The aerospace industry is steadily increasing its use of polymer-matrix composites (PMCs) in airframe structures as it seeks to benefit from the high specific in-plane strength of laminated structural PMCs. However, PMC laminates suffer from low interlaminar shear strength due to their weaker polymer-matrix. Minimising risks of delamination is of paramount importance towards improving the safety of PMC structures. Multi-scale composites that are reinforced by both continuous fibres and nano-particles were identified as a potential solution for improving toughness and reducing risks of delamination in PMCs. An important challenge in the fabrication of multi-scale PMCs is to ensure that nano-particles are dispersed uniformly within the matrix. This is only achieved through minimal filtration of nano-particles during processing. The short resin flow lengths enabled by the resin film infusion (RFI) process make this process a prime candidate for the fabrication of multi-scale PMCs. The main objective of this thesis is to validate the possibility of using out-of-autoclave RFI for fabricating multi-scale carbon fibre composites featuring epoxy resins modified with carbon nanotubes (CNTs). The work is accomplished in 5 phases. In phase 1, preliminary work investigates the fabrication of PMCs with and without CNTs, using out-of-autoclave RFI. Results show that the types of reinforcement and matrix have strong effects on the porosity and interlaminar strength of PMCs. These results ushered the need for more thorough investigation and understanding of the RFI process, beyond what is available in the literature. Phases 2 to 4 focus on understanding how the choices of materials and types of stacking configuration can affect parts made using RFI. Phase 2, the in-situ characterisation of resin saturation during RFI is performed. Results enable a detailed analysis of the way in which resin flows around and inside yarns. Phase 3 consists in the characterisation of void formation during RFI. Two types of voids are observed: flow-induced voids resulting from either the merging of resin flow fronts or the drainage from capillary action; and gas-induced voids resulting from resin volatiles going out of solution and remaining in the resin matrix. In this work, the greatest source of porosity was caused by volatiles. In phase 4, the distribution and filtration of CNTs during RFI processing is characterised. Results show that processing choices can limit filtration and that clustering of CNTs prevents a uniform dispersion of CNTs in PMCs. Finally, the possibility of using RFI for making a multi-scale PMC demonstrator part is investigated. The work culminated with the successful fabrication of a delta-stringer panel. This thesis makes several important contributions to the knowledge pertaining to multi-scale PMC processing and performance, and to RFI. Firstly, it provides a robust description of RFI processing beyond was it available in literature, through in-situ observations of resin flow and void formation. Secondly, it assesses the viability of RFI for producing multi-scale PMCs featuring CNTs. In-situ observations of RFI processing enabled the identification of mechanisms leading to a loss of CNT dispersion during processing, partly explaining the minimal improvements in the interlaminar properties of composites observed when adding CNTs to the matrix. Thirdly, the fabrication of a delta-stringer panel made of a multi-scale PMC was successful, making it the first validation of the scalability of out-of-autoclave RFI processing for manufacturing multi-scale PMCs. The work presented herein contributed to the dissemination of knowledge; one conference paper was presented at ICCM20 (20th International Conference on Composite Materials), and another was presented at CANCOM2017 (10th Canadian-International Conference on Composites), and one journal article written in collaboration with project partners was submitted to Composites Science and Technology.

