Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2012. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2013-01-11T12:44:51Z No. of bitstreams: 1 taniavasques.pdf: 1211854 bytes, checksum: 38f410e383455c8514629775645d6efd (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2013-06-12T17:27:34Z (GMT) No. of bitstreams: 1 taniavasques.pdf: 1211854 bytes, checksum: 38f410e383455c8514629775645d6efd (MD5) / Made available in DSpace on 2013-06-12T17:27:34Z (GMT). No. of bitstreams: 1 taniavasques.pdf: 1211854 bytes, checksum: 38f410e383455c8514629775645d6efd (MD5) Previous issue date: 2012 / Cuidados Paliativos (CP) tem o propósito de melhorar a qualidade de vida de pacientes que recebem um diagnóstico de doença incurável que ameace a continuidade da vida, proporcionando-lhes um processo de terminalidade digno e com alívio do sofrimento. Este estudo teve como objetivo conhecer a percepção dos trabalhadores de Enfermagem que atendem pacientes em situação de impossibilidade de cura e com risco de vida acerca dos Cuidados Paliativos e de sua implementação no cotidiano do trabalho em saúde. Trata-se de um estudo qualitativo, desenvolvido no primeiro e segundo semestre de 2011, por meio da técnica de entrevista semi estruturada, realizada com vinte e três trabalhadores de enfermagem. O estudo foi submetido ao Comitê de Ética em Pesquisa na Área da Saúde (CEPAS/FURG) sob parecer de número 43/2011. Para a análise dos dados, utilizou-se a Análise Textual Discursiva, construindo-se duas categorias: Percepção dos trabalhadores de enfermagem acerca dos cuidados paliativos e Percepção dos trabalhadores de enfermagem acerca da implementação dos cuidados paliativos. Os resultados mostram um aparente desconhecimento dos trabalhadores de enfermagem sobre Cuidados Paliativos, e manifestações de sofrimento ao cuidar dos pacientes fora da possibilidade de cura e com risco de vida. Evidenciou-se ainda a necessidade de capacitação acerca da temática, enfocando um diálogo franco e aberto com os pacientes e seus familiares, evitando-se o sofrimento do paciente com a obstinação terapêutica. Verificou-se, ainda, que o processo decisório acerca dos cuidados a serem prestados a esses pacientes requer compartilhamento entre os profissionais, a fim de que tal decisão não seja exclusiva de uma só categoria. Ações de aproximação com a filosofia dos Cuidados Paliativos foram identificados, tais como:parar para tocar o paciente, dar atenção as suas queixas, entre outros. Ao finalizar o estudo pode-se dizer que a educação permanente direcionada aos trabalhadores de enfermagem que cuidam de paciente fora da possibilidade de cura e com risco de vida em relação aos cuidados Paliativos pode proporcionar uma assistência paliativa eficaz, atentando para a qualidade de vida do paciente cuidado, bem como para a a qualidade de vida no trabalho da equipe de enfermagem. Ações de cuidado embasadas nos princípios paliativos contribuem para proporcionar um fim digno a esses pacientes. / Palliative Care (PC) aims to improve life quality of patients who receive a diagnosis of an incurable disease that threatens life continuity, giving them a dignified process of terminality with relief of suffering. This study aimed to learn the perception of nursing workers who serve patients in situations of healing impossibility and life-threatening, about Palliative Care and its implementation in health daily work. This is a qualitative study, developed in the first and second semesters of 2011, through the semi-structured interview technique, performed with twenty-three nursing workers. The study was submitted to the Ethics Committee in Research in Health Area (CEPAS / FURG) under opinion number 43/2011. For data analysis, we used the Discursive Textual Analysis, building up two categories: Perception of nursing workers about palliative care and perception of nursing workers about the implementation of palliative care. The results show an apparent lack of knowledge about Palliative Care by nursing workers, and expressions of sorrow when caring for patients with no possibility of cure and life-threatening. It was evident, moreover, the need for training on the theme, focusing on a frank and open dialogue with patients and their families, avoiding the patient's suffering with therapeutic obstinacy. It was also noticed that the decision-making process about the care to be provided to these patients requires sharing among the professionals, so that such a decision is not exclusive to only one category. Proceedings of approximation to the philosophy of Palliative Care were identified, such as: stopping to touch patients, listening to their complaints, among others. At the end of the study, it can be said that continuing education in relation to Palliative Care, directed at nursing workers who care for patients with no healing possibility and life-threatening, can provide an effective palliative care, paying attention to the cared patient's life quality, as well as to the life quality at work of nursing staff. Care actions based in the palliative principles contribute to provide a worthy end to these patients. / Cuidados Paliativos (CP) tiene como objetivo mejorar la calidad de vida de los pacientes que reciben un diagnóstico de enfermedad incurable