—theatricality as “essence”, loss of faith in language and a valorisation of corporeality, theatricality as personally and politically emancipatory—are themselves imbricated in the wider discourse of modernism. In Chapter 4, I discuss the single English-language book, published to date, which critically engages with theatricality as a concept: Elizabeth Burns’s Theatricality: A Study of Convention in the Theatre and Social Life (1972). As I have demonstrated with my analysis of the discursive field and genealogy of avant-gardist thematics, I argue that implicit theories of theatricality inform contemporary discourses; theories that, in fact, deny this genealogy. Approaching her topic through the two instruments of sociology and theatre history, Burns explores how social and theatrical conventions of behaviour, and the interpretations of that behaviour, interact. Burns’s key insight is that theatricality is a spectator operation: it depends upon a spectator, who is both culturally competent to interpret and who chooses to do so, thereby deciding (or not) that something in the world is like something in the theatre. Part Two, “The Heritage of Theatricality”, delves further, chronologically, into the genealogy of the term. This part explores Burns’s association of theatricality with an idea of theatre by paraphrasing a question asked by Joseph Roach (after Foucault): what did people in the sixteenth century mean by “theatre” if it did not exist as we define today? This question threads through Chapters 5 to 7 which each explore various interpretations of theatricality not necessarily related to the art form understood by us as theatre. I begin by examining the genealogy of the theatrical metaphor, a key trope of the Renaissance, and one that has been consistently invoked in a range of circumstances ever since. In Chapter 5 explore the structural and thematic elements of the theatrical metaphor, including its foundations, primarily, in Stoic and Satiric philosophies, and this provides the ground for the final two chapters. In Chapter 6 I examine certain aspects of Renaissance theories of the self and how these, then, related to public magnificence—the spectacular stagings of royal and civic power that reached new heights during the Renaissance. Finally, in Chapter 7, I show how the paradigm shift from a medieval sense of being to a modern sense of being, captured through the metaphor of a world view, manifested in a theatricalised epistemology that emphasised a relationship between knowing and seeing. The human spectator thus came to occupy the dual positions of being on the stage of the world and, through his or her spectatorship, making the world a stage.

Burn injuries represent a major cause of mortality and morbidity as well as a significant drain on limited resources, particularly in the developing world. Advances in resuscitation, critical care, protective ventilatory strategies, earlier complete debridement complemented by more aggressive treatment of burn wound sepsis have reduced the mortality of thermal injuries. There has also been a move to focus on education and prevention campaigns, which have borne fruit and resulted in some reduction in the incidence of burns in the paediatric population. Burn care, once a Cinderella specialty, has become a well focused multi-disciplinary specialty in its own right. Burn injury is dissimilar to many forms of trauma. In major burns, the initial trauma may be limited to the skin alone or skin and lungs, but all organ systems are rapidly involved as the physiological derangement becomes systemic. The burden of this multi-system insult is substantial. Globally, the World Health Organisation estimated that fire-associated burns alone directly resulted in over 320,000 deaths in 2002, and in the USA, approximately 1million children sustain burns each year. Australasian guidelines suggest that all adult burns with greater than 15% total body surface area (TBSA) and >10% TBSA burn in children will require fluid resuscitation and possibly critical care support at some point in their hospitalisation. Mortality in these patients with severe burns follows a bimodal pattern of early and late deaths. Causes of early death comprise refractory shock, inability to obtain a safe airway or provide adequate oxygenation, co-existent trauma, non-survivable carboxyhaemoglobin poisoning, and decisions that injuries are non-compatible with recovery, leading to therapy withdrawal. With improved resuscitation strategies, 95% of patients survive the early resuscitation phase. Late deaths are secondary to sepsis normally associated with wound infection and multiple organ failure. The morbidity associated with burn injury continues well after the acute hospital admission, frequently for up to several years post burn injury, as is witnessed by prolonged rise in basal metabolic rate and worsening scar tissue1, 2. It has been calculated that in children approximately 60% of the cost of burn care occurs post wound closure; that is, dealing with the disabling and disfiguring contractures associated with hypertrophic scar3, 4. Hence, research and new modalities are being aimed at reducing cost of treatment and improving quality of life for survivors of burn injury. Thus, this PhD aims to reflect the multidisciplinary nature of modern day burn care, with the inclusion of seven published papers and one book chapter covering prevention and education relevant to paediatric burns, treatment and minimisation of wound infection , and scar minimisation, along with the first study into the relevance of fetal wound healing post burn injury.

Thesis (M.A.)--Texas State University--San Marcos, 2009. / Vita. Includes bibliographical references (leaves 142-147). Also available on microfilm.

