Spelberoende är ett allvarligt folkhälsoproblem som förorsakar en rad negativa konsekvenser för individer, där spelberoendet ofta är kombinerat med samsjuklighet, vilket gör problematiken mer komplex. På grund av denna problematik är det viktigt att ta reda på hur behandlare uppfattar behandlingsmetoder. Syftet med denna studie var att undersöka behandlares uppfattningar av behandlingsarbetet med personer som har spelberoende i kombination med samsjuklighet. Utifrån en kvalitativ ansats genomfördes sex semi-strukturerade intervjuer med behandlare. Materialet analyserades genom en tematisk analys. Resultatet visar att behandlarna belyser vikten av att integrera och anpassa olika metoder, teorier, besitta ett brett förhållningssätt och att samverka med andra aktörer för att kunna bemöta och behandla denna komplexa målgrupp. En slutsats är att behandlarna tycks ha en medvetenhet av behandlingsarbetet som tvärdisciplinärt där arbetet med olika behandlingsmetoder används eklektiskt. Studien påvisar behovet av ytterligare forskning och mer förebyggande arbete. / Gambling addiction is a public health problem that causes negative consequences for individuals, where gambling addiction is often combined with co-morbidity, which makes the problem more complex. Because of this problem, it is important to examinate how therapists perceive treatment methods. This study aimed to investigate therapists' perceptions of the treatment work, with people who have gambling addiction combined with co-morbidity. Six semi-structured interviews were conducted with therapists based on a qualitative approach. The material was analyzed through thematic analysis. The results indicate that the therapists highlight the importance of integrating and adapting different methods and theories, having a broad approach and cooperation with other actors to treat this complex target group. A conclusion is that the therapists seem to be aware that the treatment work is interdisciplinary where the work with different treatment methods is used eclectically. The study demonstrates the need for further research and preventive work.

Företaget Nobel Biocare tillverkar tandimplantat. Då tandimplantat används i munnen är den medicinska nivån hög och strikt. För att benet runt implantatet ska läka snabbare används en saltlösning på tandimplantaten. Saltlösningen appliceras i nuläget genom ett saltbad och sen ett justeringssteg för att avlägsna överflödigt salt. Detta arbete är en förstudie för att hitta en eller flera metoder som skulle kunna lösa denna process på ett enklare sätt.En fördjupad undersökning av sprayningsmetoder, sköljlackering samt physical vapor deposition gjordes för att finna eventuellt fungerande lösningar. Slutligen utvärderades dessa metoder för att föreslå en kandidat för prototypstudier. / The Company Nobel Biocare is a producer of dental implants. As implants are used in the mouth the medical restrictions are high. A saline solution is used to help the bone around the implants heal faster. The saline solution is currently applied using a salt bath followed by an adjustment step to remove superfluous salt.This report describes a pre-study to find one or more methods that could simplify the salt application. The focus was on spraying methods, flow coating and physical vapor deposition. Finally, a ranking was done to suggest the top candidate for prototype testing.

Syftet med studien är sammanställa forskning om behandlingsmetoder för män som utövat våld mot kvinnor i nära relation. I syftet ligger även att granska vilka metoder som anses vara framgångsrika i detta behandlingsarbete. Åtta artiklar utgör studiens empiri. Vi har gjort en tematisk analys som därefter analyserats utifrån studiens teoretiska utgångspunkter: professionsteorin, arbetsallians, klientorientering och yrkeskompetens. Resultaten visar att individanpassade behandlingsmetoder är avgörande i arbetet med våldsutövare och att ett holistiskt synsätt behöver tillämpas i arbetet. Våra slutsatser är att de som arbetar med behandlingsområdet behöver utgå från individanpassade behandlingsmetoder och upprätthålla en stark arbetsallians med våldsutövare. I enighet med forskningen om behandlingsmetoder ser vi också att det behövs mer forskning inom området. De behandlingsmetoder som har identifierats är duluth-modellen, kognitivbeteende- och psykodynamisk terapi samt motiverande samtal. Resultatet visar att motiverande strategier samt individanpassade metoder är de mest effektiva i behandlingsarbetet / The purpose of this study is to assemble research on treatment methods for men who have perpetrated violence against women in intimate relationships. The aim is also to examine which methods are considered successful in the treatment work. The empirical foundation consists eight articles. We have done a thematic analysis which has been analyzed based on the theoretical framework of the study: profession theory, working alliance, client orientation and professional competence. The results show that individual adapted treatment methods are crucial in working with perpetrators of domestic violence and that holistic approach needs to be applied in the work. Our conclusions are that those who work in the area treatment need to apply individually adapted treatment methods and maintain a strong working alliance with perpetrators of violence. In agreement with the research on treatment methods, we also see that more research is needed in the area. The treatment methods that have been identified are the Duluth model, cognitive behavioral and psychodynamic therapy, and motivational interviewing. The results show that motivational strategies and individually adapted methods are the most effective in treatment work.

