Uma intervenção educativa para profissionais de saúde na prevenção de pneumonia associada à ventilação mecânica

Quasi-experimental study, prospective with quantitative approach, performed at the Hospital do Coração in Natal, aimed at verified the existence of difference between the care given by health professionals to the patients under mechanical ventilation (MV) in the Intensive Care Unit, before and after an educative intervention. The population was of 31 professionals, with data collected between november 05 of 2007 to march 27 of 2008. The results show a yong population, female gender, middle level of education, nursing technique, working between 05 and 09 years on nursing profession, and 01 to 04 years on Intensive Care Unit; almost all, never had an kind of training over prevent pneumonia associated to mechanical ventilation; from those that had training, occur on the work place with duration from 12 to 24 hours. About endotracheal intubation, the cuff was tested with a sterilized syringe had a positive change after a educative intervention, increased from 75,0% to 100,0%; the sterile guide was used on 75,0% before and 100,0% after an educative intervention. Regarding endotracheal suction procedure, was not informed to the patient on 72,7% before, however was informed on 56,7% after; the hands was not previously washed 68,5% before, however was 63,3% after the procedure; mask was used on 74,2 % opportunities before and 76,7% after; the aspiration catheter had adequated size on 98,9% observation before and 100,0% after; the gaze was sterilized on 95,7% before and 100,0% after; the ventilator was connected to the patient during the aspiration intervals on 94,4% observation before and 100,0% after; the ambu bag was clean and protected on 76,1% before and 85,7% after; the aspiration catheter was discarded after be used on 98,9% before and 100,0% after; FIO2 was turned to the begging value on 32,9% observation before and 12,0% after; before the procedure 71,9% professions washed their hands and 73,3% after; before, notes of aspiration results were performed on 70,8% observation and 86,7% after. Regarding devices used on respiratory tract, aspirator flasks were not swapped on 84,6% observations before and 71,0% after; daily látex extention change was not performed on 93,6% observation before and 87,1% after; the ambu bag change was not performed on 50,0% observation before even if was duty or unprotected and on 75,8% opportunities was changed, after; nebulization was not prepared with sterile fluids or manipulated aseptically on 65,2% observation before, perhaps was on 71,7% after; before nebulizers were not changed on 65,2% observations, perhaps were on 60,9% after. Concerning ventilator breathing circuits, condense fluids cumulated on circuits were removed on 55,0% opportunities before, and 64,0% after; moisturizer was not filled with sterile water when already had small amount of liquid inside on 78,4% observations before, and 90,2% after; MV circuits were changed on 97,0% observations on presence of visible duty or when presents some kind of failure, before and 98,4% after. About body position, on 51,3% observations the decubitus position change were done before and 78,2% after; fowler position was maitened on 95,5% observations before and 98,2% after; Regarding respiratory physiotherapy, enteral diet was not interrupted before respiratory physiotherapy on 94,9% before and 90,0% after; respiratory physiotherapy devices were not disinfected or sterile on 69,6% observations before but they re on 60,0% after; before the cateter was not tested before introduction enteral diet or medications on 100,0% but after was done on 15,2%. About enteral feeding, intestine motility and measure of stomach contents were not done on 100,0% observations before, but was 15,2% after. We conclude that 05 of 07 valuated procedures in relation to MV, had a significant improvement on quality of care given after educative intervention, when compared before intervention

Uma arquitetura para detecção online de transientes em sinais de eletrocardiograma sobre o protocolo IEEE 802.3 com PM-AH

The occurrence of transients in electrocardiogram (ECG) signals indicates an electrical phenomenon outside the heart. Thus, the identification of transients has been the most-used methodology in medical analysis since the invention of the electrocardiograph (device responsible for benchmarking of electrocardiogram signals). There are few papers related to this subject, which compels the creation of an architecture to do the pre-processing of this signal in order to identify transients. This paper proposes a method based on the signal energy of the Hilbert transform of electrocardiogram, being an alternative to methods based on morphology of the signal. This information will determine the creation of frames of the MP-HA protocol responsible for transmitting the ECG signals through an IEEE 802.3 network to a computing device. That, in turn, may perform a process to automatically sort the signal, or to present it to a doctor so that he can do the sorting manually

