La atención inicial de pacientes politraumatizados en los servicios de emergencia representan un notable problema de salud por su alto índice de mortalidad y secuelas asociadas al inadecuado manejo inicial debido al limitado conocimiento del personal de salud; por ello que se realizó el trabajo titulado: Criterios de enfermería a considerar para la atención inicial de pacientes politraumatizados en un servicio de emergencia, con el objetivo de identificar los criterios que los enfermeros deben poseer durante la atención inicial a pacientes politraumatizados en los servicios de emergencia. La Enfermería Basada en Evidencia (EBE) fue la metodología empleada en este estudio secundario, optando por 08 investigaciones científicas relacionadas al tema, utilizado bases de datos como Scielo, Cochrane, PubMed, Google Académico, aplicándoles minuciosamente la guía de utilidad y validez aparente de Gálvez Toro; seleccionando para el comentario crítico un estudio titulado “Guía de práctica clínica: Atención en emergencia del paciente politraumatizado”, determinándose un nivel de evidencia 3 y un grado de recomendación A según GRADE; calificando así su beneficio en toma de decisiones. La revisión da respuesta finalmente al planteamiento de la pregunta clínica ¿Cuáles son los criterios de enfermería a considerar para la atención inicial de pacientes poli traumatizados en un servicio de emergencia? Refiriendo que la atención inicial protocolizada de forma secuencial desde el reconocimiento oportuno de signos y síntomas dentro del examen físico exhaustivo utilizando ABCDE ayudaría a minimizar las complicaciones y sus secuelas, mejorando enormemente la evolución clínica y acortando la estancia hospitalaria. / The initial care provided to polytrauma patients in emergency services poses a significant health issue due to the high mortality rate and adverse effects resulting from inadequate initial management caused by the limited knowledge of healthcare staff. Consequently, a study titled "Nursing Criteria to Consider for Initial Care of Polytrauma Patients in an Emergency Service" was undertaken to pinpoint the essential criteria that nurses should possess while attending to polytrauma patients in emergency services. Evidence-Based Nursing (EBN) was the methodology employed in this secondary study, involving the selection of 8 scientific research studies related to the subject and using databases such as Scielo, Cochrane, PubMed, Google Scholar, with rigorous application of the utility and apparent validity guide by Gálvez Toro. A study called "Clinical Practice Guidelines: Emergency Care for Polytrauma Patients" was chosen for critical evaluation, indicating an evidence level of 3 and a recommendation grade A according to GRADE, thereby validating its utility in decision-making. The review ultimately addresses the clinical query: What nursing criteria should be taken into account for the initial care of polytrauma patients in an emergency service? It proposes that a standardized initial care process, commencing with prompt identification of signs and symptoms during a comprehensive physical examination utilizing the ABCDE approach, could reduce complications and their repercussions, notably enhancing clinical outcomes and shortening hospital stays.

This thesis explores the potential of visual information and communication technologies (ICTs) for collaboration in emergency care. The thesis consists of four studies exploring future technology, 3D telepresence technology for medical consultation (3DMC), from several different methodological and analytical perspectives. Together the studies provide a broad view of the potential benefits, risks and implications of using visual technologies for collaboration in emergency care. The results show that paramedic-physician collaboration via 3DMC might have some benefits for patient care, both in the immediate patient care situation and beyond, for example, when coordinating transport and resources; improving understanding between different actors; and in developing paramedic competence and confidence in their skills. However, collaboration is heavily impacted by physicians’ and paramedics’ respective work practices which are situated in very different physical, professional and organizational contexts. Adding a visual dimension to this collaboration presents unique challenges for the overall design, development, implementation, and appropriation process. Thus, the thesis emphasizes the importance of understanding both the individual users as well as the complex overall image which, although often neglected or ignored, is crucial to understand when developing and introducing new technology that is successful and justified in the overall context while also being useful and meaningful for the individual users. / <p>Academic dissertation for the Degree of Doctor of Philosophy in Library and Information Science at the University of Gothenburg and the University of Borås to be publicly defended on Thursday 19 September 2013 at 13:15 in the auditorium at Simonsland, University of Borås, Skaraborgsvägen 3, Borås.</p>

