The Flower Workshop: a social self-organizing practice in mental health nursing

Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP)

Heart transplantation experiences: a phenomenological approach

Aim. The aim of this study was to understand the heart transplantation experience based on patients' descriptions.Background. To patients with heart failure, heart transplantation represents a possibility to survive and improve their quality of life. Studies have shown that more quality of life is related to patients' increasing awareness and participation in the work of the healthcare team in the post-transplantation period. Deficient relationships between patients and healthcare providers result in lower compliance with the postoperative regimen.Method. A phenomenological approach was used to interview 26 patients who were heart transplant recipients. Patients were interviewed individually and asked this single question: What does the experience of being heart transplanted mean? Participants' descriptions were analysed using phenomenological reduction, analysis and interpretation.Results. Three categories emerged from data analysis: (i) the time lived by the heart recipient; (ii) donors, family and caregivers and (iii) reflections on the experience lived. Living after heart transplant means living in a complex situation: recipients are confronted with lifelong immunosuppressive therapy associated with many side-effects. Some felt healthy whereas others reported persistence of complications as well as the onset of other pathologies. However, all participants celebrated an improvement in quality of life. Health caregivers, their social and family support had been essential for their struggle. Participants realised that life after heart transplantation was a continuing process demanding support and structured follow-up for the rest of their lives.Conclusion. The findings suggest that each individual has unique experiences of the heart transplantation process. To go on living participants had to accept changes and adapt: to the organ change, to complications resulting from rejection of the organ, to lots of pills and food restrictions.Relevance to clinical practice. Stimulating a heart transplant patients spontaneous expression about what they are experiencing and granting them the actual status of the main character in their own story is important to their care.

The impact of physical exercise on the gastrointestinal tract

Purpose of reviewPhysical exercise can be both beneficial and harmful for the gastrointestinal tract in a dose-effect relationship between its intensity and health. Mild-to-moderate intensity exercises play a protective role against colon cancer, diverticular disease, cholelithiasis and constipation, whereas acute strenuous exercise may provoke heartburn, nausea, vomiting, abdominal pain, diarrhea and even gastrointestinal bleeding. This review focuses on mechanisms involved in those symptoms and their associations with type of exercises in humans.Recent findingsOne quarter to one half of elite athletes are hampered by the gastrointestinal symptoms that may deter them from participation in training and competitive events. Vigorous exercise-induced gastrointestinal symptoms are often attributed to altered motility, mechanical factor or altered neuroimmunoendocrine secretions. Training, lifestyle modifications, meal composition, adequate hydration and avoidance of excessive use of some medications are the recommendations.SummaryStrenuous exercise and dehydrated states would be the causes of gastrointestinal symptoms referred by 70% of the athletes. Gut ischemia would be the main cause of nausea, vomiting, abdominal pain and (bloody) diarrhea. The frequency is almost twice as high during running than during other endurance sports as cycling or swimming and 1.5-3.0 times higher in the elite athletes than the recreational exercisers.

Low-level laser therapy for pain relief after episiotomy: a double-blind randomised clinical trial

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Uso do óxido nítrico em pediatria

Objective: To review the literature on inhaled nitric oxide and to describe its main clinical applications in pediatrics. Sources of data: A 10 year literature review with selection of the most important publications on inhaled nitric oxide, using the Medline and Cochrane Systematic Review databases. Summary of the findings: This review was organized as follows: introduction; metabolism and biological effects; clinical applications; dosage, gas administration and weaning; precautions and side-effects. Inhaled nitric oxide use was described in persistent pulmonary hypertension and hypoxia of the newborn, acute respiratory distress syndrome, primary pulmonary hypertension, heart surgery, chronic obstructive pulmonary disease, sickle cell anemia, and bronchospastic disease. Conclusions: Inhaled nitric oxide is a therapeutic approach with wide clinical applications in pediatrics. Its use is safe when administered in pediatric intensive care units under strict monitoring. As a pulmonary vasodilator, nitric oxide has beneficial effects on gas exchange and ventilation. Controlled trials, focusing on early gas administration should be performed under many clinical conditions, especially acute respiratory distress syndrome.

