Rouquidão após intubação traqueal

JUSTIFICATIVA E OBJETIVOS: Descrever as principais causas de rouquidão após intubação traqueal. CONTEÚDO: A rouquidão após intubação traqueal é um dos sintomas mais freqüentes no pós-operatório, podendo apresentar durações variáveis, dependendo dos fatores causais e da gravidade do comprometimento das estruturas da laringe. Foi realizada uma breve revisão das estruturas anatômicas da laringe, em que foram descritas as principais lesões traumáticas desse órgão, decorrentes da intubação traqueal e salientou-se a importância dos seus cuidados, bem como do diagnóstico e tratamento precoces. CONCLUSÕES: As lesões traumáticas das estruturas da laringe durante a intubação são causas freqüentes de rouquidão, sendo importante o diagnóstico precoce e a adoção de medidas preventivas.

Vinte anos de assistência a pessoas vivendo com HIV/AIDS no Brasil: a perspectiva de profissionais da saúde

O objetivo do estudo é descrever os significados atribuídos por profissionais de saúde à sua experiência de cuidar de pessoas com HIV/AIDS. Os dados foram coletados em entrevistas com 10 profissionais da saúde, em diferentes instituições paulistas. Três temas emergiram da análise dos dados: (a) o cenário da assistência ao paciente com HIV/AIDS; (b) relacionamento com o paciente; (c) aspectos éticos nesse cuidado. A despeito dos reconhecidos avanços na assistência a esse paciente, os achados revelam a persistência de comportamentos discriminatórios, relacionados a sentimentos de insegurança e medo do contágio, entre os profissionais nos serviços e hospitais gerais. O preparo específico para atender os pacientes estaria mais voltado aos profissionais dos centros especializados para a assistência ao HIV/AIDS, resultando em dificuldades na integração da assistência a esses pacientes nos demais serviços do SUS. Esses dados remetem aos aspectos da formação profissional na área da saúde como um todo, levando à reflexão sobre as competências que se espera dos profissionais da saúde em cuidar e relacionar-se com pessoas com HIV/AIDS, assim como sobre o impacto dessa realidade na prevenção da doença.

Contribuições das técnicas projetivas gráficas para a compreensão da personalidade de andarilhos de estrada

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

A multimedia environment for supporting the teaching of robotics systems

This paper aims at describing an educational system for teaching and learning robotic systems. Multimedia resources were used to construct a virtual laboratory where users are able to use functionalities of a virtual robotic arm, by moving and clicking the mouse without caring about the detailed internal robot operation. Moreover through the multimedia system the user can interact with a real robot arm. The engineering students are the target public of the developed system. With its contents and interactive capabilities, it has been used as a support to the traditional face-to-face classes on the subject of robotics.. In the paper it is first introduced the metaphor of Virtual Laboratory used in the system. Next, it is described the Graphical and Multimedia Environment approach: an interactive graphic user interface with a 3D environment for simulation. Design and implementation issues of the real-time interactive multimedia learning system, which supports the W3C SMIL standard for presenting the real-time multimedia teaching material, are described. Finally, some preliminary conclusions and possible future works from this research are presented.

Ocular Reconstruction After Zygomatic Complex Fracture With Retention of a Foreign Body

Facial injuries with the retention of foreign bodies inside the tissues, both in soft and hard ones, can cause major functional and aesthetic damage. Among the different etiological agents, cutting tools, fragments of a firearm, the splinter of wood, steel, or iron, launched by misuse, or even caused by defects in equipment, are the main cause of these injuries. The aim of this study was to discuss the peculiarity of the multidisciplinary approach in caring of a 33-year-old man, victim of an accident at work, by the rupture of an emery disc and consequent penetration of the fragments in violation of the tissues in the orbital and zygomatic region of the left side, with perforation of the eyeball and orbital-zygomatic fracture. Urgent treatment consisted of debridement of wounds, bleeding control, removal of foreign bodies, fracture reduction with rigid internal fixation, and suture, performed by the oral and maxillofacial surgical team. Reconstruction of orbital tissues by the ophthalmology team consisted of suture of the injuries. About 1 month after the trauma, phthisis bulbi was noted, and the patient underwent a new procedure under general anesthesia for eye evisceration and installation of an alloplastic prosthesis associated with the homogenous sclera. Facial harmony was restored, especially in aesthetics and function of the zygomatic-orbital complex.