Abstract The purpose of this study was to describe and investigate the health-related quality of life of patients suffering from lower limb arteriosclerotic disease before and after treatment. In addition, patients' experiences of living with their illness were examined a year after treatment, and the costs of treatment were investigated before and after treatment. A total of 180 patients took part in the study; 64 were treated conservatively, 85 endovascularly and 31 surgically. During the study, the health-related quality of life of the patients (N = 180) was monitored at the beginning of the study and 6 and 12 months after treatment using the Nottingham Health Profile (NHP) and the 15D quality of life scale. Theme interviews were conducted with some of the patients (n = 18) a year after treatment. In addition, the costs of different treatment methods were examined using a questionnaire which mapped the patients' (n = 153) use of health and social services and the hospital's municipal billing data. The patients' (N = 180) ankle-brachial systolic blood pressure ratio (ABI) was measured at the beginning of the study and 12 months after treatment. The data were analysed using basic statistical methods and content analysis. Compared to the age-and-gender-standardised normal population, the health-related quality of life of women (n = 62) suffering from lower limb arteriosclerotic disease was significantly poorer only in the dimension of pain. Prior to treatment, men's (n = 118) health-related quality of life was significantly lower than that of other Finnish men of the same age (N = 2 126) in all the areas of the NHP scale. In addition, as measured on the 15D scale, the patients' health-related quality of life was statistically significantly poorer compared to normal population (N = 4 048). The claudication distance and the ABI index of patients treated with endovascular and surgical methods was significantly improved one year after treatment. The quality of sleep and emotional reactions of patients treated with conservative methods improved as measured on the NHP scale, while the emotional reactions and energy levels of endovascularly treated patients improved as measured on the NHP scale. The 15D scale also indicated improvement in the overall quality of life, mobility, coping with daily tasks, quality of sleep and energy levels, as well as a decrease in pain and anxiety, which in turn decreased social exclusion. One year after treatment, the NHP scale showed decreased pain and improved mobility, quality of sleep and emotional reactions in surgically treated patients, while the 15D scale indicated improvement in the overall quality of life, mobility, energy levels and quality of sleep. During content analysis, three main categories were formed based on patient experiences: struggle with the effects of the illness, pursuit of a balanced life and the use of internal resources. The direct costs of the diagnostic phase of conservative treatment were €1 625. As the treatment proceeded, the costs decreased in a statistically significant manner to €702. The direct costs of endovascular treatment were €1 522 during the diagnostic phase, increasing in a statistically significant way as the treatment proceeded to €4 579. The direct costs of the diagnostic phase of surgical treatment were €1 579, increasing to €5 608 in a statistically significant way as the treatment proceeded. The study produced an extensive and varied description of the health-related quality of life of patients suffering from lower limb arteriosclerotic disease, patients' experiences of living with the illness and the costs of different treatment methods. The new information produced in this study can be used in a multidisciplinary and multiprofessional way, particularly in improving the treatment and rehabilitation of patients suffering from arteriosclerosis