Titel: Vi vill men orkar inte: Sjuksköterskors beskrivningar av varför de slutar på akutmottagning – en kvalitativ studie Bakgrund: På akutmottagningen utförs avancerad akutsjukvård som ställer höga krav på sjuksköterskans kompetens. Under de senaste åren har dock många sjuksköterskor valt att lämna akutsjukvården för att påbörja arbete på annan arbetsplats inom vården. Detta leder till att kompetensen hos kvarvarande personalgrupp sjunker och arbetsbelastningen på akutmottagningarna ökar relaterat till personalbristen. Syfte: Syftet med studien var att belysa arbetsmiljörelaterade anledningar som leder till att sjuksköterskor på akuten slutar sin anställning. Metod: Studien utfördes genom kvalitativ design där tio sjuksköterskor beskrev sina erfarenheter genom semistrukturerade individuella intervjuer. Deltagarna var alla kvinnor verksamma vid olika akutmottagningar i södra halvan av Sverige. Analys av data genomfördes med kvalitativ innehållsanalys. Resultat: Studiens resultat pekade tydligt på att sjuksköterskorna upplevde arbetet på akutmottagningen som givande samtidigt som det fanns allt för många negativa aspekter i form av exempelvis bristande stöd från ledningen, känslan av maktlöshet och upplevelse av påverkad hälsa på grund av arbetsmiljörelaterade faktorer. Resultatet presenteras i tre kategorier: Stimulerande, Frustrerande och Motiverande, där den sista kategorien behandlar sjuksköterskornas egna förbättringsförslag för att orka stanna kvar på akutmottagningen. Slutsats: Studien påvisar att sjuksköterskorna tyckte om arbetet på akutmottagning men att arbetsmiljörelaterade faktorer som stress, påverkan på den egna hälsan och bristande stöd från arbetsledningen påverkade deras vilja att stanna på arbetsplatsen. Arbetsmiljön på akutmottagningen måste således förbättras och till största delen är det arbetsledningen som behöver utveckla sitt ledarskap för att få sjuksköterskorna att känna sig uppskattade, delaktiga och sist men inte minst respekterade. / Title: We want to, but do not have the strength: Nurses descriptions of why they quit their jobs in the emergency department – a qualitative study Background: In the emergency department advanced emergency care is performed which place high demands on nurses’ skills. In recent years, however, many nurses have chosen to leave the emergency medical care to begin work at another workplace in health care. This leads to the a decrease in the skills of remaining staff and the workload on emergency departments increases related to staff shortages. Aim: The aim of the study was to highlight working environment related reasons that makes nurses in the emergency department want to terminate their employment. Method: The study was conducted with a qualitative design with ten nurses that described their experiences through semi-structured individual interviews. The participants were all women active in different emergency departments in the southern half of Sweden. To analyze the data a qualitative content analysis was carried out. Results: Our results clearly indicated that nurses experienced the work in the emergency department as rewarding, whilst there were too many negative aspects in the form of, for example, lack of management support, the feeling of powerlessness and experience of affected health due to working environment related factors. The results are presented in three categories: Stimulating, Frustrating and Motivating, where the last category covers nurses own suggestions for improvement to help them have the strength to remain at work in the emergency department Conclusion: This study demonstrates that nurses enjoy working in the emergency department but working environmental factors affected their ability to remain in the workplace like stress, impact on their own health and the lack of support from the management affected their willingness to stay in the workplace. The work in the emergency department must be improved, for the most part it is the workplace management that need to develop their leadership to help the nurses achieve the feeling of being valued, involved and last but not least respected.

Este estudo de abordagem qualitativa, descritivo e de caráter exploratório tem como objetivo investigar a vivência da equipe multiprofissional na assistência ao adulto em situação de parada cardiorrespiratória, numa unidade de suporte avançado de vida de Atendimento Pré-Hospitalar móvel (APH) da Secretaria Municipal de Saúde de Ribeirão Preto-SP. Para a coleta de dados, foi utilizada a entrevista semi-estruturada que compreendeu questões sobre o perfil sociodemográfico, profissional e questões norteadoras sobre o tema. A amostra foi constituída por 16 profissionais, médicos, enfermeiros e condutores de veículo de urgência terrestre integrantes da Unidade de Suporte Avançado (USA). Os dados foram organizados por meio da análise de conteúdo proposta por Bardin (1977), sendo identificados quatro temas: o trabalho no APH móvel avançado, os sentimentos e emoções da equipe multiprofissional de APH móvel avançado frente ao atendimento à Parada Cardiorrespiratória (PCR), identificação dos agentes estressores ao atendimento à PCR e as reações de estresse no atendimento à PCR. Na presente pesquisa, a equipe multiprofissional relata a sua vivência nesse tipo de atividade com a visão de um serviço desafiante e difícil, por vivenciar diariamente situações inesperadas, desconhecidas e angustiantes, mas