Avaliação da dor pós-operatória: análise em pacientes submetidos a cirurgias abdominais em um hospital universitário de Natal/RN

It is an exploratory and descriptive study made by a quantitative approach, developed among February and May 2010, aiming to assess the pain of patients underwent abdominal surgeries in a University Hospital, in Natal/RN; to identify the local and intensity of the pain based on Numerical Estimative Scale; to analyze the pain related to the sensorial-discriminative, motivational-affective and cognitive-assessment dimensions, using the McGill Questionnaire pain; to establish a relation between the pain process and age, gender, religion, and king of surgery; to identify the medicines efficiency used to control postoperative pain. The sample was composed by 253 patients underwent abdominal surgeries. The results showed a total of 63.63% females between 38 and 47 years of age (21.34%); illiterates (21.73%); married (64.03%), living in Natal and surroundings (67.97%) and Catholics (74.30%). In their first assessment, 84.19% showed postoperative pain; the pain was considered light in 18.97% of them, moderate in 21.74% and severe in 43.48%. The mean number of descriptors chosen through the McGill Questionnaire Pain was 10.78 (DP= 6.09) and pain rating 23.65 (DP= 15.93). The descriptors selected with higher frequency were: sickening pain (69.01%), tired (65.25%), thin (62.44%), bored (58.69%), ardor (46.48%), pointed (38.50%) and colic (35.21%). In their second assessment, 57.71% of patients didn t relate any postoperative pain and 42.29% were still complaining about the pain. After taking analgesic medication, just 41.90% of patients who had complete pain relief. The Pharmacological groups most used were: simple analgesic (37.86%), weak opioids (32.98%), AINES (19.85%) and strong opioid (9.31%). It was not found a significant postoperative pain variation related to the sexes, religion and kind of surgery. It was concluded there were a high level in the number of patients with postoperative pain, mainly in a severe scale. Less than half of patients had the pain relief. Then, it was observed there was not coherence between the pain intensity and the analgesic it was used. To solve or relieve this kind of problems is necessary a permanent education to the health professionals who works in this area

Avaliação da dor oncológica: estudo comparativo com pacientes internados em um hospital de referência em Natal/RN

Quasi-experimental study, with prospective data, comparative with quantitative approach, performed in a reference hospital, aiming to identify the effectiveness of the Numerical Rating Scale (NRS) and McGill Pain Questionnaire, used simultaneously, to evaluate a group of patients with oncologic pain (Experimental Group); to identify the effectiveness of the Numerical Rating Scale (NRS) to evaluate a group of patients with oncologic pain (Control Group); to identify the resolution of pain according to prescribed medication, considering the result of the rating scales, and to compare it between the two groups of patients in the study. The population consisted of 100 patients, with both the experimental and control groups being composed of 50 people, with data collected from February to April 2010. The results show that in the experimental group, 32% of the patients were aged 60 to 69, 80% were female; 30% had a primary tumor in the breast, 58% had metastasis, and on 70% the disease was localized. In the first pain evaluation, 26% identified it as light; 46%, moderate; and 28%, severe; with an average of 5.50. In the second pain evaluation, 2% reported no pain; 70%, light; 26%, moderate. and 2%, severe, with an average of 3.30. On those with moderate pain, 60% used non-opioid medicine, 25% under severe pain were medicated with non-opioids and 41.67% with weak opioids. Regarding the Pain Management Index (PMI), 44.0% were rated as "-1". In the control group, 28% were aged 40 to 49, and 54% were male; 20% had primary tumor in the breast and genital-urinary system, consecutively; 56% presented metastasis; on 64% the disease was localized. In the first pain evaluation, 14% considered it light; 42%, moderate; and 44%, severe; with an average of 6.26. In the second pain evaluation, 18% did not signal pain; on 38% pain was light; 40%, moderate; and 4%, severe; with an average of 3.0. Regarding medicine therapy, 71.43% with moderate pain used non-opioids, 22.73% with severe pain used non-opioids and 27.27% weak opioids. Considering PMI, 42% were rated "-1"; and 42%, rated "0". We conclude that, despite the importance of pain as the 5th vital sign, it is still under-identified and under-treated by professionals. Nevertheless, studied oncologic patients had a tendency to report pain more easily when evaluated with the NRS instrument than with the combined use of NRS and MPQ. We believe, however, that the combination of these two instruments represents a more effective evaluation of pain, as it allows comprehension of its quantitative and qualitative aspects. We recommend, however, the replication of this study on a larger population, for a longer span of time, and consequently generating more evaluations, so this can confirm or deny the hypothesis that NRS and MPQ can, together, better evaluate pain on the oncologic patient

