Thesis (M.H.A.)--University of Michigan, 1970.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2004. / Restricted until May 2005. Bibliography: leaves 97-99.

Introdução: A Associação Internacional para o Estudo da Dor (IASP) tem estimulado a organização de Programas de Tratamento de Dor Aguda (SDAP) para um manejo mais efetivo, bem como avaliar seu impacto em desfechos passiveis de mensuração. Estudos têm sido conduzidos para mostrar a necessidade dos hospitais organizarem serviços de dor aguda pós-operatória, com vistas a melhora do tratamento da dor e para avaliar o processo de recuperação do paciente, redução do tempo de internação consequente ao uso de técnicas analgésicas mais eficazes. Então o objetivo deste estudo foi comparar o tempo de internação de pacientes submetidos a cirurgias eletivas com alta probabilidade de apresentarem dor pós operatória intensa sob os cuidados de uma equipe multidisciplinar especializada do SDAP comparado a uma coorte submetida a procedimentos cirúrgicos equivalentes no mesmo período, que tiveram seu tratamento da dor pós-operatório sob o cuidado da cirurgia equipe. Métodos: trata-se de uma coorte naturalista, retrospectiva, que incluiu 1011 pacientes com idade superior a 18 anos, de ambos os sexos submetidos à cirurgia eletiva de grande porte, tais como cirurgias torácicas com toracotomia, cirurgias proctológicas com abertura da cavidade abdominal e cirurgias ortopédicas para prótese de joelho e quadril. Os dados foram obtidos a partir do pontuaria o eletrônico do Hospital de Clinicas de Porto Alegre (HCPA) no período compreendido entre 2011 e 2015. Resultados: Avaliamos retrospectivamente 1050 pacientes assim distribuídos [cirurgia proctológica 506 (50,4%), cirurgia torácica 216 (21,36%) e cirurgia ortopédica 293 (29,17%)]. A média (SD) da internação hospitalar em pacientes sob o atendimento do SDAP foi de 7,84 (4,41) comparado controles correspondentes sob o cuidado da equipe cirúrgica, que apresentaram uma média (SD) de internação de 9,72 (8,64), respectivamente. Foram fatores associados com prolongada internação pós-operatória a mortalidade pós-operatória, reoperação cirúrgica e pacientes que necessitaram de terapia intensiva pós-operatória. Conclusão: Estes resultados sustentam a hipótese de que uma mudança no cuidado pós-operatório de pacientes submetidos a cirurgias com propensão para dor pós-operatória intensa, sob os cuidados de uma equipe multidisciplinar especializada do SDAP reduziu o tempo de internação pós-operatório comparado aos pacientes submetidos a cirurgias equivalentes com o tratamento da dor pós-operatória aos cuidados da equipe assistente. / Background: The American Pain Society stimulate to organize Programs of the Acute Pain Services (APS) fora most efficient pain management, as well to assesses its impact on the measurable outcomes. Studies around the world remind us of the imminent need for hospitals maintain service acute postoperative pain, since it is known that in this way, through better treatment of pain increases the likelihood of establishing strategies to improve patient recovery, coupled with reductions in average length of stay (hospital), more effective analgesic techniques and potential cost savings. Thus, this study compared the long hospital stay between patients underwent to care for a specialized multidisciplinary team of the APS, with a matched cohort suffered to same surgical procedures, during the same period, which had their postoperative pain management under the care of the surgical team. Methods: This is a retrospective naturalistic cohort that included 1011 patients older than 18 years, male and female underwent to elective major surgery, with an open cavity (proctologic and thoracic surgeries) and orthopedic surgeries (knee and hip replacement). The Electronic Information Database, comprehend the years of 2011 through 2015 at a teaching hospital in the south of Brazil. Results: We assessed retrospectively 1050 patients [proctologic surgery 506 (50.4%), thoracic surgery 216 (21.36%) and orthopedic surgery 293 (29.17%)]. The mean (SD) of hospital stay in patients under of the APS care was 7.84 (4.41) compared to their matched controls, which had a mean (SD) of hospital stay of 9.72 (8.64), respectively. Another risk factor for the long hospital stay were the postoperative mortality, surgical re-operation, and patients that needed postoperative intensive care. Conclusion: These findings support the hypothesis that a change in patients undergone to surgeries with a higher propensity to have severe postoperative pain with the postoperative pain management under a specialized multidisciplinary team of APS reduced the postoperative extended hospital stay.