que, com tudo isso, também são capazes de perceber satisfações pessoais e realização profissional. Na análise, evidenciaram-se também nas demais categorias, as expressões: conhecimento e constante capacitação técnica e tecnológica, habilidade e agilidade, tomada de decisões, trabalho em equipe, a dificuldade de lidar com o sofrimento dos familiares na cena do agravo, envolvimento emocional em situações de grande sofrimento e dor, trabalhar em altas temperaturas, dificuldades em lidar com a morte, principalmente em situações inesperadas e com vítimas jovens, trazendo sentimentos de impotência, frustração e tristeza. Portanto essa equipe multiprofissional vivencia diariamente a real possibilidade de sofrimento psíquico e mostra por meio deste estudo, a necessidade de que a equipe promova momentos para reflexão e discussão acerca dos aspectos técnicos, científicos e éticos referentes ao cuidado dos pacientes críticos, em parada cardiorrespiratória, quanto às diferentes possibilidades de situações que os envolva durante o atendimento, com vistas à melhoria da qualidade do atendimento e do relacionamento interpessoal. Levando em consideração os resultados e conclusões da nossa investigação, é relevante a questão da saúde mental desses profissionais no exercício de suas funções, diante do exposto nos seus próprios relatos, e até que ponto os mecanismos de enfrentamento utilizados pelos mesmos são eficientes, ou seja, são métodos eficazes de elaboração do estresse. Sugerimos como métodos que podem ser eficazes: buscar informações e discutir o assunto em grupos; aceitar os acontecimentos, buscando o lado positivo da situação, buscar auxílio de especialistas, psicólogos ou psiquiatras e seguir suas orientações. Diante da importância desse serviço, vemos a necessidade de propor formas alternativas dentro dessa equipe, para que ela alcance um equilíbrio no estresse individual e coletivo e que efetivamente não atinja os limites de sofrimento psíquico. Assim são necessárias outras investigações, porque as seqüelas advindas podem comprometer a vida social e pessoal do indivíduo. / This study of qualitative boarding and of exploratory character has as objective investigate the experience of the multi-professional team in the assistance for the adults in situations of cardiorespiratory emergency in a unity of advanced support of life and movable pre-hospitalar attendance (APH) of the Municipal Secretary of Health from Ribeirão Preto?SP. To collect the data was utilized a semi-structuralized interview that was included questions about the sociodemographic profile and professional and questions directed to the topics. The sample was constituted of 16 professionals, doctors, nurses and conductors by the way of the USA. Data were organized and analyzed the content proposed by Bardin (1977), identifying four topics: The Work in the APH advanced movable, the feelings and emotions of the multi professional team of APH advanced movable in front of the attendance to PCR, identification of the stresses agents in the attendance to PCR. In the present search the multi-professional team relate their experience in this kind of activities with the vision of a hard and challenger job by experience the daily of non waiting situations, unknown and overwhelming but even with of all of this they are also able to percept personal satisfactions and professional realization. In the analyze evidence too in the others categories the expressions: knowledge and constant technique qualification and technologic, ability and agility, taken decisions, group work, the difficult to deal with the pain of the familiars in the scene of the aggravate, emotional involvement and situations of a lot suffer and pain, work in high temperatures, difficult to deal with the death, principally in unexpected situations and of young victims bringing feelings of incapacitation, frustration and sadness. Therefore this multi-professional team experience daily the real possibility of psychic suffer, and show trough this study the necessity that the team promote moments of reflection and discussion around of the techniques aspects, scientifics and ethical referring to the cautions of the critics patients in cardio respiratory problems and of the different possibilities of situations that involve them during the attendance with vision on better quality of the attendance and the interpersonal relation. Considering the results and conclusions of our investigation is important the aspect of mental healthiness of this professionals in the act of their functions based in their own experiences and the mechanisms of fronting utilized by the team are efficient so are methods of elaboration of stress. So we suggest how methods can be efficient: search for informations and discuss the subject in group; accept the knowledge looking for the good side of the situation, search aid of specialists, psychologist or psychiatrist, and follow their orientations. Once that is necessary this kind of service we see the necessity to propose alternatives ways inside of this team, to got a equilibrium of personal stress and of the group that don?t affect the limits of psychic suffer. So it makes necessary others investigations because the symptoms can interfere in the personal life.

