The outcome in Australian children with hyperinsulinism of infancy: early extensive surgery in severe cases lowers risk of diabetes

AIMS Hyperinsulinism of infancy (HI) is characterized by unregulated insulin secretion in the presence of hypoglycaemia, often resulting in brain damage. Pancreatic resection for control of hypoglycaemia is frequently resisted because of the risk of diabetes mellitus (DM). We investigated retrospectively 62 children with HI from nine Australian treatment centres born between 1972 and 1998, comparing endocrine and neurological outcome in 28 patients receiving medical therapy alone with 34 who required pancreatic resection to control their hypoglycaemia. METHODS History, treatment and clinical course were ascertained from file audit and interview. Risk of DM (hazard ratio) attributable to age at surgery (< vs. greater than or equal to 100 days at last pancreatectomy) and extent of resection (< vs. greater than or equal to 95%) were calculated using Cox proportional hazards regression and categorical variables compared by the chi(2) -test. Neurological outcome (normal, mild deficit or severe deficit) was derived from the most authoritative source. RESULTS Surgically treated patients had a greater birthweight, earlier presentation and higher plasma insulin levels. Of 18 infants < 100 days and 16 greater than or equal to 100 days of age at surgery, four (all greater than or equal to 100 days) became diabetic as an immediate consequence of surgery and five (two < 100 days and three greater than or equal to 100 days) became diabetic 7-18 years later. Surgery greater than or equal to 100 days and pancreatectomy greater than or equal to 95% were associated with development of diabetes (HR = 12.61, CI 1.53-104.07 and HR = 7.03, CI 1.43-34.58, respectively). Neurodevelopmental outcome was no different between the surgical and medical groups with 44% overall with neurological deficits. Patients euglycaemic within 35 days of the first symptom of hypoglycaemia (Group A) had a better neurodevelopmental outcome than those still hypoglycaemic > 35 days from first presentation (Group B) (P = 0.007). Prolonged hypoglycaemia in Group B was due either to delayed diagnosis or to need for repeat surgery because of continued hypoglycaemia. Within Group A, medically treated patients (who presented later with apparently milder disease) had a higher incidence of neurodevelopmental deficit (n = 15, four mild, three severe deficit) compared with surgically treated patients (n = 18, two mild, none severe deficit) (P < 0.025). CONCLUSIONS Poor neurodevelopmental outcome remains a major problem in hyperinsulinism of infancy. Risk of diabetes mellitus with pancreatectomy varies according to age at surgery and extent of resection. Patients presenting early with severe disease have a better neurodevelopmental outcome and lower risk of diabetes if they are treated with early extensive surgery.

Neuro-electromagnetic imaging of the human visual cortex

Methods of solving the neuro-electromagnetic inverse problem are examined and developed, with specific reference to the human visual cortex. The anatomy, physiology and function of the human visual system are first reviewed. Mechanisms by which the visual cortex gives rise to external electric and magnetic fields are then discussed, and the forward problem is described mathematically for the case of an isotropic, piecewise homogeneous volume conductor, and then for an anisotropic, concentric, spherical volume conductor. Methods of solving the inverse problem are reviewed, before a new technique is presented. This technique combines prior anatomical information gained from stereotaxic studies, with a probabilistic distributed-source algorithm to yield accurate, realistic inverse solutions. The solution accuracy is enhanced by using both visual evoked electric and magnetic responses simultaneously. The numerical algorithm is then modified to perform equivalent current dipole fitting and minimum norm estimation, and these three techniques are implemented on a transputer array for fast computation. Due to the linear nature of the techniques, they can be executed on up to 22 transputers with close to linear speedup. The latter part of the thesis describes the application of the inverse methods to the analysis of visual evoked electric and magnetic responses. The CIIm peak of the pattern onset evoked magnetic response is deduced to be a product of current flowing away from the surface areas 17, 18 and 19, while the pattern reversal P100m response originates in the same areas, but from oppositely directed current. Cortical retinotopy is examined using sectorial stimuli, the CI and CIm ;peaks of the pattern onset electric and magnetic responses are found to originate from areas V1 and V2 simultaneously, and they therefore do not conform to a simple cruciform model of primary visual cortex.

