Avaliação da dor oncológica: estudo comparativo com pacientes internados em um hospital de referência em Natal/RN

Quasi-experimental study, with prospective data, comparative with quantitative approach, performed in a reference hospital, aiming to identify the effectiveness of the Numerical Rating Scale (NRS) and McGill Pain Questionnaire, used simultaneously, to evaluate a group of patients with oncologic pain (Experimental Group); to identify the effectiveness of the Numerical Rating Scale (NRS) to evaluate a group of patients with oncologic pain (Control Group); to identify the resolution of pain according to prescribed medication, considering the result of the rating scales, and to compare it between the two groups of patients in the study. The population consisted of 100 patients, with both the experimental and control groups being composed of 50 people, with data collected from February to April 2010. The results show that in the experimental group, 32% of the patients were aged 60 to 69, 80% were female; 30% had a primary tumor in the breast, 58% had metastasis, and on 70% the disease was localized. In the first pain evaluation, 26% identified it as light; 46%, moderate; and 28%, severe; with an average of 5.50. In the second pain evaluation, 2% reported no pain; 70%, light; 26%, moderate. and 2%, severe, with an average of 3.30. On those with moderate pain, 60% used non-opioid medicine, 25% under severe pain were medicated with non-opioids and 41.67% with weak opioids. Regarding the Pain Management Index (PMI), 44.0% were rated as "-1". In the control group, 28% were aged 40 to 49, and 54% were male; 20% had primary tumor in the breast and genital-urinary system, consecutively; 56% presented metastasis; on 64% the disease was localized. In the first pain evaluation, 14% considered it light; 42%, moderate; and 44%, severe; with an average of 6.26. In the second pain evaluation, 18% did not signal pain; on 38% pain was light; 40%, moderate; and 4%, severe; with an average of 3.0. Regarding medicine therapy, 71.43% with moderate pain used non-opioids, 22.73% with severe pain used non-opioids and 27.27% weak opioids. Considering PMI, 42% were rated "-1"; and 42%, rated "0". We conclude that, despite the importance of pain as the 5th vital sign, it is still under-identified and under-treated by professionals. Nevertheless, studied oncologic patients had a tendency to report pain more easily when evaluated with the NRS instrument than with the combined use of NRS and MPQ. We believe, however, that the combination of these two instruments represents a more effective evaluation of pain, as it allows comprehension of its quantitative and qualitative aspects. We recommend, however, the replication of this study on a larger population, for a longer span of time, and consequently generating more evaluations, so this can confirm or deny the hypothesis that NRS and MPQ can, together, better evaluate pain on the oncologic patient

Efetividade dos exercícios em cadeia cinética aberta e cadeia cinética fechada no tratamento da síndrome da dor femoropatelar

FEHR, Guilherme Lotierso et al. Efetividade dos exercícios em cadeia cinética aberta e cadeia cinética fechada no tratamento da síndrome da dor femoropatelar. Revista Brasileira de Medicina do Esporte, [s.l], v. 12, n. 2, p.66-70, mar./abr. 2006. Bimestral. Disponível em: . Acesso em: 04 out. 2010.

Avaliação da efetividade de estratégias não farmacológicas para o alívio da dor de parturientes na fase ativa do período de dilatação no trabalho de parto

This study was aim to evaluate the effectiveness of strategies non pharmacological for the relief of the intensity of the parturient pain in the phase activates of the dilation period in the labor. Is a clinic rehearse of the type therapeutic intervention before and after" with a quantitative approach, accomplished in the Humanized Unit of Childbirth of the Maternity Januário Cicco School of the Federal University of Rio Grande do Norte, in Natal/RN, whit 130 parturient, being 30 in the pre-test of the strategies and 100 in the application of the strategies non pharmacological combined (breathing exercises, muscular relaxation and lombossacral massage) and isolated (shower bath in a normal temperature). We used the visual analogical scale to evaluate the intensity of the pain of the study parturient before and after" to the application of the strategies in the phases of acceleration, maximum inclination and desaceleration in the phase activates of dilation period in the labor. The principal results showed that the majority of the study parturient was between 20 to 30 years old (60%); with incomplete fundamental teaching (85%); family income until 2 minimum wages (74%); 78% had a companion and these, 44% were the own husband. The oxytocin was administered in the parturient during the phase activates of the labor in 81% of the cases and only 15% these women didn´t reciev anything medication. We verified significant relief (ρ=0.000) of intensity of the pain of the study parturient after application of the strategies non pharmacological combined and isolated. We concluded that the strategies non pharmacological combined and isolated were effective in the relief of the pain of the study parturient in the phase activates de labor