Introdução: Manaus dispõe de um Serviço de Atendimento Móvel de Urgência (SAMU) fluvial que atende a população que reside em comunidades ribeirinhas dos rios Negro e Amazonas. Tem-se observado várias iniciativas de atendimento pré-hospitalar (APH) com uso desse tipo de transporte; no entanto, não foram encontradas na literatura informações sobre esses serviços, perfil dos usuários e fatores associados a desfechos indesejáveis do atendimento. Objetivo: Caracterizar o perfil dos usuários, aspectos do atendimento do SAMU fluvial de Manaus e identificar fatores relacionados ao agravamento no APH fluvial. Método: Estudo descritivo correlacional realizado em duas etapas. Na primeira etapa, a coleta de informações foi retrospectiva e teve como fonte os registros dos atendimentos realizados pelo SAMU fluvial de Manaus de 2009 a 2015. Na segunda etapa, a coleta de dados foi prospectiva; indivíduos com 15 anos ou mais, atendidos pelo SAMU fluvial no período de seis meses (janeiro a junho de 2016), tiveram informações coletadas desde a chamada na Central de Regulação até a chegada à base fluvial. Pacientes encaminhados para hospitais tiveram a coleta de informações estendida até a saída hospitalar. Testes de associação foram aplicados considerando as características do atendimento e usuário perante o agravamento do paciente, identificado por meio das mudanças do Rapid Emergency Medicine Score (REMS) entre o atendimento inicial e final do SAMU fluvial. Resultados: Entre 2009 e 2015, o SAMU fluvial de Manaus realizou 2.002 atendimentos, a maior parte em comunidades do Rio Negro e próximas da base fluvial. A grande maioria dos atendidos pelo SAMU fluvial foi removida para Manaus (92%), variando o tipo de embarcação mais frequentemente utilizada no transporte ao longo dos anos e com ajustes na tripulação da modalidade Unidade de Suporte Avançado (USA) após 2015. Foi baixa a frequência de procedimentos nos atendimentos (média 1,5 procedimento), porém o acesso venoso foi realizado em quase todos os usuários (97,8%). Houve grande variabilidade dos tempos de APH. As médias do tempo de resposta (84 minutos) e total de APH fluvial (172 minutos) foram bastante elevadas. A maioria dos pacientes removidos foi encaminhada para hospital (44,9%) ou serviço de pronto atendimento (37,1%). A frequência de homens e mulheres atendidos foi semelhante e os usuários com menos de 35 anos predominaram. As causas mais frequentes dos atendimentos foram as relacionadas a sintomas, sinais e achados anormais e causas externas de morbidade e mortalidade. Os parâmetros fisiológicos e o valor médio do REMS inicial, 2,7 (dp = 3,6), indicaram baixo risco de morte dos pacientes. No entanto, a mortalidade hospitalar dos internados foi de 8,7%. Dos pacientes transportados pelo SAMU fluvial, 68,5% mantiveram o quadro clínico, 18,0% pioraram e 13,5% melhoraram durante o atendimento. Houve associação entre piora e local de destino dos usuários (p=0,037), também com as ocorrências relacionadas a contato com serpentes venenosas (p= 0,039) e dor aguda (p= 0,005). Conclusão: No geral, os resultados mostraram peculiaridades do SAMU fluvial de Manaus em relação a serviços terrestres que necessitam ser consideradas no planejamento, implementação e avaliação do APH fluvial. / Introduction: Manaus has a fluvial Mobile Emergency Care Service (SAMU) that serves the population who lives in riverside communities of Negro and Amazon rivers. Several prehospital care initiatives (APH) have been observed regarding this type of transportation. However, information on these services, users\' profiles and factors associated with undesirable outcomes were not found in the literature. Objective: To characterize the profile of the users and aspects of Manaus fluvial SAMU and to identify factors related to the worsening in fluvial APH. Method: Descriptive, correlational study carried out in two stages. In the first stage, the information collection was retrospective and was based on the records of the services performed by Manaus fluvial SAMU from 2009 to 2015. In the second stage, data collection was prospective. Individuals aged 15 years and older attended by fluvial SAMU in the six-month period (January to June 2016) had information collected from the call to the Regulation Center until arrival at the fluvial base. Patients referred to hospitals had information collection extended until hospital discharge. Association tests were applied considering the characteristics of care and user before the patient\'s worsening, identified through the changes of the Rapid Emergency Medicine Score (REMS) from the initial care until the final care by fluvial SAMU. Results: From 2009 to 2015, Manaus fluvial SAMU carried out 2,002 visits, mostly in communities of Rio Negro and near the fluvial base. The vast majority of people served by the fluvial SAMU were removed to Manaus (92%). The type of boat most frequently used has changed over the years. Additionally, there were