Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2018-03-05T18:58:44Z No. of bitstreams: 1 Rachael Miranda dos Santos.pdf: 5659646 bytes, checksum: e846222a2924541f727ebc4447340212 (MD5) / Made available in DSpace on 2018-03-05T18:58:44Z (GMT). No. of bitstreams: 1 Rachael Miranda dos Santos.pdf: 5659646 bytes, checksum: e846222a2924541f727ebc4447340212 (MD5) Previous issue date: 2017 / Mestrado Profissional em Enfermagem Assistencial / As doenças inflamatórias intestinais (DII), apresentam uma crescente incidência mundial, são crônicas, progressivas, podendo se tornar graves. Esse estudo objetivou: Avaliar a efetividade do telecuidado dos pacientes portadores de Doenças Inflamatórias Intestinais, comparado ao tratamento ambulatorial convencional; Realizar telecuidado a um grupo de pacientes a partir do Índice Simples de Harvey-Bradshaw para Doença de Crohn (DC), e do Índice Clínico Simples de Atividade da Colite para Retocolite ulcerativa (RCU), acompanhando a flutuação de score, assim como; Avaliar a incidência de complicações relacionadas a DII, no grupo telecuidado pelo enfermeiro e no grupo controle dos pacientes atendidos no Ambulatório de Doenças Inflamatórias Intestinais da Policlínica Piquet Carneiro. Método: Ensaio clínico controlado e randomizado com tempo de seguimento de 24 semanas. A amostra foi de 176 voluntários. A coleta de dados ocorreu de abril a outubro de 2016. O desfecho primário do estudo foi a redução do índice de atividades da DII dos pacientes telecuidados e os desfechos secundários foram a redução de complicações relacionadas a doença. A pesquisa foi submetida, aprovada e registrada no Comitê de Ética em Pesquisa do Hospital Universitário Pedro Ernesto parecer 1.598990, e pelo Registro Brasileiro de Ensaios Clínicos com registro RBR-7t8fv7. Resultados: Os grupos foram homogêneos quanto às características sociodemográficas e clínicas. A população é tipicamente de mulheres (61,4%), brancas (47,26%), com idade média 44,7 anos. Quanto ao diagnóstico (54,5%) DC e (45,5%) RCU. As principais comorbidades foram hipertensão arterial sistêmica (36,4%) e diabetes mellitus (10,3%). E quanto à evolução ao longo de 24 semanas de tratamento, o grupo telecuidado apresentou maiores taxas de remissão da doença (97,7%), e menor escore de atividade da doença (1,7). Assim como maior adesão as condutas orientadas pela equipe multiprofissional do que o grupo controle. Os experimentados com baixo peso, tiveram sua classificação aproximada a faixa de normalidade. Conclusão: o telecuidado apresentou maior efetividade que o tratamento convencional no controle de atividade das DII / The inflammatory bowel diseases (IBD), a growing global impact, are progressive, chronic and may become severe. This study aimed to: Assess the effectiveness of the telenursing of patients with inflammatory bowel diseases, compared to the conventional outpatient treatment; Perform telenursing to a group of patients from the Simple Index of Harvey-Bradshaw to Crohn's disease (ad), and Simple Clinical index of activity of colitis for ulcerative rectocolitis (RCU), following the score, as well as fluctuation; To evaluate the incidence of complications related to IBD in the telecuidado group by the nurse and in the control group of patients seen in inflammatory bowel disease clinic of Piquet Carneiro Polyclinic. Method: randomized controlled trial with follow-up time of 24 weeks. The sample was of 176 volunteers. Data collection occurred from April to October 2016. The primary outcome of the study was the reduction in the index of activities of the IBD of telecare patients and the secondary outcomes were the reduction of complications related to the disease. The research was submitted, approved and registered in the Committee of Ethics in Research of the Hospital Universitário Pedro Ernesto opinion 1.598990, and by the Brazilian Registry of Clinical Trials with registry RBR-7t8fv7. Results: The groups were homogeneous regarding sociodemographic and clinical characteristics. The population is typically female (61.4%), white (47.26%), with a mean age of 44.7 years. Regarding the diagnosis (54.5%), DC and (45.5%) RCU. The main comorbidities were systemic arterial hypertension (36.4%) and diabetes mellitus (10.3%). Regarding the evolution over 24 weeks of treatment, the telecution group presented higher rates of disease remission (97.7%), and lower disease activity score (1.7). As well as greater adhesion the conducts guided by the multiprofessional team than the control group. Those with low weight, had their classification close to the normal range. Conclusion: telenursing was more effective than conventional treatment in the control of IBD activity