Fatores preditivos da dor em pacientes submetidos à cirurgia cardíaca

A identificação de fatores que interferem na dor pós-operatória é útil para minimizar o sofrimento desnecessário e favorecer a uma intervenção analgésica adequada, evitando generalizações nas condutas terapêuticas. O propósito dessa investigação foi identificar os fatores preditivos da dor em pacientes submetidos à cirurgia cardíaca e a relação existente entre dor, analgesia e personalidade. Trata-se de um estudo prospectivo e analítico, aprovado pelo comitê de ética da UFRN (175/06), o qual proporcionou uma abordagem multidisciplinar ao envolver áreas distintas como: fisioterapia, psicologia, médica e enfermagem (interdisciplinaridade) na elucidação do objeto de estudo relacionado a fatores preditivos da dor. Para caracterização geral dos pacientes foi utilizada uma ficha de avaliação fisioterapêutica; a dor pós-operatória foi avaliada pela escala numérica de dor e questionário para dor McGill e o Inventário Millon de Estilos de Personalidade (MIPS) foi utilizado para identificar e avaliar as manifestações das características comportamentais e de personalidade. Foram acompanhados, do 1º ao 5º dia de pós-operatório (DPO), 160 pacientes submetidos à cirurgia cardíaca, 57,5% do sexo masculino, com idade média de 56,8±14,4 anos, sendo incluídos no estudo aqueles que se queixaram de dor no pós-operatório em pelo menos um dos dias de avaliação e assinaram termo de concentimento livre e esclarecido (TCLE). Os dados foram submetidos ao teste Qui-quadrado, regressão logística multivariada, teste de correlação de Spearman, teste t e ANOVA. Ao serem submetidos à análise de regressão foram encontrados seis fatores preditivos da dor: tempo cirúrgico > 3 horas, dreno mediastinal e lateral, tosse, vômitos, tempo de dreno > 24 horas e sexo feminino. Estes fatores apresentaram uma correlação positiva e significava com a intensidade dolorosa referida pelos pacientes na escala numérica de dor e os pacientes que apresentaram mais fatores preditivos da dor referiram mais dor. 23 Já em relação ao McGill não se obteve diferença significativa entre os pacientes com mais e menos fatores preditivos. Observou-se que foram administrados diferentes tipos de analgésicos, isolados ou associados, sendo estes: paracetamol, paracetamol associado à codeína, dipirona, tramadol, toradol e tilatil. A percepção dolorosa apresentou magnitudes variando de leve a moderada do 1º ao 5º DPO e ao ser relacionada com as características de personalidade, nos pacientes com menos dor, observou-se os fatores: preservação, individualismo, introversão e os com mais dor foram: proteção, extroversão, retraimento, discrepância, afetividade, acomodação, comunicabilidade e firmeza. Evidenciou-se que o comportamento doloroso pós-cirurgia cardíaca é multifatorial e que a determinação da existência de fatores preditivos da dor permite ao profissional da área de saúde fazer o uso adequado dos analgésicos, haja vista que o alívio da dor é responsabilidade de todos os profissionais da saúde. Os aspectos psicológicos enquanto características de personalidade podem influenciar padrões de comportamento como os observados.