Recent advances in topical therapeutics for vitreoretinal diseases

Eye drops are convenient for patients, but achieving therapeutic doses and maintaining sustained drug release without frequent re-application to treat diseases of the retina has been largely unsuccessful. Topical administration of drugs is hindered by the anatomy, physiology, and biochemistry of the eye and its highly effective defence mechanisms. Advances in nanotechnology have led to the experimental use of topical permeation-enhancing liposomes, emulsions, and microspheres to enhance absorption and penetration of drugs across membranes; allow controlled release of the drug; and to target drugs at distinct tissues to allow sufficient local bioavailability. In the near future it is hoped that improved technologies may provide means of sustained topical drug delivery for retinal therapy, with improved side-effect profiles and reduced cost compared with currently available clinical treatments.

Clinical utility of the KAMRA corneal inlay

The treatment of presbyopia has been the focus of much scientific and clinical research over recent years, not least due to an increasingly aging population but also the desire for spectacle independence. Many lens and nonlens-based approaches have been investigated, and with advances in biomaterials and improved surgical methods, removable corneal inlays have been developed. One such development is the KAMRA™ inlay where a small entrance pupil is exploited to create a pinhole-type effect that increases the depth of focus and enables improvement in near visual acuity. Short- and long-term clinical studies have all reported significant improvement in near and intermediate vision compared to preoperative measures following monocular implantation (nondominant eye), with a large proportion of patients achieving Jaeger (J) 2 to J1 (~0.00 logMAR to ~0.10 logMAR) at the final follow-up. Although distance acuity is reduced slightly in the treated eye, binocular visual acuity and function remain very good (mean 0.10 logMAR or better). The safety of the inlay is well established and easily removable, and although some patients have developed corneal changes, these are clinically insignificant and the incidence appears to reduce markedly with advancements in KAMRA design, implantation technique, and femtosecond laser technology. This review aims to summarize the currently published peer-reviewed studies on the safety and efficacy of the KAMRA inlay and discusses the surgical and clinical outcomes with respect to the patient’s visual function.

Personal autonomy in discharge planning decision -making in mentally alert hospitalized elderly individuals: The social workers' perspective

This study was conducted to understand (a) hospital social workers' perspectives about patients' personal autonomy and self-determination, (b) their experiences, and (c) their beliefs and behaviors. The study used the maximum variation sampling strategy to select hospitals and hospital social work respondents. Individual interviews were conducted with 31 medical/surgical and mental health hospital social workers who worked in 13 hospitals. The data suggest the following four points. First, the hospital setting as an outside influence as it relates to illness and safety, and its four categories, mentally alert patients, family members, health care professionals, and social work respondents, seems to enhance or diminish patients' autonomy in discharge planning decision making. Second, respondents report they believe patients must be safe both inside and outside the hospital. In theory, respondents support autonomy and self-determination, respect patients' wishes, and believe patients are the decision makers. However, in practice, respondents respect autonomy and self-determination to a point. Third, a model, The Patient's Decision in Discharge Planning: A Continuum, is presented where a safe discharge plan is at one end of a continuum, while an unsafe discharge plan is at the other end. Respondents respect personal autonomy and the patient's self-determination to a point. This point is likely to be located in a gray area where the patient's decision crosses from one end of the continuum to the other. When patients decide on an unsafe discharge plan, workers' interventions range from autonomy to paternalism. And fourth, the hospital setting as an outside influence may not offer the best opportunity for patients to make decisions (a) because of beliefs family members and health care professionals hold about the value of patient self-determination, and (b) because patients may not feel free to make decisions in an environment where they are surrounded by family members, health care professionals, and social work respondents who have power and who think they know best. Workers need to continue to educate elderly patients about their right to self-determination in the hospital setting. ^