Acute phase protein profile in agoutis (Dasyprocta azarae; Lichtenstein, 1823) in captivity, determined by sodium dodecyl sulfate polyacrilamyde gel electrophoresis

The acute phase response refers to a nonspecific and complex systemic reaction of the organism that occurs shortly after any tissue injury. The acute phase response is considered a part of the innate host defense system, which is responsible for the survival of the host during the critical early stages of attack, and in evolutionary terms, it precedes the acquired immune response. The purpose of this study was to determine serum protein concentrations, including the acute phase protein profile in agoutis (Dasyprocta azarae) in captivity, by means of sodium dodecyl sulfate polyacrylamide gel electrophoresis. Blood samples from 11 adult healthy animals (nine females and two males) were obtained. The serum proteinogram had 21 proteins with molecular weights ranging from 15 to 240 kD. The acute phase proteins identified were: ceruloplasmin, transferrin, albumin, haptoglobin, α-1-acid glycoprotein, and hemoglobin. IgA, IgG heavy and light chains, and nonnominal identified proteins of 240, 210, 140, 98, 78, 48, 35, 31, 23, and 15 kD were also identified. The determination of the acute phase protein concentrations is a useful method for the early detection of subclinical disease or changes in the healthy animal, with predictive information on the development of disease in the future. It is possible to standardize the reference values of the serum protein profile of agoutis, which can be used for diagnosis and prognosis, treatment and clinical follow-up of nutritional disorders, and immune-mediated inflammatory diseases that may affect these animals. © 2012 Springer-Verlag London Limited.

Anemia e fatores associados em crianças assistidas por creches públicas

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Nutritional parameters are associated with mortality in acute kidney injury

OBJECTIVE: The objective of this study was to perform a nutritional assessment of acute kidney injury patients and to identify the relationship between nutritional markers and outcomes.METHOD: This was a prospective and observational study. Patients who were hospitalized at the Hospital of Botucatu School of Medicine were evaluated between January 2009 and December 2011. We evaluated a total of 133 patients with a clinical diagnosis of acute kidney injury and a clinical presentation suggestive of acute tubular necrosis. We explored the associations between clinical, laboratory and nutritional markers and in hospital mortality. Multivariable logistic regression was used to adjust for confounding and selection bias.RESULTS: Non-survivor patients were older (67 +/- 14 vs. 59 +/- 16 years) and exhibited a higher prevalence of sepsis (57.1 vs. 21.4%) and higher Acute Tubular Necrosis-Individual Severity Scores (0.60 +/- 0.22 vs. 0.41 +/- 0.21) than did survivor patients. Based on the multivariable analysis, laboratorial parameters such as blood urea nitrogen and C-reactive protein were associated with a higher risk of death (OR: 1.013, p = 0.0052; OR: 1.050, p = 0.01, respectively), and nutritional parameters such as low calorie intake, higher levels of edema, lower resistance based on bioelectrical impedance analysis and a more negative nitrogen balance were significantly associated with a higher risk of death (OR: 0.950, p = 0.01; OR: 1.138, p = 0.03; OR: 0.995, p = 0.03; OR: 0.934, p = 0.04, respectively).CONCLUSIONS: In acute kidney injury patients, a nutritional assessment seems to identify nutritional markers that are associated with outcome. In this study, a low caloric intake, higher C-reactive protein levels, the presence of edema, a lower resistance measured during a bioelectrical impedance analysis and a lower nitrogen balance were significantly associated with risk of death in acute kidney injury patients.

Indicadores de qualidade assistencial e Nursing Activities Score análise correlacional em um Hospital Especializado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo bibliográfico de publicações sobre a atividade administrativa da enfermagem em saúde mental

0bjetivando estudar a atividade administrativa do enfermeiro em saúde mental enquanto um instrumento do processo de trabalho, realizamos um estudo bibliográfico de publicações de enfermagem sobre esta temática no período de 1988 a 1997. Através da leitura e análise crítica de 8 artigos e 19 dissertações e teses selecionadas, identificamos as principais características dessa prática, quais sejam: os enfermeiros são os responsáveis pela equipe e assistência de enfermagem, obedecendo à lógica determinada pela instituição; suas ações não são planejadas, coordenadas e avaliadas; as atividades administrativas utilizam a maior parte de seu tempo de trabalho e o cuidado direto de enfermagem é realizado pela equipe auxiliar de enfermagem, sendo que nos serviços extra--hospitalares os atendimentos diretos e grupais são mais freqüentes.

