Eventos adversos relacionados à gravidade e carga de trabalho de enfermagem em Unidade de Terapia Intensiva

Pós-graduação em Enfermagem - FMB

Padronização de técnica manual para obtenção de plasma rico em plaquetas de bovino

To evaluate the biochemical profile and protein concentration of whey from milk samples of healthy Murrah primiparous and pluriparous buffaloes, 30 female buffaloes were analyzed during a complete lactation. The animals were divided into three groups: G1 = 10 primiparous buffaloes, G2 = 10 pluriparous buffaloes with 2-3 lactations and G3 = 10 pluriparous buffaloes with > 3 lactations. The lactation period was divided into: early stage (I: 1-3 months of lactation), intermediate stage (T: 4-6 months of lactation) and final stage (F: 7-9 months of lactation). Before milk sampling, physical examination of the mammary gland, strip cup test and California Mastitis Test (CMT) were performed. After mammary quarters asepsis, 20mL of milk were collected monthly from each mammary quarter, during a complete lactation, in sterilized plastic bottles without preservative, in order to perform microbiological isolation, biochemical profile and protein electrophoresis in sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), and 30mL of milk from each mammary quarter were collect, in sterilized plastic bottles containing preservative bronopol to perform the somatic cell count (SCC). A total of 1,042 milk samples were collected from the experimental groups during lactation, of which 923 samples showed negative reaction to CMT and negative microbiological isolation and were selected to biochemical profile analysis and protein electrophoresis in SDS-PAGE. There were influence of parity order and stage of lactation in biochemical profile and protein concentration of healthy Murrah buffaloes'whey. Primiparous buffaloes (G1) showed higher gamma-glutamyltransferase (GGT: 2,346 U/L), alkaline phosphatase (ALP: 181 U/L), phosphorus (P; 56.6mg/dL), potassium (K; 32.0mg/dL) and alpha-lactalbumin (458mg/dL). Buffaloes with 2-3 lactations (G2) showed higher SCC (70,700 cells/mL) and higher concentrations of total protein (1.55g/dL), albumin (100mg/dL), magnesium (Mg; 8.80mg/dL), chlorides (Cl; 176mg/dL), iron (Fe; 10.7 mu g/dL), sodium (Na; 178mMol/L) and lactoferrin (59.5mg/dL). Bufalloes with > 3 lactations (G3) showed higher concentrations of total calcium (Ca; 41.8mg/dL), ionized calcium (iCa; 2.92mMol/L), immunoglobulin A (IgA; 1.32mg/dL), serum albumin (99.1mg/dL), immunoglobulin G (IgG; 49.7mg/dL) and beta-lactoglobulin (1,068mg/dL). During lactation it was observed increase in SCC, GGT, ALP, total protein, albumin, P, Mg, Cl, Na, lactoferrin, serum albumin, IgG and alpha-lactalbumin, as well as decrease in concentrations of Ca, Fe, iCa, K, IgA and beta-lactoglobulin in buffaloes'whey. The results may be used as reference for buffaloes and to support diagnosis and prognosis of diseases common to lactation periods.

Controle motor em pacientes com doença de Parkinson: terapia do espelho, foco de atenção e tarefa dupla

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Fisioterapia respiratória, pressão intra-abdominal e função renal de pacientes de terapia intensiva

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Valoración clínica y microbiológica del láser Er, Cr: YSGG en la terapia periodontal no quirúrgica

Se observa en la literatura una gran controversia alrededor de la capacidad del láser para aportar mejorías al tratamiento periodontal no quirúrgico. El objetivo de este estudio es valorar si, en el tratamiento periodontal básico, el láser es más eficaz que el raspado y alisado radicular en cuanto a la mejoría de parámetros tanto clínicos (profundidad de sondaje, sangrado al sondaje y nivel de inserción) como microbiológicos (presencia o ausencia de A. actinomycetemcomitans, P. gingivalis, T. forsythia). 10.3. MATERIALES Y MÉTODOS Se seleccionan 36 pacientes con enfermedad periodontal crónica generalizada de grado moderado-severo y se reparten en dos grupos: 18 pacientes para el grupo control, en el que se realiza el tratamiento periodontal convencional con instrumentación manual, y 18 pacientes para el grupo experimental, en el que se realiza el tratamiento con el láser Er,Cr:YSGG. Los datos clínicos analizados son: el índice de placa, el índice gingival, la recesión gingival, el nivel de inserción y la profundidad de sondaje. En el laboratorio se analiza, por medio de la PCR, la muestra microbiológica del surco gingival. Los participantes también rellenan un cuestionario sobre la hipersensibilidad dental y las molestias en general percibidas durante el tratamiento. Todos los datos se toman al principio del estudio y a las seis semanas de haber finalizado el tratamiento. Se utiliza el método UNIANOVA para el análisis estadístico entre los dos grupos...

