Recent federal legislation has incentivized hospitals to focus on quality of patient care. A primary metric of care quality is patient readmissions. Many methods exist to statistically identify patients most likely to require hospital readmission. Correct identification of high-risk patients allows hospitals to intelligently utilize limited resources in mitigating hospital readmissions. However, these methods have seen little practical adoption in the clinical setting. This research attempts to identify the many open research questions that have impeded widespread adoption of predictive hospital readmission systems. Current systems often rely on structured data extracted from health records systems. This data can be expensive and time consuming to extract. Unstructured clinical notes are agnostic to the underlying records system and would decouple the predictive analytics system from the underlying records system. However, additional concerns in clinical natural language processing must be addressed before such a system can be implemented. Current systems often perform poorly using standard statistical measures. Misclassification cost of patient readmissions has yet to be addressed and there currently exists a gap between current readmission system evaluation metrics and those most appropriate in the clinical setting. Additionally, data availability for localized model creation has yet to be addressed by the research community. Large research hospitals may have sufficient data to build models, but many others do not. Simply combining data from many hospitals often results in a model which performs worse than using data from a single hospital. Current systems often produce a binary readmission classification. However, patients are often readmitted for differing reasons than index admission. There exists little research into predicting primary cause of readmission. Furthermore, co-occurring evidence discovery of clinical terms with primary diagnosis has seen only simplistic methods applied. This research addresses these concerns to increase adoption of predictive hospital readmission systems. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Nursing care is considered a primary predictor of patient assessment of the overall hospital experience. Yet, quality nursing care remains difficult to define. Limited research about nurse or patient perspectives on what constitutes quality nursing care in hospital settings prevents the identification of a shared description or insight into their possible interrelationship. Research about nurse and patient descriptions is needed to establish behaviors, attributes, and activities associated with quality nursing care to improve the health and well-being of hospitalized patients. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

Objetivos: Avaliar a capacidade funcional de pacientes vítimas de trauma um ano após alta hospitalar e verificar associação da capacidade funcional com fatores relacionados ao trauma e à internação hospitalar. Metodologia: Estudo de coorte prospectivo, com pacientes vítimas de trauma grave (Injury Severity Score - ISS >=16), internados entre Junho e Setembro de 2010 em unidade de terapia intensiva (UTI) cirúrgica especializada em paciente politraumatizado de um hospital público de grande porte na cidade de São Paulo, Brasil. Variáveis de interesse como idade, sexo, escore de Glasgow, Acute Physiology and Chronic Health Disease Classification System II (APACHE II), mecanismos de trauma, número de lesões, região corpórea afetada, número de cirurgias, duração da ventilação mecânica (VM) e tempo de internação hospitalar foram coletadas dos prontuários médicos. A capacidade funcional foi avaliada um ano após alta hospitalar utilizando as escalas Glasgow Outcome Scale (GOS) e Escala de Atividades Instrumentais de Vida Diária de Lawton (AIVDL). Os pacientes também foram questionados se haviam retornado ao trabalho ou estudo. Resultados: O seguimento um ano após trauma foi completo em 49 indivíduos, a maioria composta por jovens (36±11 anos), do sexo masculino (81,6%) e vítimas de acidentes de trânsito (71,5%). Cada indivíduo sofreu aproximadamente 4 lesões corporais, acarretando uma média no ISS de 31 ± 14,4. O traumatismo cranioencefálico foi o tipo de lesão mais comum (65,3%). De acordo com a GOS, a maioria dos pacientes apresentou disfunção moderada (43%) ou disfunção leve ou ausente (37%) um ano após o trauma. A escala AIVDL apresentou pontuação média de 12±4 com aproximadamente 60- 70% dos indivíduos capazes de realizar de forma independente a maioria das atividades avaliadas. Escore de Glasgow, APACHE II, duração da VM e tempo de internação hospitalar foram associadas com a capacidade funcional um ano após lesão. A regressão linear múltipla considerando todas as variáveis significativas revelou associação entre a pontuação da escala AIVDL e o tempo de internação hospitalar. Apenas 32,6% dos indivíduos retornaram ao trabalho ou estudo. Conclusões: A maioria dos pacientes vítimas de trauma grave foi capaz de realizar as atividades avaliadas com independência; apenas um terço deles retornou ao