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-09-04T15:18:51Z No. of bitstreams: 0 / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-09-04T15:53:06Z (GMT) No. of bitstreams: 0 / Made available in DSpace on 2018-09-04T15:53:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-07-31 / A colite ulcerativa (CU) é uma doença inflamatória crônica cujas manifestações podem afetar drasticamente a qualidade de vida do indivíduo sendo por isso importante a adesão ao tratamento a fim de mantê-la em fase de remissão. Fatores individuais podem interferir na continuidade do tratamento do paciente em remissão. Assim, o objetivo deste estudo foi avaliar a prevalência de não adesão e a possível influência das características sóciodemográficas, clínicas e farmacoterapêuticas associadas com a não adesão ao tratamento da CU em remissão. Trata-se de estudo transversal com adultos portadores de CU em remissão acompanhados no Centro de Doenças Inflamatórias Intestinais do Hospital Universitário da Universidade Federal de Juiz de Fora, Minas Gerais, conduzido entre agosto de 2017 e janeiro de 2018. Os fatores associados à não adesão ao tratamento foram investigados por meio da aplicação de questionário padronizado contendo dados sociodemográficas, clínicos e farmacoterapêuticos dos pacientes, além da Escala de Adesão Terapêutica de Morisky (MMAS-8), Inventario de Depressão de Beck (IDB) e Subescala de Ansiedade de sete itens da Escala Hopitalar de Ansiedade e Depressão. O total de 90 pacientes foi incluído neste estudo com média de idade de 50,4±12,9. A prevalência de não adesão foi de 77,8% e não foram encontradas dentre as 21 variáveis analisadas, nenhuma relacionada com o comportamento de não adesão. A prevalência de não adesão em pacientes com CU em remissão foi elevada. Nenhuma das características sociodemográficos, clínicas e farmacoterapêuticas analisadas foram associadas com este comportamento, alertando para a necessidade de maior atenção dos profissionais de saúde a esse importante aspecto do tratamento. / Ulcerative colitis (UC) is a chronic inflammatory disease whose manifestations can drastically affect the quality of life of patients. Therefore, treatment adherence is important in order to keep it in remission. Individual factors may interfere with the continuity of the patient's treatment in remission. To verify the prevalence of non-adherence and the influence of the sociodemographic, clinical and pharmacotherapeutic characteristics associated with non-adherence to the treatment of UC in remission. A cross-sectional study was conducted with adults presenting UC in remission followed at the Clinical Gastroenterology outpatient clinic of the Clinical Gastroenterology Ambulatory of Universitary Hospital, in Juiz de Fora, Minas Gerais, Brazil, between August 2017 and January 2018. Factors of risk for non-adherence to treatment were investigated by applying a questionnaire on sociodemographic, clinical and pharmacotherapeutic characteristics of the patient. The Morisky Therapeutic Adhesion Scale (MMAS-8), Beck Depression Inventory (BDI) and Subscale of Anxiety of seven items of the Hopitalar Anxiety and Depression Scale were also applied. A total of 90 patients were included, with a mean age of 50.41±12.94 years. The prevalence of non-adherence to therapy was 77.8% and we did not identified among 21 variables analyzed anyone associated with non-adherence prevalence. High proportions of patients with UC in remission presented non-adherents to therapy; however, we did not found characteristics among sociodemographic, clinical and pharmacotherapeutic data that would be able to explain this behavior, alerting the need for greater attention of health professionals to this important aspect of treatment.

