Effectiveness of Enteral Nutritional Therapy in the Healing Process of Pressure Ulcers: A Systematic Review

OBJECTIVE To evaluate the effectiveness of enteral nutritional therapy (ENT) in the healing process of pressure ulcers (PU) in adults and the elderly. METHOD A systematic review whose studies were identified through the databases of Cochrane, MEDLINE/PubMed, SciELO, LILACS, EMBASE, CINAHL, Web of Science, and manual searches. It included randomized clinical trials (RCTs) without delimiting the period or language of publication, which addressed adults and elderly patients with pressure ulcers in a comparative treatment of enteral nutritional therapy and placebo or between enteral nutritional therapy with different compositions and dosages. RESULTS We included ten studies that considered different interventions. It resulted in more pressure ulcers healed in the groups that received the intervention. The included studies were heterogeneous with regard to patients, the type of intervention, the sample and the follow-up period, all of which made meta-analysis impossible. CONCLUSION Although the enteral nutritional therapy demonstrates a promotion of pressure ulcer healing, sufficient evidence to confirm the hypothesis was not found.

A Adopção, pela primeira vez – Constrangimentos Encontrados na Adopção n óptica Financeira

Os efeitos da globalização da economia, a graduação de Cabo Verde à categoria de país de desenvolvimento médio, a entrada para a OMC, a parceria especial com a União Europeia, são acontecimentos verificados num passado próximo que vieram trazer novas exigências ao país em diversos domínios. A preparação das contas e o relato da informação pode ser considerada uma delas. De facto, o normativo contabilístico existente até então, assente num Plano Oficial de Contabilidade (PNC) aprovado por diploma legislativo datada de 1984 já não respondia a todas as necessidades de informação nos domínios da contabilidade, fiscalidade e financeira. O trabalho assenta sobretudo na adopção do SNCRF – Sistema de Normalização Contabilística e de Relato Financeiro. O objectivo é analisar o processo de adopção pela primeira vez deste sistema e os impactos que esta adopção teve na posição financeira nas empresas. Foi feito um estudo de caso para ilustrar este processo. Descrevemos como foi adoptado o SNCRF, fizemos uma apreciação a essa adopção e sugerimos melhoria que deveria ser introduzidas para que os resultados do processo incorporassem a quase totalidade dos procedimentos instituídos nos diversos documentos normativos e legais. Ao trabalho foi dado uma dimensão prática consubstanciada num estudo de caso que serviu para ilustrar o processo de transição. O estudo foi abordado numa perspectiva apreciativa tendo sido inventariadas as situações que deveriam ser salvaguardas (de acordo com o novo normativo e imperativos legais) no processo de transição / conversão e que não foram feitas. Demonstrou-se ainda (através da análise da posição financeira da entidade), que o processo de adopção implicou algumas alterações na estrutura financeira e no valor do capital próprio. A conclusão que se chegou indica que o processo não terá sido tão linear como se desejaria apesar de em, substancia, os principais requisitos terem sido cumpridos. The effects of globalization of its economy, the upgrading of Cape Verde to the category of medium development country, the entry to WTO, the special partnership with European Union, are recent events that brought new demands to the country in several areas. . Preparation of the accounts and information report are included in these new requirements. In fact, the accounting standards till then in force, based on an Official Chart of Accounts (PNC) in force after a law of 1984, didn’t meet the requirements on accounting, fiscal and financial information. This work is basically on the adoption of the new SNCRF – System of Accounting Standardization and Financial Reporting. Our aim is to review the initial adoption process of such system and the impacts this adoption has caused to the financial position of enterprises. A case study is included to illustrate this process. We describe how the SNCRF was adopted; we made an analysis of this adoption and suggested improvements to be introduced in such way that the results of the process include most of the procedures established by law. A practical dimension was attached to this work, through a case study illustrating the transition process. The study adopted an analytical approach, listing the situations that should have been (according to the new standards and legal prescriptions) but were not prevented during the transition / conversion process. The study shows (by the analysis of the financial statements of the studied entity) that the adoption process implied some changes to the financial structure and to the owners’ equity value). One arrives to the conclusion that the process was not as linear as one would expect, although essentially the main requirements were accomplished.

