D-3 2001-1 Dependent Adult Abuse Report, January-June 2001

Adult dependent abuse report from the Iowa Department of Human Services

Adapta����o para a l��ngua portuguesa e valida����o do Lunney Scoring Method for Rating Accuracy of Nursing Diagnoses

O Lunney Scoring Method for Rating Accuracy of Nursing Diagnoses (LSM) �� uma escala de diferencial sem��ntico que foi desenvolvida por Lunney para estimar a acur��cia dos diagn��sticos de enfermagem. O objetivo deste estudo foi adaptar o LSM para a l��ngua portuguesa e avaliar as sua propriedades psicom��tricas. A escala original foi traduzida para o portugu��s, revertida para o ingl��s e as duas vers��es em ingl��s foram comparadas para ajustar a vers��o em portugu��s que passou a ser denominada Escala de Acur��cia de Diagn��stico de Enfermagem de Lunney - EADE. Quatro enfermeiras foram orientadas sobre a EADE e a aplicaram em 159 diagn��sticos formulados para 26 pacientes de tr��s estudos prim��rios com base nos registros de entrevista e exame f��sico de cada paciente. Os ��ndices Kappa de Cohen mostraram aus��ncia de concord��ncia entre as avaliadoras, o que indica que o instrumento adaptado n��o tem confiabilidade satisfat��ria. Em virtude desse resultado, n��o foi realizada estimativa de validade.

Nursing Activities Score (NAS) como instrumento para medir carga de trabalho de enfermagem em UTI adulto

Pesquisa de campo, prospectiva, quantitativa, descritiva-explorat��ria, realizada na UTI geral/adulto de um hospital privado do munic��pio de S��o Paulo. Objetivos: avaliar o NAS - Nursing Activities Score - como medida de carga de trabalho de enfermagem; sua aplicabilidade por turnos e sua correspond��ncia com o quantitativo de enfermagem efetivo. Classificados 33 pacientes: idade m��dia: 70,4 anos (+/-16,5), 66,7% do sexo masculino; perman��ncia m��dia na UTI: 17 dias (+/- 20,4); SAPSII: 41,7 (+/-17,9); risco de morte: (RM) 33,5% (+/- 26,8); 63,6% transferidos para Unidades de Cuidados Semi-Intensivos, 18,2% evolu��ram a ��bito. Obtiveram-se 396 medidas por turnos (134-manh��; 132-tarde; 130-noturno), m��dia de 55,4 (+/-12,3) e 147 medidas de NAS de 24h, m��dia de 69,6 (+/-18,2). O instrumento mostrou-se mais adequado �� aplica����o em 24 horas que por turnos, tendendo a refletir o n��mero de profissionais efetivo, revelando-se interessante instrumento de classifica����o de pacientes e carga de trabalho de enfermagem em terapia intensiva.

Iron and transfusion medicine.

Blood bankers have focused their energy to secure blood transfusion, and only recently have studies been published on the effect of blood donation on iron metabolism. In many facilities, hemoglobin measurement is only performed just before or even during blood donation, but the determination of iron stores is largely ignored. The 2013 paradox of transfusion medicine is due to the fact that blood donation may be harmful and leads to iron deficiency with or without anemia, but for other individuals, it may be a healthy measure preventing type 2 diabetes. The purpose of this review is to discuss iron metabolism in the perspective of blood donation, notably regarding their possible genetic profiles that eventually will discriminate "good" iron absorbers from "bad" iron responders.

D-3 2001-2 Dependent Adult Abuse Report, July-December 2001

Adult dependent abuse report from the Iowa Department of Human Services

CNVs and genetic medicine (excitement and consequences of a rediscovery).

The extensive variability of individual human genomes contributes to phenotypic variability. Structural genomic variants, and copy number variants (CNVs) in particular, have recently been rediscovered as contributors to the genomic plasticity and evolution and as pathoetiologic elements for both monogenic and complex traits. Herein we review some of the consequences of CNVs in the context of human inherited diseases.