Biossistemática do complexo Cryptanthus zonatus (Vis.) Beer

The taxonomic delimitation at the species level in plants is not an easy task due to the large polymorphism of plants. In this project we aimed to evaluate three morphotypes (forms) of Cryptanthus zonatus (Vis.) Beer ( Bromeliaceae, Bromelioideae ) described in the literature using fl oral biology and phenology, as well as flo ral morphology and leaf anatomy . These studies were conducted in the Parque Estadual das Dunas de Natal, Rio Grande Norte (RN) and Private Reserve of Natural Patrimony Mata Estrela , in the municipality of Ba í a Form osa. The survey of the phenology of the morphotypes involved monthly specimen observation in the field, during one year. In each visit, we observed the status of flowering and fruiting phenophases of the population of the three forms of C. zonatus . For flo ral biology we sought to evaluate data like: observed floral visitors, nectar volume and concentration, time of anthesis and closing of flowers . Flowers of the three fo rms were collected in the field , analyzed by stereomicroscope, and measurements of the f loral pieces were made with the help of a caliper . Transversal and paradermal sections of the leaves of the three forms were stained and then examined under an optical microscope. Observations of the epidermis under scanning electron microscopy were also conducted. The three m orphotypes could not be sepated based on all evidence investigated. Thus, we conclude that there is not evidences to support the recognition of C. zonatus morphotypes as taxonomic entities, and also that the tools of phenology, anatomy, biology and floral morphology were not useful to delimit these three forms . Yet to characterize better the Flora of Bromeli aceae of RN, the leaf anatomy of Orthophytum disjunctum was also studied. Orthophytum is the sister genus to Cryptanthus and only recently documented in the semiarid of RN. The anatomical comparison between Cryptanthus and Orthophytum allowed the separatio n of both genera based on the arrangement of stomata and thickness of aquiferous parênquima . During the fieldwork, it was still possible to document the first occurrence of Aechmea muricata in RN, inside the Mata Estrela preserve, aiding the understanding of the distribution of the taxon that is currently threatened with extinction.

Efeitos de fungicidas alternativos em folhas de Carthamus tinctorius L. (Asteraceae), potencial espécie para cultivo em agricultura familiar

The currently main development model on global society is driven by an economic rationality that endangers the environment and social justice. More and more, attention to this way of production and consumption is increasing, boosting research for sustainable development, with an environmental rationality that can harmonize nature preservation and welfare of all socioeconomic classes. One of the efforts on this sense is changing the sources supplying the energy demand, replacing fossil fuels for renewable and cleaner sources, such as biofuels. Carthamus tinctorius (safflower) is an oilseed crop with potential for biodiesel production, with good oil yield and chemical profile, allied to good adaptation to climates such like the northeastern semiarid lands of Brazil. With public policies fomentation, the use of this species may be an interesting alternative for family farming. In farming in general, the use of pesticides to prevent and combat diseases and plagues is common, which is not a sustainable practice. Thus, there are researched alternative, less dangerous substances. In this study, it was aimed to assess if neem (Azadirachta indica) leaf extract (20% m/v) and Bordeaux mixture (copper sulfate) have effects on safflower. It was also aimed to verify acceptance of farmers on safflower crop in Apodi, a municipality in Rio Grande do Norte state, Brazil, in view of it being localized in the aimed region for this crop cultivation. Besides that, understanding that the farmers’ knowledge and inclination to adopt the crop is fundamental for the introduction of this species and socioeconomic growth due to its exploration. In addition, a booklet with basic information on safflower was produced. In the field experiment, the fungicides were pulverized on plants cultivated in field experimental plots, with collection of leaf samples for analysis on anatomy, cuticle, and epicuticular wax morphology, the protective layer that interfaces with the surrounding ambient. In Apodi, forty-five farmers from Potiguar Cooperative of Apiculture and Sustainable Rural Development (COOPAPI) underwent semi-structured interviews, which also addressed their assessment on currently cultivated crops and perception of pesticide uses and sustainable alternatives. After comparing using analysis of variance, it was found that there was no difference between treatments in the experiment, as well as no anatomical or morphological modifications. Safflower acceptation among farmers was wide, with 84% of interviewees believing in a perspective of good incomes. The current scenario, comprised of low crop diversity, fragile in face of droughts and plagues, can partially explain this opinion. The booklet was effective in catching people attention for the species potential. There was wide acknowledgement on the importance of alternative pesticides, justified by health security. Based on the assessed parameter in the results of this research, the treatments here utilized may be recommended as fungicides for safflower. Given the crop susceptibility to fungi in heavy rainy period, it is advised that its potential introduction on the region shall be focused on semiarid areas.