La perfusion intraveineuse, continue ou intermittente, est un acte courant dans les services de soins bien que non dénué de risque. Différents dispositifs médicaux peuvent être employés pour permettre l’administration parfois simultanée de plusieurs substances actives. Ces dispositifs peuvent, de par leurs caractéristiques propres, générer des fluctuations plus ou moins importantes du débit massique de principe actif, c’est-à-dire la quantité de médicament administrée au patient par unité de temps. Le premier axe de travail concernant ces dispositifs médicaux est l’étude des prescriptions des normes, en particulier les définitions, les méthodes d’essai et les seuils de conformité attendus. Les principaux éléments de physiologie et de mécanique des fluides sont abordés afin d’appréhender la problématique. Cette étude est complétée par l’analyse des données de la littérature concernant l’impact des dispositifs médicaux sur le débit massique des principes actifs délivrés par voie intraveineuse. Une revue systématique de la littérature a été effectuée. Elle porte sur les travaux in vitro ou in vivo se rapportant au sujet et concernant tout élément susceptible de modifier le débit ou la concentration du médicament perfusé. Le premier travail expérimental réalisé in vitro concerne la perfusion simultanée de trois médicaments au moyen d’un dispositif unique de perfusion présentant plusieurs points d’accès. Les trois médicaments étaient perfusés par pousse-seringues et une solution d’hydratation par gravité. Le but de cette étude était d’évaluer l'impact des caractéristiques (volume résiduel et valve anti-retour) de deux dispositifs de perfusion, un premier présentant un très faible volume résiduel (0,046 ml) et une valve anti-retour et le second présentant un volume résiduel élevé (6,16 ml) et sans valve anti-retour) sur le débit massique de trois principes actifs. La quantification simultanée de trois principes actifs en solution (dinitrate d’isosorbide, midazolam et noradrénaline) a nécessité la mise au point d’une méthode multivariée sur spectre UV (régression partial least square (PLS)). Cette technique a permis de doser en continu (1 dosage par seconde) les trois principes actifs à la sortie de la ligne de perfusion. La méthode a été validée dans les échelles de concentrations respectives de 5-60, 10-80 et 2,5-20 µg.mL-1 pour le dinitrate d’isosorbide, le midazolam et la noradrénaline, dans des mélanges binaires et 6,67 à 30, 0,83 à 7,5 et 1,67 à 23,33 µg.ml−1 pour ces mêmes produits, dans des mélanges ternaires. La mise au point du modèle a permis de retenir la zone du spectre située entre 220 et 300 nm associée à un index Q2cum optimal. L’étude de recouvrement, employant le modèle pour prédire les compositions de 8 mélanges ternaires, retrouvait des valeurs de concentrations situées dans un intervalle de 99,5 à 101 % des valeurs théoriques. Les principaux paramètres dans cette étude étaient 1) l'évolution du débit massique des trois médicaments, 2) la valeur du plateau du débit massique à l'équilibre, et 3) l’efficience de perfusion (flow change efficiency (FCE)). Le FCE est obtenu en divisant l’aire sous la courbe du débit massique expérimental en fonction du temps par l’aire sous la courbe du débit massique attendu en fonction du temps. Ce paramètre est calculé pour chaque intervalle de 5 minutes après le début de la perfusion. Les systèmes de perfusion avec un volume résiduel réduit offrent de façon significative un meilleur FCE (53,0  15,4% avec un volume résiduel très faible après 5 minutes de perfusion comparativement à 5,6  8,2% avec un système de perfusion avec un volume résiduel élevé), quel que soient les conditions de changements de débit. Une relation non-linéaire a été établie entre le volume résiduel, le temps depuis le début de la perfusion et le FCE. [...] / Intravenous infusion, whether used continuously or intermittently, is a common feature in healthcare, although not without risk. Various medical devices can be used to administer the infusion, sometimes simultaneously, of several active substances . These devices, because of their characteristics, may generate more or less significant variations in drug mass flow rate, which is the amount of drug delivered per unit of time to the patient. The first part of this work on these medical devices focuses on studying standard requirements and norms, especially definitions, as well as trial methods and expected conformity thresholds. The main elements of physiology and fluid mechanics are also addressed to offer a better grasp of the problems involved. This study is complemented by analyses of published data on the impact of medical devices on drug mass flow rate when delivered intravenously. A systematic review of publications was made, covering in vitro or in vivo studies related to the topic, targeting more particularly any infusion device likely to alter the flow or concentration of the infused drug. The first experimental in vitro work involves the simultaneous infusion of three drugs using a single infusion device with several access points. The three drugs were infused by syringe pump and a hydration solution by gravity. The purpose of this study was to assess the impact of certain features (residual volume and check valve) of two infusion devices (the former with very low residual volume and a check valve and the latter with a high residual volume and no check valve) on the mass flow of three active