Thesis (D. Min.)--Trinity Evangelical Divinity School, 1995. / Abstract. Includes a copy of The Fruitbearers' manual. Includes bibliographical references (leaves 227-234).

Diss. (sammanfattning) Linköping : Linköpings universitet, 2009.

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Orientador: Marcos Ferreira Minicucci / Coorientador: Sandro José Conte / Banca: Marina Politi Okoshi / Banca: Daniela de Rezende Duarte Maksymczuk / Resumo: Introdução: Alguns estudos mostraram que o processo inflamatório está relacionado à gravidade da queimadura. Nesse contexto, a utilização de estratégias para modular essa hiper-resposta inflamatória é bastante atrativa. Nos últimos anos, a vitamina D tem se destacado por sua ação anti-inflamatória e pela modulação da resposta imunológica. Parte das ações da vitamina D é mediada pelo receptor nuclear da vitamina D (VDR). Estudos recentes mostram que polimorfismos do gene do receptor VDR pode influenciar a resposta à vitamina D. Objetivos: O objetivo deste estudo é avaliar a associação dos polimorfismos Taql e Bsml do gene VDR com o tempo de internação, o surgimento de infecção e a mortalidade em pacientes queimados. Casuística e métodos: Foram incluídos prospectivamente os pacientes queimados, com idade ≥ 18 anos, que internaram na enfermaria e na Unidade de Terapia Intensiva do Setor de Tratamento de Queimados do Hospital Estadual Bauru. Os pacientes foram incluídos no período de janeiro de 2013 a janeiro de 2014. Na admissão dos pacientes foram registrados dados demográficos e clínicos foram registrados. Amostras sanguíneas foram coletadas na admissão dos pacientes para dosagem bioquímica, de 25 (OH) vitamina D e determinação dos polimorfismos Taql e Bsml do gene VDR. Os pacientes foram acompanhados durante toda a internação e o surgimento de infecção, o tempo de internação e a mortalidade foram registrados. Para avaliar a associação dos polimorfismos com o tempo de internação utilizamos a análise de regressão linear simples e múltipla. Para avaliar a associação dos polimorfismos com o surgimento de infecção e mortalidade utilizamos a análise de regressão logística. O nível de significância adotado foi de 5%. Resultados: Foram avaliados 87 pacientes, mas em 7 deles, devido problemas técnicos, não foram avaliados os polimorfismos do receptor da vitamina D, Taql e Bsml, por isso... / Abstract: Introduction: Some studies showed that the inflammatory process was related with severe burn injury. Thus, strategies for modulation of inflammatory response are of great interest. In the last years, vitamin D received attention due to its anti-inflammatory and immunomodulatory actions. Most of the actions of vitamin D are through its nuclear receptor (VDR). Recent studies showed that VDR gene polymorphisms could influence vitamin D response. Objective: The objective of this study is to evaluate the association of Taql and Bsml polymorphisms of VDR gene with length of hospital stay, infection development and mortality in burn patients. Methods: We prospectively evaluated burn patients, over the age of 18 years, admitted to the Burn Unit of Hospital Estadual Bauru. The patients were included from January 2013 to January 2014, after signing the written informed consent. Upon admission demographical and clinical data were recorded. Blood sample was collected for biochemical analysis, measure of serum 25(OH) vitamin D3 concentration, and Taql and Bsml polymorphisms determination. The patients were followed during hospital admission, and length of hospital stay, infection development and mortality were recorded. For association between length of hospital stay and VDR polymorphisms we used uni and multivariate linear regressions. For association between polymorphisms and infection development and mortality, uni and multiple logistic regressions were performed. Significance level was 5%. Results: We evaluated 87 patients, however 7 were excluded due to technical problems with VDR polymorphism evaluation. Thus, 80 patients were studied. Considering these patients 60% were male, and average age was 42.5 ± 16.1 years. Regarding the cause of burn 47.5% were caused by fire, 33,7% due to hot liquids, 15% caused by electricity and 3.8% due to other causes. The median of burn surface area was 8.0 (3.0-18.8)% and 47.5% were treated in intensive care ... / Mestre