of the lower extremities, and in basic and continuing nursing education. / Tiivistelmä Tämän tutkimuksen tarkoituksena oli kuvailla ja selvittää alaraajojen valtimonkovetustautia sairastavien potilaiden terveyteen liittyvää elämänlaatua ennen hoitomenetelmiä ja niiden jälkeen. Lisäksi tarkasteltiin heidän kokemuksiaan elämästä sairauden kanssa vuoden kuluttua hoitomenetelmistä ja potilaille tehtyjen hoitomenetelmien kustannuksia ennen hoitoa ja sen jälkeen. Tutkimuksessa oli yhteensä 180 potilasta, joista 64 hoidettiin konservatiivisesti, 85 endovaskulaarisin ja 31 kirurgisin hoitomenetelmin. Tutkimuksessa seurattiin potilaiden (N = 180) terveyteen liittyvää elämänlaatua Nottingham Health Profile (NHP) ja 15D-elämänlaatumittareilla tutkimuksen alussa, sekä 6 ja 12 kuukauden kuluttua hoidoista. Osalle potilaista (n = 18) tehtiin teemahaastattelu vuoden kuluttua hoidoista. Lisäksi selvitettiin eri hoitomenetelmien kustannuksia potilaiden (n = 153) terveydenhuolto- ja sosiaalipalvelujen käyttöä kartoittavalla kyselylomakkeella sekä sairaalan kuntalaskutustiedostoilla. Potilaiden (N = 180) nilkan ja olkavarren välisten systolisten verenpaineiden suhde (ABI) mitattiin tutkimuksen alussa ja 12 kuukauden kuluttua hoitomenetelmistä. Aineistojen analyyseissa käytettiin tilastollisia perusmenetelmiä sekä sisällön analyysia. Verrattuna ikä- ja sukupuolivakioituun normaaliväestöön alaraajojen valtimonkovetustautia sairastavien naisten (n = 62) terveyteen liittyvä elämänlaatu oli merkitsevästi huonompi vain kivun ulottuvuudella. Miesten (n = 118) terveyteen liittyvä elämänlaatu oli ennen hoitomenetelmiä kaikilla kuudella NHP-mittarin osa-alueella merkitsevästi huonompi kuin vastaavanikäisillä suomalaisilla miehillä (N = 2126). Potilaiden elämänlaatu oli myös 15D-mittarilla mitattuna tilastollisesti merkitsevästi huonompi kuin normaaliväestöllä (N = 4048). Vuoden päästä hoidoista endovaskulaarisilla ja kirurgisilla toimenpiteillä hoidettujen potilaiden katkokävelymatka ja ABI-indeksi parantuivat merkitsevästi. Konservatiivisesti hoidetuilla potilailla unen laatu ja tunnereaktiot parantuivat NHP-mittarilla mitattuna. Endovaskulaarisesti hoidetuilla potilailla paranivat NHP- mittarilla mitattuna tunnereaktiot ja tarmokkuus. Myös sosiaalinen eristäytyminen väheni, kun 15D- mittari osoitti paranemista yleisessä elämänlaadussa, liikkumisessa, päivittäisissä toiminnoissa selviytymisessä, unen laadussa ja energisyydessä sekä kivut ja ahdistuneisuus helpottuivat. Vuoden kuluttua kirurgisesti hoidetuilla potilailla NHP-mittari osoitti kivun vähenemistä, liikkumisen, unen laadun ja tunnereaktioiden paranemista, kun 15D-mittarilla mitattuna paranemista tapahtui yleisessä elämänlaadussa, liikkumisessa, energisyydessä ja unen laadussa. Sisällön analyysin tuloksena muodostui kolme pääkategoriaa potilaiden kokemuksista: sairauden vaikutusten kanssa kamppailua, tasapainoisen elämän tavoittelua ja sisäisten voimavarojen käyttöä. Konservatiivisen hoidon diagnosointivaiheen suorat kustannukset olivat 1 625 €. Ne laskivat tilastollisesti merkitsevästi hoidon edettyä ja olivat 702 €. Endovaskulaarisen hoidon suorat kustannukset olivat diagnosointivaiheessa 1 522 € ja ne nousivat tilastollisesti merkitsevästi hoidon edettyä ja olivat 4 579 €. Kirurgisen hoidon suorat kustannukset diagnosointivaiheessa olivat 1 579 € ja ne nousivat tilastollisesti merkitsevästi hoidon edettyä ja olivat 5 608 €. Tutkimus tuotti laajan ja monipuolisen kuvan alaraajojen valtimonkovetustautia sairastavien terveyteen liittyvästä elämänlaadusta, potilaiden kokemuksista elämästä sairauden kanssa ja hoitomenetelmien kustannuksista. Tässä tutkimuksessa tuotettua uutta tietoa voidaan hyödyntää monitieteisesti, moniammatillisesti ja erityisesti alaraajojen valtimonkovetustautia sairastavien hoidon ja kuntoutuksen kehittämisessä, sekä hoitotyön perus- ja täydennyskoulutuksessa.

