Bloqueio contínuo do plexo lombar via posterior bilateral com bomba de infusão descartável: relato de caso

JUSTIFICATIVA E OBJETIVOS: O número de artroplastia total de quadril (ATQ) bilateral tem aumentado a cada ano. Analgesia pós-operatória pela infusão contínua perineural com anestésico local tem se mostrado favorável quando comparada com analgesia sistêmica. O uso de bombas elastoméricas tem aumentado a satisfação do paciente quando em comparação com os modelos eletrônicos. O objetivo deste relato foi descrever um caso de analgesia contínua bilateral do plexo lombar via posterior, com infusão contínua através de bomba elastomérica, em paciente submetido à uma artroplastia bilateral de quadril. RELATO do CASO: Paciente feminina, 46 anos, 65 kg, 162 cm, com artrite reumatoide e hipertensão arterial, estado físico ASA II, escalada para ser submetida a ATQ bilateral em um único estágio. Uso de corticosteroide por 13 anos. Hemoglobina = 10,1 g.dL-1, hematócrito = 32,7%. Monitoração de rotina. Raquianestesia com 15 mg de bupivacaína 0,5% isobárica. Anestesia geral com propofol (PFS) e remifentanil e intubação sem bloqueadores neuromusculares. ATQ direita e no final, bloqueio plexo lombar com estimulador e conjunto agulha 150 mm e injeção de 20 mL bupivacaína 0,2% e passagem de cateter. ATQ esquerda e, no final, mesmo procedimento. Estudado dispersão do anestésico e contraste. Instalado bomba elastomérica com bupivacaína 0,1% (400 mL) em velocidade de 14 mL.h-1. Transferida para Unidade de Cuidados Intensivos (UCI). Vinte e quatro horas após, nova bomba com a mesma solução. Nenhum bolus durante 50 horas. Após remoção de cateter, dor controlada por via oral com cetoprofeno e dipirona. CONCLUSÕES: O bloqueio bilateral contínuo periférico com infusão de bupivacaína a 0,1% com bombas elastoméricas é um procedimento seguro e efetivo em adultos.

Validação do monitor de medida de pressão arterial Omron HEM 742 em adolescentes

FUNDAMENTO: A medida precisa da pressão arterial é fundamental para a investigação científica ou decisão clínica. Nesse sentido, é importante verificar valores fornecidos por equipamentos eletrônicos. OBJETIVO: Validar o monitor Omron HEM 742 de medida de pressão arterial em adolescentes, segundo os critérios sugeridos pela British Hypertension Society. MÉTODOS: Participaram do estudo 150 adolescentes com idades entre 10 e 16 anos. O monitor automático Omron HEM 742 foi conectado em Y com equipamento auscultatório de coluna de mercúrio, e realizaram-se três avaliações simultâneas, calculando-se as diferenças entre os dois equipamentos. Para verificar a relação entre ambos, utilizaram-se o coeficiente de correlação intraclasse e a plotagem de Bland-Altman (concordância). A especificidade e a sensibilidade do aparelho foram determinadas pela curva ROC. RESULTADOS: A comparação entre as medidas acusou uma diferença menor ou igual a 5 mmHg em 67,3% dos valores sistólicos e 69,3% dos valores diastólicos; uma diferença menor ou igual a 10 mmHg ocorreu em 87,3% e 90,6% dos valores sistólicos e diastólicos, respectivamente; e uma diferença menor ou igual a 15 mmHg em 96,6% dos valores sistólicos e 97,3% dos diastólicos. Esses resultados indicam grau A segundo o protocolo da British Hypertension Society. Observou-se ainda elevada concordância nos valores obtidos por meio do monitor automático, e verificou-se que esse equipamento é capaz de identificar a presença ou a ausência da pressão arterial elevada. CONCLUSÃO: O monitor Omron HEM 742 mostrou-se válido para medidas de pressão arterial em adolescentes, conforme os critérios sugeridos pela British Hypertension Society.