Inter-relação entre lesão cervical não cariosa e comprometimento periodontal: diagnóstico, tratamento e previsibilidade - estudo clínico prospectivo e laboratorial

The coexistence of gingival recession (GR) with root coverage indication and non-carious cervical lesions (LCNC) generates the need for a protocol that respects and promotes health of dental and periodontal tissues and allows treatment predictability. The main objectives of this theses were: (1) verify, through clinical evaluations, the connective tissue graft for root coverage on direct and indirect restorations made of ceramic resin; (2) analyze the influence of the battery level of the LED curing unit in the composite resin characteristics; (3) assess the influence of restorative materials, composite resin and ceramics, on the viability of gingival fibroblasts from primary culture. Nine patients with good oral hygiene and occlusal stability diagnosed with LCNCs the anterior teeth including premolars associated with gingival recession (class I and II of Miller) and only gingival recession were selected. After initial clinical examination, occlusal adjustment was performed and the patients had their teeth randomized allocated on direct composite resin restoration of LCNC, polishing and GR treatment with connective tissue graft and advanced coronally flap CR group (n = 15); and indirect ceramic restoration of the LCNC's and GR treatment (CTG+CAF) Group C (n = 15). The GR presented teeth with no clinically formed LCNCs cavity were treated using (CTG+CAF) being the control group (n = 15). Sorption and solubility tests, analysis of the degree of conversion and diametral tensile strength were performed in composite resin samples (n = 10) photoactivated by 100, 50 and 10% battery charge LED unit. The viability of fibroblasts on composite resin, ceramics and dentin disks (n = 3) was examined. Clinical follow-up was performed for three months. The data obtained at different stages were tabulated and subjected to analysis for detection of normal distribution and homogeneity. The results showed that: the LED unit with 10% battery affects the characteristics of the composite resin; restorative materials present biocompatibility with gingival fibroblasts; and the association of surgical and restorative treatment of teeth affected by NCCL and GR presents successful results at 3-month follow-up.

Electron beam lithography assisted high-resolution pattern generation

This thesis details the top-down fabrication of nanostructures on Si and Ge substrates by electron beam lithography (EBL). Various polymeric resist materials were used to create nanopatterns by EBL and Chapter 1 discusses the development characteristics of these resists. Chapter 3 describes the processing parameters, resolution and topographical and structural changes of a new EBL resist known as ‘SML’. A comparison between SML and the standard resists PMMA and ZEP520A was undertaken to determine the suitability of SML as an EBL resist. It was established that SML is capable of high-resolution patterning and showed good pattern transfer capabilities. Germanium is a desirable material for use in microelectronic applications due to a number of superior qualities over silicon. EBL patterning of Ge with high-resolution hydrogen silsesquioxane (HSQ) resist is however difficult due to the presence of native surface oxides. Thus, to combat this problem a new technique for passivating Ge surfaces prior to EBL processes is detailed in Chapter 4. The surface passivation was carried out using simple acids like citric acid and acetic acid. The acids were gentle on the surface and enabled the formation of high-resolution arrays of Ge nanowires using HSQ resist. Chapter 5 details the directed self-assembly (DSA) of block copolymers (BCPs) on EBL patterned Si and, for the very first time, Ge surfaces. DSA of BCPs on template substrates is a promising technology for high volume and cost effective nanofabrication. The BCP employed for this study was poly (styrene-b-ethylene oxide) and the substrates were pre-defined by HSQ templates produced by EBL. The DSA technique resulted into pattern rectification (ordering in BCP) and in pattern multiplication within smaller areas.

