Eventos vitais estressores e lesão renal aguda em centros de terapia semi-intensiva e intensiva

INTRODUÇÃO: Diversos estudos evidenciam que as alterações fisiopatológicas, quando associadas ao estresse, podem influenciar a fisiologia renal e estão associadas ao aparecimento de doenças. Entretanto, não foi encontrado nenhum estudo que tivesse realizado investigação associando estresse e lesão renal aguda. OBJETIVO: Avaliar a associação entre os eventos vitais estressores e o diagnóstico de lesão renal aguda, especificando as classes de eventos mais estressores para esses pacientes, nos últimos 12 meses. MÉTODOS: Estudo caso-controle. Foi realizado no Hospital São Paulo da Universidade Federal de São Paulo e no Hospital dos Servidores do Estado de São Paulo. Foram incluídos pacientes com lesão renal aguda, sem doenças crônicas, assistidos em Centros de Terapia Intensiva ou semi-intensivas. Os Controles incluíram pacientes assistidos nos mesmos Centros de Terapia Intensiva, com outras doenças agudas, exceto lesão renal aguda e, também, sem doenças crônicas. Dos 579 pacientes inicialmente identificados, 475 responderam ao instrumento Social Readjustment Rating Scale (SRRS) e 398 pacientes foram pareados por idade e sexo (199 casos/199 controles). RESULTADOS: Constatou-se que a frequência dos eventos vitais estressores nos casos apresentava equivalência estatística aos controles. A regressão logística para examinar os efeitos combinados das variáveis independentes associados aos eventos estressantes evidenciou que: o aumento da idade e as classes econômicas AB intensificam a chance da presença do evento estressante em cerca de duas vezes; as classes socioeconômicas AB do Hospital São Paulo elevam a chance de evento estressante. CONCLUSÕES: O presente estudo não evidenciou que o grupo com lesão renal aguda estivesse associado à maior frequência de eventos estressores, mas idade e renda elevadas e, ainda, o tipo de centro clínico estão associados.

Fatores de risco para lesão renal aguda em pacientes com trauma grave e seus efeitos na mortalidade

Os estudos que relacionaram lesão renal aguda (LRA) e trauma surgiram durante a Segunda Guerra Mundial e, desde então, tem havido progressiva evolução dos cuidados para a prevenção da LRA. Entretanto, a determinação dos fatores de risco para o desenvolvimento de LRA pós-trauma permanece crucial e pode ajudar a reduzir esta complicação. OBJETIVO: Este estudo tem como objetivo identificar os fatores de risco para o desenvolvimento de LRA em pacientes com trauma grave e sua influência na mortalidade. Trata-se de um estudo retrospectivo com 75 pacientes incluídos por apresentarem trauma grave; seis foram excluídos por terem chegado ao hospital sem condições de ressuscitação. MÉTODO: As variáveis estudadas foram: idade, sexo, gravidade do trauma de acordo com Injury Severity Score (ISS) e Escala de Coma de Glasgow (ECG), mecanismo de trauma, pressão arterial média na admissão, reposição volêmica nas primeiras 24h, níveis séricos de creatinina, uso de antibióticos nefrotóxicos, tempo de internação, necessidade de internação em UTI e mortalidade. RESULTADOS: A prevalência de LRA em traumatizados graves foi de 17,3%, sendo que os fatores associados à IRA nessa amostra foram TCE, ECG < 10. A mortalidade, o tempo de internação e a necessidade de UTI foram significativamente maiores nos pacientes que desenvolveram LRA. CONCLUSÕES: A identificação desses fatores de risco é de suma importância para a formulação de estratégias de atendimento aos pacientes vítimas de trauma grave, visando à prevenção da lesão renal aguda e da elevada mortalidade.

Hemodiálise estendida em lesão renal aguda

Cerca de 10% dos pacientes em unidade de terapia intensiva que desenvolvem injúria renal aguda irão depender de terapia renal substitutiva. Embora não existam dados que comprovem redução da mortalidade, quando comparadas às terapias intermitentes, as terapias contínuas fornecem maiores doses de diálise cumulativa e maior estabilidade hemodinâmica. Contudo, apresentam custos elevados e não estão disponíveis em vários centros. Nesse contexto, a Hemodiálise Estendida ganha espaço na prática clínica, pois combina a tolerabilidade hemodinâmica, o controle de soluto lento e sustentado e as doses efetivas de diálise das terapias contínuas associadas aos custos reduzidos e facilidades logísticas das terapias intermitentes.