adjustments to the Advanced Support Unit (USA) crew after 2015. The frequency of procedures occurred during management was low (mean 1.5 procedure), but venous access was performed in almost all patients (97.8%). There was great variability of APH times. The mean response time (84 minutes) and total fluvial APH (172 minutes) were quite high. The majority of patients removed were referred to hospital (44.9%) or emergency care (37.1%). The frequency of men and women attended was similar and users less than 35 years old predominated. The most frequent causes of the visits were related to \"symptoms, signs and abnormal findings\" and \"external causes of morbidity and mortality\". The physiological parameters and the mean value of the initial REMS, 2.7 (SD = 3.6), indicated a low risk of death related to the patients. However, in- hospital mortality was 8.7%. Considering the patients transported by fluvial SAMU, 68.5% maintained the clinical presentation, 18.0% worsened and 13.5% improved during the care. There was an association between worsening and destination of the users (p = 0.037), as well as occurrences related to contact with venomous snakes (p = 0.039) and acute pain (p = 0.005). Conclusion: In general, the results showed peculiarities of Manaus fluvial SAMU related to terrestrial services that need to be considered in the planning, implementation and evaluation of fluvial APH.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-11-18T11:35:24Z No. of bitstreams: 1 Douglas Fabiano Lourenço.pdf: 1604469 bytes, checksum: b615b17c4a8ddd4a5b7ec91905da223a (MD5) / Made available in DSpace on 2016-11-18T11:35:24Z (GMT). No. of bitstreams: 1 Douglas Fabiano Lourenço.pdf: 1604469 bytes, checksum: b615b17c4a8ddd4a5b7ec91905da223a (MD5) Previous issue date: 2016-09-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Computational intelligence participates as a support tool in various areas of knowledge, particularly specialized area of health. This thesis raises some basis for development of a model to meet the pregnant women, users of the Mobile Emergency Care Service - SAMU. Patient medical records are essential and should contain all the health history from birth, in addition to treatment and care prescribed and received in the institutions, and the informational way to store electronic health records, assists in the health services, beyond the individual and chronologically, generating information, called the Electronic Patient Record - PEP. Thus, the goal is to develop a computer model by algorithm based on the score Malines and Manchester classification that can be used to care for pregnant women. Through this approach, it concluded, determine a computational algorithm, then the implementation of a prototype software to record data derived from pregnant women and suggest an effective service to the requester, able to perform in this manner, a solution in service, using intelligence computer / A inteligência computacional participa como ferramenta de apoio em várias áreas do conhecimento, em especial a área especializada da saúde. Essa pesquisa busca levantar fundamentos para elaboração de um modelo para atendimento as mulheres gestantes, utilizadoras do Serviço de Atendimento Móvel de Urgência – SAMU. Registros médicos do paciente são essenciais e devem conter todo o histórico de saúde, além dos tratamentos e cuidados prescritos e recebidos nas instituições. A forma informacional para armazenar os registros eletrônicos de saúde, auxiliam nos serviços da área especializada, gerando informação, assim, denominando-se como Prontuário Eletrônico do Paciente – PEP. Dessa forma, o objetivo é desenvolver um modelo computacional, através de algoritmo, baseado na pontuação de Malinas e classificação de Manchester, para aplicação no atendimento às gestantes. Por meio dessa abordagem, se conclui na determinação de um algoritmo computacional, posteriormente a implementação de um protótipo de software para registro de dados oriundos das mulheres gestantes e sugerir um atendimento eficaz à solicitante, capaz de realizar dessa maneira, uma solução no atendimento, utilizando a inteligência computacional

Bakgrund:Ambulanssjukvård är ett område som blir allt mer avancerat. Prehospital akutsjukvård karakteriseras av snabb bedömning, beslutsfattande och utvärdering i både säkra och osäkra miljöer. Ett korrekt omhändertagandeav patientenförutsätter en fungerande kommunikation. Risken ökar annars för missförstånd, minskad patientsäkerhet, vårdskadorochökat lidande. Språkbarriär är ett merstuderat fenomen inom intrahospital vård men forskningen kring fenomenet inom ambulanssjukvårdenärytterst sparsmakad.Syfte: Syftet var att utforska ambulanspersonalens uppfattningar av språkbarriär i mötet med patienten.Metod: Studien har genomförts med en kvalitativ, induktiv ansats. Data inhämtades genom semistrukturerade intervjuer med 18 deltagare med olika professionell bakgrund, erfarenheter, kön och åldrar. Fenomenografisk