As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Carga de trabalho de enfermagem e infecções relacionadas à assistência à saúde na unidade de terapia intensiva

In recent decades, the search for quality care has been widely discussed by the institutions and health professionals. In this context, it is the nurse coordinator of the process of providing nursing staff, reflecting the commitment to quality of care. In this process, it is the appearance of Infections Related to health care and its potential association with the workload in nursing as a valuable indicator of quality of care. Thus, this research contributes to studies to characterize the demand of nursing work to promote a safe healthcare practice. This study aimed to identify the association of nursing workload with the number of cases of Ventilator-Associated Pneumonia, urinary tract infection and central venous catheter infection in the intensive care unit. This is a quantitative research approach, descriptive, cross-sectional and prospective, held at Unimed Hospital in Natal-RN. The study population consisted of all patients treated in the Intensive Care Unit, Hospital for a period of 90 consecutive days in 2011. The convenience sample was compostapelos patients admitted to the ICU during the period of data collection, a total sample of 286 patients. To perform the data analysis software were used: Statistica 6.0, SPPS (Statistical Package for Social Sciences) version 17.0 (2004) and Excel 2007. In the descriptive analysis, we used Measures of Central Tendency and Measures of Dispersion or Variability and the use of nonparametric tests. Of the 286 patients, 88 were from the ICU and 198 ICU II II. Males predominated in the ICU I (51.1%) and female ICU II (57.6%) patients in the ICU I were aged 61-80 years (39.8%) followed by greater than 80 years (39.8%). In the ICU II, most of the patients were aged 61-80 years (38.9%) and then from 41 to 60 years (24.2%). In relation to the class of TISS inlet predominant class II in the two ICUs (59.1%), followed by Class III also in the two units (34.6%). Most patients (70.6%) out of the ICUs belonging to class II TISS. In the ICU I, the average number of forms of the TISS 28 was 6, has in ICU II this value drops to 3.2 forms. The overall mean was 19.9 TISS points in ICU patients I and ICU II.the 17 points in the average hours required to provide adequate nursing care to patients in the ICU I found that is 10 , 7 hours, and the ICU II 9.2 hours. It was found that the time provided by the nursing staff were higher in ICU II, with an average of 19 hours available for nurses in this sector. In the ICU I, which showed higher need of available hours, it was found that the mean value of 12.7 available hours. It was found that only 2.4% of patients had these units Ventilator-Associated Pneumonia, 1.0% were infected central venous catheter and 1.4% of patients had urinary tract infection. Infection associated with health care occurs, on average, on the tenth day of hospitalization. In the ICU II, this average value extends to the twelfth day with an excess of 2.7 hours of nursing care while in ICU I value decays to the ninth day of hospitalization with a deficiency of 12-hour assistance. It is concluded that patients generally showed a need for classification of semi-intensive care and has been assisted in their need to load. As for his association with the Related Infections Health will assist this analysis could not be performed due to the small number of notifications in this period. It is suggested further study how other factors related to infections me a longer period of analysis

Kinetic Analysis of Substrate Utilization by Native and TNAP-, NPP1-, or PHOSPHO1-Deficient Matrix Vesicles

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Caracterização da curva de maturação de pêssegos 'Aurora-1', na região de Jaboticabal-SP

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Performance of supplemented heifers on Marandu grass pastures in the wet-to-dry transition and dry seasons

