Caring for organ donors: the intensive care unit physicians' view

This study examined the meanings that the intensive care unit (ICU) physicians attribute to their practice when caring for brain-dead organ donors. It is a phenomenological study, a qualitative method that searches for describing and understanding the experiences lived. Data were collected through recorded individual interviews made with 10 ICU physicians who work in a university hospital in the interior of São Paulo, Brazil. Three categories emerged from data: (1) providing care for brain-dead organ donors; (2) relating to donors and their families; and (3) the ethical concerns and self-awareness of the physicians. There is consensus as to-many aspects: demand of technical qualification and excellence in practice; need of investing in technology of organ transplant; and donors seen as human beings and holders of human rights. Participants understand that family participation is decisive in the donation process, although interactions between the family members and the physicians are difficult because of the sensitive nature of the situation. The physicians often felt ill-prepared to openly discuss the topic of brain death and organ donation. Educational programs for physicians and family members may assist with this difficult process.

Factors influencing psychotropic prescription by non-psychiatrist physicians in a nursing home for the elderly in Brazil

CONTEXTO E OBJETIVO: Embora os psicotrópicos sejam uma das classes de medicações mais prescritas em abrigos para idosos, os estudos avaliando o seu padrão de prescrição são limitados em número e escopo. Este estudo visou investigar os fatores associados ao uso de psicofármacos em um abrigo para idosos no Brasil. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo observacional realizado no Abrigo da Velhice de Rio Claro, Instituto de Biociências, Universidade Estadual Paulista. MÉTODOS: Dados sobre prescrições foram extraídos dos prontuários médicos dos 108 idosos moradores do abrigo. Sessenta e cinco sujeitos (idade média ± desvio padrão = 74,5 ± 9,4 anos), em uso regular de medicação, constituíram a amostra. Foram examinados os efeitos das variáveis sociodemográficas e clínicas sobre o padrão de prescrição de psicofármacos. RESULTADOS: As mulheres recebiam mais psicofármacos (p = 0.038); indivíduos em uso de medicações para doenças cardiovasculares recebiam menos psicofármacos (p = 0.001). Houve correlação negativa entre número de psicofármacos prescritos e, ambos, idade (p = 0.009) e número de medicações clínicas (p = 0.009). CONCLUSÃO: Embora preliminares, os resultados indicam as doenças cardiovasculares como a variável clínica que mais influenciou a prescrição de psicofármacos. Uma excessiva precaução por parte dos clínicos pode explicar parcialmente este resultado. Novas investigações, com amostras maiores e de diferentes regiões são desejáveis para confirmação destes dados.

DIAGNOSIS of REGIONAL CEREBRAL BLOOD FLOW ABNORMALITIES USING SPECT: AGREEMENT BETWEEN INDIVIDUALIZED STATISTICAL PARAMETRIC MAPS and VISUAL INSPECTION BY NUCLEAR MEDICINE PHYSICIANS WITH DIFFERENT LEVELS of EXPERTISE IN NUCLEAR NEUROLOGY

INTRODUCTION: Visual analysis is widely used to interpret regional cerebral blood flow (rCBF) SPECT images in clinical practice despite its limitations. Automated methods are employed to investigate between-group rCBF differences in research Studies but have rarely been explored in individual analyses.OBJECTIVES: To compare visual inspection by nuclear physicians with the automated statistical parametric mapping program using a SPECT dataset of patients with neurological disorders and normal control images.METHODS: Using statistical parametric mapping, 14 SPECT images from patients with various neurological disorders were compared individually with a databank of 32 normal images using a statistical threshold of p<0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). Statistical parametric mapping results were compared with Visual analyses by a nuclear physician highly experienced in neurology (A) as well as a nuclear physician with a general background of experience (B) who independently classified images as normal or altered, and determined the location of changes and the severity.RESULTS: of the 32 images of the normal databank, 4 generated maps showing rCBF abnormalities (p<0.05, corrected). Among the 14 images from patients with neurological disorders, 13 showed rCBF alterations. Statistical parametric mapping and physician A completely agreed on 84.37% and 64.28% of cases from the normal databank and neurological disorders, respectively. The agreement between statistical parametric mapping and ratings of physician B were lower (71.18% and 35.71%, respectively).CONCLUSION: Statistical parametric mapping replicated the findings described by the more experienced nuclear physician. This finding suggests that automated methods for individually analyzing rCBF SPECT images may be a valuable resource to complement visual inspection in clinical practice.