Submitted by Diogo Misoguti (diogo.misoguti@gmail.com) on 2016-06-24T12:07:53Z No. of bitstreams: 1 2015-05-doutorado-monica-sarto-piccolo.pdf: 14505712 bytes, checksum: 800df59e1ec7b1a2c46cc224d6b64497 (MD5) / Approved for entry into archive by Diogo Misoguti (diogo.misoguti@gmail.com) on 2016-06-24T12:08:35Z (GMT) No. of bitstreams: 1 2015-05-doutorado-monica-sarto-piccolo.pdf: 14505712 bytes, checksum: 800df59e1ec7b1a2c46cc224d6b64497 (MD5) / Made available in DSpace on 2016-06-24T12:08:35Z (GMT). No. of bitstreams: 1 2015-05-doutorado-monica-sarto-piccolo.pdf: 14505712 bytes, checksum: 800df59e1ec7b1a2c46cc224d6b64497 (MD5) Previous issue date: 2015 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / INTRODUÇÃO: O aumento da taxa de sobrevida dos pacientes com queimaduras, nas últimas décadas, promoveu o aumento da atenção em sua fase de reabilitação e na avaliação da qualidade de vida. Verificou-se que o Burn Specific Health Scale-Brief (BSHS-B) é o instrumento específico mais utilizado mundialmente para esse fim. OBJETIVOS: Traduzir o BSHSB para a língua portuguesa adaptá-lo culturalmente no Brasil e testar suas propriedades psicométricas. . MÉTODOS: O questionário foi traduzido para a língua portuguesa do Brasil, adaptado culturalmente pela metodologia de GUILLEMIN, BOMBARDIER, BEATON (1993) e testado em relação à reprodutibilidade, validade de face, de conteúdo e de construto. A versão traduzida foi aplicada em 92 pacientes com sequela de queimaduras. A consistência interna foi testada pelo alfa de Cronbach. A validação de construto foi realizada correlacionando o instrumento traduzido com os questionários BSHS-R, BurnSexQ-EPM/UNIFESP, Escala de Autoestima de Rosenberg (EAR) e Inventário de Depressão de Beck (IDB), todos já traduzidos para a língua portuguesa do Brasil. RESULTADOS: Na fase de reprodutibilidade o valor geral do alfa de Cronbach foi de 0,85. A correlação linear de Person foi significativa nos três momentos das entrevistas. Na validação de construto observou-se correlação significativa entre os domínios do BSHS-B com os domínios do BSHS-R, com a EAR e com o IDB. Em relação ao BurnSexQ-EPM/UNIFESP a correlação foi significativa entre o domínio conforto social e imagem corporal do BSHSB. CONCLUSÃO: O Burn Specific Health Scale-Brief (BSHS-B) foi traduzido para a língua portuguesa, do Brasil, foi adaptado culturalmente e validado. E passou a ser chamado BSHS-B-Br. / Introduction: Progressive increases in burn trauma survival rates have shifted attention to patient rehabilitation and post trauma quality of life. The assessment of quality of life is strongly dependent on reliable instruments for its measurement. A literature review has revealed that the Burn Specific Health Scale-Brief (BSHS-B) is the instrument most commonly used worldwide. Objectives: We set out to translate the BSHS-B into the Portuguese language, adapting it culturally to the Brazilian population, and testing its psychometric properties. Methods: The questionnaire was translated into Portuguese, culturally adapted and tested for reproducibility, face, content and construct validity. The translated version was tested on 92 burn injury patients. Results: Internal consistency was tested by means of Cronbach´s alpha (0,85). Pearson correlation coefficients were significant at three time points of the reliability analysis. Construct validity was performed correlating the BSHS-B questionnaire with the Burn Specific Health Scale-Revised (BSHS-R), BurnSexQEPM/UNIFESP, and with the Rosenberg Self-Esteem Scale and Beck´s Depression Inventory. A significant correlation was observed between BSHS-B domains and BSHS-R, Rosenberg and Beck domains. A significant correlation was also observed between BSHS-B and the BurnSexQ-EPM/UNIFESP social comfort and body image domains. Conclusion: BSHS-B questionnaire was translated into Portuguese; it is a reliable tool, also in this language, showing face, content and construct validity. The instrument has been named BSHS-B-Br.