trabalho e/ou estudo um ano após alta hospitalar. O tempo de internação hospitalar foi revelado como preditor significativo para a recuperação da capacidade funcional um ano após lesão grave / Objectives: To investigate the functional capacity of trauma survivors at one year after hospital discharge and to verify the association between functional capacity and trauma-related aspects and hospital stay. Methods: This prospective cohort study included severe trauma patients (Injury Severity Score - ISS >= 16) admitted between June and September 2010 to a surgical intensive care unit (ICU) of a large public hospital in São Paulo, Brazil. Variables of interest such as age, gender, Acute Physiology and Chronic Health Disease Classification System II (APACHE II), trauma mechanisms, number of injuries, body region injured, number of surgeries, mechanical ventilation (MV) duration and hospital length of stay (LOS) were collected from patient records. Functional capacity was assessed one year after hospital discharge using the Glasgow Outcome Scale (GOS) and the Lawton Instrumental Activities of Daily Living Scale (LIADL). Patients were also asked if they had returned to work or school. Results: A total of 49 trauma survivors completed 1 year of follow-up. Most subjects were young (36±11 years), male (81.6%) and victims of traffic accidents (71.5%). Each patient suffered approximately 4 injuries, with a mean ISS of 31 ± 14.4. Traumatic brain injury was the most common type of injury (65.3%). According to the GOS, most patients were classified into two categories, indicating moderate dysfunction (43%) or mild or no dysfunction (37%) at one year after trauma. Additionally, the LIADL also showed favorable functional outcomes (average score 12 ± 4); approximately 60-70% of the subjects were able to perform most activities independently. Glasgow score, APACHE II score, MV duration and hospital LOS were factors related to the recovery of functional capacity one year after injury. Multiple linear regression analysis including all variables with statistical power revealed a significant association between the LIADL score and hospital LOS. Only 32.6% of the subjects had returned to work or school. Conclusions: Most severe trauma patients were able to perform the assessed activities independently, although only a third had returned to work or school one year after hospital discharge. Hospital LOS was identified as a significant predictor of functional capacity recovery one year after severe injury

Trata-se de estudo avaliativo, fundamentado no referencial de avaliação de estrutura, processo e resultado, do tipo quantitativo descritivo de corte transversal com momento, no desenho da pesquisa, de sistematização e análise de dados qualitativos. Objetivou-se avaliar a atenção à saúde aos usuários com diabetes mellitus em um Centro de Saúde Escola em Ribeirão Preto, SP. Compuseram a amostra 150 sujeitos. Para coleta de dados, entre agosto e outubro de 2012, utilizaram-se prontuários e técnica de observação direta. No momento qualitativo foram entrevistados 20 sujeitos, pertencentes à amostra, por meio de entrevistas semiestruturadas. Utilizou-se estatística descritiva e teste qui-quadrado, considerando a Avaliação de Cuidados em Saúde proposta por Donabedian. Na análise das entrevistas, para compreensão da satisfação dos usuários, compondo a avaliação dos resultados, foi utilizada a técnica da Análise de Conteúdo na categoria Temática. Os resultados mostraram que a maioria dos usuários era do sexo feminino, na faixa etária de 50-59 anos; 56,6% eram acompanhados por médico especialista, 70,7% apresentavam duas ou mais comorbidades e 32,7% utilizavam a combinação de antidiabético oral e insulina. A estrutura física atende as recomendações preconizadas pela Agência Nacional de Vigilância Sanitária e a equipe mínima estabelecida pelo Ministério da Saúde para atendimento aos usuários com diabetes mellitus. Os recursos materiais, medicamentos e insumos atendem as necessidades dos usuários. No processo, os registros eram predominantemente de profissionais médicos, sendo 3,3% de enfermeiros. No registro de atividades técnicas, o peso corporal foi o único parâmetro identificado na totalidade dos prontuários seguido de 85,3% da pressão arterial e 40% da altura. O cálculo do índice de massa corporal foi registrado em 31,3% dos prontuários e a medida da circunferência abdominal em 2,6%. O perfil glicêmico teve maior frenquência de registro, seguido do perfil lipídico. Quanto às estratégias educativas para autocuidado verificou-se a ausência de registros detalhados nos prontuários e o registro de atividade física predominantemente referente à prescrição de caminhada. Nas consultas de enfermagem, predominaram orientações acerca do uso de insulina e nos atendimentos realizados por auxiliares e técnicos observou-se principalmente a verificação de peso na pré-consulta e orientação das prescrições e agendamento de retorno na pós consulta. No componente resultado, constatou-se o atendimento apenas da exigência do indicador LDL colesterol <100mg/dl. Houve associação estatisticamente significativa entre