Utilização de recursos pedagógicos por professores da educação infantil

O presente estudo teve como objetivo identificar e classificar os recursos pedagógicos mais utilizados pelos professores da Educação Infantil de uma cidade do interior do estado de São Paulo. O instrumento utilizado para coleta de dados foi um questionário aplicado para 145 professores que ministravam aula no Ensino Infantil de uma cidade do interior do estado de São Paulo. Os resultados mostraram que os professores de educação infantil utilizavam com maior frequência, nas salas de aula, os jogos de acoplagem e na escola, os jogos de exercícios. Portanto, é imprescindível o conhecimento pelos professores no que se refere à classificação dos brinquedos e jogos, uma vez que cada um possibilita o desenvolvimento de habilidades diferenciadas.

Estratégias para disseminação do conhecimento organizacional: o papel da arquitetura da informação

Introduction: Organizations are expending more and more, the spaces electronic / digital (Internet / intranet / extranet) as a way to efficiently manage information and knowledge in the organizational environment. The management of inputs informational and intellectual belongings ranges from the strategic level to the operational level; the results demonstrate the strength of the socialization of organizational strategies. Objective: To reflect on the role of information architecture for the development of electronic spaces / digital in organizational environments. Methodology: Analytical study supported by specialized literature, based on three aspects emphasized by Morville and Rosenfeld (2006) and applied to information architecture: context, content and user studies beyond the search and use of information Choo (2006) which also highlights three aspects: situational dimensions, cognitive needs and emotional reactions. Results: In the context of the Web environment organizations have a large number of sites for brands / products that have mostly no organizational structure or shared navigation. The results show that when a department needs to contact another department must do so in order offline. Conclusion: The information architecture has become essential for the development of management information systems that makes possible to easily find and access data and information, as well as helps in developing distinct hierarchies to structure the distribution of content, promoting developed quality and effectiveness of the management systems.

O valor probatório dos documentos contábeis eletrônicos no ordenamento jurídico brasileiro

El trabajo analiza la caducidad probatoria atribuida por el ordenamiento jurídico brasileño a los documentos contables. Se analizan los cambios ocurridos en la legislación brasileña durante la década de 2000, con respecto a la legitimación jurídica del uso de documentos contables electrónicos. La legislación brasileña ha sufrido cambios considerables en cuanto a los documentos contables electrónicos principalmente a partir de 2007, con el advenimiento del Sistema Público de Escritura Digital (Sped). El ordenamiento jurídico brasileño se encuentra en un período de transición. Hay diferentes interpretaciones respecto a los mecanismos previstos por este ordenamiento en cuanto a la seguridad de las informaciones contables almacenadas en el medio digital. Es necesario analizar la seguridad y los límites de la utilización de documentos contables electrónicos.

A dimensão estética na formação das educadoras e dos educadores da infância: todos os tons do mundo

Pós-graduação em Artes - IA

Instrumentación para el registro del color en odontología

Color is an important variable in cosmetic dentistry, and it has traditionally been measured by a visual method, comparing teeth with standard color guides. In recent decades, electronic instruments have been developed to eliminate the subjective factor of visual measurement. This objective method has mainly been performed with colorimeters, spectrophotometers and the analysis of images obtained with digital cameras. These instruments have proven to be reliable with a high degree of precision and accuracy. Its use is recommended as an adjunctive tool to assess color in direct and indirect restorations, in aesthetic treatments like bleaching, and to facilitate communication with the dental laboratory. The spectrophotometer is the device that has reported better “in- vitro “ and “in -vivo” performance, being the “Vita Easyshade “ the one with more reliable results.

O jogo como mediador na entrevista: um novo lugar no processo psicoterápico com adolescentes