Terapia de aceptación y compromiso en un caso de tras¬torno mixto de ansiedad y depresión en una paciente con cáncer

This paper introduces the case of a woman with breast cancer who had developed a mixed depressive-anxiety disorder with avoidance behaviors. The patient presented depressive symptoms like listlessness, insomnia, weeping, food disorders and hopelessness though. Also, she exhibited physiological arousal and restlessness feelings. Additionally, the patient had an avoidance patron behavior in relation with all stimulus she believed could hurt her. Based on the Acceptance and Commitment Therapy (ACT) the intervention planted the following objectives: the patient will learn to accept her illness and the emotional distress that she was experiencing, also, the patient will recover the other areas of her life that she had abandoned. The treatment was developed in 14 sessions. The therapist used these techniques: creative hopelessness, disabling verbal functions, values clarification and loss of control over private events. In the results, it was observed a positive change in the behavior of the patient as well as a decrease in emotional distress that was his reason for initial consultation

O Efeito da Terapia Cognitivo Comportamental na Anorexia Nervosa: uma meta-análise

Introdução: A Anorexia Nervosa (AN) é a perturbação do comportamento alimentar (PCA) com a maior taxa de mortalidade de todos os transtornos psiquiátricos. Carateriza-se pela recusa em manter um peso corporal normal mínimo, pela distorção da imagem corporal e por um obsessivo medo de ganhar peso. Os comportamentos patológicos a ela associados podem levar a uma semi-inanição que necessita de cuidados médicos pluridisciplinares, muitas vezes, em regime de internamento. Vários ensais clínicos avaliaram a eficácia da Terapia Cognitivo- Comportamental (TCC), indicando que ela favorece a remissão ou a diminuição da frequência de episódios de compulsão alimentar, dos comportamentos purgativos e da restrição alimentar. Objetivo: Combinar os resultados da melhor evidência científica de forma a avaliar a eficácia da TCC em comparação com outras terapias utilizadas no tratamento da AN. Métodos: A pesquisa realizou-se nas bases de dados eletrónicas da MEDLINE, Psyc-Info, Embase, CCTR e de forma manual, incluindo ensaios clínicos controlados randomizados que comparam a TCC com qualquer outro tipo de intervenção no tratamento da AN. Resultados: Foram incluídos 10 estudos que envolveram 957 pacientes: dos quais 571 (59,7%) foram submetidos a tratamento com Terapia cognitivo comportamental e 556 (49,3%) a outras terapias. Não se registaram diferenças significativas nos resultados obtidos em diversos outcomes, exceto nas subescalas Restrições (z=3,03; p=0,02), Preocupações alimentares (z=2,98; p=0,002) e Preocupações com a forma (z=1,71; p=0,09) do EDE e nos scores da escala GAF (z=1,87; p=0,06). Registaram-se diferenças estatisticamente significativas no número de episódios bulímicos (z=2,61; p=0,009), número de episódios de indução de vómito (z=2,11; p=0,03) e no número de episódios de uso indevido de laxantes (z=3,04; p=0,002). Conclusão: A utilização da Terapia Cognitivo-Comportamental no tratamento de doentes com AN parece melhorar bastante os sintomas da doença, revelando-se particularmente eficaz nos resultados obtidos na Eating Disorder Examination Scale. A sua utilização parece levar a uma melhoria no scores da GAF, evidenciando uma melhoria geral do estado de saúde dos pacientes (redução dos episódios de vómito, bulimia e uso de laxantes). / Página | viii ABSTRACT Background: Anorexia Nervosa is an eating disorder with the highest mortality rate of all psychiatric disorders. It is characterized by refusal to maintain a minimally normal body weight, the distortion of body image and obsessive fear of gaining weight. The pathological behaviors associated with it can lead to semi-starvation, requiring medical treatment and multidisciplinary inpatient care. Several clinical trials evaluated the efficacy of Cognitive Behavioral Therapy (CBT) in lead to remission or reduction of the frequency of bingue eating episodes, purgative behaviors and food restriction. Objective: Combining the results of the best scientific evidence to assess the efficacy of CBT in comparison with other therapies used in the treatment of AN. Methods: The research was carried out in electronic databases of MEDLINE, Psyc- Info, Embase, CCTR and manually, including randomized controlled trials that compared CBT with any other type of intervention in the treatment of AN. Results: Of which 571 (59.7%) were treated with cognitive behavioral therapy and 556 (49.3%) to other therapies: 10 studies involving 957 patients were included. No significant differences in the results obtained in different outcomes, except subscales Restrictions (z = 3.03, p = 0.02), Eating Concerns (z = 2.98, p = 0.002) and Shape Concerns (z = 1.71, p = 0.09) in the scores of EDE and the GAF scale (z = 1.87, p = 0.06). There were statistically significant differences in the number of bulimic episodes (z = 2.61, p = 0.009), number of episodes of induced vomiting (z = 2.11, p = 0.03) and the number of occurrences of use misuse of laxatives (z = 3.04, p = 0.002). Conclusion: The use of cognitive-behavioral therapy in the treatment of patients with AN seems to greatly improve the symptoms of the disease, revealing particularly effective results in the Eating Disorder Examination Scale. Its use seems to lead to an improvement in the GAF scores, showing a general improvement of the health status of patients (reduction of episodes of vomiting, bulimia and laxative use).

