After a diagnosis of cancer, timely access to oncology care is a priority. For patients living in a rural community, there are many challenges such as proximity to cancer care, reduced access to state-of-the art therapies, lack of coordinated care, and limited access to clinical trials. A multidisciplinary consultation (MDC) via telehealth can improve access to care for rural oncology patients. The purpose of this project was to determine the effects of telehealth MDC on the time in days from diagnosis to the first treatment with the goal of persuading the project site to implement a telehealth MDC. The data involved a comparison of 2 rural locations, 1 with telehealth MDC and 1 without. Data from 36 oncology patients were compared using time in days from the initial diagnosis to the first oncology treatment. The patients who received the initial consultation with telehealth MDC had an average timeframe of 19 days from diagnoses to first treatment, whereas those without telehealth MDC had an average of 51 days, meaning there was a statistically significant difference (z = -5.811, p < .0001). The data will be presented to leadership at the project site to provide the rationale to implement telehealth MDC. This project can lead to a positive social change for rural oncology patients by encouraging telehealth MDC, which may address the several identified barriers that affect access for oncology patients by improving access to clinical trials, coordination of care, and nursing education to rural community patients at the project site.

There are many public health organizations with guidelines concerning the best first-aid treatment for burn injuries. The Australian and New Zealand Burn Association recommends that a burn wound should be cooled with tap water (8-20°C) for 20 minutes, up to three hours after the injury has occurred. However, the evidence that these guidelines are based on is inconclusive and contradictory. As a result of the conflicting published data, there is controversy over whether ice water or ice may confer any beneficial wound healing effects, and what temperature of water is optimal. In the wider community there are also many different alternative therapies believed to be beneficial for the treatment of burn injuries which do not have much evidence to support their use. In this study, patients were found to use agents such as Aloe vera, tea tree oil dressings, butter, toothpaste, papaya ointment and moisturizer on the burn wound. The aim of this work was to review the current field of first-aid treatment for burn injuries and obtain evidence for the optimum first aid treatment using a good animal model, with clinically relevant assessments of wound healing and scar formation. The mechanisms behind the best first aid treatment were also investigated in an effort to better understand and identify the factors involved in optimal wound healing. Studies showed that cool running water at 15°C and 2°C improved the speed of wound healing, gave a better cosmetic outcome and decreased amounts of scar tissue compared to untreated controls. Other treatments Aloe vera, tea tree oil dressings, ice and saliva did not improve wound healing compared to untreated controls. All cold treatments acted to decrease the subdermal temperature, however as the running water was beneficial for wound healing whereas the ice was not, this suggests that the running water acts through other non-thermal mechanisms. Further studies showed that immediate treatment with 15°C water for 20 minutes duration significantly improved the re-epithelialization for 2 weeks post-burn and decreased the distribution of scar tissue compared to untreated controls, however durations as short as 10 minutes and delays of treatment for 1 hour (and perhaps longer) were also beneficial. An audit of first aid used by pediatric patients demonstrated that although 86.1% of patients used first aid, only 12.1% applied the recommended first aid treatment of cold water for 20 or more minutes. For those that did use correct first aid, re-epithelialization time and number of hospital visits were significantly reduced for children with contact and flame burns, respectively. Inadequate first aid treatment was also found to be more common for children <3.5 years old and for friction burn injuries. These studies provide compelling evidence that correct first aid treatment of burn injuries results in improved clinical outcomes, which benefit the patient as well as health care providers. There is a definite need for greater public awareness concerning the correct first aid treatment to use for burn injuries.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2018-05-04T14:27:54Z No. of bitstreams: 1 RODRIGO MASELLI THOM? GARCIA.pdf: 1139747 bytes, checksum: 918a44a313fb8cf1d56fef9b097af761 (MD5) / Made available in DSpace on 2018-05-04T14:27:54Z (GMT). No. of bitstreams: 1 RODRIGO MASELLI THOM? GARCIA.pdf: 1139747 bytes, checksum: 918a44a313fb8cf1d56fef9b097af761 (MD5) Previous issue date: 2018-02-28 / Introduction: Acute Scrotum Syndrome is a medical emergency. Some children and adolescents cannot be cared for by a specialist or accustomed to this pathological condition of the acute scrotum, especially torsion of the spermatic cord, also called testicular torsion. Delays in care, misinformation by patients, family members or healthcare professionals can cause irreversible damage to the patient. Objective: to correlate factors that delayed the diagnosis and treatment of acute scrotal syndrome with loss of testis. Method: The charts of 127 patients from March 2007 to May 2017 were analyzed in the Patient Record Services of Hospital e Maternidade Celso Pierro. Patients who underwent surgery are included in the study (n = 71). Patients with incomplete records, age greater than 18 years or who did not undergo surgical treatment were not included in the study (n = 56). Exploratory data analysis was performed through descriptive measures (mean, standard deviation, minimum, median, maximum, frequency and percentage). Orchiectomy and orchidopexy groups were compared using the Mann-Whitney test (age, distance from the house to the hospital, time of symptoms and time in the Hospital e Maternidade Celso Pierro) or Qui-Square (race, agreement, side affected and pr?