Influência da dor na capacidade funcional de idosos institucionalizados

The aim of this study was to evaluate the pain influence regarding location, intensity and duration over functional capacity in institutionalized elderly (Fundacao Leur Brito). This is a descriptive exploratory study with a transversal design and quantitative approach. The population of the study was composed of 60 elderly, being 50% males with 60 years-old minimum age and 104 years-old maximum age, with mean age 77,6 (?}11,64) years-old. Data was collected by a structured query formulary divided in four parts: 1) Social, health and demographic characterization; 2) Pain related aspects (time and location); 3) Pain evaluation by numeric scale and 4) Functional capacity measured by Barthel Index. It was observed after evaluation by Squared-chi test (x2) statistical significant difference between pain presence and Barthel Index activities: bath (pvalue=0,015), dressing (p-value= 0,041), intimal hygiene transference (p-value=0,001), chair and bed transference (p-value=0,032), walking (p-value=0,010) and go upstairs (p-value=0,008). It was also observed statistical difference between total Barthel score (dependent/independent) and pain presence, p-value<0, 000. Through data obtained by this study, a multiprofessional approach is necessary to proper pain control and maintenance and/or regain of functional capacity, leading to an increase in life quality with more independence and autonomy to elderly

O exame neurológico do recém-nascido pré-termo não complicado: avaliação pela escala de saint-anne dargassies, e screening pelas escalas de amiel-barrier-shnider modificada e prechtl ao termo

This study compared the evolution of posture, tone and neonatal reflexes in preterm infants without clinical or neurological complications before and after the age of term using the scale of Saint-Anne Dargassies. To reach the age of the term, was applied Scales Amiel-Barrier-Shnider changed and the Prechtl, traditionally used in the evaluation of term newborns, looking for possible changes to the term, while also evaluating the sensitivity of these scales. We studied 20 non-complicated preterm infants, both sexes aged 32-36 weeks, born in Januário Cicco Maternity School, from August 2006 to August 2007. Was applied to the scale of Saint-Anne Dargassies every two weeks until reach the term, and the range of Amiel-Barrier-Shnider changed and the Prechtl, after reaching 39 and 41 weeks. The evaluation result of articular angles was subjected to the test of Friedman ANOVA, significant differences between the three measurements of the scale of Saint-Anne Dargassies only for angles heel-to-ear to term. Neonatal reflexes changed in the period of prematurity were the cardinal points reflexes, Moro reflexes, cross extensions reflex and the automatic walking reflexes. The posture was the parameter which remained unchanged in the three scales. Considering a significance level of 5% by applying Cochran Q Test, it was found that the scale of Saint-Anne Dargassies is more sensitive to detect suspects. With this methodology and the results it was possible to prepare a manuscript: The neurological examination of non-complicated preterm newborns using the Sanit-Anne Dargssies Scale from birth to term: normal or altered? In which we describe that despite the good clinical condition, the RNP show changes in tone and neonatal reflexes. These data are important because though non-complicated RNP need further attention its maturation process, enabling us to detect and intervene early. With these results we can build a scale simplified neurological assessment made with items found most altered during the application of three scales. The development of this project has a multidisciplinary approach, because it involved Paediatric Neurologist, Physiotherapist and Neonatologist, as recommended by PPGCSA

Prevalência e fatores associados à dor em professores de educação física em academias de ginástica da cidade do Salvador-BA

Physical Education professionals are usually exposed to excessive physical workloads that evolve into painful symptomatology and muscle and bone disorders that originate from the work-related exercises. Purposo: The goal of this study was to investigate the prevalence and factors associated with pain painful symptomatology in teachers in gymnastics academies. An analytical transversal cut study was performed involving 163 gymnastics teachers working in the main gyms in the city of Salvador-BA. For evaluation of pain, validated versions in Portuguese of the McGill Protocol and the Wisconsin Pain Inventory were used. For obtain results of descriptive statistical analysis of the collected data was performed, followed by TStudent, and Pearson and Spearman correlation tests to verify possible correlations between the presence of pain and other variables which were considered independent. Finally, for the identification of potential risk factors associated with pain, a binary logistic regression analysis was performed. For all statistical analysis, we cnsidered p< 0.05. Results: The painful symptoms was reported by 88.3% of the subjects surveyed. High pain levels were observed in 63.8% of the interviewed professionals, where the intensity varied from moderate to severe. Pain in the lumbar region was present in 55.2% of subjects. Positive correlations were found between the level of pain intensity and the variables related with the workload activity and daily life of the teachers in almost all body joints analyzed. Some factors had been verified associates to the painful sintomatologia as the age of the professionals, the daily hours load of labor work, and the lack of interval of rest between the lessons. Conclusions: We found a high prevalence in gym teachers working in the city of Salvador-BA, which interfered in various daily activities of their home and professional lives. The most affected region was the lumbar region, followed by the knees, neck, shoulders, ankles, hands, hips, feet, elbows and forearms. The factors associated with development of painful symptomatology were the age of the professionals, daily hours of work and the lack of rest intervals between lessons. The high prevalence of pain in Physical Education teachers can be regarded as a serious occupational health problem, which would demand the urgent deployment of preventive intervention programs to minimize the impact of pain among these professionals