idade e hemoglobina glicada acima de 7% (p=0,004). Na avaliação da satisfação do usuário foram elaboradas duas categorias temáticas 1: a acessibilidade organizacional- a percepção do usuário e 2- o cuidado ao usuário com diabetes mellitus- a longitudinalidade em foco. No agendamento de retorno de consultas a maioria relatou insatisfação. No fluxo interno de atendimento pelos profissionais e a espera no serviço para consulta ou realização de exames foi identificada insatisfação. No acompanhamento observou-se que o usuário identificava o ambulatório de especialidades como fonte regular de cuidado. A assistência prestada por diferentes profissionais a cada atendimento revelou-se como fragilidade do vínculo terapêutico. Considera-se o referido estudo como possível instrumento de avaliação no atendimento aos usuários diabéticos e na tomada de decisões para reestruturar o referido Centro em face às fragilidades constatadas / This evaluation study was based on the classical reference framework of structure, process and outcome assessment. The design was quantitative, descriptive and cross-sectional and involved the systemization and analysis of qualitative data. The objective was to assess health care delivery to diabetes mellitus patients at a Teaching Health Center in Ribeirão Preto/SP. The sample consisted of 150 subjects. Data were collected between August and October 2012, using patient files and the direct observation technique. In the qualitative phase, 20 sample subjects participated in semi-structured interviews. Descriptive statistics and the chi-square test were used, in view of Donabedian\'s Health Care Assessment. In the analysis of the interviews, Thematic Content Analysis was used. The results showed that most users were female, in the age range from 50 to 59 years; 56.6 % were being monitored by a specialist physician. 70.7% of the patients suffered from two or more comorbidities and 32.7% combined oral anti-diabetic medicines and insulin. The physical structure complies with the recommendations of the Brazilian National Health Surveillance Agency and the minimal team established by the Ministry of Health for care delivery to diabetes mellitus patients. The material resources, medicines and inputs attend to the users\' needs. In the process, the records predominantly come from medical professionals, with 3.3% nurses. In technical records, body weight was the only parameter identified in all patient files, followed by 85.3% blood pressure and 40% height. In 31.3% of the files, the calculation of the body mass index was registered and, in 2.6%, the abdominal circumference measure. The glucose profile was more frequently registered, followed by the lipid profile. As regards the educative strategies for self-care, no detailed records were found in the files, while physical activity records predominantly related to the prescription of walking. During the nursing consultations, orientations about insulin use were predominant and, during care by auxiliary nurses and nursing technicians, the verification of the patient\'s weight predominated during the pre-consultation and orientations regarding prescriptions and scheduling of return appointments during the post-consultation. In the outcome component, only the requirement related to LDL cholesterol < 100mg/dl was complied with. A statistically significant association of more than 7% was found between age and glycated hemoglobin (p= 0.004). In the assessment of users\' satisfaction, two thematic categories were elaborated 1: Organizational accessibility: the user\'s perception and 2: Care delivery to DM patients: a longitudinal focus. The majority reported dissatisfaction with regard to the scheduling of return appointments. Concerning the internal professional care flow and waiting times at the service to get a consult or take tests, dissatisfaction was mentioned. In terms of monitoring, the user identifies the specialty outpatient clinic as a regular source of care. The fact that the professionals delivering care differ between appointments revealed to be a weak point for therapeutic bonding. This study is considered as a possible assessment instrument in care delivery to diabetic patients and in decision making with a view to the restructuring of the Center, considering the weak points identified.

Introdução: Interrupção diária da sedação e sedação intermitente são efetivas na redução do tempo de ventilação mecânica. No entanto, a superioridade de uma em relação à outra não foi ainda determinada. Nosso objetivo foi comparar a interrupção diária da sedação e a sedação intermitente quanto à duração da ventilação mecânica em uma unidade de terapia intensiva (UTI) com baixa densidade de pessoal de enfermagem. Métodos: Pacientes adultos com expectativa de permanecerem por mais de 24h em ventilação mecânica foram randomizados, em um centro único, à interrupção diária da infusão de sedativos e opioides ou à sedação intermitente. Em ambos os casos, o objetivo era manter os pacientes em nível de SAS (Sedation Agitation Scale) 3 ou 4, ou seja, os pacientes deveriam estar calmos ou serem facilmente despertos com