Preliminary results of the roman camp of La Cabeza del Cid (Hinojosa, Guadalajara, Spain)

The recent archaeological works in Hinojosa, allowed us to discover a camp from Roman republic period. It is located in the center of the Celtiberian area and its study could open interesting perspectives to study this historical period. This paper shows the results of its preliminary studies.

Fonction et structure des muscles du plancher pelvien de femmes traitées par chirurgie et radiothérapie à la suite d'un cancer de l'endomètre

Ce mémoire porte sur les propriétés fonctionnelles du plancher pelvien à la suite de traitements pour un cancer de l’endomètre. Chez les femmes, le cancer de l’endomètre est le cancer gynécologique ayant la plus forte prévalence. Les traitements oncologiques de ce cancer ont des conséquences néfastes sur la continence urinaire et il est possible que des altérations aux muscles du plancher pelvien à la suite de ces traitements puissent expliquer en partie cette problématique. Ce mémoire est composé de deux études principales. La première étude porte sur la recension des écrits liés aux impacts de la radiothérapie sur la structure anatomique et la fonction musculaire du plancher pelvien chez des adultes atteints d’un cancer pelvien. La deuxième étude compare les propriétés fonctionnelles du plancher pelvien de femmes avec incontinence urinaire à la suite d’un cancer de l’endomètre traité par chirurgie et une radiothérapie adjuvante (groupe à l’étude), à celles de femmes avec hystérectomie sans incontinence (groupe témoin). Cette étude a permis de mettre en évidence une diminution de l’ouverture maximale à l’entrée vaginale, de la longueur vaginale, de la force maximale volontaire du plancher pelvien, du taux de développement de la force dans un test de force maximale et de la coordination lors d’un test de contractions rapides. Ainsi, les deux études de ce mémoire apportent de nouvelles évidences sur les altérations des propriétés fonctionnelles du plancher pelvien à la suite de traitements pour un cancer génital.

Leanin soveltaminen haavanhoitotuotteiden valmistuksen läpimenoaikojen lyhentämiseksi

Mölnlycke Health Care valmistaa kertakäyttöisiä leikkaussali- ja haavanhoitotuotteita. Yritys on saavuttanut arvostetun aseman markkinoilla ja pitääkseen asemansa sen tulee koko ajan kehittää toimintaansa. Keväällä 2016 yritys aloitti leanin implementoinnin, minkä vuoksi nykytilanteen kartoittaminen ja sen pohjalta tuotannon kehittäminen tuli ajankohtaiseksi. Diplomityössä selvitettiin Mölnlycke Health Care Oy:lle sopiva nykytilan kartoitusmenetelmä. Sopivaksi menetelmäksi osoittautui arvovirtakuvaus. Nykytilanteen kartoitus tehtiin yrityksen kannalta tärkeälle tuoteperheelle, joka tässä tapauksessa oli edistyksellinen haavanhoitotuote ja haavasidos Mepilex Border. Nykytilanteen kartoitus antoi tuotteen läpimenoajaksi 100 päivää varaston riitto huomioituna. Tästä ajasta kuitenkin suurin osa oli hukkaa, jota pystytään poistamaan. Nykytilanteesta tehtiin kuva, jonka pohjalta pystyttiin havainnoimaan kehittävät kohteet ja tekemään ehdotukset kohteiden parantamiseksi. Kehitysehdotusten tavoitteena oli tuoda yritystä lähemmäs Lean-filosofiaa ja auttaa pitämään yllä jatkuvan parantamisen kulttuuria.