No description available.

Rapporten handlar om olika reningstekniker vilka kan användas för att behandla avloppsvatten som släpps ut vid bräddning innan det når recipienten. Rapporten beskriver först vad bräddning är och även vilka problem som kan uppstå när orenat vatten släpps ut och vad det eventuellt kan innehålla. Flera potentiella reningstekniker lyfts fram och analyseras för att sedan kunna användas i en multikriterieanalys med kriterier såsom miljöpåverkan, passivitet och kapacitet. Olika viktningar används för att bestämma hur bra de olika reningsteknikerna är med olika fokus. / The report focuses on various purification techniques that can be used to treat wastewater discharged during overflow events before it reaches the receiving water body. The report begins by describing what overflow events are and the potential issues that can arise when untreated water is discharged, including possible contaminants. Several potential purification techniques are highlighted and analyzed, intending to be utilized in a multicriteria analysis with criteria such as environmental impact, efficiency, and capacity. Different weightings are employed to determine the performance of the various purification techniques based on different focal points.

Thesis (MBA (Business Management))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The aim of this research report is to investigate sustainable alternative solid waste management methods for the Drakenstein Municipal Area in particular and South African municipalities in general. The point of departure is that landfilling alone is not sustainable and that alternative and/or complementary methods are required. Current solid waste management policies and practices in various countries all over the world are investigated in order to understand the global context of municipal solid waste management. The development of solid waste management in both developed and developing countries is considered in order to appreciate the different approaches and legal frameworks underpinning each approach. Several solid waste treatment methods, both established and advanced, are considered before the development of solid waste management in South Africa since 1992 is reviewed. An important aspect of evaluating alternatives is the identification of relevant stakeholders, key drivers for success and the constraints. An important conclusion reached in the research is that the lack of funding and the inherent inability of most municipalities in South Africa to render even basic municipal services currently make the introduction of advanced solid waste treatment methods non-sustainable. It is therefore suggested that the newly developed legal framework underpinning solid waste management in South Africa, be implemented in such a manner that all stakeholders are involved in the implementation of the basic principles of the waste hierarchy. The author believes that the introduction of technologically advanced waste treatment and disposal options will be premature if the basics of the waste hierarchy are not practiced by all. / AFRIKAANSE OPSOMMING: Die fokus van hierdie navorsingsverslag is ‘n ondersoek na volhoubare, alternatiewe vaste afvalbestuursmetodes vir Suid-Afrikaanse munisipaliteite in die breë en die Drakenstein Munisipaliteit in die besonder. Die basiese uitganspunt is dat vaste afvalstorting alleen nie volhoubaar is nie en dat alternatiewe/komplementêre metodes nodig word. Die vaste afvalbestuursbeleid en –praktyke wat tans wêreldwyd gevolg word, word ondersoek met die doel om die globale konteks daarvan beter te verstaan. Die ontwikkeling van vaste afvalbestuur in beide ontwikkelde en ontwikkelende lande word nagevors sodat die verskillende benaderings en wetlike raamwerke wat dit onderskryf, bestudeer kan word. Verskeie vaste afvalbestuursmetodes – beide gevestig en gevorderd – word bespreek waarna die ontwikkeling van vaste afvalbestuur in Suid-Afrika sedert 1992 