estímulo verbal ou leve sacudida. O desfecho primário foi número de dias livres da ventilação mecânica em 28 dias. Os desfechos secundários foram mortalidade na UTI e hospitalar, incidência de delirium, carga de trabalho da enfermagem, extubação acidental e stress psicológico seis meses após a alta da UTI. Resultados: Foram incluídos 60 pacientes. Não houve diferenças quanto ao número de dias livres em 28 dias entre interrupção diária da sedação e sedação intermitente (mediana: 24 vs. 25 dias, P = 0,160). Também não houve diferenças quanto à mortalidade na UTI (40 vs. 23,3%, P = 0,165) ou hospitalar (43,3 vs. 30%, P = 0,284), incidência de delirium (30 vs. 40%, p = 0,472), extubação acidental (3,3 vs. 6,7%, P = 0,514) e stress psicológico seis meses após a alta da UTI. A carga de trabalho de enfermagem não foi diferente entre os dois grupos, mas reduziu-se no quinto dia de internação na UTI em comparação com o primeiro dia [Nurse Activity Score (NAS) no grupo sedação intermitente foi 54 no dia 1vs. 39 no dia 5, P < 0.001; NAS no grupo interrupção diária da sedação foi 53 no dia 1 vs. 38 no dia 5, P < 0.001]. As dosagens de fentanil e midazolam por paciente foram maiores no grupo interrupção diária da sedação. O volume corrente foi maior no grupo sedação intermitente durante os primeiros cinco dias de internação na UTI. Conclusões: Não houve diferenças quanto ao número de dias livres de ventilação mecânica em 28 dias entre os grupos. Sedação intermitente associou-se a um menor uso de sedativos e opioides / Introduction: Daily sedative interruption and intermittent sedation are effective in abbreviating the time on mechanical ventilation. Whether one is superior to the other has not yet been determined. Our aim was to compare daily interruption and intermittent sedation during the mechanical ventilation period in a low nurse staffing intensive care unit (ICU). Methods: Adult patients expected to need mechanical ventilation for more than 24 hours were randomly assigned, in a single center, either to daily interruption of continuous sedative and opioid infusion or to intermittent sedation. In both cases, our goal was to maintain a Sedation Agitation Scale (SAS) level of 3 or 4; that is patients should be calm, easily arousable or awakened with verbal stimuli or gentle shaking. Primary outcome was ventilator-free days in 28 days. Secondary outcomes were ICU and hospital mortality, incidence of delirium, nurse workload, self-extubation and psychological distress six months after ICU discharge. Results: A total of 60 patients were included. There were no differences in the ventilator-free days in 28 days between daily interruption and intermittent sedation (median: 24 versus 25 days, P = 0.160). There were also no differences in ICU mortality (40 versus 23.3%, P = 0.165), hospital mortality (43.3 versus 30%, P = 0.284), incidence of delirium (30 versus 40%, P = 0.472), self-extubation (3.3 versus 6.7%, P = 0.514), and psychological stress six months after ICU discharge. Also, the nurse workload was not different between groups, but it was reduced on day 5 compared to day 1 in both groups (Nurse Activity Score (NAS) in the intermittent sedation group was 54 on day 1versus 39 on day 5, P < 0.001; NAS in daily interruption group was 53 on day 1 versus 38 on day 5, P < 0.001). Fentanyl and midazolam total dosages per patient were higher in the daily interruption group. The tidal volume was higher in the intermittent sedation group during the first five days of ICU stay. Conclusions: There was no difference in the number of ventilator-free days in 28 days between both groups. Intermittent sedation was associated with lower sedative and opioid doses

Introdução: A Doença do Refluxo Gastroesofágico (DRGE) possui elevada prevalência e morbidade. O tratamento clínico consiste em recomendações quanto ao estilo de vida e, essencialmente, no uso de inibidores da bomba protônica (IBP). A aderência (Ad) dos pacientes com DRGE à prescrição, embora fundamental para o sucesso terapêutico, tem sido pouco estudada. Objetivo: Avaliar a Ad ao tratamento com IBP e possíveis variáveis relacionadas em pacientes com DRGE. Métodos: Estudo transversal e prospectivo com 240 pacientes adultos consecutivos com DRGE erosiva e não-erosiva (ne-DRGE) que haviam recebido dose padrão ou dose dobrada de omeprazol em uso contínuo. Todos os pacientes foram classificados conforme o grau, segundo os achados da endoscopia digestiva alta (EDA) em ne-DRGE (162; 67,5%), classificação endoscópica de Los Angeles (LA) A (48; 20,0%), LA B (21; 8,6%), LA C (1; 0,4%), LA D (1; 0,4%) e Barrett (7; 2,9%). Foi aplicado o questionário de Morisky et al constituído de 4 questões com respostas dicotômicas para avaliar a Ad, classificando-a como baixa (0-2 pontos) e alta ad (3-4 pontos). Foi também aplicado o questionário QS-DRGE para a avaliação dos sintomas, com 10 questões com escores de 0 a 50, conforme a frequência menor ou maior dos sintomas. Os resultados de Ad foram relacionados com os dados sócio-demográficos, polifarmácia (PF) (uso de mais de cinco medicamentos diariamente), comorbidades (CM), tempo de tratamento (TT), escore QS-DRGE, presença de sintomas descrita em prontuário, achados da EDA e conhecimento do paciente sobre a doença. Resultados: (1) 126 pacientes (52,5%) apresentaram alta Ad e 114 (47,5%) baixa Ad; (2) Os pacientes mais jovens (p = 0,002) foram menos aderentes; (3) Pacientes sintomáticos de acordo com relato em prontuário apresentaram maior percentual de baixa Ad e 2 vezes maior probabilidade de ter baixa Ad em relação aos assintomáticos (p = 0,02); (4) Os pacientes casados apresentam probabilidade 2,41 vezes maior de ter baixa Ad do que os viúvos. (5) As demais variáveis estudadas não influenciaram a Ad ao tratamento. Conclusões: Pacientes em uso de IBP em tratamento ambulatorial em hospital terciário em São Paulo apresentaram grande percentual de baixa Ad ao tratamento, sendo esta uma possível causa da falha da terapia com IBP. Idade < 60 anos e estado civil casado podem ser fatores de risco para a baixa Ad / Introduction: The Gastroesophageal Reflux Disease (GERD) is a highly prevalent disease and a major cause of morbidity. Clinical treatment is based on lifestyle recommendations and, essentially, in the use of a proton pump inhibitor (PPI). Adherence (Ad) of GERD patients to the prescribed treatment, although critical for therapeutic success, has been little studied. Objective: Assess adherence to the PPI treatment and potential associated variables in patients with GERD. Case studies and Methods: Transversal and prospective study with 240 consecutive adult patients, diagnosed with erosive GERD (e-GERD) and non-erosive GERD (ne-GERD) for whom continuous use of the standard dose or the double dose of omeprazol had been prescribed. Patients were ranked according to the findings of high digestive endoscopy (HDE) in ne-GERD (162; 67.5%); e-GERD: Los Angeles (LA) endoscopic classification A (48; 20.0%), LA B (21; 8.6%), LA C (1; 0.5%), and LA D (1; 0.5%) and Barretts esophagus (7; 2.9%). The Morisky questionnaire, that includes four questions with dicotomic responses to assess Ad, was applied. Ad was classified as low (0-2 points) and high (3-4 points). In addition, the QS-GERD questionnaire was applied to assess symptoms, using 10 questions with score 0 to 50, according to the greater or lesser symptom frequency. Ad results were correlated with personal data (gender and age), demography, polypharmacy (PF), comorbidities (CM), treatment time (TT), QS-GERD scores, symptoms described in the patients record, HDE findings and patient awareness about the disease. Results: (1) 126 patients (52.5%) exhibited high Ad and 114 (47.5%) low Ad; (2) younger patients (p = 0,002) were less compliant; (3) married patients had a 2.41 greater probability to exhibit low Ad as compared to widowers (p = 0.03); (4) patients with symptoms indicated in the patients record exhibited a lower Ad rate and twice greater probability of exhibiting low Ad as compared to asymptomatic patients (p = 0.02); (5) the other variables studied had no influence on treatment adherence. Conclusion: Patients using PPI as out-patients in third care hospital in São Paulo exhibited high rate of reduced treatment adherence, and this may be a potential cause of PPI therapy failure. Age < 60 years and marital status may be risk factors for low adherence

The implantable cardioverter defibrillator (ICD) is an electronic medical device that was invented by Dr. Michael Mirowski and his team in 1980. The purpose of the ICD, which is implanted in a person's chest, is to sense and shock the heart when detecting a lethal cardiac arrhythmia into a rhythm that can sustain life. While the ICD saves lives, it also has the potential to deliver painful shocks when it is activated. The ICD was initially inserted in people who had survived a sudden cardiac arrest; the device is now being implanted in older adults with heart failure and no known history of cardiac arrhythmias. When talking with patients and personal family members who had an ICD, it was unclear what influenced their decision to have an ICD implanted. Understanding the experience of decision-making for older adults who had an ICD has added to nursing knowledge, practice, and education when working with people who had an ICD inserted. To understand the lived experience, the researcher conducted a phenomenological research study, guided by the theoretical lens of Paterson and Zderad's (1976/1988) humanistic nursing and analyzed the data as outlined by Giorgi (2009). The results of the study indicated the participants' lived experience of decision-making for older adults who had an implantable cardioverter defibrillator inserted was influenced by the following : trust in their physician's decision; accepting the device was necessary; the decision was easy to make; and hope and desire to live longer. / by Louise A. Lucas. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Patients who are hospitalized and are without voice would like to participate in their care. This requires clear communication. Speak for Myself™ (SFM) was developed for use at the bedside so that communication may be facilitated between patient and nurse when the patient is voiceless. The objective of this study was to evaluate Speak for Myself™ at the bedside and to measure the outcomes. This was a mixed methods, one group pre-test-post-test, quasi-experimental study. Twenty adult patients in three hospitals in South Florida agreed to use Speak for Myself™ during their acute care hospital stay (M = 8.86 hours). This group of participants (n = 20) ranged from 45 to 91 years old (males = 14; females = 6). Of the participants, 15 (75%) self-identified as European American, 2 (10%) self-identified as Hispanic, 2 (10%) self-identified as African American, and 1 (5%) self-identified as Asian. Ten of the participants (50%) were in respiratory failure. Two (10%) were receiving oxygenation measures related to unspecified complications of their illnesses. Of the remaining eight participants (40%), one each was receiving oxygenation measures due to atrial fibrillation, arteriosclerotic heart disease, cardiogenic shock, endocarditis, neck abscess, renal failure, status post seizure activity, and tongue metastasis. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Submitted by PPG Odontologia (odontologia-pg@pucrs.br) on 2018-03-28T17:56:00Z No. of bitstreams: 1 ALEXANDRE_WEBER_DIS.pdf: 783948 bytes, checksum: 88cfac1ab658550afa3a87b25b872da9 (MD5) / Rejected by Tatiana Lopes (tatiana.lopes@pucrs.br), reason: Devolvido devido ? falta de folha de rosto no pdf. on 2018-04-12T12:05:10Z (GMT) / Submitted by PPG Odontologia (odontologia-pg@pucrs.br) on 2018-05-29T12:15:20Z No. of bitstreams: 1 ALEXANDRE_WEBER_DIS.pdf: 783948 bytes, checksum: 88cfac1ab658550afa3a87b25b872da9 (MD5) / Rejected by Sheila Dias (sheila.dias@pucrs.br), reason: Devolvido novamente devido ? falta de folha de rosto no pdf . on 2018-06-07T12:52:13Z (GMT) / Submitted by PPG Odontologia (odontologia-pg@pucrs.br) on 2018-06-08T19:05:42Z No. of bitstreams: 1 ALEXANDRE_WEBER_DIS.pdf: 359121 bytes, checksum: 86424efdd5d668baacef118324363a8f (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-06-19T11:16:25Z (GMT) No. of bitstreams: 1 ALEXANDRE_WEBER_DIS.pdf: 359121 bytes, checksum: 86424efdd5d668baacef118324363a8f (MD5) / Made available in DSpace on 2018-06-19T11:45:42Z (GMT). No. of bitstreams: 1 ALEXANDRE_WEBER_DIS.pdf: 359121 bytes, checksum: 86424efdd5d668baacef118324363a8f (MD5) Previous issue date: 2017-12-20 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Objetivo: Comparar, em pacientes tratados com pr?tese total da articula??o temporomandibular (ATM), a qualidade de vida relacionada ? sa?de bucal antes e ap?s a cirurgia, utilizando a forma curta do perfil de impacto na sa?de bucal (OHIP-14). Material e M?todos: Os participantes foram convidados a completar o OHIP-14 antes da cirurgia (T0) e aos 2 meses (T1), 6 meses (T2) e 1 ano ap?s a cirurgia (T3). A intensidade da dor e a gravidade dos sintomas foram avaliadas usando uma escala visual anal?gica (EVA). Resultados: Dez pacientes tratados com pr?tese de ATM com acompanhamento de 1 ano foram inclu?dos. Entre T0 e T3, os escores m?dios diminu?ram significativamente de 1,1 ? 1,0 para 0,1 ? 0,2 na limita??o funcional, de 3,4 ? 0,6 para 0,0 ? 0,1 em dor f?sica, de 2,9 ? 0,9 para 0,1 ? 0,2 em desconforto psicol?gico, de 2,2 ? 1,5 para 0,1 ? 0,3 em defici?ncia f?sica e de 1,7 ? 0,9 para 0,0 ? 0,0 em defici?ncia psicol?gica (p <0,001 para todas as compara??es). Houve tamb?m uma diminui??o significativa no escore total m?dio de OHIP-14 entre T0 (12,32 ? 5,18) e T3 (0,44 ? 0,65) (p <0,001). Observou-se melhora significativa na dor na ATM de T0 a T3 (p <0,001), com melhorias tamb?m observadas na dor de cabe?a e na fadiga muscular. Conclus?es: Nossos resultados sugerem que a reposi??o total da ATM reduz os sintomas e a dor, levando a uma melhora na qualidade de vida dos pacientes e no bem-estar psicol?gico. / Objective: To compare, in patients treated with total temporomandibular joint (TMJ) prostheses, oral health-related quality of life before and after surgery using the short form of the Oral Health Impact Profile (OHIP-14). Material and Methods: Participants were asked to complete the OHIP-14 before surgery (T0) and at 2 months (T1), 6 months (T2), and 1 year after surgery (T3). Pain intensity and symptom severity were rated using a visual analogue scale (VAS). Results: Ten patients treated with TMJ prostheses completed the 1-year follow-up and were included. Between T0 and T3, mean scores decreased significantly from 1.1?1.0 to 0.1?0.2 in functional limitation, from 3.4?0.6 to 0.0?0.1 in physical pain, from 2.9?0.9 to 0.1?0.2 in psychological discomfort, from 2.2?1.5 to 0.1?0.3 in physical disability, and from 1.7?0.9 to 0.0?0.0 in psychological disability (p < 0.001 for all comparisons). There was also a significant decrease in the mean total OHIP-14 score between T0 (12.32?5.18) and T3 (0.44?0.65) (p < 0.001). Significant improvement was observed in TMJ pain from T0 to T3 (p < 0.001), with improvements also seen in headache and muscle fatigue. Conclusions: Our results suggest that total TMJ replacement reduces symptoms and pain, leading to an improvement in patients? quality of life and psychological well-being.