Terapia de ressincronização cardíaca em doentes com fibrilhação auricular : uma metanálise

Introdução: A insuficiência cardíaca (IC) e a fibrilhação auricular (FA) coexistem frequentemente e estão associadas a elevada morbilidade e mortalidade. O impacto da terapia de ressincronização cardíaca (TRC) nestes doentes é incerto. Também a influência da ablação auriculoventricular (AV) continua por esclarecer. Objetivo: Combinar os resultados da melhor evidência científica de forma a comparar os efeitos da TRC em doentes com IC em FA e em ritmo sinusal (RS) e determinar a influência da ablação AV no grupo de doentes em FA. Métodos: A pesquisa realizou-se nas bases de dados eletrónicas da PubMed, B-On e CENTRAL e de forma manual, incluindo ensaios clínicos controlados randomizados e estudos de coorte até novembro de 2012. Analisou-se a mortalidade total e cardiovascular e a resposta à TRC. Resultados: Foram incluídos 19 estudos que envolveram 5324 pacientes: 1399 em FA e 3925 em RS. O grupo com doentes em FA apresenta maior risco de mortalidade total, comparativamente ao grupo de doentes em RS (OR = 1,69; IC 1,20–2,37, p = 0,002). Não foram verificadas diferenças estatisticamente significativas quanto à mortalidade cardiovascular (OR = 1,36, IC 0,92–2,01, p = 0,12). A não resposta à TRC foi maior no grupo em FA (OR = 1,41; IC 1,15–1,73; p = 0,001). Entre os indivíduos em FA, a ablação do nódulo auriculoventricular foi associada à redução da mortalidade total (OR = 0,42; IC 0,22–0,80; p = 0,008), mortalidade cardiovascular (OR = 0,39; IC 0,20–0,75; p = 0,005) e número de não respondedores à TRC (OR = 0,30; IC 0,10–0,90; p = 0,03). Conclusão: A presença de FA está associada a maior probabilidade de morte por todas as causas e de não resposta à TRC, comparativamente aos doentes em RS. Contudo, um número significativo de doentes em FA beneficia da TRC. A ablação AV parece aumentar os benefícios da TRC nos doentes com FA.