Importância da normalização contabilística na análise económica e financeira da empresa

O presente trabalho tem como objectivo demonstrar a importância da normalização contabilística para a análise da informação financeira, tendo em conta o meio envolvente em que, hoje, as empresas encontram-se inseridas. As mudanças que ocorreram na economia global levou a que as empresas passassem a adoptar novas formas de elaborar o reporte financeiro como forma de acompanhar essa evolução. A harmonização contabilística, surge neste contexto, como forma de reduzir as diferenças existentes no relato financeiro dos vários países. Nesse sentido o trabalho abordará as várias iniciativas que tem sido feitas em favor da harmonização/normalização contabilística e a sua relevância no contexto internacional e nacional bem como o caso de Cabo Verde, que recentemente aderiu ao processo da normalização. O caso prático baseia-se na transposição das demonstrações financeiras para o novo normativo em vigor e também na análise destas. A metodologia utilizada no trabalho baseia-se na revisão bibliográfica em livros, revistas, pela consulta de sites na Internet e legislação. The purpose of this paper is to demonstrate the importance of the accounting standard for the analysis of financial information, taking into account the environment in which, today, the companies are incorporated. The changes that occurred in the global economy have led companies to introduce new ways of preparing the financial reporting as a way to monitor these developments. The accounting harmonization, it is in this context as a way of reducing the differences existing in the financial reporting of the several countries. In this sense the work will address a variety of initiatives that have been made in favor of harmonization / normalization accounting and its relevance in the international and national context as well as the case of Cape Verde, who recently joined the process of standardization. The practical case is based in on the translation of financial statements for the new rules enforced and also in their analysis. The follows methodology used in the process is based on the literature review in books, magazines, by consulting Web sites and legislation

The nurse in the management of materials in teaching hospitals

OBJECTIVETo present the nurse's integration within materials management of six teaching hospitals of Paraná - Brazil, and to describe the activities performed by nurses within this process.METHODA study of a qualitative approach and descriptive nature, conducted in teaching hospitals in Paraná, between June and August of 2013. The data collection was conducted through semi-structured interviews with eight nurses who worked in materials management; data were analyzed using content analysis.RESULTSThese showed that nurses perform ten categories of activities, distributed into four of the five steps of the materials management process.CONCLUSIONThe nurse, in performing of these activities, in addition to favoring the development of participative management, contributes to the organization, planning, and the standardization of the hospital supply process, giving greater credibility to the work with professionals who use the materials, and to the suppliers.

Assessment of the teaching-learning process in students of the health area: cardiopulmonary resuscitation maneuvers

OBJECTIVETo evaluate the skills and knowledge of undergraduate students in the health area on cardiopulmonary resuscitation maneuvers with the use of an automatic external defibrillator.METHODThe evaluation was performed in three different stages of the teaching-learning process. A theoretical and practical course was taught and the theoretical classes included demonstration. The evaluation was performed in three different stages of the teaching-learning process. Two instruments were applied to evaluate the skills (30-items checklist) and knowledge (40-questions written test). The sample comprised 84 students.RESULTSAfter the theoretical and practical course, an increase was observed in the number of correct answers in the 30-items checklist and 40-questions written test.CONCLUSIONAfter the theoretical class (including demonstration), only one of the 30-items checklist for skills achieved an index ≥ 90% of correct answers. On the other hand, an index of correct answers greater than 90% was achieved in 26 (86.7%) of the 30 items after a practical training simulation, evidencing the importance of this training in the defibrillation procedure.

Guidelines for imaging retinoblastoma: imaging principles and MRI standardization.

Retinoblastoma is the most common intraocular tumor in children. The diagnosis is usually established by the ophthalmologist on the basis of fundoscopy and US. Together with US, high-resolution MRI has emerged as an important imaging modality for pretreatment assessment, i.e. for diagnostic confirmation, detection of local tumor extent, detection of associated developmental malformation of the brain and detection of associated intracranial primitive neuroectodermal tumor (trilateral retinoblastoma). Minimum requirements for pretreatment diagnostic evaluation of retinoblastoma or mimicking lesions are presented, based on consensus among members of the European Retinoblastoma Imaging Collaboration (ERIC). The most appropriate techniques for imaging in a child with leukocoria are reviewed. CT is no longer recommended. Implementation of a standardized MRI protocol for retinoblastoma in clinical practice may benefit children worldwide, especially those with hereditary retinoblastoma, since a decreased use of CT reduces the exposure to ionizing radiation.

