950 resultados para Key intervention


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Relatório de estágio de mestrado em Ensino de Filosofia no Ensino Secundário

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Dissertação de mestrado em Educação Especial (área de especialização em Intervenção Precoce)

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OBJECTIVE - This analysis was undertaken to determine the composite incidence of cumulative adverse events (death, reinfarction, disabling stroke, and target vessel revascularization) at the end of the first year after acute myocardial infarction, in diabetic patients who underwent coronary stenting or primary coronary balloon angioplasty. METHODS - From the STENT PAMI trial, we analyzed the 6-month angiographic and 1-year clinical outcomes of 135 diabetic (112, noninsulin dependent) patients who underwent the randomization process of the trial and compared them with 758 nondiabetic patients. RESULTS - Coronary stenting did not significantly reduce the primary composite clinical end point when compared with PTCA (20 vs. 30%, p=0.2). A significant benefit from stenting was observed in patients with noninsulin dependent diabetes, with a trend toward a lesser need for new revascularization procedures (10 vs. 21%, p<.001), with a significant reduction in the primary composite clinical end point at 1 year (12 vs. 28%, p=. 04). At 6 months, the restenosis rate were significantly reduced only in nondiabetic patients (18 vs. 33%, p<. 001). Diabetic patients had the same restenosis rate (38%) either with stenting or balloon PTCA. CONCLUSIONS - Coronary Stenting in diabetics noninsulin dependent offered a significant reduction in the composite incidence of major clinical adverse events compared with balloon PTCA.

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Dissertação de Mestrado em Administração Pública – Especialização em Administração da Educação

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Las poblaciones microbianas juegan un rol fundamental en la estabilidad de los sistemas agrícolas e indican los niveles de salud de un suelo, tanto que pueden ser utilizadas como indicadores de sustentabilidad de un agroecosistema. Los microorganismos reflejan el efecto que tienen las prácticas agrícolas sobre el suelo a través de modificaciones en la abundancia (biodiversidad estructural) y actividades de sus poblaciones (como control biológico de los patógenos, entre otras). Al cuantificarse la biodiversidad microbiana nativa se puede conocer la riqueza de un agroecosistema y utilizarla para el manejo sustentable de hongos patógenos. En este trabajo se evaluará el efecto de la rotación de cultivo (soja-maíz y soja en monocultivo) y los sistemas de labranza (siembra directa y labranzas reducida) sobre la biodiversidad microbiana. Se cuantificarán a partir de suelo: poblaciones de hongos y bacterias totales; agentes potenciales de biocontrol de como Trichoderma spp., Gliocladium spp. y micorrizas vesículo arbusculares (mediante la cuantificación de glomalina), biomasa y respiracion microbiana, y la biodiversidad de comunidades de microorganismos que habitan en el suelo mediante el análisis de perfiles de ácidos grasos (PLFA). Al final del ciclo de cultivo de soja se cuantificará la incidencia de enfermedades causadas por hongos de suelo. Dada la gran abundancia y diversidad de los microorganismos del suelo, las metodologías que se emplearán permitirán obtener información global de la riqueza microbiana de un agro-ecosistema. Se relacionará la biodiversidad microbiana con la incidencia de enfermedades por hongos de suelo, en respuesta a diferentes prácticas de manejo. Esto permitirá aprender a combinar las tecnologías para mejorar los beneficios de la produccion y preservar el agroecosistema en el marco de una agricultura sustentable, y no de una agricultura sostenida por insumos.

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The sustained economic growth that has been experienced in the Irish economy in recent years has relied, to a large extent, on the contribution and performance of those industry sectors that possess the ability to provide high-value-added products and services to domestic and international markets. One such contributor has been the Technology sector. However, the performance of this sector relies upon the availability of the necessary capabilities and competencies for Technology companies to remain competitive. The Expert Group on Future Skills Needs have forecasted future skills shortages in this sector. The purpose of this research has been to examine the extent to which Irish Technology companies are taking measures to meet changing skills requirements, through training and development interventions. Survey research methods (in the form of a mail questionnaire, supported by a Web-based questionnaire) have been used to collect information on the expenditure on, and approach to, training and development in these companies, in addition to the methods, techniques and tools/aids that are used to support the delivery of these activities. The contribution of Government intervention has also been examined. The conclusions have been varied. When the activities of the responding companies are considered in isolation, the picture to emerge is primarily positive. Although the expenditure on training and development is slightly lower than that indicated in previous studies, the results vary by company size. Technical employees are clearly the key focus of training provision, while Senior Managers and Directors, Clerical and Administrative staff and Manual workers are a great deal more neglected in training provision. Expenditure on, and use of, computer-based training methods is high, as is the use of most of the specified techniques for facilitating learning. However, when one considers the extent to which external support (in the form of Government interventions and cooperation with other companies and with education and training providers) is integrated into the overall training practices of these companies, significant gaps in practice are identified. The thesis concludes by providing a framework to guide future training and development practices in the Technology sector.