O cuidado integral ao idoso pode ser garantido mediante a utilização do Processo de Enfermagem (PE), aliado a um referencial teórico como, por exemplo, o Modelo Multidimensional de Envelhecimento bem Sucedido (MMES), que possui uma proposta de avaliação do idoso. Há, contudo, uma lacuna para a sua utilização, uma vez que não há estudos que comprovem a sua eficácia na prática clínica da Enfermagem associado à aplicação de sistemas de classificação da disciplina como a NANDA-I, NIC e NOC. O objetivo deste estudo é construir um modelo multidimensional de cuidado ao idoso associado aos Sistemas de Linguagens Padronizadas de Enfermagem NANDA-I, NIC e NOC, aplicável à consulta de enfermagem. O estudo foi conduzido em duas etapas metodológicas distintas. A primeira compreendeu um estudo de validação de conteúdo enquanto a segunda uma pesquisa de resultados, que contemplou um estudo quase experimental. As amostras foram constituídas de 15 especialistas em Enfermagem Gerontológica e 28 idosos em primeira consulta na Cidade do Idoso, local do estudo, com idade igual ou superior a 60 anos, que apresentaram o diagnóstico de enfermagem Risco de Síndrome do Idoso Frágil (RSIF) ou Síndrome do Idoso Frágil (SIF), no período de maio a outubro de 2017. Após a validação do conteúdo do modelo multidimensional, com a opinião dos especialistas, efetuou-se a sua aplicação aos idosos em quatro consultas de enfermagem para cada um. Durante as consultas estabeleceram-se os diagnósticos, mensuraram-se os resultados e implementaram-se as intervenções de enfermagem, conforme o modelo e a avaliação clínica. Os especialistas validaram informações da anamnese e exame físico referentes às características definidoras, fatores relacionados e de risco dos dois diagnósticos e às dimensões fisiológica, psicológica e social, conforme propõe o MMES. A validação também confirmou que dos 13 diferentes resultados de enfermagem validados, 10 foram comuns em ambos os diagnósticos. Os resultados validados para os dois diagnósticos avaliaram Equilíbrio (0202), Cognição (0900), Estado nutricional (1004), Autocontrole da doença crônica (3102), Conhecimento: controle da dor (1843), Participação em programa de exercício físico (1633), Conhecimento: controle da doença crônica (1847), Conhecimento: prevenção de quedas (1828), Conhecimento: controle do peso (1841) e Estado de conforto (2008). Apenas dois dos 13 resultados foram validados para o diagnóstico SIF, sendo eles: Nível de fadiga (0007) e Autocuidado: atividades da vida diária (0300), e um resultado, Conhecimento: medicamento (1808), foi validado apenas para o diagnóstico RSIF. As intervenções de enfermagem da NIC, validadas para os dois diagnósticos de enfermagem, foram praticamente iguais. Das oito diferentes intervenções validadas apenas a Assistência ao Autocuidado (1800) foi validada exclusivamente para o diagnóstico SIF e as outras sete foram validadas para os dois diagnósticos. As intervenções destacam a importância da Promoção do exercício (0200), Aconselhamento nutricional (5246), Controle de medicamentos (2380), Estimulação cognitiva (4720), Melhora na socialização (5100), Prevenção contra quedas (6490) e Ensino sobre o processo da doença (5602). A segunda etapa mostrou que dos 28 idosos a maioria era do sexo feminino (17 - 60,7%), com idade média de 65,6 ± 6,3 anos e, desses, 23 idosos foram diagnosticados com RSIF e cinco com SIF. Dos resultados de enfermagem utilizados para avaliar idosos com RSIF e SIF percebeu-se melhora significativa na média dos escores dos seus indicadores: Participação em programa de exercício físico; Autocontrole da doença crônica; 7 Conhecimento: controle da doença crônica; Conhecimento: controle do peso; Conhecimento: prevenção de quedas e Estado de conforto. Os resultados Estado nutricional e Conhecimento: controle da dor tiveram melhora significativa nos escores dos indicadores somente para idosos com RSIF, assim como a avaliação do Autocuidado: atividades da vida diária para idosos com SIF. As intervenções que apresentaram efetividade estatisticamente significativa na utilização de suas atividades em idosos, com ambos os diagnósticos, foram: Ensino: processo da doença e Promoção do exercício, enquanto a intervenção Prevenção contra quedas foi encontrada somente em idosos com RSIF. Conclui-se que as sete intervenções de enfermagem validadas pelos especialistas foram implementadas aos idosos com diagnóstico de enfermagem RSIF e foram consideradas efetivas, tendo como base a avaliação de nove resultados que apontaram melhora significativa na comparação entre as médias da primeira e quarta consultas. Dentre as oito intervenções de enfermagem implementadas aos idosos com diagnóstico de enfermagem SIF, sete foram consideradas efetivas, tendo como base a avaliação de 11 resultados que apontaram melhora significativa na comparação entre as médias da primeira e quarta consultas. Dessa forma, conclui-se ainda, que o modelo multidimensional de cuidado ao idoso associado aos SLP contribui para a prática assistencial do enfermeiro na consulta de enfermagem, com vistas ao envelhecimento bem sucedido. Dentre as importantes implicações e contribuições dos resultados desta pesquisa está a possibilidade de apoiar a ligação entre resultados e intervenções validados com os diagnósticos de enfermagem RSIF e SIF, facilitando a avaliação de enfermagem e os cuidados de enfermagem aos idosos na prática clínica. Além disso, recomenda-se a construção de definições operacionais para os indicadores dos