A tese desenvolvida neste estudo é que a depressão respiratória em pacientes queimados que utilizam opiódes como terapeutica farmacológica da dor, pode ser prevenida por meio de ações de enfermagem que identifiquem os fatores predisponentes para a depressão respiratória, que considerem na rotina de aprazamento da terapeutica farmacológica da dor, as características farmacológicas dos medicamentos, para evitar interações medicamentosas e que monitorem adequadamente o paciente queimado para identificar precocemente sinais de depressão respiratória. Para tanto, este estudo teve como objetivo desenvolver barreiras de segurança com foco em ações de enfermagem, para prevenção de depressão respiratória em pacientes queimados em uso de opióides. Trata-se de um estudo restrospectivo, em que foram analisados 272 prontuários de pacientes queimados internados em um Centro de Tratamento de Queimados (CTQ), de um hospital público federal de grande porte, no município do Rio de Janeiro. nos anos de 2011 a 2013. Dentre os 272 prontuários 42 atenderam os critérios de seleção da pesquisa, e destes, em 28,58% (n=12) foi identificada a ocorrência de depressão respiratória. Predominaram pacientes adultos jovens do sexo masculino. O óbito predominou no grupo com DR, assim como, queimaduras de 2 e 3 graus, e superfície corporal queimada com mediana de 50%. Os fatores predominantes para depressão respiratória foram insuficiencia renal, hipoalbuminemia e hipertensão arterial. Na terapia medicamentosa dos pacientes queimados, os analgésicos opióides são os mais utilizados, predominando o tramadol (45,49%) e a metadona (18,45%). Diazepam é o benzodiazepínico de escolha, entre os antidepressivos a imipramina é o mais utilizado, apesar de classificada como anticonvulsivantes a gabapentina, nos queimados é utilizada em dose analgésica. Tanto no grupo de pacientes com ou sem DR, os horários de adiministração de medicamentos que predominaram foram 22h e 06h. Foi evidenciado PIM em 66,6% dos pacientes estudados. A associação entre a ocorrência de PIM e a DR demonstrou-se positiva; os pacientes com que apresentaram PIM têm 2,5 vezes mais risco de apresentar DR. Os pares de medicamentos prevalentes e que apresentaram PIM no grupo com DR foram, metadona com diazepam (n=5), tramadol com fentanil (4), metadona com impramina e metadona com tramadol (n=3). No grupo sem DR foram metadona e tramadol (n=8), tramadol com fentanil (4), e metadona com diazepam (3). As vias oral e intravenosa predominaram nos pacientes com e sem DR, e não houve associação positiva entre a administração por essas vias e a oorrência de DR, constatando-se que a via de administração não é tão relevante para a DR. Nos pacientes com DR, 83,3% apresentaram PIM, principalmente nos horários 22h e 06h, horários próximos aos de ocorrência de DR. Espera-se que este estudo contribua para a segurança medicamentosa no uso de opióides, e na prevenção do eventos adverso grave como a depressão respiratória em pacientes queimados. / The thesis developed in this study considers that the respiratory depression (RD) in burned patients using opioids as pharmacological therapeutic for pain can be prevented through nursing actions that identify its predisposing factors; also, nurses should consider the pharmacological characteristics of drugs during the routine schedule to apply pharmacological therapeutic for pain, aiming to prevent drug interactions; and adequately they should monitor the burned patient to identify early signs of respiratory depression. Therefore, this study had as general objective to develop safety barriers with a focus on nursing actions to prevent respiratory depression in burned patients in use of opioids; those barriers were related to the pharmacology of opioids, to the predisposing factors for respiratory depression by opioid, and to the monitoring of respiratory depression. This is a retrospective study that analyzed 272 medical records of burned patients admitted into a Burn Treatment Center (BTC) of large federal public hospital in the city of Rio de Janeiro, Brazil, from 2011 to 2013. Among those records, 42 records met the selection criteria of this research; and the occurrence of respiratory depression was identified in 28.58% (n=12) of them. Young adult male patients were prevalent. The death predominated in the group with RD, as well as, in the group with burns of 2nd and 3rd degrees and about 50% burned body surface. The prevalent factors for respiratory depression were renal failure, hypoalbuminemia, and high blood pressure. In drug therapy of burn patients, opioid analgesics are the most used, predominantly tramadol (45.49%) and methadone (18.45%). Diazepam is the chosen benzodiazepine; and among antidepressants, imipramine is the most used, although gabapentin is classified as anticonvulsant; in burned patients, it is used in analgesic dose. Either in patients with or without RD, the prevalent drugs administration schedule was made at 10:00 p.m. and 6:00 a.m. Potential Drug Interaction (PDI) was evidenced in 66.6% of studied patients. Correlation between the PDI occurrence and the RD proved to be positive; patients who presented PDI have 2.5 times higher risk for developing RD. The pairs of prevalent drugs and that presented PDI in the group with RD were methadone with diazepam (n=5), tramadol with fentanyl (4), methadone with imipramine, and methadone with tramadol (n=3). In group without DR, the prevalent drugs were methadone and tramadol (n=8), tramadol with fentanyl (4), and methadone with diazepam (3). The oral and intravenous drugs administration was prevalent in patients with and without RD, and no positive correlation between the administration by these forms and the occurrence of RD was found, evidencing up that the administration form is not so important to the RD. In patients with RD, 83.3% had PDI, mainly in the schedules of 10:00 p.m. and 6:00 a.m., close to the occurrence times of RD. It is expected that this study can contribute to safe drug administration when using opioids, and in the prevention of serious adverse events like respiratory depression in burned patients.