Using Mastitis Records and Somatic Cell Count Data

On-farm records are essential for managing mastitis in dairy herds. Mastitis records are a useful tool for caring for an individual cow, to monitor compliance of farm personnel working with groups of animals, to understand the epidemiology of mastitis in the herd, to ensure responsible drug utilization, and to document accountability in care of the cow. Herds have become larger and more people are involved with individual animal care. This article describes a records plan that can be used to monitor mastitis at the herd level, aid in decision-making processes for individual cows, and improve drug use on dairy herds.

Territorial hypothesis predicts the trade-off between reproductive opportunities and parental care in three species of damselfishes (Pomacentridae: Actinopterygii)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Communication that values patient autonomy is associated with satisfaction with care: a systematic review

Question: Which communication factors used by clinicians during patient-clinician interactions are associated with satisfaction with care? Design: Systematic review with meta-analysis of studies investigating the association of verbal or nonverbal factors or interaction styles used by clinicians with patient satisfaction during an encounter between clinician and patient. Participants: Clinicians interacting with patients in primary care or rehabilitation settings. Results: Twenty-seven studies investigated 129 verbal, nonverbal, and interaction style factors. of these, 38 factors were consistently associated with satisfaction. Verbal factors concerning clinicians involving, facilitating, and supporting patients were associated with satisfaction with care. Most communication factors presented a fair correlation (r >= 0.21 but < 0.41) with satisfaction with care. Nonverbal factors such as time spent discussing prevention and time spent reading patient charts had a fair association with satisfaction with care (correlations range from 0.21 to 0.40). A moderate association was found between interaction styles such as caring (pooled r = 0.51, 95% CI 0.42 to 0.60) and satisfaction with care. Over half (58%) of the 129 identified factors never associated with satisfaction with care and the remainder associated inconsistently. Conclusion: The number of potential modifiable communication factors associated with satisfaction with care and the magnitude of their association partially support interventions to train clinicians in communication skills that value patient autonomy. [Oliveira VC, Refshauge KM, Ferreira ML, Pinto RZ, Beckenkamp PR, Negrao Filho RF, Ferreira PH (2012) Communication that values patient autonomy is associated with satisfaction with care: a systematic review. Journal of Physiotherapy 58: 215-229]

Epidemiologia de candidíase hospitalar: Importância da identificação específica

Nosocomial infections with Candida species are recognized as a significant cause of morbidity and mortality in both seriously ill immunocompetent and immunocompromised patients. Infections with Candida albicans and non-albicans Candida species have become a significant cause of infection in humans. Several of the more commonly Candida spp isolates are less susceptible to the antifungal drugs currentlly applied in clinical treatment, a factor that means significant difficulties for effective treatment. The modern mycology laboratory has an important role to play in several aspects relating to these organisms, including therapy, detection, identification and epidemiological analysis. In this study, we have provided an initial comparison of differences in species distribution among Candida isolates from four general hospitals of São Paulo,SP. Overall, 40 isolates of C. albicans, C. parapsilosis and C. tropicalis were isolated respectively in 35%, 50% and 15%, revealed a tendency of higher frequency of non-albicans species. The species distribution in patients with candidemia showed that the most commonly species were C. parapsilosis (45,4%), followed by C. albicans (36,4%) and C. tropicalis (18,2%); thus, we have an increase of non-albicans species. The three different species were include in 6, 3, and 4 different biotypes, respectively C. albicans, C. parapsilosis e C. tropicalis. This study emphasizes the importance of periodic evaluation of Candida species distribution especially in centers caring for patients at risk.

Nurse-patient communication while performing home dialysis: The patients' perceptions

This study aimed at describing patients' perception of their communication with nurses when performing home dialysis. Data were collected from interviews guided by the question: What is communication like, between you and nurses, during home dialysis treatment? Results show participants' perception of treatment during home peritoneal dialysis [Continuous ambulatory peritoneal dialysis (CAPD)]; relationship with nurses and family and the effects of treatment on one's existence. Patients can be self-caring and they learn to value the autonomy in their own care. However, some are unable to assume the responsibility for self-care. It was discovered that the connotation of inspection that some participants attributed to the nurse's visits, led to an alienation from the education process in the CAPD education. Findings suggest that effective communication and the development of the relationship of a working partnership with patients is crucial. Improvement in the nurses' communication, aiming at adapting it to the characteristics, limitations and specific needs of each patient, is significant for achieving better outcomes. © 2010 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Atitudes distintas de profssionais de diferentes especialidades médicas relacionadas à autonomia e aspectos jurídicos no cuidado de pacientes com demência