Introdução: A Associação Internacional para o Estudo da Dor (IASP) tem estimulado a organização de Programas de Tratamento de Dor Aguda (SDAP) para um manejo mais efetivo, bem como avaliar seu impacto em desfechos passiveis de mensuração. Estudos têm sido conduzidos para mostrar a necessidade dos hospitais organizarem serviços de dor aguda pós-operatória, com vistas a melhora do tratamento da dor e para avaliar o processo de recuperação do paciente, redução do tempo de internação consequente ao uso de técnicas analgésicas mais eficazes. Então o objetivo deste estudo foi comparar o tempo de internação de pacientes submetidos a cirurgias eletivas com alta probabilidade de apresentarem dor pós operatória intensa sob os cuidados de uma equipe multidisciplinar especializada do SDAP comparado a uma coorte submetida a procedimentos cirúrgicos equivalentes no mesmo período, que tiveram seu tratamento da dor pós-operatório sob o cuidado da cirurgia equipe. Métodos: trata-se de uma coorte naturalista, retrospectiva, que incluiu 1011 pacientes com idade superior a 18 anos, de ambos os sexos submetidos à cirurgia eletiva de grande porte, tais como cirurgias torácicas com toracotomia, cirurgias proctológicas com abertura da cavidade abdominal e cirurgias ortopédicas para prótese de joelho e quadril. Os dados foram obtidos a partir do pontuaria o eletrônico do Hospital de Clinicas de Porto Alegre (HCPA) no período compreendido entre 2011 e 2015. Resultados: Avaliamos retrospectivamente 1050 pacientes assim distribuídos [cirurgia proctológica 506 (50,4%), cirurgia torácica 216 (21,36%) e cirurgia ortopédica 293 (29,17%)]. A média (SD) da internação hospitalar em pacientes sob o atendimento do SDAP foi de 7,84 (4,41) comparado controles correspondentes sob o cuidado da equipe cirúrgica, que apresentaram uma média (SD) de internação de 9,72 (8,64), respectivamente. Foram fatores associados com prolongada internação pós-operatória a mortalidade pós-operatória, reoperação cirúrgica e pacientes que necessitaram de terapia intensiva pós-operatória. Conclusão: Estes resultados sustentam a hipótese de que uma mudança no cuidado pós-operatório de pacientes submetidos a cirurgias com propensão para dor pós-operatória intensa, sob os cuidados de uma equipe multidisciplinar especializada do SDAP reduziu o tempo de internação pós-operatório comparado aos pacientes submetidos a cirurgias equivalentes com o tratamento da dor pós-operatória aos cuidados da equipe assistente. / Background: The American Pain Society stimulate to organize Programs of the Acute Pain Services (APS) fora most efficient pain management, as well to assesses its impact on the measurable outcomes. Studies around the world remind us of the imminent need for hospitals maintain service acute postoperative pain, since it is known that in this way, through better treatment of pain increases the likelihood of establishing strategies to improve patient recovery, coupled with reductions in average length of stay (hospital), more effective analgesic techniques and potential cost savings. Thus, this study compared the long hospital stay between patients underwent to care for a specialized multidisciplinary team of the APS, with a matched cohort suffered to same surgical procedures, during the same period, which had their postoperative pain management under the care of the surgical team. Methods: This is a retrospective naturalistic cohort that included 1011 patients older than 18 years, male and female underwent to elective major surgery, with an open cavity (proctologic and thoracic surgeries) and orthopedic surgeries (knee and hip replacement). The Electronic Information Database, comprehend the years of 2011 through 2015 at a teaching hospital in the south of Brazil. Results: We assessed retrospectively 1050 patients [proctologic surgery 506 (50.4%), thoracic surgery 216 (21.36%) and orthopedic surgery 293 (29.17%)]. The mean (SD) of hospital stay in patients under of the APS care was 7.84 (4.41) compared to their matched controls, which had a mean (SD) of hospital stay of 9.72 (8.64), respectively. Another risk factor for the long hospital stay were the postoperative mortality, surgical re-operation, and patients that needed postoperative intensive care. Conclusion: These findings support the hypothesis that a change in patients undergone to surgeries with a higher propensity to have severe postoperative pain with the postoperative pain management under a specialized multidisciplinary team of APS reduced the postoperative extended hospital stay.