metod användes i analys av de transkriberade intervjuerna.Resultat: De variationer av uppfattningar som författarna identifierat fördelades i fyrabeskrivningskategorier.Ett positivt synsätt, Inverkan på patientmötet,Strategier för att överbrygga språkliga hinderoch En del av ett komplext förhållande.Slutsatser:Studien belyser att ett samband mellan språkbarriär och försämrad vård finns. Bristfällig kommunikation innebär att patienten riskerar att inte få lika vård på lika villkor. Ambulanspersonal agerar pragmatiskt och lösningsorienterat, i tidskritiska situationer, för att tillvarata patientens intressen och leverera säker vård. Tillgängliga hjälpmedel uppfattas varaotillfredsställande och behöver ses över. / Background: Ambulance care is a field which is becoming more and more advanced. Prehospital emergency care is characterized by quick assessments, decision making and evaluation in safe as well as unsafe environments. Correct management of the patient demands a functioning communication. Otherwise there is an increased risk of misunderstandings, diminished patient safety, adverse events and increased suffering. Language barriers have been studied extensively within intra-hospital care but research regarding the phenomenon in the ambulance care setting is utterly sparse.Aim: The aim of this studywas to explore the ambulance personnel’s perceptions of language barrier in the encounter with the patient.Methods: The study was conducted using a qualitative, inductive approach. Data was collected through semi structured interviews with 18 participants from different professions, of varying experience, sex and age. Phenomenographic method was used when analysing the transcribed interviews. Results:The variations of perceptions that the authors have identified were distributed in four categories of description: A positive outlook, Effects on the encounter, Strategies to overcome language barriersand Part of a complex relationship.Conclusions:This study highlights the presence of a relationship between language barrier and insufficient care. When communication is unsatisfactory the patient runs the risk of not receiving equal careon equal terms. Ambulance personnel’s actions are pragmatic and solution orientedin time critical situations in order to secure the patient’s interests and deliver safe care.Available tools are perceivedas inadequate and need to be re-evaluated.

Orientador: Alessandro Lia Mondelli / Resumo: Introdução: O Acidente Vascular Cerebral (AVC) é uma das principais causas de morte e sequelas neurológicas no mundo. O reconhecimento precoce e a pré-notificação hospitalar por serviços de atendimento pré-hospitalar têm sido relacionados com o aumento nas taxas de tratamento adequado. Sendo assim, a American Heart Association e a European Stroke Organisation recomendam o uso de escalas de avaliação pelas equipes do atendimento pré-hospitalar. Objetivo: Traduzir para o idioma português do Brasil, realizar a adaptação transcultural das escalas Cincinnati Prehospital Stroke Scale e Los Angeles Prehospital Stroke Screen e avaliar a confiabilidade e validade na população brasileira. Material e Métodos: Trata-se de um estudo metodológico, transversal e prospectivo realizado em 2 etapas: a primeira constituída pelos processos de tradução e adaptação transcultural das escalas e a segunda pela aplicação das mesmas, que ocorreu entre julho de 2016 e dezembro de 2017. Resultados e Discussão: A Cincinnati Prehospital Stroke Scale ficou denominada de “Escala de Avaliação pré-hospitalar do AVC – Cincinnati”. Os resultados mostraram um Coeficiente de alpha de Cronbach foi de 0,39 e uma alta confiabilidade interobservador do instrumento final, evidenciada pelo alto valor do índice de Kappa, principalmente nos itens “queda do braço” e “fala” que obtiveram o valor máximo. A escala apresentou acurácia de 93% (IC 95% 87,76, – 98,24%), sensibilidade de 92,42% (IC 95%, 86,03 – 98,80% / VPP = 71,7... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Strokes are one of the leading causes of death and neurological disability in the world. Early recognition and prehospital notification may increase rates of thrombolysis with recombinant tissue plasminogen activator (rt-PA). Therefore, the American Heart Association and the European Stroke Organization recommend the use of assessment scales by prehospital care teams. Objective: To translate the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen to Portuguese, make a cross-cultural adaptation to Brazilian culture, and validate and verify its reliability in a Brazilian population. Material and Methods: This was a cross-sectional and prospective methodological study carried out in two stages: the first one consisted of the translation and crosscultural adaptation of the original scale and the second involved the application of the final instrument, which occurred between July 2016 and December 2017. Results and discussion: The final version of the Cincinnati Prehospital Stroke Scale was called the “Escala de Avaliação pré-hospitalar do AVC – Cincinnati”. The results showed Cronbach's alpha was 0,39 and a high interobserver reliability of the final instrument, evidenced by the high value of the Kappa index, especially in the items "arm drop" and "speech," which exhibited the maximum values. The scale showed accuracy of 93% (95% CI 87.76 - 98.24%), sensitivity of 92.42% (CI 95% 86.03 - 98.80% / PPV = 71.76) and specificity of 4%... (Complete abstract click electronic access below) / Doutor