<p>UVOD: Hronične inflamatorne bolesti se ispoljavaju kao Kronova bolest i ulcerozni kolitis. Njihova značajnost ogleda se u hronicitetu kao i u stepenu u kom ograničavaju rast i razvoj dece i omladine. Brojne su posledice ovih oboljenja: dugotrajno izostajanje sa nastave, ograničavanje životnih aktivnosti i pojava komplikacija koje neretko zahvataju i druge organske sisteme. Etiologija je i dalje nerazja&scaron;njenja navodeći kao značajan hronični inflamatorni proces u genetski uslovljenih pojedinaca a provociranih nekim infektivnim agensom. Početkom 21. veka genetska istraživanja su otkrila osnovu nasleđivanja hroničnih inflamatornih oboljenja povezanih sa NOD2 genom. Kako je u pitanju organskim sistem koji je ograničeno pristupačan kliničkom pregledu, osnovu dijagnostike čine radiolo&scaron;ke metode. Kako je potrebno sprečiti kontinuirano izlaganje &scaron;tetnom dejstvu rendgenskog zračenja istraživanja se usmeravaju ka UZ i magnetnoj rezonanca. Na&scaron;e istraživanje se baziralo na mogućnostima ovih dveju metoda u svakodnevnom radu za dijagnostiku i dalje praćenje hroničnih inflamatornih bolesti creva. CILJEVI: Utvrditi senzitivnost i specifičnost ultrazvučne dijagnostike i magnetne resonance kod upalnih oboljenja creva u dečjem i adolescentnom uzrastu. Definisati i uporediti prednosti i ograničenja ultrazvučne dijagnostike sa dijagnostikom magnetne rezonace kod upalnih obolenja creva u dečjem i adolescentnom uzrastu. MATERIJAL I METODE: U istraživanje je uključeno 62. dece i adolescenata u toku prvog ataka bolesti ili ponovljenim fazama bolesti ili tokom redovnog praćenja u remisiji. Obuhvaćeni uzrast je od 4. do 18. godina. Potom su razvrstani u grupe na osnovu vrste pregleda i prisustva zadebljanja crevnog zida na A i B (pregled UZ), gde je A grupa imala zabeleženo zadebljanje crevnog zida preko 3 mm, a kod dece u grupi B debljina crevnog zida je bila između 2,5-3 mm. Sa druge strane na osnovu pregleda magnetnom rezonancom podeljeni su u A1 i B1 grupe, takođe po kriterijumu zadebljanja crevnog zida većeg od 3 mm (A1), odnosno između 2,5-3 mm (B1). Istraživanje je sprovedeno na Institutu za zdravstvenu za&scaron;titutu dece i omladine Vojvodine i Institutu za radiologiju Kliničkog centra Vojvodine. Prvi pregled načinjen je UZ a potom je načinjen pregled magnetnom rezonanacom. Podaci su obrađivani retrospektivno i prospektivno. Kriterijumi za uključivanje u studiju pored uzrasta bili su radiolo&scaron;ki: zadebljanje crevnog zida &gt;3mm, postojanje naru&scaron;ene arhitektonike crevnog zida, zadebljanje pojedinih crevnih segmenata-dužina segmenta, znaci fibroze, odsustvo peristaltike, izražena hiperemija na kolor Doppleru, transmuralni znaci upale, uvećani mezenterijalni limfni nodusi kao i kontrolni pregledi kod dece sa ranije ustanovljenom dijagnozom. Načinjena je endoskopija sa biopsijom radi postavljanja definitivne dijagnoze, potom se pristupilo statističkoj obradi dobijenih podataka. Izračunate su prosečne i standardne devijacije i frekvencije kao i pripadajući procenti. Određivane su maksimalne i minimalne vrednosti, medijane i interkvartalni raspon. Dobijeni podaci prikazani su u grafikonima i tabelama. Za parametrijske varijable upotrebljavan je Man &ndash; Vitni U test. Za kategoričke vrednosti upotrebljeni su &chi;2 i Fi&scaron;erov test. Nadalje su određivane senzitivnost, specifičnost kao i pozitivne i negativne prediktivne vrednosti. Veze između dva parametra uspostavljene su pomoću Pirsonove korelacione analize i linearnim regresionim modelom. Upotrebljen je program za obradu podataka SPSS 21 Statistics,a kao statistički značajne vrednosti uzete su vrednosti p&lt;0,05. REZULTATI: Nakon statističke obrade nije zabeležena signifikantnost u pogledu zastupljenosti hroničnih inflamatornih bolesti među polovima. Statistička značajnost pronađena je u pogledu uzrasta dece u akutnoj fazi kao i remisiji bolesti. Statistička značajnost je dobijena za posmatranu debljinu crevnog zida, hiperemiju creva, prisustvo fibroze u digestivnom traktu. Primećeno je da UZ bolje razgraničava decu sa akutnim oboljenjem po pitanju zahvaćenosti segmenata. Ostala posmatrana obeležja nisu nakon statističke obrade imala statistički značaju razliku kada se procenjuju ultrazvučno ili magnetnom rezonancom. ZAKLJUČAK: Inicijalne hipoteze ovog istraživanja su nakon obrade podataka i potvrđene. Određivanjem senzitivnosti i specifičnosti UZ i MR dobijene su sledeće vrednosti: senzitivnost UZ je 88,4% naspram 92,3% koliko ima pregled magnetnom rezonancom. U pogledu specifičnosti UZ ima 88% a magnetna rezonanca 91,6%. Verifikovano je da magnetna rezonanca bolje razvrstava decu u akutnoj fazi bolesti kao i decu u remisiji. Rezultati pozitivnih i negativnih verovatnoća odnosa ne predviđaju neuspeh nijednim od ova dva pregleda.