Master of Science / Department of Computer Science / Mitchell L. Neilsen / It’s difficult to keep track of sleep patterns, medicine and water intake. Having sufficient sleep every day is very important as not getting enough sleep can lead to difficulties remembering things, concentrating and other problems. This application provides tools to track the sleeping pattern of the user based on the inputs given. When the user picks a date, a weekly graph is generated to see how the user’s sleep cycle looks. It also displays the average hours the user slept each day and the sleep pattern type below the graph. Medicine reminder is another tool which reduces the risk of skipping medicines. As many people tend to complicate the severity level of the disease by forgetting to take the required medicine, this app can help them to prevent such problems. It reminds them to take their medicine at the entered times until the end of the course duration. People often tend to forget to drink enough water. Staying hydrated is very important for our body to function properly and flush out toxins. For this purpose, this app features a water reminder to remind the user to drink water every hour until the daily limit is reached. This is done by calculating the amount of water that should be consumed every day based on the user’s details like age, weight, physical activity and gender. Apart from these, to stay fit and healthy one should do some physical activity every day which helps to activate their body. The instructions and videos of some exercises, information on health tips, and natural remedies to some common health problems that can be cured without any medication are provided in the app. This would be a very convenient application for those who are very busy with their work life and have difficult time tracking their sleep, medicine times and staying hydrated at work.

Abstract Using three different schizophrenic populations from Northern Finland, gender differences in some sociodemographic variables, age at onset, incidence, treatment, outcome and deinstitutionalization of schizophrenia were examined. The first study population comprises the Northern Finland 1966 Birth Cohort, which is an unselected, general population birth cohort. We followed prospectively 11017 subjects from 16 to 28 years of age by means of the Finnish Hospital Discharge Register. From this study population gender differences at the age of onset and incidence of schizophrenia were calculated. The second study population was formed of 1525 patients who had their first treatment episodes at the closed therapeutic community ward situated at the Department of Psychiatry, University of Oulu during 1977 - 1993. Gender differences were assessed in relation to age at first admission, some sociodemographic variables, degree of active participation of the patients in individual, group, and milieu therapy and institutional outcome of the patients with schizophrenia. The third study population consisted of all the 253 long-stay psychiatric inpatients treated for at least six months without a break during 1992 in the Department of Psychiatry, Oulu University Hospital. From this study population gender differences at the age of onset and in relation to some sociodemographic and clinical variables were studied. The placements after the last discharge and at the end of the follow-up and factors predicting hospitalization after the follow-up were also monitored. There were no statistically significant gender differences regarding age at onset in any of these three different study populations. The time lag between the first psychotic symptoms and the first psychiatric hospitalization was minimal. In the Northern Finland 1966 Birth Cohort study the annual incidence rate of DSM-III-R schizophrenia was relatively high, 7.9 per 10 000 in men and 4.4 in women by the age of 28. In men it was highest in the age group of the 20-24 year-olds while in women the peak occurred earlier in the age group of the 16-19 year-olds. In the Therapeutic community study there were no statistically significant gender differences in the sociodemographic variables, in the length of stay and in the number of treatment episodes in this ward in any of the diagnostic groups. Differences with regard to male and female participation in individual, group and milieu therapy and the institutional outcome were minimal, some trends, however, favoring females. In the long-stay patients study almost two-thirds of these patients were men. Very few gender differences were found in relation to sociodemographic and clinical characteristics or regarding the utilization of psychiatric hospital care. About 70% of the long-stay patients were discharged during the four year follow-up period and only 15% were able to live without continuous support. Marital status (being not married), dwelling place (living in city), absence of negative symptoms and severity of the illness were associated with hospitalization at the end of the follow-up. Gender did not predict hospitalization at the end of the follow-up period. The results of this study indicate that there are probably different subgroups of schizophrenia in which there are no gender differences regarding age at onset and in the clinical picture of the disturbance or there are regional differences in the manifestation of the illness. In Finland patients are hospitalized earlier after the onset of the first psychotic symptoms than in many other countries. According to the Northern Finland 1966 Birth Cohort study the incidence of schizophrenia is higher among young men than women and the total life-time incidence of schizophrenia may be smaller in women. The results from the Therapeutic community study suggest that therapeutic community treatment may level out the gender differences in the treatment process and outcome. The long-stay patient study showed that long-term patients are dependent on considerable support and that the most seriously ill patients are in fact in hospital. Alternative residential facilities have been a presupposition to the deinstitutionalization of the long-stay patients.