Vården ska ges på den nivå som bäst är anpassad efter patientens individuella tillstånd. Patient väljer ibland att vända sig till akutsjukvården då vårdbehovet egentligen inte är akut utan bättre kan behandlas inom primärvården. Tidigare forskning påvisar att patienter föredrar att söka sig till akutsjukvården framför primärvården då den är mer lättillgänglig samt att den uppfattas som bättre. Att det är flera personer som är inblandade i beslutet att kontakta larmcentralen samt att det är ett svårt beslut framkommer också i tidigare studier. Syftet med föreliggande studie är att beskriva patientens beslut att ringa larmcentral i stället för att ta kontakt med primärvården. Deltagarna i studien hade alla tackat ja och var inkluderade i projektet Vård på Rätt Vårdnivå och vi kom på så sätt i kontakt med dem. Studien har genomförts som en kvalitativ intervjustudie och är baserad på åtta informanter. Resultatet påvisar att beslutet att ringa larmcentralen i stället för att kontakta primärvårdens vårdcentral kan förstås som att 112 samtalet ersätter vårdcentralen som har begränsningar eller saknar akutmottagningens resurser. Att ringa larmcentralen kan också vara ett uttryck för ohälsa eller att ha förlorat kontrollen. Ofta är det någon annan än patienten som tar beslutet att ringa 112. Vårdcentralen väljs bort bland annat på grund av sämre tillgänglighet och begränsat vårdutbud i förhållande till akutmottagningen. Flera jourmottagningar i primärvårdens regi, ett ökat samarbete mellan akutsjukvården och primärvården samt regelbundna hälsokontroller som skall ges tätare med stigande ålder är förslag till kliniska implikationer. [Summary in English:] Care should be given at the best level suitable to the individual patient condition. Sometimes the patients choose to contact Emergency care when the actual need is not that urgent and can be better treated within the Primary care. Earlier research shows that patients prefer to get in contact to Emergency care prior to Primary care as it is easier to access and that it is perceived as a better option. Earlier studies also show that it’s difficult decision and more persons are often involved to decide to contact Emergency care. The purpose of this study is to describe the patient&apos;s decision to call the Emergency care instead of the Primary care. Persons participating in the study have all accepted and were already included in the project &quot;care at the right level&quot;, and that was how we got in touch with them. The study was performed as a qualitative interview and based on eight informants. The result shows that the decision to call the Emergency care instead of the Primary care can be recognized as the 112 call replace Primary Care that is limited or do not the same resources as Emergency care. To call the Emergency care can also be an expression of suffering or that the patient lost control. Often it is someone else than the patient who makes the decision to call 112. The Primary care that is chosen away means limited availability and limited care in relation to Emergency care. More emergency receptions handled by the Primary care, greater corporation between emergency care and primary care and regular health checks more frequent as age increase is some proposals to clinical implications. / Program: Specialistsjuksköterskeutbildning med inriktning mot distriktssköterska

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2016-03-16T13:51:51Z No. of bitstreams: 1 PDF - Kennia Sibelly Marques de Abrantes.pdf: 709000 bytes, checksum: 01b29af6095c581f2574fa5a5a28e7de (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2016-07-21T20:50:00Z (GMT) No. of bitstreams: 1 PDF - Kennia Sibelly Marques de Abrantes.pdf: 709000 bytes, checksum: 01b29af6095c581f2574fa5a5a28e7de (MD5) / Made available in DSpace on 2016-07-21T20:50:11Z (GMT). No. of bitstreams: 1 PDF - Kennia Sibelly Marques de Abrantes.pdf: 709000 bytes, checksum: 01b29af6095c581f2574fa5a5a28e7de (MD5) Previous issue date: 2013-02-22 / The aim of this study was to analyze the incidence of trauma among elderly victims rescued by the Mobile First-Aid Service (MFAS). MATERIAL AND METHODS: Cross-sectional study conducted in the city of Sousa / PB using data from 190 records of elderly victims of trauma rescued by MFAS in the period from January 1 to December 31, 2011. The survey instrument included a specific form containing demographic variables (gender and age group) and data related to the trauma (time, location, day of week, month, trauma mechanism, existing lesions, presence of ethylic breath and patient referral). From those who had suffered falls, information about socio-demographic characteristics and consequences of the fall were collected. Data were analyzed using the SPSS software (Statistical Package for the Social Sciences) 17.0 for Windows. Associations were verified by using the Chi-square test or Fisher's exact test with Freeman-Halton extension, whenever appropriate, adopting significance level of  < 5%. RESULTS: Data were collected from records of 190 elderly victims of diverse trauma (51.1% male). Their ages ranged from 60 to 104 years, with mean age of 75.3 years (SD 10.44 years) and median of 74.0 years. According to the characteristics of the occurrence of traumas, significant association was observed between presence of ethylic breath and sex (p <0.001) and age group (p = 0.004) and trauma mechanism with sex (p <0.001). From the total traumatized elderly, 124 (65 3%) suffered falls. However, due to losses and / or refusals, 93 elderly patients who suffered falls were evaluated, whose interview was conducted at their homes. Their ages ranged from 60 to 104 years, with mean age of 79.0 years (SD = 10.5 years) and median of 78.0 years. Among those who suffered falls, 62.4% were female, 47.3% had 80 years or more, 65.6% lived without a partner, 51.6% had incomplete primary education or above and 66.7% had no income or earned up to one minimum wage. Data regarding elderly who suffered falls showed association between sex and age group (p = 0.004), marital status (p = 0.002), hospitalization (p = 0.047) and place of fall (p = 0.006). CONCLUSION: Among the traumas occurred, most were due to falls, followed by traffic accidents. Among those who suffered falls, the majority reported that the fall was due to the height, to have occurred at home and mainly due to dizziness / imbalance and environmental factors. / OBJETIVO: Analisar a ocorrência dos traumas entre as vítimas idosas socorridas pelo Serviço de Atendimento Móvel de Urgência (SAMU). MATERIAL E MÉTODOS: Estudo transversal realizado no município de Sousa/PB, utilizando as fichas de ocorrência de atendimento a idosos vítimas de traumas diversos socorridos pelo SAMU no período de 01 de janeiro a 31 de dezembro de 2011. O instrumento de pesquisa compreendeu um formulário específico sendo analisadas as variáveis demográficas (sexo e grupo etário) e referentes ao trauma (horário, local, dia da semana, mês, mecanismo do trauma, lesões existentes, presença de hálito etílico e o encaminhamento do paciente). Daqueles indivíduos que sofreram queda, foram coletadas, ainda, informações sócio-demográficas, características e consequências da queda. Os dados foram analisados por meio do aplicativo estatístico SPSS (Statistical Package for the Social Sciences) versão 17.0 for Windows. As associações foram verificadas por meio do teste Qui-quadrado de Pearson, ou Teste Exato de Fisher com extensão de Freeman-Halton, quando apropriado, sendo adotado o nível de significância  <5%. RESULTADOS: Foram estudados 190 idosos vítimas de traumas (51,1% do sexo masculino), com idade variando de 60 a 104 anos, média etária de 75,3 anos (DP= 10,44 anos) e mediana de 74,0 anos. De acordo com as características das ocorrências dos traumas, foi observada associação significativa da presença de hálito etílico com o sexo (p<0,001) e grupo etário (p=0,004) e do mecanismo de trauma com o sexo (p<0,001). Do total de idosos traumatizados, 124 (65,3%) sofreram queda, contudo, devido às perdas e/ou recusas, foram avaliados 93 idosos. A idade desses idosos variou de 60 a 104 anos, com média de 79,0 anos (DP= 10,5 anos) e mediana de 78,0 anos. Do total de idosos que sofreram quedas 62,4% eram do sexo feminino, 47,3% apresentava 80 anos ou mais, 65,6% vivia sem companheiro, 51,6% possuíam ensino fundamental incompleto ou acima e 66,7% não tinha renda ou ganhava até um salário mínimo. Os dados referentes aos idosos que sofreram quedas mostraram associação entre grupo etário e sexo (p= 0,004), situação conjugal (p= 0,002), hospitalização (p= 0,047) e lugar da queda (p= 0,006). De todos os traumas ocorridos, a maioria foi devido a quedas, seguido pelos acidentes de transporte. Entre os idosos que sofreram quedas, maior proporção referiu ter sido da própria altura, ocorrida em casa e causadas principalmente por tontura/desequilíbrio e fatores ambientais. CONCLUSÃO: Entre os principais traumas ocorridos foi observada associação significativa da presença de hálito etílico com o sexo e grupo etário e do mecanismo de trauma com o sexo. Assim, considera-se que esta pesquisa foi relevante para caracterizar os idosos socorridos e as ocorrências dos traumas e espera-se que os profissionais de saúde envolvidos no atendimento a idosos sejam sensibilizados quanto à alta frequência e gravidade dos episódios de trauma.