resultados de enfermagem. Uma limitação do estudo foi o fato de realizarmos a pesquisa com especialistas do mesmo país. / Comprehensive care for the elderly can be guaranteed through the use of the Nursing Process (PE), together with a theoretical framework such as the Multidimensional Model of Successful Aging (MMSA), which has a proposal for the evaluation of the elderly. There is, however, a gap to its use, since there are no studies that prove its effectiveness in the clinical practice of Nursing associated with the application of discipline classification systems such as NANDA-I, NIC and NOC. The objective of this study is to build an elderly care multidimensional model associated with the standardized NANDA-I, NIC and NOC Nursing language systems, applicable to the nursing consultation. The study was conducted in two different methodological steps. The first comprised a content validation study while the second a results research, which included a quasi-experimental study. The samples consisted of 15 specialists in Gerontology Nursing and 28 elderly people in a first consultation in the City of the Elderly, place of study, with age equal to or greater than 60 years, of both sexes, who presented the diagnosis of Nursing Risk of Syndrome of the Elderly (RSIF) or Fragile Elderly Syndrome (SIF), from May to October 2017. After the validation of the multidimensional model content, with the opinion of the specialists, it was applied to the elderly in four every elderly person. During the consultations the diagnoses were established, the results were measured and the Nursing interventions were implemented, according to the multidimensional model and the clinical evaluation. The specialists validated information about the anamnesis and the physical examination referring to the defining characteristics, related and risk factors of the two diagnoses and the physiological, psychological and social dimensions, as proposed by the MMSA. Validation also confirmed that of the 13 different validated Nursing outcomes, 10 were common in both diagnoses. The results validated for the two diagnoses evaluated: Equilibrium (0202), Cognition (0900), Nutritional status (1004), Self-control of chronic disease (3102), Knowledge: pain control (1843), Knowledge: control of chronic disease (1847), Knowledge: prevention of falls (1828), Knowledge: weight control (1841) and Comfort state (2008). Only two of the 13 results were validated for SIF diagnosis, being: Fatigue level (0007) and Self-care: activities of daily living (0300), and a result, Knowledge: medicine (1808), was validated only for the diagnosis RSIF. The Nursing interventions of the NIC, validated for the two Nursing diagnoses, were practically the same. Of the eight different validated interventions, only Self-care Assistance (1800) was validated exclusively for SIF diagnosis and the other seven were validated for both diagnoses. The interventions emphasize the importance of Promoting Exercise (0200), Nutrition Counseling (5246), Medication Control (2380), Cognitive Stimulation (4720), Improving Socialization (5100), Fall Prevention (6490) and Teaching the Process of the disease (5602). The second stage showed that of the 28 elderly, the majority were female (17-60.7%), with a mean age of 65.6 ± 6.3 years, and of these, 23 elderly were diagnosed with RSIF and five with SIF. Nursing results used to evaluate the elderly with RSIF and SIF showed a significant improvement in the mean of the scores of their indicators: Knowledge: control of chronic disease; Self-control of chronic disease; Knowledge: prevention of falls; Weight control; State of comfort and Participation in physical exercise program. The results Knowledge: pain control and nutritional status had significant improvement in the scores of indicators only for the elderly with RSIF, as well as the self-care evaluation: daily life activities for elderly with 9 SIF. The interventions that presented a statistically significant reduction in the use of their activities in the elderly, with both diagnoses, were Teaching: disease process and Exercise promotion, while the intervention Prevention of falls was found only in the elderly with RSIF. It is concluded that the seven nursing interventions validated by the specialists were implemented to the elderly with a diagnosis of RSIF Nursing and were considered effective, based on the evaluation of nine results that indicated a significant improvement in the comparison between the means of the first and fourth visits. Among the eight Nursing interventions implemented to the elderly with SIF Nursing diagnosis, seven were considered effective, based on the evaluation of 11 results that indicated a significant improvement in the comparison between the means of the first and fourth visits. Thus, it can be concluded that the multidimensional model of elderly care associated with standardized Nursing language systems contributes to the nurses practice in the nursing consultation, with a view to successful aging. Among the important implications and contributions of the results of this research is the possibility of supporting the link between results and validated interventions with the RSIF and SIF, facilitating nursing assessment and nursing care for the elderly in clinical practice. In addition, it is recommended to construct operational definitions for indicators of nursing outcomes. One limitation of the study was the fact that we conducted the research with specialists from the same country.