CPR training in households of patients with chest pain

The objectives of this study are to (1) quantify prior cardiopulmonary resuscitation (CPR) training in households of patients presenting to the Emergency Department (ED) with or without chest pain or ischaemic heart disease (IHD); (2) evaluate the willingness of household members to undertake CPR training; and (3) identify potential barriers to the learning and provision of bystander CPR. A cross-sectional study was conducted by surveying patients presenting to the ED of a metropolitan teaching hospital over a 6-month period. Two in five households of patients presenting with chest pain or IHD had prior training in CPR. This was no higher than for households of patients presenting without chest pain or IHD. Just under two in three households of patients presenting with chest pain or IHD were willing to participate in future CPR classes. Potential barriers to learning CPR included lack of information on CPR classes, perceived lack of intellectual and/or physical capability to learn CPR and concern about causing anxiety in the person at risk of cardiac arrest. Potential barriers to CPR provision included an unknown cardiac arrest victim and fear of infection. The ED provides an opportunity for increasing family and community capacity for bystander intervention through referral to appropriate training. (C) 2003 Published by Elsevier Science Ireland Ltd.

Impaired postural compensation for respiration in people with recurrent low back pain

This study evaluated the degree to which the disturbance to posture from respiration is compensated for in healthy normals and whether this is different in people with recurrent low back pain (LBP), and to compare the changes when respiratory demand is increased. Angular displacement of the lumbar spine and hips, and motion of the centre of pressure (COP), were recorded with high resolution and respiratory phase was recorded from ribcage motion. With subjects standing in a relaxed posture, recordings were made during quiet breathing, while breathing with increased dead-space to induce hypercapnoea, and while subjects voluntarily increased their respiration to match ribcage expansion that was induced in the hypercapnoea condition. The relationship between respiration and the movement parameters was measured from the coherence between breathing and COP and angular motion at the frequency of respiration, and from averages triggered from the respiratory data. Small angular changes in the lumbopelvic and hip angles were evident at the frequency of respiration in both groups. However, in quiet standing, the LBP subjects had a greater displacement of their COP that was associated with respiration than the control subjects. The LBP group had a trend for less hip motion. There were no changes in the movement parameters when respiratory demand increased involuntarily via hypercapnoea, but when respiration increased voluntarily, the amplitude of motion and the displacement of the COP increased in both groups. The present data suggest that the postural compensation to respiration counteracts at least part of the disturbance to posture caused by respiration and that this compensation may be less effective in people with LBP.

The effects of peripheral and central warming on body temperature during canine laparotomy

Actively warming patients during surgery is considered the best method of preventing inadvertent hypothermia due to multiple causes: anaesthetic depression of the hypothalamic thermoregulatory centre, cutaneous vasodilatation, reduction of heat production by skeletal muscles, cold intravenous fluid administration and heat loss from opened body cavities. To compare the effects of active peripheral skin warming and trunk warming on body temperature during surgery, 15 dogs undergoing ovariohysterectomy were studied using a prospective randomised trial design. Dogs were randomised into two groups: one group was warmed by compress leg pads (n=7) on limbs and the other group by a circulating warm water mattress (n=8), applied to the trunk. The rectal, oesophageal and room temperatures and relative humidity were measured. The results showed that the compress leg pads (active peripheral warming) were significantly (P

Does participation in a pain course based on the international association for the study of pain's curricula guidelines change student knowledge about pain?

The People in Pain course was set up as a joint initiative of the Departments of Occupational Therapy and Physiotherapy within the School of Health and Rehabilitation Sciences at The University of Queensland. It was instigated in response to the publication of Pain Curricula for Occupational Therapy and Physiotherapy by the International Association for the Study of Pain (IASP) in 1994 (1). The first year it was offered, the "People in Pain" course comprised 14 h of lecture content. It was then expanded to encompass 28 h of lectures and seminar involvement. OBJECTIVES: To evaluate the impact of participation in a university pain course that meets the IASP pain curricula guidelines to increase health professional students' knowledge about pain. METHODS: Students who participated in the People in Pain course over the first three years were invited to complete the Revised Pain Knowledge and Attitudes Questionnaire (R-PKAQ) pre- and postcourse. Data obtained from 22 students in the short course formed a pilot project, and data from 22 students in the longer version of the course were used in the present study. RESULTS: Examination of the correlation matrix indicated substantial correlations between all R-PKAQ subscales except physiological basis of pain and pharmacological management of pain. In both the pilot project during the first year of the course and the expanded course in the following two years, significant improvement was found in the students' knowledge on five of the six subscales of the R-PKAQ: physiological basis of pain, psychological factors of pain perception, assessment and measurement of pain, cognitive-behavioural methods of pain relief, and pharmacological management of pain. Improvements in the developmental aspects of pain perception subscale failed to reach significance. CONCLUSIONS: An integrated pain course developed according to the pain curriculum guidelines developed by the IASP resulted in increased student knowledge regardless of the length of the program attended.