ingredients. Simultaneous quantification of three active ingredients in solution (isosorbide dinitrate, midazolam and norepinephrine) made it necessary to develop a multivariate method on UV spectrum (partial least square regression (PLS)). This technique meant that the three drugs could be dosed continuously (1 dose per second) at the catheter egress. The method was validated for concentration scales of 5-60, 10-80 and from 2.5 to 20 µg/ml for isosorbide dinitrate, midazolam and noradrenaline in binary mixtures and 6.67 to 30, 0.83 to 7.5 and 1.67 to 23.33 µg/ml for the same products, in ternary mixtures. The perfecting of the model made it possible to maintain the spectral region between 220 and 300 nm with an optimal Q2cum index. The recovery study, performed on prediction sets containing eight different ternary mixtures of isosorbide dinitrate, midazolam and noradrenalin, yielded recovery values ranging from 99.5 to 101% of the theoretic values. The main parameters assessed in this study were 1) the evolution of mass flow rate for the three drugs, 2) the value of the plateau mass flow rate, and 3) flow change efficiency (FCE).. FCE is obtained by dividing the area under the curve of the experimental mass flow in relation to time by the area under the curve of the expected mass flow in relation to time. This parameter was calculated at each 5-minute interval after the start of infusion. Infusion systems with reduced residual volume provided significantly better FCE (53.0  15.4% with very low residual volume after 5 minutes’ infusion compared to 5.6  8.2% with high residual volume), regardless of any changes in flow conditions. A nonlinear relationship was established between residual volume, time since the onset of infusion and FCE. [...]

As the aerospace industry continues to incorporate composites into its aircraft, there will be a need for alternative solutions to the current autoclaving process. Liquid composite molding (LCM) has proven to be a promising alternative, producing parts at faster rates and reduced costs while retaining aerospace grade quality. The most important factor of LCM is controlling the resin flow throughout the fiber reinforcement during infusion, as incomplete filling of fibers is a major quality issue as it results in dry spots or voids. Void formation occurs at the resin flow front due to competition between viscous forces and capillary pressure. The purpose of this work is to characterize capillary pressure in vacuum infusion, and develop a model that can be incorporated into flow simulation. In all tests performed capillary pressure was always higher for the carbon fiber versus fiberglass samples. This is due to the increased fiber packing associated with the carbon fabric. As the fabric samples were compressed to achieve specific fiber volumes an increase in capillary pressure was observed due to the decrease in porosity. Measured values for capillary pressure in the carbon fabric were ~2 kPa, thus the relative effects of Pcap may become significant in flow modeling under certain slow flow conditions in composite processing.

This study determined whether the measures implemented to address barriers to technology infusion changed the technology use patterns of teachers at a middle school. The research question was: Will middle school teachers infuse technology in teaching when the barriers of a lack of time, tools, training, and support are addressed? Document analysis of lesson plans and educational technologist (ET) logs was conducted to analyze the change in the teachers? teaching practices. Interviews were conducted to gather information about the participant?s perceptions of the project and their involvement in using technology in teaching. Observations were conducted to determine whether changes occurred in teaching practices and to confirm information provided by the teachers. Data analysis revealed that the provision of resources did make a difference in teaching practices. Three of the five core teachers changed their teaching practices; two teachers? teaching practices did not change because they faced second order as well as first order barriers to technology integration. Recommendations for practice included (a) leaving the ET at Covington in his ET position and investing in the funding the ET position at the other schools in the district, (b) utilizing the expertise of the core teachers to provide technology training and support for teachers in the district, (c) selecting persons with a strong technology vision who are willing to practice their vision as well as translate their vision into teacher use of technology in instruction. Recommendations for further research were that follow up studies be conducted that (a) determine whether there was a continuation in the integration of technology in teaching after the project no longer operates in the school setting, (b) determine whether the school continued with the model of providing time, tools, training, and support for teachers to integrate technology into their teaching, (c) determine whether the school district implements these measures in other schools, (d) seek to gain a more in-depth understanding of the reasons that teachers fail to integrate technology into teaching when the first order barriers to technology integration have been removed, and (e) address the issue of technology use for instructional purposes and its effects on students? willingness to participate in the learning process.

