Pulsioximetría de pacientes en hemodiálisis, de la unidad de terapia renal – fundación cardioinfantil, análisis para establecer recomendaciones

Introducción. En Colombia, el 80% de los pacientes con enfermedad renal crónica en hemodiálisis tienen fístula arteriovenosa periférica (FAV) que asegura el flujo de sangre durante la hemodiálisis (1), la variabilidad en el flujo de sangre en el brazo de la FAV hacia la parte distal, puede afectar la lectura de la oximetría de pulso (SpO2) (2), llevando a la toma de decisiones equivocadas por el personal de salud. El objetivo de este estudio es aclarar si existe diferencia entre la SpO2 del brazo de la FAV y el brazo contralateral. Materiales y métodos. Se realizó un estudio de correlación entre los valores de SpO2 del brazo con FAV contra el brazo sin FAV, de 40 pacientes que asistieron a hemodiálisis. La recolección de los datos se llevó a cabo, con un formato que incluyó el resultado de la pulsioximetria y variables asociadas, antes, durante y después de la hemodiálisis. Se comparó la mediana de los deltas de las diferencias con pruebas estadísticas T Student – Mann Whitney, aceptando un valor significativo de p < 0,05. Resultados. No se encontraron diferencias estadísticamente significativas de la SpO2 entre el brazo con FAV y el brazo sin FAV, antes, durante y después de la diálisis, sin embargo si se apreció una correlación positiva estadísticamente significativa. Conclusiones. Se encontró correlación positiva estadísticamente significativa, donde no hubo diferencias en el resultado la pulsioximetría entre el brazo con FAV y brazo sin FAV, por lo tanto es válido tomar la pulsioximetría en cualquiera de los brazos.

När hjärtat sviktar : Information och undervisning med hjälp av sjuksköterskan

Syftet med denna litteraturstudie var att ta reda på hur information och undervisning kan utformas och vara ett bra sätt att förbättra den hälsorelaterade livskvaliteten hos patienter med hjärtsvikt. Femton vetenskapliga artiklar valdes ut genom fulltextdatabasen United States National Library of Medicine (MEDLINE) och Högskolan Dalarnas sökmotor Electronic Library Information Navigator (ELIN). Sökorden som användes var heart failure, quality of life, information/education och nursing i olika kombinationer. Artiklarna som valdes ut granskades med hjälp av modifierade granskningsmallar för att säkerställa att dom var av så hög kvalite som möjligt. Fysisk funktionell förmåga och kunskap om sjukdomen har betydelse för patientens upplevelse av sin hälsorelaterade livskvalitet. Flera av artiklarna i litteraturstudien visar att sjuksköterskeinriktad patientutbildning är effektivt för att förbättra livskvaliteten och den hjälper patienterna att se sina symtom och främjar egenvård. Utbildningen innefattar ofta information om att förändra sin livsstil, fysisk aktivitet, daglig vägning, diet och läkemedelsdosering samt information och undervisning till både patienter och anhöriga om hjärtsvikt och dess symtom. Familj och vänner är ofta ett stort stöd för patienter med hjärtsvikt. Studier visar dock att de ofta har de begränsade kunskaper om vad hjärtsvikt är och hur behandlingen ser ut. De övergripande resultaten av litteraturstudien visar på att databaserad utbildning ger ökad kunskap om hjärtsvikt i jämförelse med sedvanlig utbildning.

Omvårdnadsbehov hospatienter med diabetesmellitus typ 2 : En systematisk litteraturstudie

Föreliggande systematiska litteraturstudie syftade till att klarlägga vilka omvårdnadsbehov som föreligger hos patienter med typ 2-diabetes. Sammanlagt 15 vetenskapliga artiklar valdes ut via sökmotorn Electronic Library Information Navigator (ELIN), databasen Cumulative Index of Nursing and Allied Health (CINAHL) samt sökmotorn och databasen för medicinska artiklar som drivs av United States National Library of Medicine (MEDLINE), för vidare granskning. Sökorden type 2 diabetes AND quality of life AND nurs* användes. Alla titlar lästes, om titeln verkade relevant för forskningsområdet lästes även abstraktet. Kvalitetsgranskning av artiklarna genomfördes efter granskningsmallar med 28 bedömningskriterier. Omvårdnadsbehoven hos patienter med typ 2-diabetes som framkom vid artikel granskningen evidensgraderades på basen av kvalitetsgranskningen med hjälp av graderingsskala. Resultatet visade att hjälp till förbättrad egenvård, önskan om utökad utbildning, information och kunskap, socialt stöd och kontinuerlig vårdkontakt var de omvårdnadsbehov som studien fann evidens för. Omvårdnadsbehov hos patienter med typ 2-diabetes som framkom var kända sedan tidigare men föreliggande studie säkrade evidensen för dessa. Resultatet diskuterades utifrån Virginia Hendersons omvårdnadsteori där omvårdnaden måste ha en utgångspunkt i individens egna upplevelser av sina behov och hur dessa behov på bästa sätt kan tillfredsställas. Med hjälp av studiens resultat sammanlänkat med Virginia Hendersons teori om individens omvårdnadsbehov kan sjuksköterskan få en bättre bild av vilka behov som föreligger hos patienter med typ 2-diabetes för att bevara deras livskvalité.