Efficacia delle Tecniche di Terapia Manuale nel Trattamento dei Disturbi Temporomandibolari: una Revisione Sistematica della Letteratura

Background. I disturbi temporomandibolari sono una serie di condizioni cliniche che colpiscono l’ATM, la muscolatura masticatoria e le strutture annesse ad esse. I TMD hanno come sintomo principale il dolore e possono condurre a limitazioni della mobilità articolare, diminuendo la qualità della vita. Il trattamento è multidisciplinare e il primo intervento è quello conservativo. Le tecniche di terapia manuale rappresentano uno dei metodi conservativi di cui ci si può avvalere per il trattamento di pazienti affetti da TMD. Obiettivi. Valutare l’efficacia delle tecniche di terapia manuale nel miglioramento di outcome, quali: dolore, disabilità, range di movimento e qualità della vita. Metodi. La ricerca è stata condotta nel periodo tra Maggio 2022 e Settembre 2022, su tre banche dati: PubMed, PEDro e Chocrane Library. Sono stati selezionati esclusivamente RCT in lingua inglese, con partecipanti adulti affetti da TMD. La qualità metodologica degli studi è stata valutata tramite l’utilizzo della PEDro Scale. Risultati. Sono stati inclusi sei studi. Nei singoli studi, le tecniche di terapia manuale sono state confrontate o meno con altri approcci conservativi. In cinque RCT su sei, è stata rilevata un’alta qualità metodologica, con un punteggio medio di 7/10 nella PEDro Scale. Discussione. Nei sei studi inclusi, c’è stato un miglioramento degli outcome indagati, ad eccezione del ROM che in uno studio non ha mostrato miglioramenti post-trattamento manuale. In quattro studi su sei la valutazione finale degli outcome è avvenuta al termine delle settimane di trattamento, permettendo una visione esclusiva degli effetti a breve termine. La limitata indagine degli effetti a lungo termine e l’elevata eterogeneità tra gli studi denotano la necessità di ulteriori ricerche riguardanti l’argomento. Conclusioni. Le tecniche di terapia manuale sembrerebbero avere un effetto positivo nei pazienti affetti da TMD, se inserite all’interno di un programma riabilitativo multimodale.

Construction Of A Manual Of Work Processes And Techniques From Centro De Dispensação De Medicamentos De Alto Custo (cedmac), Hospital De Clínicas, Unicamp.

The Centers for High Cost Medication (Centros de Medicação de Alto Custo, CEDMAC), Health Department, São Paulo were instituted by project in partnership with the Clinical Hospital of the Faculty of Medicine, USP, sponsored by the Foundation for Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo, FAPESP) aimed at the formation of a statewide network for comprehensive care of patients referred for use of immunobiological agents in rheumatological diseases. The CEDMAC of Hospital de Clínicas, Universidade Estadual de Campinas (HC-Unicamp), implemented by the Division of Rheumatology, Faculty of Medical Sciences, identified the need for standardization of the multidisciplinary team conducts, in face of the specificity of care conducts, verifying the importance of describing, in manual format, their operational and technical processes. The aim of this study is to present the methodology applied to the elaboration of the CEDMAC/HC-Unicamp Manual as an institutional tool, with the aim of offering the best assistance and administrative quality. In the methodology for preparing the manuals at HC-Unicamp since 2008, the premise was to obtain a document that is participatory, multidisciplinary, focused on work processes integrated with institutional rules, with objective and didactic descriptions, in a standardized format and with electronic dissemination. The CEDMAC/HC-Unicamp Manual was elaborated in 10 months, with involvement of the entire multidisciplinary team, with 19 chapters on work processes and techniques, in addition to those concerning the organizational structure and its annexes. Published in the electronic portal of HC Manuals in July 2012 as an e-Book (ISBN 978-85-63274-17-5), the manual has been a valuable instrument in guiding professionals in healthcare, teaching and research activities.

Guidelines On The Treatment Of Anemia Of Chronic Renal Failure Using Recombinant Human Erythropoietin: Associação Brasileira De Hematologia, Hemoterapia E Terapia Celular Guidelines Project: Associação Médica Brasileira - 2014.