Les procédés d’élaboration de pièces composites par infusion de résine, malgré leurs nombreux avantages, peinent à s’imposer dans les phases de production industrielle en raison de difficultés pour les maitriser. Ainsi, en partenariat avec ESI Group, un modèle complet pour la simulation de ces procédés est développé à l’ENSM-SE depuis les travaux précurseurs de P. Celle.Nos travaux portent sur la généralisation de ce modèle afin de traiter des cas, ainsi que sur son extension à la simulation des écoulements « post-infusion ». L'approche repose sur un découpage du domaine en trois zones (drainant, préformes imprégnées, préformes sèches) consistant ainsi à coupler un écoulement de Stokes dans le drainant à un écoulement de Darcy dans les préformes. De plus, l'influence mutuelle de la résine sur le comportement des préformes et de la déformation des préformes sur la perméabilité est considérée, à travers la loi de Terzaghi et des lois exprimant la perméabilité en fonction de la fraction de fibres, paramètre accessible uniquement dans une approche 3D mécanique couplée. Enfin, le procédé est découpé en trois phases : compression initiale des préformes sèches, remplissage et « post-infusion ». Les méthodes numériques, développées dans ces travaux, s'appliquent à des cas réels d'infusion souvent mis de côté dans les publications récentes car inaccessibles, impliquant des perméabilités très faibles (~10-15 m²), un drainant fin (~1 mm) et des géométries complexes.Cette approche innovante a été implémentée dans un code de calcul industriel (ProFlotTM), validée analytiquement sur des cas tests et expérimentalement sur des cas industriel dans le cadre du projet européen INFUCOMP. / Composite manufacturing processes by resin infusion, despite their many benefits, struggle to establish themselves in the industrial production phases due to difficulties to control them. So, in partnership with ESI Group, a comprehensive model for the simulation of these processes is developed at the ENSM-SE since the pioneering work of P. Celle.Our work focuses on the generalization of this model to handle complex industrial cases in three dimensions, as well as its extension to “post-infusion” flow simulation. The approach is based on three domains decomposition of the field (Distribution medium, impregnated preforms, dry preforms) consisting in coupling a Stokes flow in the distribution medium with a Darcy flow in the preforms. In addition, the mutual influence of the resin on the preforms and of the preforms deformation on the permeability is considered, through Terzaghi’s law and models expressing the permeability as a function of the fibre fraction, data only accessible with a 3D coupled mechanical approach. Finally, the process is divided into three phases: initial compression of dry preforms, filling and “post-infusion”. The numerical methods developed in this work, apply to real infusion cases often discarded in recent publications, involving very low permeability (~10-15 m²), thin distribution medium (~ 1 mm) and complex geometries (3D curved).This innovative approach has been implemented in an industrial simulation code (ProFlotTM), validated analytically over test cases and experimentally over industrial cases in the European project INFUCOMP.