Multiple particle and cluster emissions from Zr following intermediate energies photo absorption

A new approach based on a N-a cluster photoabsorption model is proposed for the understanding of the puzzling steady increase behavior of the 90Zr (e, α) yield measured at the National Bureau of Standards (NBS) within the Giant Dipole Resonance and quasideuteron energy range. The calculation takes into account the pre-equilibrium emissions of protons, neutrons and alpha particles in the framework of an extended version of the multicollisional intranuclear cascade model (MCMC). Another Monte Carlo based algorithm describes the statistical decay of the compound nucleus in terms of the competition between particle evaporation (p, n, d, α, 3He and t) and nuclear fission. The results reproduce quite successfully the 90Zr (e,α) yield, suggesting that emissions of a particles are essential for the interpretation of the exotic increase of the cross sections.

Avaliação clínica do efeito de dois métodos de desinfecção sobre a rugosidade, estabilidade de cor e formação de biofilme de próteses reembasadas

Pós-graduação em Reabilitação Oral - FOAR

Toll-like receptors 2, 3 and 4 and thymic stromal lymphopoietin expression in fatal asthma

Background Airway inflammation in asthma involves innate immune responses. Toll-like receptors (TLRs) and thymic stromal lymphopoietin (TSLP) are thought to be involved in airway inflammation, but their expression in asthmatics both large and small airways has not been investigated. Objective To analyse the expression of TLR2, TLR3, TLR4 and TSLP in large and small airways of asthmatics and compare their expression in smoking and non-smoking asthmatics; to investigate whether TLR expression is associated with eosinophilic or neutrophilic airway inflammation and with Mycoplasma pneumoniae and Chlamydophila pneumoniae infection. Methods Using immunohistochemistry and image analysis, we investigated TLR2, TLR3, TLR4 and TSLP expression in large and small airways of 24 victims of fatal asthma, FA, (13 non-smokers, 11 smokers) and nine deceased control subjects (DCtrl). TLRs were also measured in 18 mild asthmatics (MA) and 12 healthy controls (HCtrl). M. pneumoniae and C. pneumoniae in autopsy lung tissue were analysed using real-time polymerase chain reaction. Airway eosinophils and neutrophils were measured in all subjects. Results Fatal asthma patients had higher TLR2 in the epithelial and outer layers of large and small airways compared with DCtrls. Smoking asthmatics had lower TLR2 levels in the inner and outer layers of the small airways than non-smoking asthmatics. TSLP was increased in the epithelial and outer layers of the large airways of FA. FA patients had greater TLR3 expression in the outer layer of large airways and greater TLR4 expression in the outer layer of small airways. Eosinophilic airway inflammation was associated with TLR expression in the epithelium of FA. No bacterial DNA was detected in FA or DCtrls. MA and HCtrls had only a small difference in TLR3 expression. Conclusions and Clinical Relevance Increased expression of TLR 2, 3 and 4 and TSLP in fatal asthma may contribute to the acute inflammation surrounding asthma deaths.

Mental Disorders in Megacities: Findings from the Sao Paulo Megacity Mental Health Survey, Brazil

Background: World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. Sao Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders. Methods and Results: A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year. Discussion: Adults living in Sao Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.

Underground insulated piping systems : excluding walk-in tunnels.

"Prepared under Contract No. CST 263 between the National Academy of Sciences and the National Bureau of Standards."

Fingerprints : fingerprinting living and deceased individuals : latent fingerprints : court decisions.

At head of title: Federal Bureau of Investigation. United States Department of Justice.

Training guide for hate crime data collection : Uniform Crime Reporting.

Shipping list no.: 2004-0278-P.

Passenger tire use survey. Consolidated report.

National Bureau of Standards, Office of Vehicle Systems Research, Washington, D.C.

Tire use survey; interim report based upon summer observations.

National Bureau of Standards, Office of Vehicle Systems Research, Washington, D.C.

A procedure for determining ambient tire pressures from field measurements.

National Bureau of Standards, Office of Vehicle Systems Research, Washington, D.C.

A truck and bus tire use pattern study. Final report.

National Bureau of Standards, Tire Systems Section, Washington, D.C.