Limiar e tolerância à dor em mulheres com fibromialgia: correlação com a capacidade funcional, qualidade do sono e força muscular

O estudo tem como objetivo principal comparar o limiar e a tolerância à dor em mulheres com fibromialgia e mulheres sem sintomas de dor, correlacionando com capacidade funcional, qualidade do sono e força de preensão manual. Trata-se de um estudo descritivo de corte transversal realizado na Universidade Potiguar e na Universidade Federal do Rio Grande do Norte, envolvendo uma equipe multidisciplinar com fisioterapeutas, médicos e educadores físicos. Setenta e duas mulheres foram divididas em dois grupos: grupo com fibromialgia (GF, n = 40) e grupo controle (GC, n = 32) sem sintomas de dor, pareadas por idade e índice de massa corporal. Questionários foram usados para medir capacidade funcional (Fibromyalgia Impact Questionnaire FIQ) e qualidade do sono (Pittsburgh Sleep Quality Index - PSQI). Limiar e tolerância à dor foram medidas por um algômetro de pressão e para determinar força foi usado um dinamômetro de preensão manual. Na análise estatística o teste T de Student foi usado para comparar grupos e o coeficiente de correlação de Spearman foi usado no GF para correlacionar limiar e tolerância à dor com as demais medidas. O GF mostrou piores resultados nas medianas comparado ao GC: limiar de dor 2 kg/cm2 versus 5,5 kg/cm2 (p <0,001), tolerância à dor 2,8 kg/cm2 versus 7,2 kg/cm2 (p <0,001) e força de preensão manual 14,5 kgf versus 25,2 kgf (p <0,001). Adicionalmente os dois questionários apresentaram resultados piores também no GF em relação ao GC, respectivamente: FIQ 65 versus 14,3 (p <0,001) e PSQI 13 versus 5 (p <0,001). No GF foi observada correlação negativa tanto entre o limiar de dor quanto a tolerância à dor com os escores do FIQ e do PSQI. No GF foram observadas correlações positivas tanto entre o limiar de dor (p <0,01) quanto a tolerância à dor (p <0,01) com força de preensão manual. É possível concluir que limiar de dor e tolerância à dor estão correlacionados com capacidade funcional, qualidade do sono e força de preensão manual em mulheres com fibromialgia

Prevalência e fatores associados à dor em bailarinos profissionais

To investigate the prevalence and factors associated to painful symptomatology in professional ballet dancers. Methodos: An analytical transversal cut study was performed with 141 professional ballet dancers in the main capital cities of the Brazilian Northeast. McGill`s Pain Questionnaire and the Wisconsin Brief Pain Inventory, both validated for Portuguese, were used to assess painful symptomatology. Descriptive statistical analysis of the results was carried out, followed by Student`s t-test and Pearson s correlation with pvalue < 0.05. Results: High pain tolerance levels were observed in 70.2% of the subjects, where the intensity varied from moderate to severe. Pain in the lumbar region was present in 85.8% of the individuals. Positive correlations were verified between the degree of pain intensity and activities how to dance (60,3%), general activities (32,6%), sleep (28,4%), mood (27,7%), march (20,6%) and relations with others (16,3%). Conclusions: High pain prevalence was found in professional ballet dancers in the main capital cities of the northeast, and the most affected area was the lumbar followed by knees, neck, hip and feet, with substantial interference of pain symptoms in several activities of the personal and professional lives of these people

Design de interfaces para aplicativo de smartphone como recurso auxiliar no acompanhamento clínico de pacientes fibromiálgicos