Volym- och sprutpumpar används inom neonatalvården tillsammans med en specialanpassad kateter. De prematurfödda barnen är mycket känsliga för feldoseringar men det finns minimalt med dokumenterade projekt som undersöker hur väl den distribuerade dosen stämmer överens med den angivna på infusionspumpen. Målet med denna studie var att kontrollera om det fettbaserade läkemedlet Clinoleic flyter tillbaka i det gemensamma blocket, avgöra tiden det tar för läkemedel att flyta fram samt mäta mängden av läkemedel som kommer till mynningen av katetern. Antalet pumpar begränsades till startuppsättningen inom intensivvården på neonatalavdelningen, vilket är fyra pumpar. Mängden av läkemedlet för fem olika flöden undersöktes endast för läkemedlet Peyona med koffeinbas. Projektet genomfördes på Karolinska Universitetssjukhuset och i samarbete med Nya Karolinska Solna förbättrades förståelse för uppsättningens användning. Samtliga sjuksköterskor och ingenjörer vi kom i kontakt med på sjukhusen ansåg att fler studier behöver göras inom distribution av läkemedlen. Tydliga kopplingar kan ses mellan resultat som presenteras i arbetet och misstankar och förväntningar efter samtal med de som jobbar med pumpar. Möjliga framtida experiment som kan ge tydligare riktlinjer inom neonatalvården diskuteras. Det är några anmärkningsvärda resultat som redovisas i studien. De är att Clinoleic flyter bakåt i blocket och att fylla backventilen tar mellan 16 och 25 minuter för de undersökta flödena. Dessutom framgår det att distributionen av Peyona avviker minst för de högre flödena. / Volume and syringe pumps are used in neonatal care together with a customized catheter. The premature born children are extremely sensitive to incorrect dosage, but there are only a short number of documented projects that investigate how well the distributed dose corresponds to that indicated on the infusion pump. The aim of this study was to check whether the fat-based drug Clinoleic flows back into the common block, determine the time it takes for drug to flow and measure the amount of drug that comes to the orifice of the catheter. The number of pumps and drugs was limited to the initial set that is used in intensive care in the neonatal department. The setup consists of four pumps and the drugs Peyona, Clinoleic, Glucos and Sodium Chloride solution. The amount of medicine distributed for five different flows was investigated only for the caffeine-based drug Peyona. The project was implemented at Karolinska Universitetssjukhuset and with help of Nya Karolinska Solna the understanding for the used setup was improved. All nurses and engineers we came into contact with at the hospitals felt that more studies should be done in the subject of the distribution of the drugs. Obvious connections are seen between results that are presented and suspicions and expectations after consultation with those who work with pumps daily. Possible future experiments that provide clearer guidelines for neonatal care are discussed. There are some notable results reported in the study. They are that Clinoleic is flowing back into the block and filling the check valve takes between 16 and 25 minutes for the investigated flows. for the investigated flows and that that the smallest distribution deviation of Peyona is observed in higher flows.

Many large composite structures are manufactured using sandwich laminates to achieve high specific bending strength and stiffness. Examples include wind turbine blades, where self-weight becomes increasingly important as blade size increases. Resin infusion of three-dimensional sandwich laminates can result in complex resin flow paths, and subsequent defect formation, which are difficult to predict. The core material used for sandwich construction and its interaction with liquid resins may also influence the formation of defects, and in the case of balsa this effect can be used to reduce defect severity. In order to evaluate the effect of cored sandwich laminate construction on the formation of defects, this thesis concentrates on the characterisation of commonly used core materials and their interaction with liquid resin under high vacuum conditions. It also considers two numerical flow-modelling packages which are shown to be effective at the prediction of flow front convergence for monolithic laminate, but over-estimate defect severity when modelling air- permeable cored laminates. For balsa core, experiments indicate that the available pore space can act as sink for trapped air, which can aid the reduction of defects where multiple flow fronts converge due to the complexity of flow in sandwich laminates. Empirical data for air absorption and desorption rates in balsa core were obtained using a custom-designed experiment. Using these data a theoretical model was developed that can indicate available pore space, which can inform optimum processing conditions, such as time under vacuum. The diffusion coefficients obtained for air absorption and desorption in balsa are very similar, and lie in the middle of published ranges for hard woods at around 2 x 10 -7 m2/s. The methodology developed for this research project represents actual behaviour of air absorption/desorption during resin infusion, whilst other techniques do not, merely measuring diffusion of air through a sample not allowing for finite pore space. In consequence, infusion strategies can be planned more precisely because core/resin interaction is better understood. Knit line defect formation could be predicted with greater accuracy with suitably modified flow-modelling programs.