The thesis analyses the influence of reimbursement regulatory fee for hospitalization which was introduced in regional hospitals in 2009 in Czech Republic. The difference in differences analysis was used to study the possible relationship between reimbursement of the fee for length of hospitalization in acute care hospitals and in after-care facilities. In acute care the influence was 0,5-1 % of the length and in after-care facilities between 8-12 %. This relationship may be biased because of introduction of DRG system which may decrease the length of stay and may be differently distributed between the treatment and control groups.

Orientador: Sergio Tadeu Martins Marba / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T00:24:59Z (GMT). No. of bitstreams: 1 Moura_MonicaBarthelsonCarvalhode_M.pdf: 1974404 bytes, checksum: f66d3899041444039f1356215d0843ac (MD5) Previous issue date: 2006 / Resumo: O objetivo deste estudo foi verificar a tendência secular de permanência hospitalar de recém-nascidos sadios e = 2.500 gramas em uma maternidade de grande porte em Campinas (Hospital Maternidade de Campinas) e sua modificação com algumas variáveis maternas e do recém-nascido. Foi um estudo descritivo, analítico, retrospectivo, realizado através de dados dos prontuários de pacientes nascidos vivos entre os anos de 1951 a 2000, com uma amostra de 5001 recém-nascidos, selecionada através de sorteio, dentre a população total incluindo todos os anos do período de estudo. A variável dependente foi o tempo de permanência hospitalar e as independentes foram peso de nascimento, idade materna, tipo de parto e categorias de internação. Para analisar a tendência secular do tempo de permanência hospitalar em função do ano de nascimento, bem como sua associação com as variáveis independentes, foi utilizado análise de regressão linear com estimação pelo método dos quadrados mínimos. O nível de significância adotados para os testes estatísticos foi de 5%. A média de tempo de permanência hospitalar do binômio mãe-filho na maternidade em 1951 foi de 123 horas e em 1970, já havia diminuído para 55, 8 horas. O tempo de permanência Hospitalar não variou com o peso de nascimento, a idade materna e a categoria de internação, variando apenas com o tipo de parto. Concluiu-se que houve um decréscimo vertiginoso no tempo de permanência hospitalar no período de 1951 a 1970 independente do peso de nascimento, da idade materna e das categorias de internação, variando apenas com o tipo de parto, as cesáreas apresentaram queda mais significativa do tempo de internação, destes recém- nascido / Abstract: The objective of this research was to become known the secular tendency of lenght of perinatal hospital stay in healthy newborns, with birth weight more than 2.500g in a big hospital of Campinas (Hospital Maternidade de Campinas). It was a descriptive, analitic and retrospective study, analyzing prontuary datas of pacients that have been borned from 1951 to 2000. They have been choosen by picking them up from the total population during all years. The dependent variable has been the lenght of stay and the independents have been birth weight, maternal age, kind of delivery and economic categories. To analyse the secular tendency of length of stay for each year and associate it with the independent variables, it has been used linear regression analysis. The significance level was 5%. The middle time of length of stay for mother and newborn, in 1951, was 123 hours and in 1970, was 55,8 hours.The variables: birth weight, maternal age and economic categories haven't change hospitalar permanency, only kind of delivery has interwied in this process. Conclusion: the length of stay has decreased significantly between 1951 to 2000. Birth weight, maternal age and economic categories haven't interviewed in this process. Only the kind of delivery, the cesareans have been decreased significantly during 1951 to 2000 / Mestrado / Pediatria / Mestre em Saude da Criança e do Adolescente

No description available.

Objective: The primary purpose of this study was to determine the relationship between respiratory status and feeding difficulties in infants with NAS in comparison to full-term infants with no exposure to opioids. Methods: A group of infants with NAS (262) were compared to a group of full-term infants with no exposure to opioids (279). These groups were further divided into feeding and respiratory groups based on severity. These groups were analyzed for differences in behavior and outcomes. Results: Infants with NAS are 34.23 times more likely to develop respiratory distress and 111.03 times more likely to develop severe feeding difficulty. For infants with NAS, respiratory and feeding impairment may occur in isolation, suggesting a different withdrawal-based etiology of impairment as compared to premature infants. Conclusion: This study is unique in its size, scope, and attention to the respiratory factors involved in the feeding outcomes of infants with NAS.