Este trabalho tem como objetivo o desenvolvimento de interfaces com o usuário para aplicativo móvel smartphones com intuito de contribuir para a eficiência das atividades de profissionais e pesquisadores da área de fisioterapia ao oferecer suporte ao acompanhamento clínico da dor no tratamento de pacientes fibromiálgicos. Utilizando a abordagem de Design Centrado no Usuário - DCU, foram realizadas entrevistas e uma investigação contextual para a identificação inicial dos problemas e necessidades dos usuários. Verificou-se que as atividades de monitoramento e acompanhamento das sessões do tratamento de pacientes fibromiálgicos são, tradicionalmente, realizadas por meio de manipulando de formulários e fichas em papel (registro das condições de saúde do paciente) e escalas de classificação da dor em formato impresso (apresentadas ao paciente para indicação de sua dor percebida para cada ponto pré-determinado do corpo). Os procedimentos envolvidos nestas atividades dificultam o gerenciamento do desempenho do tratamento, o que, segundo relatos, reflete no comprometimento dos pacientes na adesão e frequência as sessões. A partir da observação e do levantamento das necessidades desses profissionais diante de suas atividades, foi proposto um aplicativo para smartphone com a intenção de minimizar os problemas ocasionados pelo uso das ferramentas convencionais e de prover informações rápidas acerca dos dados coletados. Então, seguindo a abordagem do DCU foi elaborado um modelo conceitual durante a etapa de concepção de soluções, o qual guiou a criação dos protótipos. A avaliação das interfaces do protótipo foi realizada com o envolvimento dos usuários a partir da técnica de avaliação cooperativa. Seus resultados proporcionaram o refinamento das interfaces e o desenvolvimento de uma nova proposta do design das interfaces em protótipo de alta fidelidade, produzido para o ambiente Android. Assim, esse trabalho faz parte do processo de desenvolvimento de um produto de software personalizado com foco na concepção e avaliação das interfaces com o usuário. Por meio da metodologia aplicada, observaram-se indícios os quais sugerem que as interfaces propostas apresentaram-se como um recurso facilitador e capaz de contribuir para eficiência das atividades no acompanhamento do tratamento de pacientes fibromiálgicos

Ecologia trófica de anfíbios anuros: relações filogenéticas em diferentes escalas

Understand the origin, maintenance and the mechanisms that operate in the current biodiversity is the major goal of ecology. Species ecology can be influenced by different factors at different scales. There are three approaches about the ecological differences between species: the first brings that differences result from current processes on niche characteristics (e.g. diet, time, space); the second that species differences are explained by random patterns of speciation, extinction and dispersion, the third that historical events explain the formation and composition of species in communities. This study aims to evaluate the influence of phylogenetic relationships in determining ecological characteristics in amphibians (globally) and test with that, if ecological differences between species of frogs are the result of ancient pre-existing differences or as result of current interactions. Another objective of this study is to verify if ecological, historical or current characteristics determine the size of species geographical distribution. The diet data for analysis of trophic ecology were collected from published literature. We performed a non-parametric MANOVA to test the existence of phylogenetic effects in diet shifts on frogs history. Thus, it is expected to know the main factors that allow the coexistence of anuran species. We performed a phylogenetic regression to analyze if niche breadth, body size and evolutionary age variables determine the size of the geographical distribution of amphibians in the Amazon. In the present study, new contributions to knowledge of major ecological patterns of anurans are discussed under a phylogenetic perspective

Atuação de técnicos de enfermagem junto ao recém-nascido com dor em uma unidade de terapia intensiva neonatal