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Fatores associados à maior mortalidade e tempo de internação prolongado em uma unidade de terapia intensiva de adultos

OBJECTIVE: The intensive care unit is synonymous of high severity, and its mortality rates are between 5.4 and 33%. With the development of new technologies, a patient can be maintained for long time in the unit, causing high costs, psychological and moral for all involved. This study aimed to evaluate the risk factors for mortality and prolonged length of stay in an adult intensive care unit. METHODS: The study included all patients consecutively admitted to the adult medical/surgical intensive care unit of Hospital das Clínicas da Universidade Estadual de Campinas, for six months. We collected data such as sex, age, diagnosis, personal history, APACHE II score, days of invasive mechanical ventilation orotracheal reintubation, tracheostomy, days of hospitalization in the intensive care unit and discharge or death in the intensive care unit. RESULTS: Were included in the study 401 patients; 59.6% men and 40.4% women, age 53.8±18.0. The mean intensive care unit stay was 8.2±10.8 days, with a mortality rate of 13.5%. Significant data for mortality and prolonged length of stay in intensive care unit (p <0.0001), were: APACHE II>11, OT-Re and tracheostomy. CONCLUSION: The mortality and prolonged length of stay in intensive care unit intensive care unit as risk factors were: APACHE>11, orotracheal reintubation and tracheostomy.

Terapia oclusiva em ambliopia: fatores prognósticos

Purpose: Amblyopia is the most common form of visual problem in children and for more than 250 years occlusion therapy is the standard treatment. Thus our purpose is to identify the factors that influence the outcome of amblyopia treatment with occlusion therapy. Methods: We reviewed 169 amblyopic children seen in the outpatient clinic of amblyopia of the Campinas State University, between January 1996 and May 1998. Patients were analyzed regar-ding sex, age at start of treatment (3 groups), affected eye, type of amblyopia (strabismic, anisometropic, visual depri-vation, associated), follow-up, initial visual acuity (light, moderate, severe), compliance with treatment (good, poor) and outcome (fully treated, partially treated, not treated). Results: Compliance was not seen to be significantly related to age at start of treatment (p=0.68) or initial visual acuity (p=0.82). 52.67% of the patients were fully treated while 19.52% were partially treated and 27.81% were not treated. Children recorded as showing good compliance had a significantly better outcome than those with poor complian-ce (p=0.0009). Neither the age at start of treatment (p=0.39) nor the initial visual acuity (p=0.30) were significantly corre-lated with the final outcome. Conclusions: We concluded that the main factor affecting the final outcome of amblyopia treatment is compliance.

Influencia do treinamento fisico aerobio sobre as respostas cardiovasculares e respiratorias em mulheres na menopausa com e sem terapia de reposição hormonal

Universidade Estadual de Campinas. Faculdade de Educação Física

Comparative study of intermaxillary relationships of manual and swallowing methods

This study compared the mandibular displacement from three methods of centric relation record using an anterior jig associated with (A) chin point guidance, (B) swallowing (control group) and (C) bimanual manipulation. Ten patients aged 25-39 years were selected if they met the following inclusion criteria: complete dentition (up to the second molars), Angle class I and absence of signs and symptoms of temporomandibular disorders and diagnostic casts showing stability in the maximum intercuspation (MI) position. Impressions of maxillary and mandibular arches were made with an irreversible hydrocolloid impression material. Master casts of each patient were obtained, mounted on a microscope table in MI as a reference position and 5 records of each method were made per patient. The mandibular casts were then repositioned with records interposed and new measurements were obtained. The difference between the two readings allowed measuring the displacement of the mandible in the anteroposterior and lateral axes. Data were analyzed statistically by ANOVA and Tukey's test at 5% significance level. There was no statistically significant differences (p>0.05) among the three methods for measuring lateral displacement (A=0.38 ± 0.26, B=0.32 ± 0.25 and C=0.32 ± 0.23). For the anteroposterior displacement (A=2.76 ± 1.43, B=2.46 ± 1.48 and C=2.97 ± 1.51), the swallowing method (B) differed significantly from the others (p<0.05), but no significant difference (p>0.05) was found between chin point guidance (A) and bimanual manipulation (C). In conclusion, the swallowing method produced smaller mandibular posterior displacement than the other methods.