O discurso autobiográfico nos relatos de viagem de Nísia Floresta

En plein XIXe siècle, Nísia Floresta Brasileira Augusta a écrit sur deux voyages faits en Europe. Quelques années plus tard, cette norte-rio-grandense a livré au public ses récits de voyage : Itinéraire d un voyage en Allemagne (1857) et Trois ans en Italie Suivis d un Voyage en Grèce (1864/1872). Malgré les particularités qui entourent chacun de ces récits, un aspect y est fortement présent : les marques autobiographiques. Notre travail a comme principal objectif enquêter comment se manifeste ce discours autobiographique. A partir de l‟Analyse du Discours, nous avons travaillé quelques positionnements sur certaines oeuvres littéraires, comme par exemple, le fait qu‟elles aient plus d‟un genre. Ce qui se passe dans les récits de voyage de Nísia Floresta est semblable, car au-délà de raconter le passage de Nísia par ces lieux, nous pouvons trouver des caractéristiques qui appartiennent à l‟écriture fragmentaire, autobiographique et épistolaire. Devant les propositions indiquées par Philippe Lejeune, nous avons pu confirmer que ces récits de Nísia font partie de l‟écriture autobiographique. Sous l‟optique de quelques théories, nous avons parcouru des points intéressants qui enveloppent ces récits et, de cette façon, nous avons voyagé avec Nísia Floresta par l‟Allemagne et ultérieurement par l‟Italie et Grèce, en connaissant ainsi, pas seulement un peu plus sur ces lieux, mais beaucoup de confidences sur cette écrivain potiguar, qui a ouvert son coeur au plublic

Cartografias mito-poéticas do imaginário nelidiano: das visões do mundo arcaico ao contemporâneo no romance fundador

Esta tesis trata de cómo se desarrolla en la obra de la escritora contemporánea Nélida Piñon una especie de pensamiento cartográfico, presente desde su primer romance Guia-mapa de Gabriel Arcanjo, publicado en 1961. Para que se interprete el universo literario nelidiano, formulamos nuestro trabajo estableciendo un confronto con el texto del mito iluminado por las reflexiones de Eliade (2007; 2007b; 2008) y Meletínski (2002); con el discurso filosófico pos-estructuralista, representado principalmente por las contribuciones de Deleuze y Guattari (1995; 1996; 1997) a respecto de una geografía del nomadismo; y de Foucault (1996; 2006) sobre el orden del discurso, o nacimiento de la literatura y el ser del lenguaje. Examinadas por la lectura crítica y comparativista de esta investigación, las cartografías mito-póeticas de Piñon son presentadas al lector asociándose a una geografía de los sentimientos y al que Maffesoli (2001) denomina deseo de errância y de perdición, particularmente en las obras Tebas do Meu Coração, A República dos Sonhos, O Presumível Coração da América e Fundador. Esa última novela, publicada en 1969, por lo tanto anterior a los otros textos mencionados, servirá como corpus principal de nuestro análisis, que objetiva demostrar como la narrativa de Piñon se conecta a un linaje literario estructurado a partir de las acciones de un determinado tipo de personaje conocido como inaugurador de ciudades o héroe civilizador o cultural. En la reedición de ese arquetipo de personaje, la autora instaura el elemento de la seducción, en un juego que se establece entre los sujetos masculino y femenino y que pone de manifiesto cuestiones relacionadas al erotismo, a la transgresión y al sagrado, abordadas en nuestro discurso por las consideraciones de Baudrillard (2008) y Bataille (1987). Para que se explicite la constitución de esos puntos, realizaremos un viaje de las visiones del mundo arcaico al contemporáneo por las páginas de Fundador, apuntando de qué manera la escritora brasileña retoma las imágenes del mito cosmogónico, del mito del eterno retorno y del paraíso terreal, que se inscriben como fundamento do su texto literario