onder die loep kom. ‘n Belangrike aspek van toepassing op die evaluering van alternatiewe, is die identfikasie van alle rolspelers, kritiese suksesfaktore en beperkinge. ‘n Belangrike bevinding wat gemaak word, is dat die gebrek aan voldoende fondse sowel as die inherente onvermoë van meeste Suid-Afrikaanse munisipaliteite om selfs basiese munisipale dienste te kan lewer, die implementering van gevorderde vaste afvalbestuursmetodes tans onvolhoubaar maak. In die verslag word dus aanbeveel dat die nuut-ontwikkelde wetlike raamwerk wat vaste afvalbestuur in Suid-Afrika reguleer, so geïmplementeer moet word dat alle rolspelers betrek word om die afval-hiërargie se basiese beginsels prakties toe te pas. Die outeur is van mening dat die implementering van nuwe, tegnologiesgevorderde vaste afvalbsetuursmetodes sal faal indien dit geïmplementeer sou word voordat die afval hiërargie voldoende toegepas word.

Os primeiros indícios de tentativas de abordagem e manejo da via aérea (VA) datam de cerca de 4000 anos. A intubação traqueal (IT) consiste na introdução de um tubo na luz da traquéia, e é responsável por salvar muitas vidas. O manejo da VA nos serviços de emergência é um dos principais desafios e seguramente um dos momentos mais críticos do cuidado com o paciente grave. As principais complicações e efeitos adversos da IT decorrem da laringoscopia direta e da introdução do tubo traqueal na VA. A sequência rápida de intubação (SRI) é a realização do procedimento de IT através de uma abordagem organizada que envolve a utilização de agentes sedativos, analgésicos e bloqueador neuromuscular. A SRI tem por objetivo diminuir ou limitar os efeitos adversos do procedimento de IT, em especial da laringoscopia direta. A SRI é o método de escolha na maioria dos procedimentos de IT de emergência em pediatria na literatura internacional. Os registros de dados sobre o manejo da VA em serviços de emergência pediátricos no Brasil são raros e não abordam a SRI como técnica de IT. Dessa forma os objetivos do presente estudo foram descrever a experiência do pronto-socorro de um hospital pediátrico de atendimento terciário com o uso da SRI, e detectar possíveis fatores associados ao sucesso da SRI. Para tanto foi realizado estudo prospectivo observacional tipo \"coorte\" de julho de 2005 a dezembro de 2007, onde foram coletados os dados relacionados a todas as ITs realizadas no pronto-socorro do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP). Foram incluídos no estudo todos os pacientes que foram submetidos a SRI. Foi considerado IT com sucesso aquela realizada na primeira tentativa. O registro dos dados foi realizado pelo profissional que participou diretamente do procedimento em formulário específico. Durante o período de estudo ocorreram 117 ITs, sendo que 84% delas foram realizadas sob SRI; a idade dos pacientes variou de 29 dias a 17 anos (mediana=4,4anos) e 60% eram do sexo masculino; setenta e nove por cento eram portadores de patologias de base, sendo 21% doenças neurológicas, 18% oncológicas e 8% respiratórias; a insuficiência respiratória aguda foi a causa imediata da IT em 40% dos procedimentos e alteração do nível de consciência e choque em 20% e 18% respectivamente; todas as ITs foram realizadas no pronto-socorro e por um dos médicos da equipe; a taxa de sucesso foi de 39%; o residente de pediatria do segundo ano foi o responsável por 74% das ITs, e com taxa de sucesso de 35%; foi realizada ventilação com pressão positiva em 74% dos procedimentos, sendo menor a sua utilização entre os pacientes que foram intubados com sucesso (21 versus 49 p=0,002). O midazolam foi o sedativo de escolha, utilizado em 80% dos procedimentos, e o rocurônio foi o bloqueador neuromuscular em 100% dos procedimentos; complicações decorrentes da SRI foram descritas em 75 (80%) dos procedimentos, sendo queda da saturação de oxigênio relatada em 47% do total, e significativamente menor nos pacientes que foram intubados com