Carambola como causa de lesão renal aguda

A carambola pertence à família das Oxalidáceas, espécie Averrhoa carambola. É rica em sais minerais, vitaminas A, C, complexo B e ácido oxálico. Estudos recentes demonstram que a toxicidade da fruta difere entre os indivíduos e pode ser explicada pelas respostas biológicas individuais como idade, quantidade da ingestão, neurotoxinas em cada tipo de fruta. Adicionalmente, a nefrotoxicidade causada pela fruta é dose dependente, podendo levar ao desenvolvimento de lesão renal aguda pela deposição de cristais de oxalato de cálcio intratubular, assim como por lesão direta das células epiteliais tubulares, levando à apoptose das mesmas. Relatamos o caso de uma paciente que, após a ingestão do suco da fruta e fruta in natura, desenvolveu lesão renal aguda, necessitando de terapia dialítica, evoluindo com desfecho favorável e recuperação da função renal.

Fatores de risco associados à lesão renal aguda em pacientes tratados com polimixina B em um hospital terciário

Resumo Introdução: O uso de polimixinas foi praticamente abandonado nos anos 1970 devido as altas taxas de nefropatia. Entretanto, foram reintroduzidas na prática médica devido a sua ação contra bactérias gram negativas resistentes a carbapenemicos. A literatura recente sugere uma taxa de nefropatia mais baixa do que a historicamente reportada. Objetivo: Determinar a incidência de nefropatia associada ao uso de polimixina utilizando os critérios de RIFLE. Métodos: Foi realizada coorte retrospectiva de todos pacientes adultos que receberam polimixina B no Hospital Nossa Senhora da Conceição de dezembro de 2010 até março de 2011. Resultados: 61 pacientes (43%) preencheram os critérios de rifle para injúria renal e 28 (13,7%) necessitaram de diálise. Preditores independentes para nefrotoxicidade foram hipotensão (OR, 2.79; CI 1.14-5.8; p = 0.006) e uso concomitante de vancomicina (OR, 2.86; CI, 1.27-6.4; p = 0.011). Conclusão: Nessa coorte retrospectiva, nefrotoxicidade (definida pelos criterios de RIFLE) ocorreu em 43% dos pacientes tratados com polimixina B. O uso concomitante de vancomicina e hipotensão foram fatores de risco independentes para desenvolvimento de nefropatia. Mais estudos são necessarios, particularmente com polimixina B, para esclarecer se as caracteristicas dessa droga e da colistina são sobreponíveis.

Challenges for virtual teams in voluntary organizations

This research concerns virtual teams in the field of volunteer work. The developments in the area of information and communication technology have decreased their costs and made them easily accessible. As a result, it seems natural that also the voluntary organizations have adopted online tools and virtual teams as a part of their work modes. However, virtual teams have not received much research in this context, and one of the goals of this study was to begin closing that gap. The research had two main focus areas: the challenges that the volunteers face in the teams, and the leadership that the teams have. The study used a qualitative approach and semi-structured interviews. The interviews were conducted over Skype and email and included members from six different teams. The case organization was a European-wide student organization that widely utilized virtual teams in its work. The study identified three critical issues for managing the virtual teams. The first challenge was creating common ground for teamwork through electronic communication. Secondly, volunteering created challenges for the teams through variations in the level of commitment of the members, as some left the organization during the term of the team. Lastly, knowledge transfer was a challenge that came from changing the team members regularly each year. As for the second key topic, leadership in the teams was spread among the team members unevenly. The teams had a formal leader, but they exhibited signs of shared leadership, and the team members were able to influence the team through their own level of involvement. Especially the experience that a member had contributed the amount of influence she held. All in all, the challenges that the volunteers faced were similar to those of normal virtual teams. Volunteering brought additional challenges through the varying levels of commitment and the changing of the team members. Additionally, the role of the team leader was not as firm. The results of the study can be applied to other volunteer organizations that utilize virtual teams.