Iracema: a alegoria da mãe genti(o)l

A abordagem da visão da literatura nacional dentro do contexto cultural brasileiro da segunda metade do século XIX e do posicionamento crítico de José de Alencar fez, de sua produção romanesca, especialmente a indianista, representada aqui por sua obra Iracema, um símbolo do conjunto de intenções nacionalistas que invadiu a alma e o coração de todo o povo, no que diz respeito ao sentimento de brasilidade , condizente com a estética romântica da qual faz parte seu autor. Seu posicionamento, quer seja crítico ou artístico, faz de Alencar o maior polemista em defesa da liberdade cultural e literária do Brasil, enquanto alguém bem consciente de sua função social, e por que não dizer, crítica, identificando a metalinguagem como um diferencial fomentador de uma teorização de poética na defesa de sua ficção, abrindo caminho, assim, para a pesquisa da poética explícita na sua produção artística. A referida análise buscará, a partir de uma análise estrutural das partes formais que o compõem esteticamente, como também de uma compreensão temática dos ditos e interditos utilizados pelo narrador alencariano na composição de seu discurso, identificar Iracema enquanto um romance que disputa o título de obra fundacional do Brasil. Para isso se faz necessário empreender uma abordagem do como e do quanto os elementos da Natureza, num romance romântico que tem a Natureza enquanto uma de suas temáticas mais significativas, podem constituir e interferir na percepção e construção de um personagem, que é todo Natureza, e no meio natural em que ele vive; até mesmo ser, por causa disso, o elemento mais representativo dessa nação que se deseja criar, trazendo para o cenário cultural brasileiro do século XIX uma versão de instituição baseada no revigoramento da memória da cultura selvagem. Faz-se lícito também animar forças da natureza e da terra-paisagem que poderiam ser tidas, apenas, como exóticas, mas que na obra em questão funcionam como protagonistas, mesmo fantasmas, de um pacto social e político que, mesmo quando rompe, recusa-se em deixar romper, mergulhando no espaço romanesco da magnitude das águas ou na frieza tumular da terra. Tomar-se-á, também, como ponto de estudo, a análise da fusão da experiência histórica com a experiência ficcional, observando o imbricamento de um discurso no outro, como também as fronteiras que se estabelecem a partir dessa tentativa; tomando o erotismo e a alegoria como pontos de convergência na obra em questão. Por meio da verificação de uma relação que se constrói a partir da solidão, da memória e do esquecimento em que acabam por mergulhar todos os seus personagens, que são, por vezes, tragados em algum dilúvio bíblico da purificação, dentro de um projeto audacioso de invenção de uma nação, que se quer de identidade cultural, e também política, mas que termina condenado ao silêncio, não gozando de liberdade em relação ao espaço a que pertence e, no entanto representa, só cabendo a eles regressarem para dentro da terra-mãe, ou se submeterem a um ritual de profunda aculturação, verificar-se-á, através desse discurso historicamente construído, o ideário de uma nação que se almejava projetar. O conflito de Iracema, personagem protagonista de sua obra homônima, a negação e a perda de si mesma, de tudo aquilo que poderia representar a sua identidade social e cultural, e, conseqüentemente, a morte e a vida dessa mãe genti(o)l, simbolizam a vida e a arte de um povo que, passando pelos embates da colonização, através de seus artistas rebeldes e românticos da Independência, que ilustraram, em grande síntese, a visão através da qual o homem do Novo Mundo foi vislumbrado, rabiscou a imagem da americanidade pelo discurso da História

Comportamento de mergulho do boto-cinza, Sotalia guianensis, na enseada do Curral, Praia de Pipa-RN, Brasil :possíveis adaptações cardíacas ao mergulho

The marine tucuxi, Sotalia guianensis, is one of the smallest known cetaceans, has coastal habits, and occurs from Hondures to Santa Catarina, in southern Brazil. The objective of this dissertation was to describe diving behavior of the marine tucuxi in three age classes and to analyze the cardiac capacity to dive through the examination of hearts of stranded specimens. Observations were made from October 2004 to November 2005 from a vantage point, in Curral Bay at Pipa beach-RN. We used Ad Libitum sampling and All occurrences to record the behaviors. The diving was characterized by the total exposition of the tail fluke for a few seconds, in 90° or 45° angles. Were recorded 131 dives in three behavioral contexts: foraging, traveling and socialization. The difference between juveniles and adults in dive time and fluke out at 45° or 90° to search and/or capture prey is probably influenced by the strategy used and ability to capture the prey. The frequency of fluke out at 90° for foraging in adults may be related to increased physiological efficiency of adults in comparison to juveniles. However, in the context of travel and socialization the dive time and fluke out were independent between the age classes. Dive in calves were frequent during socialization (play behavior) and traveling. This, associated with synchronic calve-adult diving suggests that a relationship of these behaviors and the acquisition of experience and foraging skills. As observed in other cetaceans, the heart (n=12) of the estuarine dolphin is broad and presents long ventricles which form a round apex. The right ventricle is long and narrow. The degree of dilatation of the aortic bulb may support the heart during diastole. The characteristic morphology of the heart and short dive duration < 2 min and depth ranged from 10m in the estuarine dolphin, can be likely at physiological adaptation for diving, typical de dolphins with coastal habits. The limitation of diving time in this specie may be influenced by anatomical and physiological restrictions