Effect of central venous catheter type on infections: a prospective clinical trial

This study reports on a block clinical trial of two types of central venous catheters (CVCs): antiseptic-impregnated catheters (AIC) and non-impregnated catheters (non-AIC), on catheter tip colonization and bacteraemia. In total, 500 catheters were inserted in 390 patients over the 18 month study period, 260 (52.0%) AIC and 240 (48.0%) non-AIC. Of these, 460 (92.0%) tips (237 AIC and 223 non-AIC) were collected. While significantly fewer AIC, 14 (5.9%), than non-AIC, 30 (13.5%), catheters were colonized (P < 0.01), there was no difference in the rates of bacteraemias in the two groups (0.8% vs. 2.7%, respectively, P = 0.16). There were 6.87 (95% CI 3.38-14.26) and 16.92 (95% CI 10.61-27.12) colonized AIC and non-AIC catheters, respectively, per 1000 catheter days, a difference that was significant (P < 0.01). However, no difference emerged between bacteraemias in AIC and non-AIC catheters per 1000 catheter days measured at 0.98 (95% CI 0.24-5.54) and 3.38 (95% CI 1.29-9.34), respectively (P = 0.10). Of the 444 CVCs that were sited in the subclavian or jugular veins and had tips collected, significantly more catheters were colonized in the jugular group, 19 (20%), compared with the subclavian group, 24 (6.9%; P less than or equal to 0.01). Overall, the low rates of colonization and bacteraemia may be explained by the population studied, the policies used and the employment of a clinical nurse dedicated to CVC management. (C) 2003 The Hospital Infection Society. Published by Elsevier Science Ltd. All rights reserved.

Unraveling the barriers to reconceptualization of the problem in chronic pain: The actual and perceived ability of patients and health professionals to understand the neurophysiology

To identify why reconceptualization of the problem is difficult in chronic pain, this study aimed to evaluate whether (1) health professionals and patients can understand currently accurate information about the neurophysiology of pain and (2) health professionals accurately estimate the ability of patients to understand the neurophysiology of pain. Knowledge tests were completed by 276 patients with chronic pain and 288 professionals either before (untrained) or after (trained) education about the neurophysiology of pain. Professionals estimated typical patient performance on the test. Untrained participants performed poorly (mean +/- standard deviation, 55% +/- 19% and 29% +/- 12% for professionals and patients, respectively), compared to their trained counterparts (78% +/- 21% and 61% +/- 19%, respectively). The estimated patient score (46% +/- 18%) was less than the actual patient score (P < .005). The results suggest that professionals and patients can understand the neurophysiology of pain but professionals underestimate patients' ability to understand. The implications are that (1) a poor knowledge of currently accurate information about pain and (2) the underestimation of patients' ability to understand currently accurate information about pain represent barriers to reconceptualization of the problem in chronic pain within the clinical and lay arenas. (C) 2003 by the American Pain Society.

Sistema de custos e informa????es gerenciais do Banco Central do Brasil

O Banco Central do Brasil desenvolveu e implantou, no per??odo de abril de 2002 a mar??o de 2003, Sistema de Custos e Informa????es Gerenciais, utilizando o m??todo de custeio baseado em atividades - Activity Based Costing (ABC), destinado a apurar os custos das atividades, dos projetos, dos processos e dos produtos e servi??os ofertados pela Institui????o, distribu??dos pela sua estrutura organizacional. O sistema, mais do que um enfoque voltado para o simples controle e redu????o de custos, constitui-se em significativo instrumento de apoio gerencial, ao propiciar a utiliza????o mais racional de todos os recursos consumidos. Ademais, apresenta-se como iniciativa pioneira vez que, pelo que se tem not??cia, inexistem experi??ncias semelhantes em organiza????es com este porte e com a amplitude adotada neste caso, tanto no ??mbito governamental brasileiro, quanto no que se refere aos demais bancos centrais espalhados pelo mundo