Class of 2009 Abstract / OBJECTIVES: To compare possible differences in the proportion of serious potential ADEs associated with high-risk medications that were avoided by the use of AID technology in adult and pediatric ICU patients and to investigate the proportion of serious ADEs associated with high-risk medications as identified by root cause analyses (RCA) that occurred before and after AID implementation. METHODS: Study Site: This retrospective study was conducted at a tertiary care, academic medical center in Tucson Arizona. Design: This was a two-part retrospective study involving data obtained from an AID database and root-cause analyses. Information on high-risk medications obtained from the AID database was used to compare the proportion of serious ADEs avoided by the use of AID technology in adult and pediatric patients. Information on high-risk medications (administered by continuous infusion) obtained from root-cause analyses was used to compare the proportion of serious ADEs that occurred during the 5-year period before and the 5-year period after AID implementation. RESULTS: A total of 261 infusions (225 in the adult and 36 in the pediatric) generated an alert where the final outcome resulted in a reprogramming event when the limit was exceeded by 2.5 times or greater. The pediatric population was 1.68 time (95% CI=1.18 to 2.38) more likely to require a reprogramming event than the adult acute care population for all high-risk medications combined. Significantly more reprogramming events occurred in the pediatric patients with potassium (RR=2.77, 95 CI=1.15 to 6.68) and insulin (RR=2.73, 95% CI=1.15 to 6.45) infusions. Overrides accounted for 80% of the total reprogramming and override events when the maximum limit was exceeded by 10 times or more. There were significantly more overrides in the pediatric compared to the adult population for the high-risk medications (RR=1.82, 95% CI=1.32 to 2.53), however, there were significantly fewer overrides in the pediatric versus adult patients on fentanyl (RR=0.34, 95% CI=0.17 to 0.70). CONCLUSIONS: We found that medication errors involving high-risk medications with the potential to cause ADEs can occur frequently during the administration phase of drug delivery. While smart AIDs cannot intercept all errors, it did show that it was able to intercept certain errors, especially key=pad entry errors. We also determined that when an alert was generated involving our high-risk medications, clinicians were more apt to reprogram the AID when the alert occurred in our pediatric population. While smart pumps have shown great improvement and allow for safer drug delivery, more research is needed in this area before the ability of these smart AIDs to improve drug administration safety can be shown.

Philosophiae Doctor - PhD / The emergence of virulent and drug-resistant bacterial strains such as methicillin-resistant Staphylococcus aureus (MRSA) is a global public health burden. The World Health Organization (WHO) has placed MRSA and vancomycin-intermediate-sensitive S. aureus (VISA) and vancomycin-resistant S. aureus (VRSA) on a high global priority pathogens list of antibiotic-resistant bacteria to promote the research and development of novel and effective antibiotic therapeutic rationales. Uncomplicated S. aureus bacteraemia (e.g., mild skin infections) may be treatable with the conventional regimens of antibiotics, but resistance strains of the bacteria (e.g., invasive infections), often persist as a high load of bacterial DNA in blood, and has been linked to increased mortality in world populations, irrespective of country or location. Several lines of evidence imply that combinations of vancomycin (a glycopeptide antibiotic that targets cell wall synthesis) and ß-lactam antibiotics that target the penicillin-binding proteins (PBPs) improve clearance of MRSA bloodstream infections (BSIs).