The pain is a sensuous and emotional experience unpleasant associated or related to real injury or potencial of the tissues. It is considered an individual and subjective experience generally has been described in the literature about in the neonatal stage a lot. This study has descriptive and exploratory character with a qualitative approach. The study has with objectives to analyze the performance of the nursing technicians working with newborns admitted in the ITUN, seeking to describe the perception of the nursing technicians about the pain, identify the parameters used for the detection and evaluation of pain in them, trying to describe the ons of this team about the pain in the newborns in ITUN. The subjects are nine nursing technicians of the ITU of the Parenting School Januário Cicco in Natal-RN, engaged in direct assistance to newborns in the ITU, on the turn of the morning, which was prepared to participate in the search. The collection of the data was conducted through a structured interview with tree questions; through a non-participatory observation with a structured roadmap and were used to record and pass on call was also as a way of obtaining data. The start of the collection made after the assent of the Ethics Committee / UFRN in November, 2007. The speakings have been transcribed and data read extensively to obtain categories.The analysis of the content made in terms of Bardin. Emerged three main categories of significance: Perceptioning of pain in newborns; Caring for the newborns with pain; Registering the pain in the newborns. A nursing technicians identifies the pain in the newborns, for the most part, so empirical, using signs of behavioral or physiological changes in isolation, giving little emphasis to the environment and to respect that the newborns is inserted. It was found that the attitudes cited by subjects of the search before the newborns with pain, are for the most part non-pharmacological actions such as sucking nutrient not, a proper positioning and measures of comfort, however pharmacological actions have also been reported.These is also the absence of records of nursing records in the report of pain and actions to minimize them and, in records and for the passage of call. With this study we understand the role of the nursing technicians, and seek to contribute to subsidies for the practice of professionals involved in caring for this age group, and also in the search for a humane assistance to the newborns

Avaliação da dor pós-operatória: análise em pacientes submetidos a cirurgias abdominais em um hospital universitário de Natal/RN

It is an exploratory and descriptive study made by a quantitative approach, developed among February and May 2010, aiming to assess the pain of patients underwent abdominal surgeries in a University Hospital, in Natal/RN; to identify the local and intensity of the pain based on Numerical Estimative Scale; to analyze the pain related to the sensorial-discriminative, motivational-affective and cognitive-assessment dimensions, using the McGill Questionnaire pain; to establish a relation between the pain process and age, gender, religion, and king of surgery; to identify the medicines efficiency used to control postoperative pain. The sample was composed by 253 patients underwent abdominal surgeries. The results showed a total of 63.63% females between 38 and 47 years of age (21.34%); illiterates (21.73%); married (64.03%), living in Natal and surroundings (67.97%) and Catholics (74.30%). In their first assessment, 84.19% showed postoperative pain; the pain was considered light in 18.97% of them, moderate in 21.74% and severe in 43.48%. The mean number of descriptors chosen through the McGill Questionnaire Pain was 10.78 (DP= 6.09) and pain rating 23.65 (DP= 15.93). The descriptors selected with higher frequency were: sickening pain (69.01%), tired (65.25%), thin (62.44%), bored (58.69%), ardor (46.48%), pointed (38.50%) and colic (35.21%). In their second assessment, 57.71% of patients didn t relate any postoperative pain and 42.29% were still complaining about the pain. After taking analgesic medication, just 41.90% of patients who had complete pain relief. The Pharmacological groups most used were: simple analgesic (37.86%), weak opioids (32.98%), AINES (19.85%) and strong opioid (9.31%). It was not found a significant postoperative pain variation related to the sexes, religion and kind of surgery. It was concluded there were a high level in the number of patients with postoperative pain, mainly in a severe scale. Less than half of patients had the pain relief. Then, it was observed there was not coherence between the pain intensity and the analgesic it was used. To solve or relieve this kind of problems is necessary a permanent education to the health professionals who works in this area

Otimização de escalas de serviço de tripulações estudo de caso em uma empresa de transporte urbano na região metropolitana de Natal/RN

This work aims to "build" rostering urban bus crews to minimize the cost of overtime. For this purpose a mathematical model was developed based on case study in an urban transport company in the metropolitan region of Natal. This problem is usually known in the literature as the Crew Scheduling Problem (CSP) and classified as NP-hard. The mathematical programming takes into account constraints such as: completion of all trips, daily and maximum allowable range of home and / or food. We used the Xpress-MP software to implement and validate the proposed model. For the tested instances the application of the model allowed a reduction in overtime from 38% to 84%

Trocando Olhares: o desejo, o amor, a angústia e a dor na poesia de Florbela Espanca

In this work, Florbela Espanca poetry is analyzed. The objective is to prove that the loving thematic in her poetry tissues a connection among wish, love and sorrow. The psychoanalitic boarding is the basis to elucidate this connection,which begans with the sight, since mythology, passing by the portuguese literature begining periods and repeating itself in Florbela contemporanian poets. If Florbela poetry corroborates the portuguese literature tradiction, otherwise, it exposes the subject human being face, being a wishful creature