-hospital care). Factors related to orchiectomy were assessed through Logistic Regression. In the multiple analysis, the variable selection criterion used was stepwise. The level of significance was 5%. Results: Among the 71 patients diagnosed with Acute Scrotum Syndrome undergoing surgery, 22 (31%) were between 0 and 12 years of age and 49 (69%) were older than 12 years. It was evidenced that there is significant difference between the groups for the variables that measure time. The time of symptoms and time of Hospital e Maternidade Celso Pierro is greater for the orchidectomy group. For the other variables, no significant differences were found between groups. The group of patients most submitted to orchiectomy are non-white patients, with no private medical insurance, right testicle affected and without pr?- hospital care. On the other hand, the group of patients most submitted to orchidopexy are the whites, also without private medical care or pre-hospital care and the affected left testicle. The 1 hour increase in symptom time increases the chance of orchiectomy by 4%. The 1 hour increase in Hospital e Maternidade Celso Pierro increases the chance of orchiectomy by 0.2%. Conclusion: Elapsed time of symptoms remains the main factor associated with loss of the testis in Acute Scrotum Syndrome and torsion of the spermatic cord. Even without data with statistical significance, we can also conclude that this study showed that patients with more than 12 years of age, not white, with right side affected, without private medical care and pr?-hospital care are the most submitted to orchiectomy. / Introdu??o: a S?ndrome do Escroto Agudo configura uma emerg?ncia m?dica. Algumas crian?as e adolescentes n?o conseguem ser atendidas por um profissional especializado ou habituado nessa condi??o patol?gica do escroto agudo em especial a Tor??o do Cord?o Esperm?tico, muito chamada tamb?m de tor??o testicular. A demora no atendimento e tratamento desses pacientes, desinforma??o dos pr?prios pacientes, familiares ou profissionais da ?rea da sa?de podem causar danos irrevers?veis ao test?culo. Objetivo: correlacionar fatores que atrasaram o diagn?stico e tratamento da s?ndrome do escroto agudo com a perda do test?culo. M?todo: os prontu?rios de 127 pacientes desde mar?o de 2007 a maio de 2017 foram analisados nos Servi?os de Prontu?rio de Pacientes do Hospital e Maternidade Celso Pierro. Os pacientes que foram submetidos ? cirurgia est?o inclusos no estudo (n=71). Pacientes com prontu?rios incompletos, idade maior que 18 anos ou que n?o foram submetidos ao tratamento cir?rgico n?o foram inclu?dos no estudo (n=56). Foi realizada an?lise explorat?ria de dados atrav?s de medidas descritivas (m?dia, desvio padr?o, m?nimo, mediana, m?ximo, frequ?ncia e porcentagem). Os grupos de orquiectomia e orquidopexia foram comparados atrav?s do teste de MannWhitney (idade, dist?ncia da casa at? o hospital, tempo de sintomas e tempo no Hospital e Maternidade Celso Pierro) ou Qui-Quadrado (etnia, conv?nio, lado acometido e atendimento pr?-hospitalar). Os fatores relacionados ? orquiectomia foram avaliados atrav?s de Regress?o Log?stica. Na an?lise m?ltipla o crit?rio de sele??o de vari?veis usado foi o stepwise. O n?vel de signific?ncia adotado foi de 5%. Resultados: Entre os 71 pacientes avaliados com o diagn?stico de S?ndrome do Escroto Agudo submetidos ? cirurgia, 22 deles (31%) tem idades entre 0 e 12 anos e 49 (69%) tem idades maior que 12 anos. Evidenciou-se que existe diferen?a significativa entre os grupos para as vari?veis que medem tempo. O tempo de sintomas e tempo de Hospital e Maternidade Celso Pierro ? maior para o grupo de orquiectomia. Para as demais vari?veis n?o foram encontradas diferen?as significativas entre os grupos. O grupo de pacientes mais submetidos ? orquiectomia s?o os n?o brancos, sem conv?nio m?dico particular, test?culo direito acometido e sem atendimento pr?-hospitalar. J? o grupo de pacientes mais submetidos ? orquidopexia s?o os brancos, tamb?m sem conv?nio m?dico particular ou atendimento pr?-hospitalar e test?culo esquerdo acometido. O aumento em uma hora no tempo de sintomas aumenta a chance de orquiectomia em 4%. O aumento em 1 hora no tempo de Hospital e Maternidade Celso Pierro aumenta a chance de orquiectomia em 0,2%. Conclus?o: o tempo decorrido de sintomas ainda permanece o principal fator associado ? perda do test?culo na S?ndrome do Escroto Agudo e Tor??o do Cord?o Esperm?tico. Mesmo sem dados com signific?ncia estat?stica, podemos concluir tamb?m que esse estudo mostrou que os pacientes com mais de 12 anos, n?o branco, com lado direito acometido, sem conv?nio m?dico particular e atendimento pr?-hospitalar s?o os mais submetidos ? orquiectomia.