Com quantas ave-marias se faz uma santa? relicário de vozes sobre a santa menina

Ce travail a comme objectif analyser la structure et l'efficacité d'un système symbolique, qui est configuré à travers qui le philosophe Dufour (2000), à partir du linguiste Benveniste (1995) et du philosophe Lyotard (1998), dans la manutention et la sustentation des récits et d'histoires, appelle de trinité naturel des la langue. C'est sous cet appareil, inscrit à travers des pronomes « moi », « toi » et « lui » qui nous étudierons les suivantes questions: 1. comme s'il établit, synchronement, la mise à jour du mythe religieux Santa Menina présente dans la ville de Florânia, gêné dans le coeur broussard du Rio Grande do Norte? 2. qui manière, diachronement, les récits sur mentionné mythe s´il récupère? Le culte religieux à la Santa Menina est marqué discoursivement à travers d´un univers à facettes multiples qui se soutient à travers les voix de floranienses sur l'histoire d'une fille, dont le corps est trouvé intact et qui, sacralitée par la population, est connu comme la Santa Menina. Une histoire qui, notamment, avait/a répercussion et résonance, en participant, efficacement, des la réalité culturelle des la population. Théoriquement, notre travail est nourri par des savoirs arrivés, des la Linguistique, et des études sur la Mémoire et l'Histoire Verbale

Acessibilidade em área comercial: um estudo do bairro do Alecrim, Natal/RN

Planejar o espaço urbano pensando na inclusão social de pessoas com deficiência significa considerar a acessibilidade como fator essencial para uma mobilidade urbana completa e segura. Esse ideal reflete-se no espaço comercial que, para ser convidativo e livre de barreiras (sejam elas físicas, tecnológicas ou atitudinais), precisa promover o direito de livre acesso a todos os cidadãos. Partindo deste entendimento, esse estudo tem como objetivo geral analisar as condições de acessibilidade da região denominada “Coração do Alecrim”, área de tradicional comércio popular em Natal. A pesquisa recorreu à abordagem multimétodos e aconteceu em três momentos: (i) avaliação técnica da área por meio da aplicação de check-list, elaborado com base na legislação específica e validado por painel de experts; (ii) elaboração de mapas com uso de Sistema de Informação Geográfica (S.I.G.), tendo como base o resultado da análise realizada na primeira etapa; (iii) aplicação de questionários e realização de entrevistas informais com usuários (visitantes, proprietários e comerciários), para coletar dados sobre sua percepção sobre o lugar, complementando a análise técnica efetuada. Resumindo as informações coletadas, foram elaboradas matrizes de descobertas, como uma junção de todas as etapas de análise. Na conclusão são apresentados pontos críticos de acessibilidade (detectados pela pesquisadora ou apontados pelos usuários) e indicadas algumas diretrizes para a intervenção no local, de modo a colaborar para futuros processos de planejamento urbano do bairro do Alecrim.

Evidências de validade do Millon Behavioral Medicine Diagnostic na avaliação de aderência terapêutica em pacientes com insuficiência cardíaca crônica

Chronic heart failure (CHF) is the final common pathway of most diseases affecting the heart, being responsible for a high level of mortality and hospitalization, as well as significant reduction in quality of life of those affected. Interventions that claim to optimize patient adherence to their medical regimen, and improve self-care behavior, have proven effective in preventing unplanned admissions and improves the outcome for patients, however, studies have shown the problem of non-adherence, and some psychological instruments have been used to show that traces indicate difficulties with treatment adherence. Having shown this, the aim of this work is to evaluate the evidence of validity of the Millon Behavioral Medicine Diagnostic (MBMD) in a population of patients with CHF. The study included individuals with CHF, males and females, between the age of 18 and 85 years, treated in a reference hospital in the city of NatalRN. A total of 120 patients answered, in addition to the MBMD, another questionnaire structured with sociodemographic aspects and clinical itens. The results indicated that the parameter of the MBMD reliability was satisfactory the most of extracted factors, and some scale. In terms of the population studied, we could verify that the disease was more prevalent in men, but women had the highest average in indicators related to negative health habits and depressed mood. Younger pacients and those who had no partner had the highest averages in groups of items that dealt with feelings of sadness and discouragement. Hasn’t been observed differences related to negative health habits and problematic adherence among patients in different functional classes. More studies in this research line, with a larger population and from other regions of the country, are needed in order to expand the data presented here