Prevalência e fatores de risco associados à infecção pelo Vírus da Imunodeficiência Humana em parturientes

OBJETIVO: Determinar a prevalência e os fatores de risco associados à infecção pelo Vírus da Imunodeficiência Humana (HIV) em parturientes admitidas no Hospital Estadual de Presidente Prudente, SP. MÉTODOS: Estudo epidemiológico transversal com 873 parturientes admitidas no Hospital Estadual de Presidente Prudente, SP, entre 1º de março de 2005 a 30 de dezembro de 2006. Foi aplicado um questionário semi-estruturado e obtidas informações em prontuários e carteiras de pré-natal. As variáveis foram sócio-demográficas, gestacionais, assistenciais do pré-natal e específicas da população reagente. RESULTADOS: A prevalência de parturientes com HIV foi de 2,1%, com escolaridades mais baixas e médias de idade e de gestações superiores às não reagentes. Os fatores de risco associados foram a residência fora do município de tratamento e a baixa escolaridade. Houve um aumento da prevalência do HIV em parturientes em relação a dados anteriores. CONCLUSÃO: Os fatores de risco encontrados podem estar envolvidos no aumento da prevalência e no comprometimento da profilaxia pré-natal para o HIV.

Febre catarral maligna em bovinos do Mato Grosso do Sul e de São Paulo

São descritos a epidemiologia, os sinais clínicos, os achados de necropsia e a histopatologia de seis casos de febre catarral maligna (FCM) em bovinos de 5 fazendas localizadas nos estados de Mato Grosso do Sul e São Paulo. A doença ocorreu em bovinos de ambos os sexos e com idades variando de 4 meses a 11 anos. Os índices de morbidade variaram de 0,25% a 6.6% e a letalidade foi de 100%. A evolução clínica foi aguda (2-3 dias) em seis casos e crônica em um (3 meses). O diagnóstico presuntivo de FCM nos casos descritos neste relato foi baseado nos sinais clínicos, achados de necropsia e confirmados pela histopatologia. Os principais sinais clínicos nos casos agudos foram febre, corrimento mucopurulento pelas fossas nasais, opacidade da córnea, sialorréia, úlceras em várias superfícies mucosas e distúrbios nervosos. O bovino do caso crônico mostrou opacidade da córnea e distúrbios neurológicos. Os principais achados de necropsia incluíam hiperemia e lesões diftéricas em várias superfícies epiteliais e a histopatologia consistiu de vasculite, focos de infiltrado mononuclear multifocal em vários órgãos e necrose de superfícies epiteliais.

Autonomia/mutualidade na assistência de enfermagem

Utilizando um estudo de caso como ilustração, a autora discute as possibilidades da participação ativa dos pacientes na assistência à saúde, visando estimulá-los ao autocuidado. A partir de considerações sobre as formas tradicionais e autoritárias da assistência à saúde nos quais os profissionais determinam os procedimentos e os pacientes aceitam passivamente o que lhes é determinado, o estudo discute as questões da dependência e independência da enfermeira e do cliente no processo saúde-doença, propondo uma inter-relação que mantenha a autonomia de um e de outro. No sentido de que ambos participem ativamente do processo de enfermagem. Tal postura entre a autonomia e a mutualidade é descrita como uma relação dialética entre duas pessoas que se percebem nas suas especificidades e potencialidades, tendo como objetivo comum desenvolver uma assistência de enfermagem que contempla os valores éticos e humanísticos.

Surveillance Programme for Healthcare Associated Infections in the State of São Paulo, Brazil. Implementation and the first three years' results

Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of São Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of São Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Willingness of Brazilian dentists to treat an HIV-infected patient

A study of the willingness of 363 general dental practices in Brazil to accept a patient infected with human immunodeficiency virus for treatment of dental pain and the provision of routine dental care showed only 44% of dental practices to be willing to provide dental care. Willingness was influenced neither by financial factors nor the local prevalence of human immunodeficiency virus disease. © 1994.