Challenges for virtual teams in voluntary organizations

This research concerns virtual teams in the field of volunteer work. The developments in the area of information and communication technology have decreased their costs and made them easily accessible. As a result, it seems natural that also the voluntary organizations have adopted online tools and virtual teams as a part of their work modes. However, virtual teams have not received much research in this context, and one of the goals of this study was to begin closing that gap. The research had two main focus areas: the challenges that the volunteers face in the teams, and the leadership that the teams have. The study used a qualitative approach and semi-structured interviews. The interviews were conducted over Skype and email and included members from six different teams. The case organization was a European-wide student organization that widely utilized virtual teams in its work. The study identified three critical issues for managing the virtual teams. The first challenge was creating common ground for teamwork through electronic communication. Secondly, volunteering created challenges for the teams through variations in the level of commitment of the members, as some left the organization during the term of the team. Lastly, knowledge transfer was a challenge that came from changing the team members regularly each year. As for the second key topic, leadership in the teams was spread among the team members unevenly. The teams had a formal leader, but they exhibited signs of shared leadership, and the team members were able to influence the team through their own level of involvement. Especially the experience that a member had contributed the amount of influence she held. All in all, the challenges that the volunteers faced were similar to those of normal virtual teams. Volunteering brought additional challenges through the varying levels of commitment and the changing of the team members. Additionally, the role of the team leader was not as firm. The results of the study can be applied to other volunteer organizations that utilize virtual teams.

Computational Market Dynamics of Virtual Economies

The last two decades have provided a vast opportunity to live and explore the compulsive imaginary world or virtual world through massively multiplayer online role-playing games (MMORPGs). MMORPG gives a wide range of opportunities to its users to participate with multi-players on the same platform, to communicate and to do real time actions. There is a virtual economy in these games which is largely player-driven. In-game currency provides its users to build up their Avatars, to buy or sell the necessary goods to play, survive in the games and so on. As a part of virtual economies generated through EVE Online, this thesis mainly focuses on how the prices of the minerals in EVE Online behave by applying the Jabłonska- Capasso-Morale (JCM) mathematical simulation model. It is to verify up to what degree the model can reproduce the virtual economy behavior. The model is applied to buy and sell prices of two minerals namely, isogen and morphite. The simulation results demonstrate that JCM model ts reasonably well to the mineral prices, which lets us conclude that virtual economies behave similarly to the real ones.

Exploring knowledge worker motivation in autonomous and interdependent problem solving tasks on virtual platforms

The objective of this study is to understand why virtual knowledge workers conduct autonomous tasks and interdependent problem solving tasks on virtual platforms. The study is qualitative case study including three case organizations that tap the knowledge of expert networks, and utilize virtual platforms in the work processes. Research data includes 15 interviews, that is, five experts from each case company. According to the findings there are some specific characteristics in motivation to work on tasks on online platforms. Autonomy, self-improvement, meaningful tasks, knowledge sharing, time management, variety of contacts, and variety of tasks, and projects motivate virtual knowledge workers. Factors that may enhance individuals’ engagement to work on tasks are trust, security of continuous task flow and income, feedback, meaningful tasks and tasks that contribute to self-improvement, flexibility and effectiveness in time management, and virtual tools that support social interaction. The results also indicate that there are some differences in individuals’ motivation based on the tasks’ nature. That is, knowledge sharing and variety of contacts motivated experts who worked on interdependent problem solving tasks. Then again, autonomy and variety of tasks motivated experts who worked on autonomous tasks.

Co-creating Value For Smart Phone Operating Systems Via Virtual Discussion Forums

In the traditional way, value is created by manufacturer or producer of a product without engaging the customers. So, traditionally value creation is a monopoly in the part of a manufacturer. After gathering all the raw materials the manufacturers are inserting value to a product. And the inserted value is recognized in the time of consuming the product. In the modern time though there is traditional way of value creation but with the increase of more educated, smart, and technically sound customers the idea of value creation has changed. Now, customers are also contributing in value creation as value co-creator even before the product is consumed. This scenario has been encountered in the thesis with the main purpose of how value is cocreated in smart phone operating systems. The purpose is further divided into the following supobjectives: o What is value co-creation in smart phone operating systems? o Who participates in value co-creation in smart phone operating systems? o What are the procedures that are involved in value co-creation in smart phone operating systems? The research was conducted as a qualitative desk study by observing two of the leading smart phone operating system providers. Data has been collected from the official discussion forum of both the operating system providers. Other general concepts relating to the purpose of the study has been encountered through literature review. The research findings reveal that customers and companies both together co-create value of anticipated level when they communicate and interact with each other. However, most of the time customer to customer interactions, dialogues and discussions that come out in the core conversation help the value co-creation. The value co-creation framework sets up the customer at the main focus of value creation theory. By nullifying the inherited notion that companies only create value within its boundary and provide it to their customers in exchange of currencies. Rationally, it has been commenced that the firms are merely compromising value propositions to its customers. But the value has been co-created in a point where offerings are combined and interacted with customers’ capabilities, knowledge, resources and perceptions. This new perspective has radically altered the prospect of firms towards its customers. Typically customers are now taking part in value cocreation as a crucial member.

Informe de satisfacción renovaciones 2013: Renovación Virtual

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