Kvinnors hantering av värkarbete vid planerad hemförlossning

BakgrundHemförlossningar är fortfarande vanligt förekommande internationellt och ofta enda alternativet för många kvinnor i låginkomstländer. Nederländerna är ett av få industrialiserade länder där planerade hemförlossningar fortfarande är norm för friska, gravida kvinnor. Forskning har visat att det är lika säkert för kvinnor med lågriskgraviditeter i Nederländerna att föda hemma som att föda på sjukhus. I dag är hemförlossningar i Sverige inte ett alternativ inom det officiella hälso- och sjukvårdssystemet. Om svenska kvinnor erbjuds fritt att välja var de skulle kunna tänkas föda, skulle hemförlossningarna vara 10 gånger fler. Kvinnor som väljer att föda hemma har en inställning till födandet som en naturlig process och att den kvinnliga kroppen har skapats för att kunna föda.SyfteSyftet med denna studie är att beskriva hur kvinnor hanterar värkarbetet vid en planerad förlossning i hemmet.MetodEn kvalitativ innehållsanalys av 118 slumpmässigt utvalda enkätsvar. Studien grundar sig på svaren på en öppen fråga, ur ett frågeformulär, riktad till kvinnor som fött eller planerade att föda i hemmet.ResultatI kvinnornas beskrivning av sin hemförlossning identifierades fyra huvudkategorier som beskriver hur kvinnorna hanterar värkarbetet vid planerad hemförlossning; Att vara kvar i vardagen och utföra vardagssysslor, genom fysisk och mental aktivitet, naturlig smärtlindring samt genom omgivande stöd. SlutsatsSlutsatsen är att kvinnorna stannar kvar i vardagen samtidigt som det sker ett mirakel och detta underlättar hanteringen av värkarbetet. Det finns ingen skiljelinje mellan graviditet och förlossning som det annars gör när kvinnorna föder på sjukhus.

Kvinnors erfarenhet av postoperativ smärta och smärtlindring efter kejsarsnitt

Background: Many women experience high levels of pain after caesarean birth. Adequate postoperative pain treatment is important for the mother to be able to breastfeed, take care of the infant and experience a positive birth. Objective: The overall aim is to study women’s experience of postoperative pain and pain relief after caesarean birth. Method: A quantitative retrospective survey. Data were collected thru a questionnaire from Centralsjukhuset in Karlstad and Falu Larsarett in Sweden. Ninety-eight women participated in the study. Data was analysed with descriptive and comparative statistic. Result: Eighty percent of the women rated the pain with VAS = 4 during the first 24 hours post operative. Those who had to undergo acute caesarean birth rated significant higher levels of pain compared with those who had undergone planned caesarean birth. Despite high level of pain the women were satisfied with the pain relief they received. Both the ability to breastfeed and take care of the infant were affected by pain the first 24 hours post operative. Those who had undergone emergency caesarean birth experienced in greater extend the birth in a negative way. Conclusion: Postoperative pain affects the women’s ability to breastfeed and takes care of here infant. Adequate pain management is therefore important. The women who had to undergo emergency caesarean birth have a more negative birth experience. Midwifes have an important role to inform and support the women in processing here experience.

Omvårdnadsåtgärders effekter påcytostatikarelaterade biverkningar

Syfte: Syftet var att utvärdera effekten av sjuksköterskans föreslagna omvårdnadsåtgärder på cytostatikarelaterade biverkningar hos cancerpatienter som genomgår cytostatikabehandling. Metod: Examensarbetet utfördes som en litteraturöversikt. Resultatet grundar sig på 13 stycken kvantitativa artiklar. För datainsamlingen användes databaserna PubMed och Cinahl. Resultat: Resultatet visade att sjuksköterskan kan utföra omvårdnadsåtgärder som minskar patienters upplevelse av cytostatikarelaterade biverkningar. Effekterna som framkom av sjuksköterskans omvårdnadsåtgärder presenteras under rubrikerna; oral kryoterapi vid oral mukosit, personcentrerad patientutbildning med underrubriken utbildning utifrån ett teoretiskt perspektiv, automatiserad och sjuksköterske- assisterad symtombehandling samt musikterapi, bildspråk och avslappning. Slutsats: Sjuksköterskan kan genom olika omvårdnadsåtgärder hjälpa patienter att lindra symtom från cytostatikarelaterade biverkningar.