sucesso (p<0.001); dificuldades relativas à IT foram menos relatadas nos procedimentos realizados com sucesso (p<0,001). Em conclusão, pode-se afirmar que a SRI foi o método de escolha nas ITs realizadas no pronto-socorro do ICr-HCFMUSP, que a população que necessitou de manejo da via aérea foi composta em sua grande maioria por pacientes portadores de doenças de base com problemas respiratórios e que, complicações do procedimento de SRI são mais frequentes quando há necessidade de maior número de tentativas de laringoscopia direta. / The first signs of attempts to approach and manage airways date from about 4000 years. The tracheal intubation (TI) consists in to introduce a tube in the trachea lumen and it is responsible for saving many lives. The airway management in the emergency services is one of the most challenges and critical moments of care for the critically ill patient. The major complications and adverse effects of TI stem from the direct laryngoscopy and tracheal tube introduction into the airway. The Rapid Sequence Intubation (RSI) is the actual procedure of TI through an organized approach that involves the use of sedative agents, analgesics and neuromuscular blocker. The objective of SRI is to minimize and limit the main adverse effects of the TI procedure and in special of the direct laryngoscopy. SRI is the method of choice in most of TI procedures in emergency pediatrics in the international literature. The data records on airway management in pediatric emergency services are rare and do not address the SRI as a technique to perform TI. The objectives of this study were to describe the experience of a pediatric tertiary care emergency department with the use of RSI, and identify possible factors associated with the success of RSI. For this, a prospective observational study type \"cohort\" was conducted from July 2005 through December 2007, where all data related to TI performed in the emergency room of the Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP) was collected. The study included all patients who underwent to RSI. Intubation was considered successful when it was performed on the first try. Data registration was done by the professional who directly participated in the procedure in a specific form. During the study period 117 tracheal intubations were performed, and 84% of these events were held under RSI; the patients\' ages ranged from 29 days to 17 years (median = 4.4 years) and 60 % were male; seventy-nine percent of patients had underlying diseases, 21% of them were neurological diseases, 18% cancer and 8% respiratory diseases; the acute respiratory failure was the immediate cause of TI in 40% of the procedures and altered level of consciousness and shock in 20% and 18% respectively; all TIs were performed in the emergency room by emergency physician with success rate of 39%; the pediatric resident\'s from the second year was responsible for 74% of the TIs, and with a success rate of 35%; positive pressure ventilation was performed in 74% of procedures, their use was lower among patients who were successfully intubated (21 vs. 49 p = 0.002); Midazolam was chosen as a sedative in 80% of procedures, and rocuronium as a neuromuscular blocking agent in 100% of procedures; Complications from the procedure of TI have been described in 75 (80%) of procedures, where a decrease in oxygen saturation was reported by 47% and significantly lower in patients who were successfully intubated (p <0.001). Difficulties related to TI were reported less in procedures performed with success (p <0.001). In conclusion, it can be stated that RSI was the method of choice in TI performed in the emergency room of ICr-FMUSP, that the patients who required airway management was composed mostly of patients with underlying diseases with respiratory problems and that complications of the RSI procedure are more frequent when there is need for a higher number of direct laryngoscopy attempts.