Workloads and strain process in Community Health Agents

ABSTRACT OBJECTIVE To identify the workloads present in the work activities of community health agents (CHAs) and the resulting strain processes. METHOD A descriptive, exploratory, cross-sectional and quantitative study conducted with 137 CHAs. Data were collected through a questionnaire and interview guided by the health surveillance software called SIMOSTE (Health Monitoring System of Nursing Workers), following the ethical codes of the current law. RESULTS In total, were identified 140 workloads involved in 122 strain processes, represented by the occurrence of health problems of the CHAs. The mechanical (55.00%) and biological (16.43%) loads stood out. The most common strain processes were the external causes of morbidity and mortality (62.31%) and diseases of the musculoskeletal system and connective tissue (10.66%). CONCLUSION From the identified overloads, it became evident that all workloads are present in the work process of CHAs, highlighting the mechanical load, represented mainly by external causes of morbidity and mortality that are related to occupational accidents.

Validation of the New Mix Design Process for Cold In-Place Rehabilitation Using Foamed Asphalt, 2007

Asphalt pavement recycling has grown dramatically over the last few years as a viable technology to rehabilitate existing asphalt pavements. Iowa's current Cold In-place Recycling (CIR) practice utilizes a generic recipe specification to define the characteristics of the CIR mixture. As CIR continues to evolve, the desire to place CIR mixture with specific engineering properties requires the use of a mix design process. A new mix design procedure was developed for Cold In-place Recycling using foamed asphalt (CIR-foam) in consideration of its predicted field performance. The new laboratory mix design process was validated against various Reclaimed Asphalt Pavement (RAP) materials to determine its consistency over a wide range of RAP materials available throughout Iowa. The performance tests, which include dynamic modulus test, dynamic creep test and raveling test, were conducted to evaluate the consistency of a new CIR-foam mix design process to ensure reliable mixture performance over a wide range of traffic and climatic conditions. The “lab designed” CIR will allow the pavement designer to take the properties of the CIR into account when determining the overlay thickness.

Spinning welfare: The gains from process innovation in cotton and car production

Economists and economic historians want to know how much better life is today than in the past.Fifty years ago economic historians found surprisingly small gains from 19th century US railroads,while more recently economists have found relatively large gains from electricity, computers and cellphones. In each case the implicit or explicit assumption is that researchers were measuring the valueof a new good to society. In this paper we use the same techniques to find the value to society ofmaking existing goods cheaper. Henry Ford did not invent the car, and the inventors of mechanisedcotton spinning in the industrial revolution invented no new product. But both made existing productsdramatically cheaper, bringing them into the reach of many more consumers. That in turn haspotentially large welfare effects. We find that the consumer surplus of Henry Ford s production linewas around 2% by 1923, 15 years after Ford began to implement the moving assembly line, while themechanisation of cotton spinning was worth around 6% by 1820, 34 years after its initial invention.Both are large: of the same order of magnitude as consumer expenditure on these items, and as largeor larger than the value of the internet to consumers. On the social savings measure traditionally usedby economic historians, these process innovations were worth 15% and 18% respectively, makingthem more important than railroads. Our results remind us that process innovations can be at least asimportant for welfare and productivity as the invention of new products.

Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.

OBJECTIVE: In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. METHODS: This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. RESULTS: During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. CONCLUSIONS: This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery rate and false positive are similar to those found in previous studies. We found our results satisfying the given short time frame of this study. Our results demonstrate that it is possible to improve the quality of emergency services at moderate or even no additional costs and this should be of interest to all EMS that do not presently benefit from using T-CPR procedures. EMS that currently do not offer T-CPR should consider implementing this technique as soon as possible, and we expect our experience may provide answers to those planning to incorporate T-CPR in their daily practice.

The role of institutions in the contractual process

Human beings increase their productivity by specializingtheir resources and exchanging their products. Theorganization of exchange is costly, however, becausespecialized activities need coordination and incentiveshave to be aligned. This work first describes how theseexchanges are organized in an institutional environment.It then focuses on the dual effect of this environment-as with any other specialized resource, institutions maybe used for expropriation purposes. They enjoyspecialization advantages in safeguarding exchange butthey also make possible new forms of opportunism,causing new costs of exchange. Three perverse tendenciesare identified:In the legal field, there is a surplus ofmandatory rules and, at the same time, a deficit in default rules. Second, courts activity is biased againstthe quasi-judicial role of the parties and the market. Third, Market enforcement is based on reputationalassets that are badly exposed to opportunism.