Politics, press and military participation in the abdication of d. Pedro I

This work seeks to contribute to a better understanding of the Abdication, analyzing how and why sections of the army joined the liberal groups against the emperor, focusing on the period that immediately preceded this event. The argument is that the alliance between sections of the army and the liberal groups in 1831 was possible because the expansion of the "public space" in the city of Rio de Janeiro, a process in which newspapers such as "O Republico" played a key role as they became a privileged locus for political disputes. The article shows that that newspaper helped to build a political identity based on the defense of Brazilian interests against Portuguese despotism, giving momentum to internal conflicts around this subject that were already taking place among sections of the army and hence triggering the process that would lead to the Abdication.

Electromyographic validation of the trapezius and serratus anterior muscles in military press exercises with open grip.

It was studied the trapezius muscle and serratus anterior muscle in 24 male volunteers using a 2-channel TECA TE 4 electromyograph and Hewlett Packard surface electrodes, during the execution of four different modalities of military press exercises with open grip. The results showed that TS acted significantly in the modalities standing and sitting press behind neck, while SI acted in all the modalities, i.e., standing and sitting press behind neck and forward, justifying their inclusion as basic exercises for physical conditioning programmes.

Electromyographic validation of the trapezius and serratus anterior muscles in military press exercises with open and middle grip

Electromyographic activity of the trapezius muscle and serratus anterior muscle was analysed in 4 different modalities of military press exercises, each of them with 2 grips: open and middle. It was analyzed 24 male volunteers using a 2-channel TECA TE 4 electromyograph and Hewlett Packard surface electrodes. The TS and SI muscles acted with high and very high activity in all the modalities of military press exercises. Statistically, they did not show significative difference in the performance of the exercises with open and middle grip, justifying the inclusion of this group of exercises with both grips for the physical conditioning programmes.

Electromyographic validation of the trapezius and serratus anterior muscles in military press exercises with middle grip

Electromyographic activity of the trapezius muscle and serratus anterior muscle was analysed in 24 male volunteers using a 2-channel TECA TE 4 electromyograp, during the execution of four different modalities of military press exercises with middle grip. The trapezius acted preferentially in the modalities standing press behind neck; and sitting forward and press behind neck, while SI did not show any significative difference among the modalities. The high levels of action potentials with which TS and SI acted justify the inclusion of these exercises in physical programmes.

Electromyographic validation of the muscles deltoid (anterior portion) and pectoralis major (clavicular portion) in military press exercises with open grip

It was analized the deltoid muscle anterior portion and the pectoralis major clavicular portion in 24 male volunteers using a two-channel electromyograph TECA TE 4, and Hewllet Packard surface electrodes, in 4 modalities of military press exercises with open grip. The results showed high inactivity for PMC in almost all the modalities while DA developed very high levels of action potentials in all the modalities assessed.

Electromyographic validation of the muscles deltoid (anterior portion) and pectoralis major (clavicular portion) in military press exercises with middle grip

With the objective to know the electromyographic activity normal parameters of the deltoid (anterior portion) and pectoralis major (clavicular portion) muscles in the different modalities of military press exercises with middle grip, we analyzed 24 male volunteers using a two-channel electromyograph TECA TE 4, and Hewllet Packard surface electrodes. It was observed high inactivity levels for PMC in almost all the modalities and the concentration in the active cases, mainly, in the weak potential, while DA presented very high levels of much strong action potentials in all the modalities assessed.

Electromyographic validation of the deltoid (anterior portion) and pectoralis major (clavicular portion) in military press exercises with open and middle grips

The deltoid (anterior portion) and pectoralis major (clavicular portion) were evaluated in several execution ways of military press exercises with open and middle grips in order to know their behavior pattern. It was analyzed 24 male volunteers, using a 2-channel TECA TE4 electromyograph and Hewllet Packard surface electrodes. It was observed that the execution variation with open and middle grips does not present any significant difference as for the demanding level neither for the pectoralis major muscle nor the deltoid muscle.

Electromyographic validation of the trapezius and serratus anterior muscles in military press exercises with open grip

It was studied the trapezius muscle and serratus anterior muscle in 24 male volunteers using a 2-channel TECA TE 4 electromyograph and Hewlett Packard surface electrodes, during the execution of four different modalities of military press exercises with open grip. The results showed that TS acted significantly in the modalities standing and sitting press behind neck, while SI acted in all the modalities, i.e., standing and sitting press behind neck and forward, justifying their inclusion as basic exercises for physical conditioning programmes.