Remoção de instrumentos fraturados em Endodontia

A área da Endodontia está em constante progresso. Os materiais utilizados nos instrumentos Endodônticos, primordialmente, eram construídos com base em cordas de piano. Seguiu-se uma fase em que estes eram de aço de carbono, mas sofriam corrosão significativa devido ao cloro presente no hipoclorito de sódio, bem como aos processos de esterilização a vapor. Foi necessário evoluir novamente e foram introduzidos os instrumentos de aço inoxidável. Estes apresentavam alta resistência e dureza, mas algumas desvantagens devido à falta de flexibilidade. Atualmente, os instrumentos de NiTi proporcionam uma melhor flexibilidade e efeito de memória de forma. A fratura de instrumentos em Endodontia pode ocorrer por dois grandes fatores: a torção e a flexão por fadiga cíclica, podendo também ser a conjugação de ambos. Fatores anatômicos, como a curvatura e a largura do canal ou outros fatores como ciclos de esterilização, número de usos, etc., podem influenciar uma fratura mais precoce dos instrumentos. A incidência da fratura de instrumentos, embora seja pouco frequente, pode ser reduzida a um mínimo absoluto se os clínicos usarem as características de torque e de stress adequadas. Um bom conhecimento dos procedimentos clínicos, da anatomia, dos materiais e a utilização de instrumentos como o microscópio podem ajudar a prevenir ou a resolver a fratura dos instrumentos. No entanto, a melhor forma de prevenir a fratura é a sua prevenção. A desinfeção é o procedimento mais importante para o sucesso de um tratamento Endodôntico, portanto para que isto seja possível, é necessária uma boa conformação canalar. A presença de um instrumento no interior do canal pode comprometer a desinfecção, especialmente caso tenha ocorrido numa fase precoce da preparação canalar. Aquando da fratura de um instrumento, deve-se refletir sobre os procedimentos a seguir, podendo-se optar por várias abordagens, nomeadamente pela manutenção do instrumento no canal e obturação incorporando o fragmento, pela remoção do segmento através de diversas técnicas (ultrassons ou técnicas de microtubos, etc.), e ainda pela realização do bypass ou pela cirurgia Endodôntica. Em última instância pode ser realizada a extração do elemento dentário.

Incidental cancer in patients surgically treated for benign thyroid disease. Our experience at a single institution

Increased incidence of incidental cancer in patients operated for benign thyroid disease has been reported. We report our experience about incidental thyroid cancer (ITC) in order to better characterize this nosologic entity. Between 2001 and 2009 a total of 568 patients underwent surgery for benign thyroid disease. Patients with preoperative cytology undetermined or positive for malignancy were excluded. The most frequent indication for surgery was multinodular or diffuse nontoxic goiter. We performed total thyroidectomy in 499 cases and emithyroidectomy in 69 cases. Final histology revealed ITC in 53 patients (9.3%): 44 had papillary carcinoma (20 classic variant and 24 follicular variant), 4 follicular carcinoma, 4 medullary carcinoma and 1 primitive thyroid paraganglioma. The preoperative diagnosis was multinodular or diffuse goiter in 45 cases of ITC and uninodular goiter in 8 cases. We performed total thyroidectomy in 46 case, emithyroidectomy in 4 patients with past history of lobectomy, emithyroidectomy in 3 patients with following radicalization and central neck dissection. In 14 patients the tumor was multifocal and in 12 of these patients the tumor foci were bilateral. The lesion was a microcarcinoma in 34 cases. Mean diameter of the ITC was 1.14 cm. We retrospectively reconsidered the results of preoperative ultrasound examinations in relation to the exact position of the tumor in the specimens and we found a statistically significant association between echogenicity and papillary histotype. Twenty-six patients were followed up at our Hospital. The mean follow-up period was 38.2 months. A relapse was observed in 3/26 patients. Incidental thyroid cancer in patients operated for benign disease has its own surgical and oncological relevance. A correct preoperative assessment, with a careful selection of nodules for fine-needle aspiration cytology on the basis of ultrasound pattern, could better address the choice of surgical procedure. The non irrelevant incidence of incidental thyroid cancer, the eventuality of multifocality and bilaterality and the possible occurrence of relapse, support that total thyroidectomy without residuum is a valuable option for treating benign thyroid conditions such as multinodular goitre. When an incidental cancer is diagnosed after emithyroidectomy, a radicalization with central neck dissection could be considered. We suggest that natural history of papillary microtumors and the correct surgical approach for these lesions could be better defined with a more extensive use of “Porto proposal” criteria. Incidental thyroid cancer, Papillary microcarcinoma, Papillary microtumors, Total thyroidectomy.