Rel��ve en m��decine interne g��n��rale: enjeux et perspectives [Perspectives and challenges to guarantee training and renewal in general internal medicine]

Training new doctors in general internal medicine represents a challenge. This requires to define future needs, which result from interest that are not necessarily convergent between patients, doctors, insurers and politicians. Problems related to medical demography in Switzerland, with the ageing of the population, the increase in health care costs and the place of Switzerland within the European Community require the implementation of specific objectives to train new physicians in general internal medicine. The success of these opportunities depends on social factors, political choices and choices from physician's association. In this article we will approach these challenges by formulating some proposals--nonexhaustive--in order to guarantee sufficient renewal in general internal medicine.

Department of Inspections and Appeals, and Department of Elder Affairs -- A Review of the Oversight of Nursing Facilities

Other Audit Reports - Special Report

D-3 2003-2 Dependent Adult Abuse Report, July-December 2003

Adult dependent abuse report from the Iowa Department of Human Services

Advanced nursing role to improve care among breast cancer patients

Background: Breast cancer is a devastating disease for women as it impacts on their intimate, familial, social life. We study the specificities of breast cancer nurse interventions related to demands of support, information and coordination. Material and Methods: More than 300 patients are treated every year in our institution. From 2006 January to 2008 December, the specialist nurse has reported demands of patients and professionals: 1. Patients' needs related to support, information and coordination of care were collected from consultations with her and from their phone calls on using working days help line 2. Demands of breast cancer specialists and general practitioners related to information and coordination for specific patients were collected from their phone calls. Results: The specialist nurse received 679 phone calls respectively 71.5% from patients and 28.5% from professionals. Data are presented in the following table. Table 1: Evolution of number of patients and professionals demands Patients consultations Patients calls Professionals calls 2006 93 45 32 2007 210 200 40 2008 245 240 122 - Seventy percent (70%) of women asked for information about exams and treatments by phone and in nurse consultation. - Forty percent (40%) of women asked for support after announce of diagnosis. The specialist nurse proposed consultations, 2 to 4 consultations were necessary for women to express emotional distress or psychosocial problem. With this specialised nursing support less than 15% of patients were referred to the psycho-oncologist setting. - Forty percent (40%) of professionals asked support for patients and 60% for information and coordination of care. Conclusion: The interventions of the specialist nurse have improved coordination and quality of care. The increase of professionals' demands showed that it was necessary that a nurse assures continuity of information between hospital and extrahospital structures. The breast cancer nurse empowers patients and helps them to get well by providing support to fulfil specific needs.

Main results of the Monte Carlo studies carried out for nuclear medicine practices within the ORAMED project

The aim of ORAMED work package 4 was the optimization of the medical practices in nuclear medicine during the preparation of radiopharmaceuticals and their administration to the patient. During the project a wide campaign of measurements was performed in the nuclear medicine departments of the collaborating hospitals. Such data were intrinsically characterized by a large variability that depended on the procedure, the employed techniques and the operator's habits. That variability could easily hide some important parameter, for example, the effectiveness of the adopted shielding (for syringe and vial) or the effect of the distances from the source. This information is necessary for a valuable optimization purpose of radiation protection. To this end a sensitivity analysis was carried out through Monte Carlo simulations employing voxel models, representing operator's hand during the considered practices. Such analysis allowed understanding at what extent the range of personal dose equivalent evaluated during measurements can be considered intrinsically related to the procedures. Furthermore, with the Monte Carlo simulations it was possible to study the appropriateness of the shielding usually utilized in these practices.