Laborat??rio Central da Eletronorte : Lacen

O Laborat??rio Central, tamb??m denominado Lacen ?? uma superintend??ncia da Diretoria de Produ????o e Comercializa????o ??? DC da Eletronorte, respons??vel pelo estudo e desenvolvimento de novas metodologias de ensaios, calibra????es e t??cnicas de manuten????o. Observou-se que o sistema de trabalho da unidade carecia de integra????o. Evidenciou-se a melhoria no ambiente de trabalho a partir do momento em que os colaboradores passaram a se concentrar em suas atividades-fim, deixando de realizar tarefas manuais e repetitivas (anota????es e c??lculos manuais que ap??s iriam alimentar relat??rios e planilhas nos meios informatizados) que puderam ser automatizadas, e tarefas antes redundantes que passaram a ser realizadas somente pelos processos administrativos competentes. A utiliza????o racional de meios informatizados fez com que a disponibiliza????o sistem??tica da informa????o aos colaboradores em tempo h??bil, de acordo com suas compet??ncias e necessidades, n??o s?? contribu??sse para melhorar as condi????es de trabalho dos mesmos quanto para reduzir o tempo de realiza????o destas tarefas, aumentando a qualidade dos servi??os prestados e, conseq??entemente, o ??ndice de satisfa????o dos clientes do Lacen

Gest??o do conhecimento e aloca????o de recursos humanos no setor p??blico: a experi??ncia do Banco Central do Brasil

Procedimentos adotados - com a finalidade de colocar a pessoa certa no lugar certo - na localiza????o de 249 servidores que ingressaram do Banco Central do Brasil - BC, por meio do Concurso Analista/2000. O BC decidiu investir nos conceitos e pr??ticas presentes na gest??o do conhecimento. Foram utilizados m??todos e programas de computador j?? testados no mercado, buscando adequar o perfil comportamental e de conhecimentos do futuro servidor ao dos postos de trabalho do BC. Sua valida????o ocorreu por meio de pesquisa de satisfa????o com os servidores e respectivas chefias

Programa de cr??dito produtivo popular Crediamigo: central de microcr??dito do Nordeste

As pol??ticas de desenvolvimento consideram que um dos principais obst??culos para o crescimento dos microeempreendimentos ?? a falta de acesso ??s fontes de financiamento, principalmente ??queles emergidos como formas alternativas de ocupa????o e renda. Esses pequenos neg??cios, em sua maioria informais, vem apresentando n??veis de alto crescimento em todo o Pa??s, em especial na regi??o Nordeste, principalmente nos grandes centros urbanos, comprovada por pesquisas cient??ficas realizadas. Considerando que o acesso dessa camada da popula????o ao sistema banc??rio ?? dif??cil, devido ao baixo n??vel operacional, ao tamanho dos neg??cios e ?? qualidade ou inexist??ncia de garantias, o Banco do Nordeste lan??a o Programa CrediAmigo com o objetivo de contribuir para o crescimento de microempresas, mediante a oferta de cr??dito para atividades produtivas e servi??os de capacita????o, de forma a garantir ao agente produtivo condi????es para ele gerir bem seus neg??cios, atrav??s da melhoria da competitividade e integra????o ao mercado globalizado. Dessa forma, o CrediAmigo permite f??cil acesso a esse segmento da popula????o marginalizada do sistema financeiro formal e que recorrem e dependem de agiotas e fornecedores que lhes cobram taxas de juros bem acima do mercado. Para atender esses agentes produtivos o CrediAmigo utiliza uma metodologia inovadora de concess??o de cr??dito que permite a libera????o dos recursos de forma ??gil, desburocratizada e sem as garantias tradicionais exigidas, funcionando com grupos solid??rios, proporcionando uma maior democratiza????o do cr??dito. At?? jul/99 o CrediAmigo j?? atendeu a 121.444 cidad??os com financiamento na ordem de R$ 74,2 milh??es

Central de atendimento al?? trabalho

O projeto refere-se ?? cria????o da Central de Atendimento "Al?? Trabalho" com o objetivo de apoiar, melhorar, agilizar e ampliar a capacidade de atendimento aos trabalhadores, empregadores, entidades de representa????o, ??rg??os de classe e entidades p??blicas, em ??mbito nacional, atrav??s de linha telef??nica com liga????o gratuita, de forma a facilitar e simplificar o acesso ??s informa????es e servi??os prestados pelo Minist??rio do Trabalho e suas unidades descentralizadas. Atuando de forma interativa e eficaz, agregando servi??os, informa????es institucionais e bases de dados, oferecendo instrumentos e recursos que proporcionem a cria????o de condi????es ideais de atendimento e descongestionando o fluxo de pessoas nos locais de atendimento ao p??blico