</p> / <p>INTRODUCTION: Chronic inflammatory diseases are manifested through two clinical entities: Crohn&#39;s disease and ulcerative colitis. Their significance lies in the chronicity and the degree to which they restrict the growth and development of children and youth. There are many consenquences that come with the very nature of the disease, in addition to long-term absence from school, limiting life activities and the occurrence of complications that often affect other organ systems. The etiology of the disease has long been in favor of the theory that a chronic inflammatory process in genetically conditioned individual is provoking an inflammation due to a certain infectious agent. However, a step closer was made regarding the etiology of the disease - when the genetic basis of inheritance studies have revealed chronic inflammatory bowel diseases were associated with NOD2 gene. It is particularly important to prevent continuous exposure to the harmful effects of X-rays. Therefore, numerous studies have been made towards the validation of complementarity, accuracy and diagnostic capabilities of ultrasound and magnetic resonance imaging as noninvasive techniques. Our research was based on the capabilities of these two methods in their daily work for diagnosis and follow-up of chronic inflammatory bowel disease. OBJECTIVES: The objectives were to determine the sensitivity and specificity of ultrasound and magnetic resonance imaging in inflammatory bowel disease in children and adolescents. Furthermore, the aim was to define and compare the advantages and limitations between ultrasound diagnosis and magnetic resonance in inflammatory bowel disease in children and adolescents. MATERIAL AND METHODS: The study included 62 children and adolescents during the first attack of disease or recurrent stages of the disease, or during regular monitoring in remission. Patients included children of both sexes, aged 4-18. Then they were sorted into groups based on the type of the examination and the presence of a thickening of the intestinal wall into groups A and B - in these groups children were examined by ultrasound, A group had observed thickening of the intestinal wall &gt; 3 mm whereas children in group B had had thickening of the intestinal wall between 2,5-3 mm. Based on the review of MRI children were divided into groups A1 and B1, also according to the criterion of bowel wall thickening greater than 3mm (A1) and between 2,5-3mm (B1). The research was conducted at the Institute for Health Protection of Children and Youth and the Institute of Radiology, Clinical Center of Vojvodina. The first review was made by ultrasound, followed by the review of magnetic resonance. Data were analyzed retrospectively and prospectively. Criteria for inclusion in the study were: thickening of the intestinal wall greater than 3 mm, the existence of disturbed intestinal wall architectural structure, no clear distinction of layers, abnormal thickening of certain intestinal segments, signs of fibrosis, the absence of peristalsis, expressed hyperemia on color Doppler, transmural inflammation, increased mesenterial lymph nodes as well as check-ups for children with previously established diagnosis. Endosccopy with biopsy has made for the definitive diagnosis and then we approached statistical analysis of the data obtained. The data are presented in graphs and tables. For parametric variables we used Man - Whitney U test. For categorical values &chi;2 and Fisher&#39;s test were used. Further the sensitivity, specificity and positive and negative predictive values were determined. Relationship between these two parameters were established using Pearson correlation analysis and linear regression model. For data processing we used the program SPSS Statistics 21, statistically significant values were taken p values &lt;0.05. RESULTS: After statistical analysis there was no for the number of chronic inflammatory diseases between the sexes. Statistical significance was found in terms of age of the children during the acute phase as well as remission. Statistical significance was obtained for the observed thickness of the intestinal wall, intestinal hyperemia, the presence of fibrosis in the digestive tract. It was noted that US better demarcates children with acute disease in terms of involvement of segments. Other features are not observed as significant after the statistical analysis. CONCLUSION: The initial hypothesis of this study, after data processing were confirmed. By determining the sensitivity and specificity of ultrasound MRI results we came to the following results: sensitivity of ultrasound was 88,4% versus 92,3%, for magnetic resonance. In terms of specifics UZ has a 88% and 91,6% of magnetic resonance imaging. The classification of children in the acute phase of the disease as well as children in remission was better when MRI was used. The results of positive and negative predictions do not predict the probability of failure in neither of these methods.</p>