Nursing Activities Score (NAS): adapta����o transcultural e valida����o para a l��ngua portuguesa

O estudo teve como objetivos adaptar para o portugu��s e avaliar as propriedades psicom��tricas do Nursing Activities Score (NAS), instrumento de medida de carga de trabalho de enfermagem em UTI. Ap��s o processo de adapta����o cultural, o NAS foi aplicado em uma amostra de 200 pacientes adultos internados em UTIs. A an��lise da consist��ncia interna pelo coeficiente Alfa de Cronbach revelou que o NAS possui 23 medidas independentes que n��o comportam consolida����o ou redu����o. A avalia����o da confiabilidade interobservadores demonstrou alta concord��ncia (99,8%) e ��ndice Kappa m��dio de 0,99. A validade concorrente foi demonstrada pela correla����o estatisticamente significativa entre o TISS-28 e o NAS (r=0,67; p<0,0001), assim como pela an��lise de regress��o multivariada (R��=94,4%; p<0,0001). Na avalia����o da validade convergente, a regress��o multivariada mostrou associa����o estatisticamente significativa entre o NAS e o SAPS II, quando ajustada pela idade (R��=99,8%; p<0,0001). Pelos resultados obtidos, o NAS mostrou-se um instrumento confi��vel e v��lido para mensurar carga de trabalho de enfermagem em UTIs brasileiras.

Medicine and Science in a New Medical-surgical Context: The Royal College of Surgery of Barcelona (1760���1843)

Taking the Royal College of Barcelona (1760 -1843) as a case study this paper shows the development of modern surgery in Spain initiated by Bourbon Monarchy founding new kinds of institutions through their academic activities of spreading scientific knowledge. Antoni Gimbernat was the most famousinternationally recognised Spanish surgeon. He was trained as a surgeon at the Royal College of Surgery in Cadiz and was later appointed as professor of theAnatomy in the College of Barcelona. He then became Royal Surgeon of King Carlos IV and with that esteemed position in Madrid he worked resiliently to improve the quality of the Royal colleges in Spain. Learning human bodystructure by performing hands-on dissections in the anatomical theatre has become a fundamental element of modern medical education. Gimbernat favoured the study of natural sciences, the new chemistry of Lavoisier and experimental physics in the academic programs of surgery. According to the study of a very relevant set of documents preserved in the library, the so-called ���juntas literarias���, among the main subjects debated in the clinical sessions was the concept of human beings and diseases in relation to the development of the new experimental sciences. These documents showed that chemistry andexperimental physics were considered crucial tools to understand the unexplained processes that occurred in the diseased and healthy human bodyand in a medico-surgical context. It is important to stress that through these manuscripts we can examine the role and the reception of the new sciences applied to healing arts.

Origin and outcome of multiple pregnancies in Bern, Switzerland, 1995-2006 and the current proposal of the Swiss parliament to revise the Swiss law of reproductive medicine: Switzerland quo vadis?

INTRODUCTION: Infertility treatments are a major source of the increase in multiple pregnancies (MPs). AIMS: The aims of the present study were (1.) to investigate the origin and maternal/neonatal outcomes of MP and (2.) to review the different measures that can be adopted to reduce these serious complications. METHODS: The study included all women with multiple births between 1 January 1995 and 31 December 2006 at the University Hospital of Bern, Switzerland. The outcomes associated with the various origins of MP (natural conception, ovarian stimulation [OS] &#8210; in-vitro fertilisation [IVF-ICSI]) were analysed using a multinomial logistic regression model. An analysis of the Swiss law on reproductive medicine and its current proposed revision, as well as a literature review using Pubmed, was carried out. RESULTS: A total of 592 MP were registered, 91% (n = 537) resulted in live births. There was significantly more neonatal/maternal morbidity in MP after OS compared with natural conception and even with the IVF-ICSI group. With a policy of elective single embryo transfer (eSET), twin rates after IVF-ICSI can be reduced to <5% and triplets to <1%. CONCLUSIONS: After OS, more triplets are found and the outcome of MP is worse. MP is known to be associated with morbidity, mortality, and economic and social risks. To counteract these complications (1.) better training for physicians performing OS should be encouraged and (2.) the Swiss law on reproductive medicine needs to be changed, with the introduction of eSET policies. This would lead to a dramatic decrease in neonatal and maternal morbidity/mortality as well as significant cost reductions for the Swiss healthcare system.