Vivências dos cuidadores de idosos durante a internação hospitalar

O estudo objetivou conhecer as vivências do cuidador principal no cuidado do idoso no hospital. Realizou-se uma pesquisa descritiva exploratória de cunho qualitativo. Foi executada nas unidades de clínica médica, cirúrgica e serviço de pronto atendimento de um hospital universitário do sul do país, entre os meses de novembro e dezembro de 2013, através de um roteiro de entrevista, respondido por 11 cuidadores de idosos com doenças crônicas. As entrevistas foram transcritas e analisadas com a técnica de análise temática de Minayo. Nesta pesquisa, os cuidadores se caracterizam por ser, na sua maioria, do sexo feminino, casadas, com filhos, sem emprego remunerado e serem filhas do idoso hospitalizado. Os cuidadores participantes entendem a atividade de cuidar como um dever moral, resultado das relações pessoais e familiares. A partir do momento em que necessitam desempenhar tal papel, o assumem como uma exigência decorrente do fato de viverem em família. Os motivos que levaram o cuidador a desempenhar este papel relacionam-se com fatores inerentes ao idoso, como estado de saúde e grau de parentesco. Ao cuidador, fazem alusão ao dever/obrigação, gratidão/retribuição, grau de parentesco, gênero, proximidade afetiva, estado civil, situação atual de emprego e ausência de outra pessoa para realizar o cuidado. Durante o processo de hospitalização do idoso, o cuidador desenvolve ações, tem facilidades e dificuldades e utiliza estratégias que o auxiliam a cuidar. Ao vivenciar o cuidado ao idoso no hospital é influenciado a tornar-se cuidador, apresenta diversas experiências ao cuidar e precisa promover mudanças, em relação ao cuidado, com a internação do idoso. Ao implementar estratégias de cuidado durante a hospitalização do idoso, o familiar cuidador se organiza para cuidar e faz uso de uma rede de apoio para o cuidado. Constatou-se que o idoso e seu cuidador centralizam as necessidades e as decisões, que a rede de apoio informal é a principal provedora de auxílio durante a hospitalização do idoso e que a rede de apoio formal extrahospitalar é existente, porém não apresenta participação ativa no suporte do cuidador familiar. Por outro lado, a equipe de enfermagem responsável pelo cuidado intra-hospitalar foi uma participante ativa na totalidade dos relatos, provendo tanto o cuidado técnico especializado quanto a ajuda nas situações cotidianas emergentes, bem como suporte emocional aos cuidadores e idosos. Outro aspecto relevante destacado foi a falta de ajuda de alguns familiares no amparo aos cuidadores ou até mesmo ao idoso hospitalizado. Esse fato é considerado, pelos cuidadores, uma situação inaceitável, pois a família é vista como o sustentáculo em momentos de crise. As implicações deste estudo nas intervenções da enfermagem no cuidado ao doente e sua família estão relacionadas às discussões e reflexões, a serem realizadas pela equipe de saúde, acerca da inclusão do familiar no espaço hospitalar, pois a sua presença auxilia na manutenção da estabilidade física e emocional do idoso. Desta forma, a enfermagem poderá oferecer apoio ao familiar acompanhante para que se mantenha estável e possa formar uma parceria de cuidados, contribuindo na reabilitação do idoso.