It is a fact that between the child and the adult there is an adolescent being that experiments his experiences in a different way than those others. Therefore, in clinical care, the use of toys and play do not have the same value as for the children, and, on the other hand, the majority of adolescents are not ready, as the adult is, for the exclusive use of speech in the psychotherapy context. There is the need to introduce some specific strategy in order to give the adolescent conditions to express himself openly in the psychotherapy process. The mediator's resource introduces this variable to enable the expression of emotions for those who cannot find the available channels for that. This paper seeks to answer this question by presenting the Time Tunnel Game in the psychotherapy with young people, based, during several years, on its clinical use with patients during this period of their lives. Explaining, when it is a question of a demand for a game, that the youngster tries to respect the rules, therefore, expressing his experiences more at ease. By using the mentioned game, it is not the psychotherapist that questions or addresses the youngster, but it is through this playing that the questions arise, providing the youngster a facilitating context for his experiences, even for the more difficult ones. At the direct request of the psychotherapist, it is possible that the adolescent may have the imposing idea that he is being evaluated, which is inadequate when attending any youngster. It is understood that this facilitation also occurs because in a game the atmosphere of lucidity is less threatening to the patient to reveal himself as playing. It is the game that "interviews" and, therefore, the youngster has less to be afraid of when expressing his experiences.

Brinquedoteca móvel: o brincar interativo na hospitalização infantil

The hospitalization process can cause significant changes in the children’s everyday life because, besides the suffering caused by the disease, there are the invasive processes which bring them sorrow. Thus, aiming to make this state of sorrow lower and to contribute for the treatment process we developed in a hospital the Mobile Toy Library project which develops interactive activities through playing, trying to make the staying of these kids at the hospital easier. The team is formed by Psychology professors and students, who daily visit the children with a trolley full of toys in order to interact and play with them. We wait on 500 patients a year. We concluded the Mobile Toy Library provides ways for kids to elaborate their psychological conflicts, lowering their sorrow as well as their negative feelings of staying in hospital, and this helps them deal with the disease, family and medical team all together.

La informática en el consultorio odontológico y el uso de los regsitros digitales

The use of computers in dental clinics has brought many benefits to dentist, helping them in various technical, administrative and legal. This study aimed to verify whether dentist, students of the post-graduate course in Orthodontics and Implantodontia of the Brazilian Association of Dentistry (ABO), regional Araçatuba-SP, using computers and digital documentation in clinical practice. They were invited to participate in the study all 60 students enrolled in courses of Orthodontics and Implantodontia of those institutions, in the year 2007 and those who consented (n = 52) answered a questionnaire containing questions open and closed on the subject . As the profile of the participants, 64.5% are male, 51.9% are between 30-39 years of age and 48.1% completed the graduation in the 90th. A 69.3% said they didn't receive any notion of computing during graduation and 67.3% use the computer in the office, mainly for management of the same (34.3%). Regarding the use of electronic record 55.8% reported using this technology, while 44.2% denied. 32.7% do not believe that electronic records that can serve as proof of judicial and 35.7% believe that the electronic records should be archived for 20 years. It follows that most professionals use the computer in the office and also the digital records, but does not feel secure about the legal validity of such documents, unknown, including the appropriate time of its filing.

Internet e democracia: a qualidade da informação sobre políticas públicas de cultura em portais de governo

Public communication comprises the dissemination of information on the various aspects of public management, with transparency and accountability, including the use of the existing technological resources. Particularly in the field of cultural policies, the right to information must be exercised as a contribution to political participation and economic expansion. This paper presents the results of research that was investigated, through analysis of the content under thirteen categories of evaluation, of the quality of information on cultural policies in web portals of the different spheres of government in Brazil. The results show the lack of information on the processes of development and implementation of policies in that field.

Decision making in the product portfolio: methods adopted by Brazil?s innovative companies

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

Use of music and play in pediatric nursing care in the hospital context

Objective. To identify and analyze scientific publications on the use of music and play in pediatric nursing care in the hospital context. Method. In this bibliographic study, papers were sought that were published in Portuguese or English between 2004 and 2009 and included the descriptors: hospitalized child, childhood, child recreation, nursing team, nursing, pediatric nursing, alternatives therapies, music, music therapy, play and playthings, play therapy, playing. For the review, the bibliographic databases used were MEDLINE, ScIELO and LILACS. Results. Seventeen publications were obtained, among which: 59% adopted a quantitative method; mainly nursing developed the activities (88%); per type of article, reviews on the theme and assessments of clinical changes associated with the use of music and play were frequent (59% and 18%, respectively); and the utility of this kind of therapies in nursing care is acknowledged (94%). Conclusion. Play and music are useful therapies that can be used in nursing care for pediatric patients.