The objective of the present study was to evaluate the characteristics of the sward canopy of Marandu grass during the rainy season, the wet-to-dry transition and the dry seasons, between March and September 2004, under intermittent grazing, and to correlate those characteristics with the performance of crossbred heifers receiving mineral supplements ad libitum or protein supplements. The experiment consisted of a randomized block design with three blocks (set of 13 paddocks), each containing five crossbred heifers per experimental unit, totaling 15 replicates. The heifers were given protein supplements daily in individual stalls and received an average 4 g/kg/day of the supplement during the rainy season and 5 g/kg/day during the dry season. Their weight gain was assessed monthly. The pasture structure was assessed through destructive sampling, and the bromatological composition of esophageal extrusa samples was also assessed. Analysis of variance was used to assess performance, and regression analysis was used to evaluate the sward canopy characteristics in relation to the months of the year. A cluster procedure was used to determine the similarity between the months of the year under assessment. Two different groups were formed for pasture evaluation: one group including the months of March to July and another group including the months of August and September. The first group exhibited a better canopy structure than the second group. This fact was corroborated by the animal performance, which was lower during the months of the second group. Low-intake protein supplementation was effective in increasing the performance of the grazing heifers. Pasture structure is critical for animal performance in a grazing environment, regardless of the type of supplementation.

Desempenho de bovinos confinados alimentados com dietas à base de farelo de algodão, uréia ou amiréia

O objetivo deste experimento foi avaliar o desempenho de bovinos em confinamento alimentados com rações suplementadas com concentrados protéicos à base de farelo de algodão (AL), uréia (UR) ou amiréia (AM), tendo como volumoso silagem de milho. O confinamento teve duração de 80 dias. As rações foram compostas mantendo a proporção volumoso:concentrado no nível de 63:37, com aproximadamente 13% PB. Não se constataram diferenças quanto ao ganho de peso diário (GDP) durante o período experimental total entre os tratamentos AL, UR ou AM (1,14; 1,17; e 1,23 kg/anim. dia), ou na ingestão de MS em % PV (2,63; 2,60; e 2,60% PV), em g/kg0,75 dia (136,19; 134,74; e 134,81) ou kg/anim. dia (9,42; 9,35; e 9,40), respectivamente. Os valores de ingestão de PB foram de 1,28; 1,24; e 1,34 kg de PB/anim. dia e de 18,54; 17,86; e 19,24 g/kg0,75 dia para os tratamentos AL, UR ou AM, não diferindo entre si. Valores obtidos para conversão alimentar da matéria seca foram de 8,41; 8,01; e 7,67 kg MSI/kg GPD e para conversão protéica, 1,15; 1,06; e 1,09 kg PBI/kg GPD, respectivamente, para os tratamentos AL, UR e AM, que foram semelhantes.

Enzimas exógenas em dietas de frangos de corte: desempenho

O experimento foi conduzido para avaliar a eficiência de enzimas exógenas em dietas sobre o desempenho de frangos de corte. Um total de 1440 pintos de corte machos (Cobb 500®) foram distribuídos em um delineamento inteiramente casualizado em esquema fatorial 2x2 (duas dietas com diferentes densidades nutricionais; com e sem a adição enzimática) com 8 repetições de 45 aves em cada unidade experimental. As dietas com diferentes densidades nutricionais foram: controle positivo (níveis normais) e um controle negativo (com redução de 4,3 e 4,5% de energia metabolizável; 16,7 e 17,7% de cálcio e 35 e 42,7% de fósforo, nas fases inicial e de crescimento, respectivamente). A suplementação enzimática consistiu da combinação das enzimas fitase (100g t-1) e amilase, xilanase e protease (500g t-1). Foi avaliado o desempenho das aves nas fases de 1 a 21 e 1 a 42 dias de idade. Na fase total de criação, as aves alimentadas com a dieta controle negativo com adição enzimática tiveram consumo de ração (5,97%), peso médio (8,47%), ganho de peso (8,64%) e conversão alimentar (2,92%) melhores (P<0,05), comparados às aves alimentadas com dieta controle negativo, sem a suplementação de enzimas. Além disso, as aves alimentadas com a dieta controle negativo com adição enzimática apresentaram consumo de ração, peso vivo médio e ganho de peso similar (P>0,05) ao grupo alimentado com a dieta controle positivo com ou sem enzima. A adição de enzimas exógenas em dieta de frangos de corte com redução de energia metabolizável, cálcio e fósforo, proporciona um consumo de ração, peso vivo médio e ganho de peso similar a uma dieta com níveis nutricionais adequados.