The evaluation of competence of Alzheimer's disease (AD) patients to assume personal or collective responsibilities and the resulting legal implications is a relevant issue. Objectives: The aim of this study was to evaluate the attitudes of different medical specialists towards the disability of patients with Alzheimer's disease and practitioners' competence to interfere with decision-making autonomy. Methods: Professionals from different areas (Neurology, Psychiatry, Geriatrics, and General Practice) were interviewed by one of the authors, after being presented a fictitious clinical case which raised several topics, namely: [1] Critical judgment and capacity of the patient to take decisions related to daily activities; [2] The role of family physicians in nominating trustees and caregivers. Results: Answers to the first question did not differ regarding degree of preservation of awareness but at least 25% stressed that the patient must be carefully listened to, independent of caregiver or legal representative opinion. There were significant knowledge gaps in responses to the second question. Half of the physicians interviewed did not have adequate information about the legal aspects of caring for patients with Alzheimer's disease. Conclusions: Legal aspects is a topic that must be incorporated into professional training in order to improve attitudes toward the long-term management of patients with dementia.

Fatores de risco da transmissão de zoonoses por costumes da população de Ilha Solteira, Brasil

Objective Determining conditions regarding possible zoonosis transmission risk based on Ilha Solteira-São Paulo citizens' habits aimed at establishing concrete recommendations for the corresponding local authorities to reduce some risk factors. Methods100 focalized interviews were held on Ilha Solteira's urban perimeter during April 2008. The people interviewed were adults who lived or worked in houses in the study area. Results This research found a significant number of cat and/or dog owners who allowed their pets to stay in internal areas of their houses. They did not define a specific place for animals to defecate and/or urinate or did not arrange appropriate final disposal of such waste. Conclusion Local authorities must make greater efforts at educating Ilha Solteira pets' owners and providing them with information and encouraging greater citizen commitment and awareness to improve habits related to caring for pets/animal sand reducing zoonosis transmission risk factors.

Aspectos relacionais, familiares e sociais da relação pai-filho com deficiência física

The survey sought information from the relationship between father and child with disability regarding space, responsibilities and feelings in the parental relationship. Ten fathers, aged 31 to 66 years, with varied educational and professional backgrounds, answered a questionnaire with 19 semi-structured questions grouped into 16 categories of analysis. The conclusion showed that fathers perceive disability differently over time. The information usually comes from a doctor, but when the disability is not very evident, and doesn't cause significant impairment, realization comes over time. The shock of the discovery and behaviors of rejection are major feelings for fathers. Most fathers report differences in roles played by women and men in raising children; they believe that their responsibility is to provide for the family, while the mother's duty is to accompany the child. They feel that they share with the mothers the responsibility for caring for the child and, in general they don't feel they have been accused of being distant. They try to follow the child's treatment. The children are as attached to them as to other family members. To live with a minimum of quality of life they agreed unanimously about the need for greater income and benefits from social welfare. Most recognize that they are afraid of having other children with disabilities. They express low expectations for the total independence of the children, and among the fathers who have more than one child, the majority acknowledged the existence of differential treatment. They attributed the causes to medical errors. Fathers feel much the same as mothers, but they have different ways of demonstrating what they feel.

Qualidade de vida de cuidadores de pe ssoas com necessidades especiais

The quality of life of caregivers is a concern because it directly affects the quality of life of individuals dependent on such care. This study aimed to analyze and compare the quality of life in health of caregivers of people with special needs who attend a rehabilitation facility. Ninety caregivers of people with special needs who attend a rehabilitation facility participated in this study. For data collection two instruments were used: a questionnaire to determine the profile of the caregiver and the person with special needs and the WHOQOL-Bref questionnaire to measure quality of life. The results were significant only between the caregiver's quality of life in the physical domain and age of the person with special needs, indicating that the older a person with special needs, the more difficult and arduous is the act of caring. The result can indicate guidelines for caring for families of people with disabilities.

Cuidado em saúde mental: a escuta de pacientes egressos de um Hospital Dia.

This is a qualitative study aiming at understanding how patients discharged from a Mental Health Day Hospital view the service, at learning whether such service contributed to changes in their lives and at whether those individuals continued treatment. Semi-structured interviews and documental research were used for nine patients who had completed treatment at the service in 2008. Thematic analysis was adopted for organization of the data obtained, which were analyzed according to the Psychosocial Rehabilitation framework. It emphasizes the importance of looking for the various subjective aspects of human existence, requiring from services and professionals the establishment of a caring relationship that enables the reconstruction of trajectories interrupted by the onset of the disease, through actions that consider the integrality and intersectionality.