Um percurso sobre o patrimônio e a morfologia urbana do centro de Fortaleza-CE

The incursion into the historical area from Fortaleza´s downtown presents reminiscences of a heritage collection that can be recognized as city built heritage, in architectural and urban aspects. The neighborhood has in its urban tracing a synthesis of the various phases from the Brazilian architecture materialized in its tracing and built goods. This composition mainly covers the eclectic production, passing the time of art déco, including the period of modern production. This paper aims to identify the existing heritage collection. This study aims to identify the existing net assets, the temporality and spatiality that allow to recreate the neighborhood´s form urbain history. Based on the theoretical and methodological support of the urban morphology urban of authors such as Aldo Rossi (1966), Gordon Cullen (1971), José Lamas (1990), Kevin Lynch (1960), and Philippe Panerai (1999) was allowed on a predefined route, to build part of urban memory of Fortaleza. The historical and morphological study runs through a sequenced analysis developed on the articulated subsets, formed by the network neighborhood squares: Praça José de Alencar, Praça Capistrano de Abreu (Lagoinha), Praça Clóvis Beviláquia, Praça do Carmo, Praça Murilo Borges (BNB), Praça Coração de Jesus, Parque das Crianças, Praça do Riacho Pajeú, Praça dos Voluntários (Polícia), Praça do Ferreira, Praça Waldemar Falcão (Correios), Praça General Tibúrcio (Leões), Praça Figueira de Melo, Bosque Dom Delgado (Pajeú), Praça Cristo Redentor, Praça Caio Prado (Sé), Praça dos Mártires (Passeio Público), e Praça Castro Carreira (Estação). Separated the neighborhood based on this square system because it is perceived that there is in these public spaces a path which includes a portion of the urban history of Fortaleza. In addition to this there is a higher concentration of goods in its area in relation to others sectors of the neighborhood, where the loss of the characterization is an imperative of the urban set. In order to find this network of public spaces contained in the study area were proposed two routes based on the city limits of 1875 established by Adolfo Herbster (Fortaleza´s city plan).The path starts by known boulevards (Imperador, Duque de Caxias and Dom Manuel avenues) and the seafront. The study is grounded in the literature review, document and empirical theme, consisting of an overlay of maps, drawings and photographic collection that ratify this net assets as both architectural urban nowadays. Among the results, it was observed that before a current context of loss of locus of the concept of historical-cultural agglomerated, the squares express the strongholds of equity ambience that perhaps stand in urban morphology of the capital from Ceará.

Características dos programas de residência médica em cardiologia do estado do Rio Grande do Norte

The present study had as goal to evaluate Rio Grande do Norte state’s medical residency programs (MRP) in Cardiology. It’s a descriptive study, including a documental analysis of the program’s accreditation processes (PAP) of cardiology’s medical residency in Rio Grande do Norte state in 2014 and the analysis of the resident’s perception about his professional education as a specialist in Cardiology. Beside the documental analysis of the PAPs, it was applied a semi-structured questionnaire with closed questions Likert style and open questions to all the current and former residents of the MRPs analyzed. Two MRPs in Cardiology were identified in Rio Grande do Norte state, one hosted in a public institution and the other in a private institution. The documental analysis showed a greater amount of preceptors with a good level of ownership on the public institution in comparison with the private one, as well as a bigger number of publications, participation in congresses and in book’s publications. The private institution presents a better Urgency’s infrastructure, with emergency room and cardiologic ICU. It IS clear that the residents are aware of how a good residency must work, as well as the strengths and fragilities of their own residences. Most of Onofre Lopes Universitary Hospital’s residents point out as a strength the organization, participation and quality of the preceptors, practice activities and scientific debates, great amount of patients and the visits and debates with the preceptors on the sickrooms. As the greatest fragilities, they emphasize the lack of a urgency service of their own and a specialized ICU. In Coração Hospital of Natal (HCor), it is listed as weak points the theoretic scheduling and the few ambulatory practices. As positive aspects, they report the preceptors, the agility on the execution of exams, a good number of serious patients and procedures. In both residences, it is seen a certain difficulty in accepting the important and mandatory items imposed by the rules of the Medical Residences’ National Committee, such as: biostatistics, bioethics, medical ethic, epidemiology and research methodology. Besides that, the residents recognize that both hospitals have a good infrastructure and technological support, especially in imaging methods. The evaluation of PRMCs identifies the strengths of each program and the aspects to be improved in both programs. It also allowed the observation of difficulties in accepting some regulations contained in the CNRM resolution by the resident, such as participation in activities such as biostatistics, epidemiology and research methodology as well as the improvement needs of specific technical training, such as in emergency care. Thus, our results make possible to develop strategies for continued improvement of PRMC in RN state. In addition, it enabled the preparation of the resident’s manual in cardiology, containing even a breakdown of resident evaluation system, which could serve as a model for other residency programs.

A Teatralidade em Clarice Lispector

This article comments on some aspects of Clarice Lispector’s theatricality It aims to highlight particular aspects of Lispector’s plastic and sensorial text pointing out and discussing about its materiality and performartic qualities. So, this article will look at the existing tension between literality and theatricality which is a constant within Lispector’s work since her inaugural work Perto do Coração Selvagem.