Performance and carcass characteristics of Nellore young bulls fed different sources of oils, protected or not from rumen degradation

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of mannanoligosaccharides and/or enzymes on antibody titers against infectious bursal and Newcastle disease viruses

O efeito da inclusão de mananoligossacarídeo (MOS) e/ou enzimas em dietas de frangos sobre os títulos de anticorpos contra os vírus das doenças de Gumboro (VDG) e de Newcastle (VDN). Setecentos e cinqüenta aves foram distribuídas em um delineamento experimental inteiramente ao acaso, em arranjo fatorial 2 x 2 + 1, com dois níveis de MOS (0 e 0,1% até 21 dias e 0,05% de 22 até 42 dias de idade), dois níveis de enzimas (0 e 0,05%) e uma dieta-controle-positivo contendo antibióticos, totalizando cinco tratamentos com cinco repetições. Para análise dos anticorpos, amostras de sangue foram colhidas semanalmente por punção da veia jugular em duas aves de cada repetição. A primeira e a última colheita foram realizadas aos sete e 42 dias de idade, respectivamente. A inclusão de MOS resultou em aumento dos títulos contra VDG na quarta (P<0,03) e quinta (P<0,02) semanas, e contra VDN na terceira (P<0,01), quarta (P<0,03) e quinta (P<0,03) semanas de idade. O MOS foi efetivo em estimular a resposta imune humoral contra VDG e VDN vacinais.

Consumo de matéria seca e desempenho de novilhas Nelore alimentadas com dietas contendo cana-de-açúcar hidrolisada

Objetivou-se avaliar o consumo de nutrientes e o desempenho de novilhas Nelore alimentadas com dietas contendo cana-de-açúcar in natura (CN) ou hidrolisada (CH) com 0,5% de Ca(OH)2 armazenada por 24, 48 e 72 horas. Foram utilizadas 24 novilhas com nove meses de idade e 119,6±8,1kg de peso corporal inicial. O delineamento experimental utilizado foi o inteiramente casualisado com quatro tratamentos e seis repetições. O consumo de matéria seca foi reduzido em 29% pela adição de Ca(OH)2, não sendo alterado pelo período de armazenamento da CH. O consumo de cálcio foi incrementado (P<0,05) pela utilização de CH nas dietas, mantendo níveis de ingestão aceitáveis. Novilhas alimentadas com CH armazenada por 24, 48 e 72 horas apresentaram, respectivamente, ganhos de peso 41, 30 e 35% inferior (P<0,05) àquelas alimentadas com CN. O tratamento da cana-de-açúcar com Ca(OH)2 não é recomendado para alimentação de novilhas Nelore, em virtude de limitar a ingestão e reduzir o ganho de peso.

Characteristics of forage and feeding behavior of Nellore heifers fed hydrolyzed sugarcane

The objective of this study was to evaluate the chemical characteristics of the forage and ingestive behavior of Nellore heifers fed hydrolyzed sugarcane in different periods of storage. Twenty-four heifers with initial body weight of 119.6±8.1 kg were utilized. The experimental design was completely randomized, in which the treatments were diets with fresh sugarcane and hydrolyzed sugarcane (5 g of lime kg-1 of chopped sugarcane) stored for 24, 48 or 72 hours as the only roughage. The addition of lime to sugarcane associated with its storage up to 72 hours provided an increase of 20% of the potentially degradable cell wall of carbohydrates, from 382.4 to 458.8 g kg-1 of total carbohydrates. The in vitro digestibility of dry matter was altered by the storage of hydrolyzed sugarcane, increasing 7.08% when the storage time was increased from 24 to 72 hours. Heifers fed fresh sugarcane remained more time consuming compared with heifers fed other diets. The time used for water intake was not influenced by the diet. The rumination time presented a quadratic variation in relation to storage time of the hydrolyzed sugarcane, with higher values for the of hydrolyzed sugarcane diets stored for 48 hours. Heifers fed hydrolyzed sugarcane spent more time on other activities than those fed fresh sugarcane. The supply of hydrolyzed sugarcane stored up to 72 hours in the proportion of 600 g kg-1 of dry matter in the diet, alters the intake patterns, reducing the feed intake in Nellore heifers.