Os primeiros indícios de tentativas de abordagem e manejo da via aérea (VA) datam de cerca de 4000 anos. A intubação traqueal (IT) consiste na introdução de um tubo na luz da traquéia, e é responsável por salvar muitas vidas. O manejo da VA nos serviços de emergência é um dos principais desafios e seguramente um dos momentos mais críticos do cuidado com o paciente grave. As principais complicações e efeitos adversos da IT decorrem da laringoscopia direta e da introdução do tubo traqueal na VA. A sequência rápida de intubação (SRI) é a realização do procedimento de IT através de uma abordagem organizada que envolve a utilização de agentes sedativos, analgésicos e bloqueador neuromuscular. A SRI tem por objetivo diminuir ou limitar os efeitos adversos do procedimento de IT, em especial da laringoscopia direta. A SRI é o método de escolha na maioria dos procedimentos de IT de emergência em pediatria na literatura internacional. Os registros de dados sobre o manejo da VA em serviços de emergência pediátricos no Brasil são raros e não abordam a SRI como técnica de IT. Dessa forma os objetivos do presente estudo foram descrever a experiência do pronto-socorro de um hospital pediátrico de atendimento terciário com o uso da SRI, e detectar possíveis fatores associados ao sucesso da SRI. Para tanto foi realizado estudo prospectivo observacional tipo \"coorte\" de julho de 2005 a dezembro de 2007, onde foram coletados os dados relacionados a todas as ITs realizadas no pronto-socorro do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP). Foram incluídos no estudo todos os pacientes que foram submetidos a SRI. Foi considerado IT com sucesso aquela realizada na primeira tentativa. O registro dos dados foi realizado pelo profissional que participou diretamente do procedimento em formulário específico. Durante o período de estudo ocorreram 117 ITs, sendo que 84% delas foram realizadas sob SRI; a idade dos pacientes variou de 29 dias a 17 anos (mediana=4,4anos) e 60% eram do sexo masculino; setenta e nove por cento eram portadores de patologias de base, sendo 21% doenças neurológicas, 18% oncológicas e 8% respiratórias; a insuficiência respiratória aguda foi a causa imediata da IT em 40% dos procedimentos e alteração do nível de consciência e choque em 20% e 18% respectivamente; todas as ITs foram realizadas no pronto-socorro e por um dos médicos da equipe; a taxa de sucesso foi de 39%; o residente de pediatria do segundo ano foi o responsável por 74% das ITs, e com taxa de sucesso de 35%; foi realizada ventilação com pressão positiva em 74% dos procedimentos, sendo menor a sua utilização entre os pacientes que foram intubados com sucesso (21 versus 49 p=0,002). O midazolam foi o sedativo de escolha, utilizado em 80% dos procedimentos, e o rocurônio foi o bloqueador neuromuscular em 100% dos procedimentos; complicações decorrentes da SRI foram descritas em 75 (80%) dos procedimentos, sendo queda da saturação de oxigênio relatada em 47% do total, e significativamente menor nos pacientes que foram intubados com sucesso (p<0.001); dificuldades relativas à IT foram menos relatadas nos procedimentos realizados com sucesso (p<0,001). Em conclusão, pode-se afirmar que a SRI foi o método de escolha nas ITs realizadas no pronto-socorro do ICr-HCFMUSP, que a população que necessitou de manejo da via aérea foi composta em sua grande maioria por pacientes portadores de doenças de base com problemas respiratórios e que, complicações do procedimento de SRI são mais frequentes quando há necessidade de maior número de tentativas de laringoscopia direta. / The first signs of attempts to approach and manage airways date from about 4000 years. The tracheal intubation (TI) consists in to introduce a tube in the trachea lumen and it is responsible for saving many lives. The airway management in the emergency services is one of the most challenges and critical moments of care for the critically ill patient. The major complications and adverse effects of TI stem from the direct laryngoscopy and tracheal tube introduction into the airway. The Rapid Sequence Intubation (RSI) is the actual procedure of TI through an organized approach that involves the use of sedative agents, analgesics and neuromuscular blocker. The objective of SRI is to minimize and limit the main adverse effects of the TI procedure and in special of the direct laryngoscopy. SRI is the method of choice in most of TI procedures in emergency pediatrics in the international literature. The data records on airway management in pediatric emergency services are rare and do not address the SRI as a technique to perform TI. The objectives of this study were to describe the experience of a pediatric tertiary care emergency department with the use of RSI, and identify possible factors associated with the success of