que amenaza la continuidad de la vida, dándoles un proceso digno de la terminal y el alivio del sufrimiento. Este estudio tuvo como objetivo conocer la percepción de los trabajadores de enfermería que atienden a los pacientes ante la imposibilidad de la curación y la amenaza para la vida-sobre los cuidados paliativos y su aplicación en el trabajo diario en la salud. Se trata de un estudio cualitativo, desarrolló la primera y segunda mitad de 2011, mediante la técnica de entrevista semiestructurada, realizada con veintitrés personal de enfermería. El estudio fue sometido al Comité de Ética en Investigación en el Ámbito de la Salud (CEPAS / FURG) aparecen bajo el número 43/2011. Para el análisis de los datos, se utilizó el análisis del discurso textual, la creación de dos categorías: Percepción del personal de enfermería sobre los cuidados paliativos y la percepción del personal de enfermería sobre la aplicación de los cuidados paliativos. Los resultados muestran una aparente falta de personal de enfermería en cuidados paliativos, y las expresiones de dolor para atender a los pacientes fuera de la posibilidad de la curación y potencialmente mortales. Era evidente la necesidad de capacitación en el tema, centrándose en un diálogo franco y abierto con los pacientes y sus familias, evitando el sufrimiento de los pacientes con obstinación terapéutica. También estaba el proceso de toma de decisiones acerca de la atención que debe proporcionarse a estos pacientes requiere compartir entre los profesionales, por lo que tal decisión no es exclusivo de una categoría. Las acciones de acercamiento con la filosofía de los cuidados paliativos fueron identificados, tales como dejar de tocar al paciente, preste atención a sus quejas, entre otros. Al final del estudio, se puede afirmar que la educación continua dirigidos al personal de enfermería que atienden a pacientes de fuera de la posibilidad de la curación y la vida en peligro, en relación a los cuidados paliativos pueden proporcionar cuidados paliativos eficaces, prestando atención a la calidad de vida de los atención de los pacientes, así como a la calidad de la vida de trabajo del personal de enfermería. Las acciones basadas en los principios de los cuidados paliativos que contribuyan proporcionando un final digno a estos pacientes.

RATIONALE & OBJECTIVE: Patients receiving maintenance dialysis have higher mortality after primary percutaneous coronary intervention (pPCI) than patients not receiving dialysis. Whether pPCI confers a benefit to patients receiving dialysis that is similar to that which occurs in lower-risk groups remains unknown. We compared the effect of pPCI on in-hospital outcomes among patients hospitalized for ST-elevation myocardial infarction (STEMI) and receiving maintenance dialysis with the effect among patients hospitalized for STEMI but not receiving dialysis. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: We used the National Inpatient Sample (2016-2018) and included all adult hospitalizations with a primary diagnosis of STEMI. PREDICTORS: Primary exposure was PCI. Confounders included dialysis status, demographics, insurance, household income, comorbidities, and the elective nature of the admission. OUTCOME: In-hospital mortality, stroke, acute kidney injury, new dialysis requirement, vascular complications, gastrointestinal bleeding, blood transfusion, mechanical ventilation, palliative care, and discharge destination. ANALYTICAL APPROACH: The average treatment effect (ATE) of pPCI was estimated using propensity score matching independently within the group receiving dialysis and the group not receiving dialysis to explore whether the effect is modified by dialysis status. Additionally, the average marginal effect (AME) was calculated accounting for the clustering within hospitals. RESULTS: Among hospitalizations, 4,220 (1.07%) out of 413,500 were for patients receiving dialysis. The dialysis cohort was older (65.2 ± 12.2 vs 63.4 ± 13.1, P < 0.001), had a higher proportion of women (42.4% vs 30.6%, P < 0.001) and more comorbidities, and had a lower proportion of White patients (41.1% vs 71.7%, P < 0.001). Patients receiving dialysis were less likely to undergo angiography (73.1% vs 85.4%, P < 0.001) or pPCI (57.5% vs 79.8%, P < 0.001). Primary PCI was associated with lower mortality in patients receiving dialysis (15.7% vs 27.1%, P < 0.001) as well as in those who were not (5.0% vs 17.4%, P < 0.001). The ATE on mortality did not differ significantly (P interaction = 0.9) between patients receiving dialysis (-8.6% [95% CI, -15.6% to -1.6%], P = 0.02) and those who were not (-8.2% [95% CI, -8.8% to -7.5%], P < 0.001). The AME method showed similar results among patients receiving dialysis (-9.4% [95% CI, -14.8% to -4.0%], P < 0.001) and those who were not (-7.9% [95% CI, -8.5% to -7.4%], P < 0.001) (P interaction = 0.6). Both the ATE and AME were comparable for other in-hospital outcomes in both groups. LIMITATIONS: Administrative data, lack of pharmacotherapy and long-term outcome data, and residual confounding. CONCLUSIONS: Compared with conservative management, pPCI for STEMI was associated with comparable reductions in short-term mortality among patients irrespective of their receipt of maintenance dialysis.