Diagnóstico para implantação do sistema de gestão ambiental em postos revendedores de combustíveis no município de Paranamirim RN: um estudo de caso

natural resources that still enjoy, in the certainty that if we do not, could culminate at the end of that remains. The environmental contamination by fuels in the retail service of oil and biofuels, has been a subject of growing research in Brazil, due to the large pollution potential of this activity. The aim of this study was to evaluate the importance of implementing the Environmental Management System (EMS) in fuel retail service stations in the city of Parnamirim-RN, but also describe the current situation the same as licensing and environmental characterization; identify existing barriers to implementation of EMS on the costs, technologies, knowledge, vision, present the potential benefits for the implementation of the EMS (social, economic and environmental), to identify the existence of plans for future action to implement the EMS , as a subsidy to promote the implementation of it. The methodology was developed through analysis of documents provided by the environmental agency responsible for licensing of retail service stations and fuel pala ANP. For data collection, we used the questionnaire was applied directly to managers or managers of sub-stations. Data were collected in 12 of 30 posts in the municipality. For purposes of data treatment was performed a descriptive analysis with respect to the opinion of twelve managers (respondents). The data acquired, according to the Likert scale were tabulated and analyzed using software SPSS 17.0 and Excel 2003, it was generated tables and graphs to observe the behavior of the data. The results showed that most respondents have a schooling level higher (58.3%) of the jobs surveyed 50% work on average 6 to 10 years and 41.6% are in operation for over 11 years , 75.0% do not have a license to operate and 12 stations, 58.3% were sued for not having a license to operate and are therefore in full commercial activity, 83% of jobs have some practice environmentally responsible, 75% agree in making planning future action to implement 8 the EMS in their ventures, 70% in full agreement that the high cost is a form of impediment to implementation of EMS; 66.67% agreed that resistance to change is an impediment to implementation of EMS; 90.91% agreed that the implementation of EMS is very complex, 80% of respondents agreed in a very significant environmental legislation is also a key factor preventing the implementation of EMS is noteworthy that 100% of respondents agreed that the knowledge about the use of the EMS will help to solve environmental problems in the fuel retail service stations, the implementation of the EMS will benefit with increased efficiency of resources applied to the findings by the agreement of 91.66% of respondents, where only 8, 33% disagreed, there was also a percentage of 100%, agreed that the company's image will be a great benefit, but also a contribution to solving environmental problems in the fuel retail service stations. Thus, the importance of the implementation of EMS in the fuel retail service stations in the city of Parnamirim-RN, with an urgent need to be deployed. And the bodies responsible for policy on state-run and supervise more tightly and action, this type of activity, in order to regulate the sustainable functioning of retail service stations of fuel, thus promoting a better quality of life for the population of the municipality of natal-RN

Desempenho de novilhos Nelore alimentados com casca de soja ou farelo de gérmen de milho em substituição parcial ao milho moído

Objetivou-se neste trabalho estudar a substituição parcial (70%) do milho moído pela casca de soja ou pelo farelo de gérmen de milho em dietas contendo farelo de girassol e uréia (fontes nitrogenadas) e silagem de milho (volumoso) para novilhos Nelore em confinamento. Avaliaram-se o consumo, o ganho de peso, a conversão alimentar e o rendimento de carcaça de 21 animais (25 meses de idade e peso inicial de 343 kg) alimentados com as dietas-teste, fornecidas na proporção 60:40 volumoso:concentrado. O período de avaliação do consumo e do ganho de peso foi de 97 dias. Os consumos de MS (10,78; 9,73 e 10,62 kg/dia), PB (1,40; 1,22 e 1,41 kg/dia) e FDN (3,41; 3,89 e 3,60 kg/dia) não foram influenciados pelas dietas com milho moído, casca de soja e farelo de gérmen de milho, respectivamente. O consumo de FDA (0,56; 0,71 e 0,55% PV) apresentou efeito significativo, observando-se maior valor quando a casca de soja substituiu 70% do milho moído. O ganho de peso não foi influenciado pelas dietas, registrando-se valores de 1,35; 1,29 e 1,32 kg/dia para as dietas contendo milho moído, casca de soja e farelo de gérmen de milho, respectivamente. Não houve efeito, também, sobre a conversão alimentar (7,88 kg de MS ingerida/kg ganho), a eficiência alimentar (0,12 kg ganho/kg MS ingerida) e o rendimento de carcaça (54,52%). A substituição parcial do milho moído pela casca de soja e pelo farelo de gérmen de milho em dietas para novilhos em confinamento não afeta o desempenho e o rendimento de carcaça.