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Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01). Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.

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Background:Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention.Objective:To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedureMethods:The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated.Results:A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 ± 70.7 Gycm2, while the staged group, to 139.2 ± 75.3 Gycm2 (p < 0.001).Conclusion:Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times.

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Das Aufmerksamkeitsdefizit-/Hyperaktivitätssyndrom, in der Praxis kurz ADHS genannt, istmit einer Prävalenz von 5% seit vielen Jahren eine der häufigsten Störungen im Kindes- undJugendalter. In dieser Arbeit wird das Phänomen ADHS vorgestellt. Aufgrund einerumfassenden Literaturrecherche konnten Informationen und Studien in die Arbeiteinbezogen werden, die es ermöglichen das Störungsbild umfassend zu beschreiben. DieKernsymptomatik ist durch motorische Unruhe, Impulsivität und Aufmerksamkeitsstörungengekennzeichnet. Entsprechende Symptomkriterien werden in den KlassifikationsystemenICD-10 und DSM IV definiert. Die ADHS wird als eine Störung über die Lebensspannebezeichnet, da sie in vielen Fällen chronisch verläuft. In der Diagnostik von ADHS beinhaltenVerfahren vor allem die methodische Erfassung beeinträchtigter Funktionen. DieseVerfahren werden auf dem Erkenntnisgewinn zu charakteristischen Symptomen aufgebaut.Obwohl die ADHS oftmals erfolgreich mit Stimulanzien und anderen Psychopharmakabehandelt wird, ist die Nachhaltigkeit der Wirksamkeitseffekte unklar. Deshalb solltentherapeutische Interventionen in eine „Multimodale Therapie“ einbezogen werden. Auchwenn Experten seit vielen Jahren zum Thema ADHS geforscht haben, ist das Störungsbildund deren Auswirkungen auf sämtliche Funktionsbereiche noch nicht vollständig erklärt.Schlüsselwörter: ADHS-Klassifikation-Symptomatik-Chronifizierung-Diagnostik-MultimodaleTherapie

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Das Ziel der vorliegenden Arbeit ist es zu prüfen, ob Tanztherapie einen Effekt auf dieLebensqualität bei Brustkrebspatientinnen hat. Brustkrebs ist die häufigste Krebserkrankungbei Frauen in Deutschland. Verbesserte Behandlungsformen und Früherkennungsmaßnahmenführen zu einem Anstieg der Überlebensrate. Dennoch bedingen ein langerBehandlungsweg und Unsicherheit über den Verlauf der Krankheit hohe Belastungen undUnsicherheiten. Nebenwirkungen und Langzeitfolgen der Interventionen beeinflussen zudemdie gesundheitsbezogene Lebensqualität. Körper und Psyche werden stark beansprucht undleiden. Die Psychoonkologie stellt dabei einen Teil des Behandlungsweges dar. Sie bildetesich aus der Erkenntnis heraus, dass die Krebserkrankung nicht nur den Körper beeinflusst,sondern den gesamten Menschen mit seiner seelischen und geistigen Verfassung. DieTanztherapie ist eine Maßnahme im Kanon der psychoonkologischen Betreuung. Sie vereintkörperliche Betätigung und kreative Ausdrucksmöglichkeiten. Psyche und Körper werden beidieser Therapieform angesprochen. Im Gruppensetting fließt zudem die soziale Komponentemit ein. Die These lautet demnach, dass Tanztherapie positive Auswirkungen auf diegesundheitsbezogenen Lebensqualität hat. Denn Körper, Psyche und soziales Umfeld sindTeile der Lebensqualität. Das methodische Vorgehen dieser Arbeit setzte sich aus demRecherchieren von relevanten Studien, Reviews und Metaanalysen zusammen. Es wurdendie Datenbanken Google Scholar, PubMed, PsyCONTENT und Springer Link bis zum Jahre2014 durchsucht. Schlüsselworte waren dabei Tanztherapie, Psychoonkologie, Krebspatient,Lebensqualität, gesundheitsbezogene Lebensqualität, künstlerische Therapie,dance/movement therapy, cancer patient, quality of life, health related quality of life.