Pacientes com hemofilia apresentam predisposição a sangramentos, tanto póstraumáticos como espontâneos, que ocorrem, principalmente nas articulações (hemartroses) e quando recorrentes podem contribuir para o estabelecimento de artropatia hemofílica, o que torna a doença potencialmente incapacitante e dolorosa, e afeta consideravelmente a qualidade de vida (QV) dos portadores. Avaliar a QV desses pacientes dá-nos subsídio para propor medidas visando a melhoria da assistência prestada e o seu bem-estar. Nesse sentido, uma importante ferramenta é o diário de infusão. O objetivo do estudo foi avaliar a QV dos portadores de hemofilia acompanhados pelo ambulatório da Fundação HEMOMINAS no Hemonúcleo Manhuaçu, utilizando ferramentas específicas e implementar o uso do Diário de Infusão como estratégia para incrementar a assistência. Trata-se de um estudo quantitativo descritivo. Para a avaliação da QV, optou-se, por utilizar o modelo de classificação de saúde, denominado CIF proposto pela OMS. Os instrumentos utilizados incluem: questionário sociodemográfico; Haem-A-Qol; Haemo-Qol; HAL, PedHAL; HJHS e FISH. Participaram da pesquisa 30 pacientes, do sexo masculino, portadores de Hemofilia, o que representou 90,9% da amostra elegível. Nos pacientes maiores de 18 anos (n=24), a média de pontuação do Haem-A-Qol foi de 53,39. No HAL, a média foi de 67,26. Já no HJHS, a média foi de 37,33. No FISH, a média foi de 25,96. Nos menores de 18 anos, (n=06), o Haemo-Qol foi respondido por pacientes e seus pais. No questionário respondido pelo paciente o escore médio foi de 50,36, já dos pais, foi de 55,16. No PedHAL, o escore médio dos pacientes foi 88,59 e dos pais 83,15. A pontuação média no HJHS foi de 5,67. Com relação ao FISH, todos atingiram nota máxima. O Diário de Infusão foi construído e implantado como ferramenta para incrementar a assistência com vistas a estimular a melhora progressiva da QV. A QV dos pacientes acompanhados obteve resultados diferentes nas faixas etárias avaliadas, sendo que pacientes mais jovens alcançaram escores melhores. A realidade do manejo da hemofilia é desafiadora. É necessário reorientar o cuidado, o foco não deve ser a doença, é preciso olhar para o indivíduo, que deve ser assistido integralmente e de maneira holística. / Patients with hemophilia are predisposed to bleeding, both post-traumatic as spontaneous, occurring mainly in the joints (hemarthrosis) and, when recurrent, they may contribute to the establishment of hemophilic arthropathy, which makes the disease potentially disabling and painful, and considerably affects the quality of life (QoL) of patients with the disease. Evaluate the QoL of these patients gives us the subsidy to provide measures that aim to improve the assistance provided and the patients well-being. In this regard, through an important edition of the infusion journal it is possible to follow the care provided. The aim of the study was to evaluate the quality of life of hemophilia patients followed by the HEMOMINAS Foundation clinic in Manhuaçu, using specific tools and implement the use of an Infusion Diary as a strategy to increase assistance. This is a descriptive quantitative study. For the evaluation of QoL, it was used the ICF (International Classification of Functioning, Disability and Health) proposed by the WHO. The tools include: a sociodemographic questionnaire; Haem-A-Qol; Haemo-Qol; HAL, pedHAL; HJHS e FISH. 30 male patients with hemophilia joined the study, which represented 90.9% of the eligible sample. In patients older than 18 years (n = 24), the Haem-A-Qol average score was 53.39. In the HAL, the average was 67.26. In the HJHS, the average score was 37.33. In the FISH, the average score was 25.96. In patients under 18 (n = 06), the Haemo-Qol was answered by patients and their parents. In the questionnaire answered by the patient the average score was 50.36, and in the parents\' score was 55.16. In PedHAL, the average score of the patients was 88.59 and their parents 83.15. The average score in the HJHS was 5.67. Regarding FISH, all patients under 18 years of age (n = 06) reached a maximum score and performed all activities without assistance. The journal of infusion was built and implemented as a tool to enhance the assistance, aiming to stimulate the progressive improvement of the quality of life. The quality of life of patients followed was different, younger ones with better results. The reality of hemophilia management is challenging. It is necessary to reorient care, the focus should not be in the disease, it is necessary to look for the individual, who should be fully assisted in the holistic way.