Atuação dos enfermeiros na emergência pré-hospitalar em situações de paragem cárdio-respiratória

Dissertação de mestrado em Enfermagem da Pessoa em Situação Crítica

Contabilidade e relato dos intangíveis: Análise das empresas cotadas na BM&FBOVESPA

O presente trabalho de investigação avalia a situação atual relativa à adoção do disposto na IAS 38 e suas consequências no reconhecimento, mensuração e divulgação obrigatória, e à divulgação voluntária, interna e externa, dos intangíveis nas empresas brasileiras cotadas na BM&FBOVESPA. Adotando a perspectiva positivista e uma abordagem quantitativa, foi utilizado o inquérito por questionário como método de recolha de dados. O questionário foi elaborado de raiz, suportado pelo arcabouço teórico. Os resultados são interpretados à luz dos argumentos da teoria dos stakeholders e da teoria institucional, que revelaram um bom potencial explicativo para o fenômeno em análise. Com a adoção das IAS/IFRS para elaboração dos balanços consolidados de empresas cotadas e não cotadas, o Brasil passa a utilizar a IAS 38, para o registro das operações envolvendo os ativos intangíveis, obrigatoriamente no exercício de 2010. A adoção deste normativo se deu essencialmente por pressões legais. No entanto, as empresas que adotaram a IAS 38 de forma voluntária validaram as razões apresentadas na literatura. Constatou-se que existe concordância quanto à nova forma de contabilização dos intangíveis prevista, sendo o grau de satisfação relativamente ao tratamento contábil dos ativos intangíveis de acordo com o novo modelo contábil adotado no Brasil (IAS 38 e CPC 04) elevado. Como principais dificuldades no reconhecimento contábil dos ativos intangíveis segundo o normativo em vigor, foram confirmados os problemas evidenciados na literatura, tais como incerteza quanto aos benefícios econômicos futuros e falta de medida com confiabilidade suficiente para o registro das transações. As empresas brasileiras acreditam ser importante que haja uma expansão da divulgação sobre intangíveis, no entanto a divulgação interna e externa está ainda em fase embrionária, não sendo uma prática generalizada. Contudo, os objetivos apresentados na literatura para a divulgação interna e externa de informações sobre intangíveis encontram suporte empírico no estudo desenvolvido. No que diz respeito aos stakeholders, conclui-se que as empresas brasileiras têm grande preocupação em atendê-los quando se trata de divulgação voluntária sobre intangíveis, entendendo que todos eles poderão beneficiar com estas informações.

A modular traffic sampling architecture for flexible network measurements

Dissertação de Mestrado (Programa Doutoral em Informática)

Os técnicos superiores de reeducação e o trabalho prisional

Dissertação de mestrado em Crime, Diferença e Desigualdade

A patente europeia com efeito unitário

Dissertação de mestrado em Direito dos Contratos e da Empresa

Avaliação externa de escolas: efeitos no desenvolvimento de projetos de educação para a saúde

Dissertação de mestrado em Ciências da Educação (área de especialização em Desenvolvimento Curricular e Inovação Educativa)

Cardiopulmonary resuscitation: update, controversies and new advances

Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of life chain, cardio-pulmonary resuscitation courses for professionals who work in emergency medical services, the automated external defibrillator, the implantable cardioverter-defibrillator, and mobile intensive care units, among others. New concepts, strategies and structures motivated by new advances have also modified the treatment and improved the results of cardiopulmonary resuscitation in the hospital setting. Among them, we can cite the concept of cerebral resuscitation, the application of the life chain, the creation of the universal life support algorithm, the adjustment of drug doses, new techniques - measure of the end-tidal carbon dioxide levels and of the coronary perfusion pressure - and new drugs under research.

Valorization of eucalyptus wood by glycerol-organosolv pretreatment within the biorefinery concept: an integrated and intensified approach

The efficient utilization of lignocellulosic biomass and the reduction of production cost are mandatory to attain a cost-effective lignocellulose-to-ethanol process. The selection of suitable pretreatment that allows an effective fractionation of biomass and the use of pretreated material at high-solid loadings on saccharification and fermentation (SSF) processes are considered promising strategies for that purpose. Eucalyptus globulus wood was fractionated by organosolv process at 200 C for 69 min using 56% of glycerol-water. A 99% of cellulose remained in pretreated biomass and 65% of lignin was solubilized. Precipitated lignin was characterized for chemical composition and thermal behavior, showing similar features to commercial lignin. In order to produce lignocellulosic ethanol at high-gravity, a full factory design was carried to assess the liquid to solid ratio (3e9 g/g) and enzyme to solid ratio (8e16 FPU/g) on SSF of delignified Eucalyptus. High ethanol concentration (94 g/L) corresponding to 77% of conversion at 16FPU/g and LSR ¼ 3 g/g using an industrial and thermotolerant Saccharomyces cerevisiae strain was successfully produced from pretreated biomass. Process integration of a suitable pretreatment, which allows for whole biomass valorization, with intensified saccharification-fermentation stages was shown to be feasible strategy for the co-production of high ethanol titers, oligosaccharides and lignin paving the way for cost-effective Eucalyptus biorefinery.

Use of automated external defibrillators in a Brazilian airline. A 1-year experience

After the incorporation of automated external defibrilators by other airlines and the support of the Brazilian Society of cardiology, Varig Airlines Began the onboard defibrilation program with the initial purpose of equiping wide-body aircrafts frequently used in international flights and that airplanes use in the Rio - São Paulo route. With all fight attendants trained, the automated. External defibrilation devides were incorporated to 34 airplanes of a total pleet of 80 aircrats. The devices were intalled in the bagage compartments secured with velero straps and 2 pairs of electrods, one or which pre-conected to the device to minimize application time. Later, a portable monitor was addres to the ressocitation kit in the long flights. The expansion of the knowledge of the basic life support fundamentors and the correted implantation of the survival chain and of the automated external defibrilators will increase the extense of recovery of cardiorespiratory arrest victins in aircrafts.