RSI. For this, a prospective observational study type \"cohort\" was conducted from July 2005 through December 2007, where all data related to TI performed in the emergency room of the Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP) was collected. The study included all patients who underwent to RSI. Intubation was considered successful when it was performed on the first try. Data registration was done by the professional who directly participated in the procedure in a specific form. During the study period 117 tracheal intubations were performed, and 84% of these events were held under RSI; the patients\' ages ranged from 29 days to 17 years (median = 4.4 years) and 60 % were male; seventy-nine percent of patients had underlying diseases, 21% of them were neurological diseases, 18% cancer and 8% respiratory diseases; the acute respiratory failure was the immediate cause of TI in 40% of the procedures and altered level of consciousness and shock in 20% and 18% respectively; all TIs were performed in the emergency room by emergency physician with success rate of 39%; the pediatric resident\'s from the second year was responsible for 74% of the TIs, and with a success rate of 35%; positive pressure ventilation was performed in 74% of procedures, their use was lower among patients who were successfully intubated (21 vs. 49 p = 0.002); Midazolam was chosen as a sedative in 80% of procedures, and rocuronium as a neuromuscular blocking agent in 100% of procedures; Complications from the procedure of TI have been described in 75 (80%) of procedures, where a decrease in oxygen saturation was reported by 47% and significantly lower in patients who were successfully intubated (p <0.001). Difficulties related to TI were reported less in procedures performed with success (p <0.001). In conclusion, it can be stated that RSI was the method of choice in TI performed in the emergency room of ICr-FMUSP, that the patients who required airway management was composed mostly of patients with underlying diseases with respiratory problems and that complications of the RSI procedure are more frequent when there is need for a higher number of direct laryngoscopy attempts.

Projektet bestod i att ge underlag för lämpliga och användbara lösningar för effektivisering av Kockums Maskins skärvätskehantering och kostnadsrelaterade faktorer gällande företagets skärvätska. En grundlig undersökning av lämpligt material inom projektets huvudsakliga område gjordes till en början för att därefter resultera i en vidare analys av företagets nuvarande system och hantering av skärvätskor. Utifrån denna analys påbörjades en vidare undersökning om möjliga förslag om förbättring gällande de berörda problemen. Genom direktkontakt med flertalet företag och personer inom hantering/inköp samt befintlig dokumentation gällande skärvätska, erhölls ett flertal lösningar och förbättringsförslag som senare utvärderades och användes vid framtagning av det sökta projektresultatet. Problematiken gällande valet av lösningar har att göra med det faktum att det krävs omfattande kompetens inom varje typ av lösningsgrupp för att uppfylla de krav och förhållanden som finns hos Kockums Maskin. Därmed har avgränsningar gjorts gällande direkta val av lösningar för att istället ge förslag på lämpliga lösningar gällande förbättring av kvalitet, som indirekt bör sänka den årliga kostnaden av skärvätska, utifrån Kockums Maskins egentliga behov. / The project was to provide the basis for appropriate and useful solutions for any eventually streamlining of Kockums Maskin's cutting fluid management. Cost-related factors regarding the company's cutting fluid are also included in this part. A detailed examination of suitable material within the project's main area were initially and subsequently result in a further analysis of the company's existing systems and management, regarding cutting fluids. Based on this analysis a further investigation on possible proposals was started for improvement regarding the issues involved with the solutions and the cutting fluids. Through direct contact with many companies and individuals in management/purchasing and existing documentation regarding cutting fluid, obtained a several solutions and suggestions for improvement regarding the searched area. This result was then later evaluated and used in the development of the project results. The problem regarding the choice of solutions has to do with the fact that it requires extensive expertise in every type of area to meet the requirements and conditions that Kockums Maskin demands. Thus, the boundaries claimed the election of solutions to instead provide suggestions for suitable solutions regarding the improvement of quality, which indirectly should lower the annual cost of cutting fluid, based on Kockums Maskin's actual needs.