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

Estratégias de intervenção utilizadas por enfermeiros da ESF do município de Natal/RN no controle do câncer do colo de útero

Cancer of the cervix (cervical cancer) is the second most prevalent cancer among Brazilian women. The high rates of cervical cancer in Brazil justify the implementation of effective strategies to control this, which include actions to promote health, primary prevention, early detection, screening, treatment and palliative care. Despite the existence of the National Programme for Control of the CCU there was no reduction in the incidence and mortality of this disease in Brazil. The Family Health Strategy (FHS) has the potential to facilitate such control and, in this context, one should consider that nurses play a central role. The study aimed to know the general intervention strategies used by nurses FHS of Natal / RN in CCU control, and how specific: analyzing the knowledge of these nurses on the CCU, the actions developed in the ESF for the control of CCU and identify the difficulties faced by them to perform it. This is a descriptive exploratory quantitative developed through a structured interview guide with 106 nurses who have experience in controlling the CCU in FHS teams of Natal / RN. Data analysis was performed using descriptive statistic s. The results pointed to actions taken in the FHS to control the CCU, collection of cervical cancer screening, health education activities, nursing consultation, referral of suspected cases for medical monitoring and active women with abnormal test result . The actions that were not mentioned by the nurses included: forming groups of prevention and health promotion; expand coverage of exams and office hours of consultations, establishment of alternatives to end the pent-up demand in the health units, participation in treatment or rehabilitation process users with the CCU; interventions for pain management, alliances and partnerships with schools, in dustry and the use of protocols. This study can be seen that the practice nurses partially shares to the CCU in Natal / RN. The participants of this study, when asked about the CCU, specifically for signs and symptoms of disease and risk factors in general showed important gaps. Difficulties such as lack of materials for collection of Pap smear; inadequate physical space in the Health Units; pent-up demand in the service, delay in arrival of the test results; obstacles in the actions of referral and counter-referral and cultural factors make the CCU control is compromised. It is believed in this research contributed to a reflection on the importance of the role of nurses in the development of the ESF control actions CCU, pointing out the factors that affect these. It is important to involve all nurses who comprise the ESF as knowledgeable of the risk factors, signs and symptoms, and existing tools for the early detection of cervical cancer in the pursuit of quality improvement actions to promote women`s health, contributing in planning future interventions that may reduce mortality from this disease in Natal / RN.

Validade e responsividade de uma escala multidimensional para avaliação de dor pós-operatória em gatos

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

Plasma concentrations and behavioral, antinociceptive, and physiologic effects of methadone after intravenous and oral transmucosal administration in cats

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

Considerações sobre analgesia controlada pelo paciente (PCA) em hospital universitário

Pós-graduação em Anestesiologia - FMB

Estudo farmacocinético e farmacodinâmico de cloridrato metadona por via oral, intramuscular e intravenosa e carreadores lipídicos nanoparticulados de metadona via oral em equinos

Pós-graduação em Anestesiologia - FMB

Current attitudes regarding the use of perioperative analgesics in dogs and cats by Brazilian veterinarians

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

Efeitos imediatos e tardios da imersão em água pós-exercício: uma revisão sistemática e um ensaio clínico randomizado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Exposição de pacientes com síndrome de dor miofascial (SDM) à capsaicina: desenvolvimento de forma farmacêutica de uso tópico com possível ação analgésica

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

Exposição de pacientes com síndrome de dor miofascial (SDM) à capsaicina: desenvolvimento de forma farmacêutica de uso tópico com possível ação analgésica

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

Dor nas unidades de internação de um hospital universitário

JUSTIFICATIVA E OBJETIVOS: Estudo exploratório-descritivo, transversal, com objetivo de determinar a prevalência, caracterização, localização, mensuração e discussão de medidas farmacológicas analgésicas em dor aguda em cinco unidades de internação de um hospital universitário. MÉTODO: Participaram 856 sujeitos, dos quais 272 com dor no momento. As informações relacionadas à dor foram obtidas através de entrevista estruturada junto ao leito. Usou-se a escala numérica de dor e diagrama corporal. RESULTADOS: A analgesia foi verificada no prontuário. A prevalência geral de dor foi de 31,8%, sendo intensa em 44,2% e a média de 6,6 na escala numérica de dor. O motivo principal foi traumatismo, o local mais frequente, o abdômen. O analgésico mais usado foi a dipirona em 76,1%, com/sem associação. Opioide forte foi prescrito em 4,4%. Para 27,5% não houve melhoria. CONCLUSÃO: Conclui-se que a dor é de alta prevalência, pouco avaliada, subtratada, com uso incorreto de analgésicos.

Pharmacogenetics in palliative care

Response to analgesics, anticancer pharmacotherapy and pharmacotherapy of other cancer related symptoms vary broadly between individuals. Age, disease, comorbidities, concomitant medication, organ function and patients' compliance may partly explain the differences. However, the focus of ongoing research has shifted towards genomic variants of phase I and II drug metabolizing enzymes with one important goal being an individual dose adjustment according to a patient's genotype. Polymorphisms of the cytochrome P 450 2D6 influence the metabolism of many drugs including the analgesics codeine, tramadol, hydrocodone and oxycodone, as well as the metabolism of tricyclic antidepressants and the anticancer drug tamoxifen. Other candidate genes such as (opioid)-receptors, transporters and other molecules important for pharmacotherapy in pain management are discussed. Although pharmacogenetics as a diagnostic tool has the potential to improve patient therapy, study results are often equivocal and limited by small sample sizes and often by their retrospective design. Well designed studies are needed to demonstrate superiority of pharmoacogenetics to conventional dosing regimes.