Prognostic factors of the results of cardiopulmonary resuscitation in a cardiology hospital

OBJECTIVE: To analyze the early and late results of cardiopulmonary resuscitation in a cardiology hospital and to try to detect prognostic determinants of both short- and long-term survival. METHODS: A series of 557 patients who suffered cardiorespiratory arrest (CRA) at the Dante Pazzanese Cardiology Institute over a period of 5 years was analyzed to examine factors predicting successful resuscitation and long-term survival. RESULTS: Ressuscitation maneuvers were tried in 536 patients; 281 patients (52.4%) died immediately, and 164 patients (30.6%) survived for than 24 hours. The 87 patients who survived for more than 1 month after CRA were compared with nonsurvivors. Coronary disease, cardiomyopathy, and valvular disease had a better prognosis. Primary arrhythmia occurred in 73.5% of the >1-month survivor group and heart failure occurred in 12.6% of this group. In those patients in whom the initial mechanism of CRA was ventricular fibrillation, 33.3% survived for more than 1 month, but of those with ventricular asystole only 4.3% survived. None of the 10 patients with electromechanical dissociation survived. There was worse prognosis in patients included in the extreme age groups (zero to 10 years and 70 years or more). The best results occurred when the cardiac arrest took place in the catheterization laboratories. The worst results occurred in the intensive care unit and the hemodialysis room. CONCLUSION: The results in our series may serve as a helpful guide to physicians with the difficult task of deciding when not to resuscitate or when to stop resuscitation efforts.

Mini-sternotomy for the treatment of aortic valve lesions

OBJECTIVE: To compare inverted-L mini-sternotomy performed above the sternal furcula with conventional sternotomy in patients with aortic valve diseases who undergo surgical treatment. METHODS: We operated upon 30 patients who had aortic valve lesions that had clinical and hemodynamic findings. All patients underwent inverted-L sternotomy, which extended from above the manubrium of the sternum to the 3rd right intercostal space, without opening the pleural cavity. Their ages ranged from 32 to 76 years, and 18 were males and 12 were females. We used negative pressure in a venous ¼-inch cannula, and the patients were maintained in Trendelemburg's position. Twenty-seven patients received bioprostheses with diameters ranging from 23 to 29mm. Three patients underwent only removal of the calcifications of the aortic valve leaflets and aortic commissurotomy. RESULTS: The mean duration of anoxic cardiac arrest was 63.11min. Access was considered good in all patients. One death was due to pulmonary and renal problems not related to the incision. All patients had a better recovery in the intensive care unit, got out of bed sooner, coughed more easily, and performed prophylactic physiotherapeutic maneuvers for respiratory problems more easily and with less pain in the incision. Early ambulation was more easily carried out by all patients. CONCLUSION: Mini-sternotomy proved to be better than the conventional sternotomy because it provided morecomfort for the patients in the early postoperative period, with less pain and greater desire for early ambulation and all its inherent advantages.

Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit

OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01) death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.

Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58%) patients, and 42 (28%) were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT) as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP) prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6), when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3), when the time of cerebral cardiopulmonary resuscitation was < 15 min; 9.2 (95% CI = 3.9-21.3), when the time of cardiopulmonary arrest was < 20 min; and 5.7 (95% CI = 2.4-13.7), when BP was > 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

Caso 4/2003 - Paciente de 61 anos, portadora de cardiopatia da doença de Chagas, com disfunção ventricular, taquicardia ventricular recorrente e marcapasso cardíaco, que apresentou morte em assistolia após ressecção cirúrgica de aneurisma de ponta

A 61 year-old Chagasic woman, with previous left ventricular systolic disfunction, ventricular tachychardia and cardiac pacemaker, presented cardiac arrest in asystolia after surgical ressection of apical aneurysm.

The Irish Pub: past, present – whither the future?

The purpose of this research is to examine the main economic, legislative, and socio- cultural factors that are currently influencing the pub trade in Ireland and their specific impact on a sample of publicans in both Galway city and county. In approaching this task the author engaged in a comprehensive literature review on the origin, history and evolution of the Irish pub; examined the socio-cultural and economic role of the public house in Ireland and developed a profile of the Irish pub by undertaking a number of semi-structured interviews with pub owners from the area. In doing so, the author obtained the views and opinions of the publicans on the current state of their businesses, the extent to which patterns of trade have changed over recent years, the challenges and factors currently influencing their trade, the actions they believed to be necessary to promote the trade and address perceived difficulties and how they viewed the future of the pub business within the framework of the current regulatory regime. In light of this research, the author identified a number of key findings and put forward a series of recommendations designed to promote the future success and development of the pub trade in Ireland. The research established that public houses are currently operating under a very unfavourable regulatory framework that has resulted in the serious decline of the trade over the last decade. This decline appears to have coincided initially with the introduction of the ban on smoking in the workplace and was exacerbated further by the advent of more severe drink-driving laws, especially mandatory breath testing. Other unfavourable conditions include the high levels of excise duty, value added tax and local authority commercial rates. In addition to these regulatory factors, the research established that a major impediment to the pub trade is the unfair competition from supermarkets and other off-licence retail outlets and especially to the phenomenon of the below-cost selling of alcohol. The recession has also been a major contributory factor to the decline in the trade as also has been the trend towards lifestyle changes and home drinking mirroring the practice in some continental European countries.