Síndrome de Guillain-Barré em Idade Pediátrica. Protocolo de Actuação

O protocolo de actuação na Síndrome de Guillain-Barré em idade pediátrica foi elaborado com o intuito de rever as mais recentes recomendações internacionais e de traçar linhas orientadoras de actuação. É constituído por duas partes: a primeira é a introdução teórica, resultante da revisão bibliográfica, e a segunda o Protocolo de actuação. Tratando-se de uma patologia para a qual ainda não existe um consenso, sobretudo no que respeita ao tratamento, optou-se por incluir as várias opções de tratamento recomendadas, permitindo a cada Unidade aplicar aquela com a qual possui mais experiência.

Ikäjohtaminen hoitotyössä

Abstract: Age management in nursing care

Innostuneena ikään katsomatta - Ikäjohtamisen vaikutus työmotivaatioon

Tämän tutkimuksen tarkoituksena oli tutkia, voidaanko ikäjohtamisella vaikuttaa henkilöstön työmotivaatioon. Tutkimus toteutettiin laadullisena tapaustutkimuksena haastattelemalla pankissa toimivia eri-ikäisiä palveluneuvojia lokakuussa 2012. Tutkimuksen tuloksena havaittiin että ikäjohtamisella on vaikutusta henkilöstön työmotivaatioon sekä suoraan että välillisesti. Suorat vaikutukset syntyvät pääasiassa yksilöllisen johtamisen kautta, jossa esimies ottaa huomioon alaisensa persoonan, taustan sekä osaamisen ja muokkaa työtehtäviä sekä omaa esimiestyötään niiden mukaisesti. Työmotivaation kannalta on oleellista että työntekijän yksilölliset ominaisuudet yhdistyvät työn sisältöön häntä motivoivalla tavalla. Motivoivassa työssä korostuvat työn merkityksellisyys, vastuullisuus ja tuloksellisuus. Välilliset vaikutukset syntyvät ennen kaikkea työn organisoinnin ja työyhteisössä vallitsevan ilmapiirin myötä ja vaikuttavat sitä kautta sekä fyysiseen että sosiaaliseen työympäristöön, joilla kummallakin on merkitystä työmotivaation rakentumisessa. 

Työssäjaksamisen voimavarat ja työssä jatkaminen ikääntyneillä vanhusten hoitotyötä tekevillä

Tässä pro gradu –tutkielmassa tarkasteltiin ikääntyneiden vanhusten hoitotyötä tekevien työssäjaksamista ja työssä jatkamissuunnitelmia voimavarakeskeisestä näkökulmasta käsin. Kiinnostuksen kohteena olivat myös työyhteisön suhtautuminen ikääntyvään työvoimaan ja keinot, joilla ikääntyneiden työssä jatkamista ja jaksamista tuetaan organisaatiossa. Tutkimusta varten haastateltiin kymmentä yli 55-vuotiasta vanhusten hoitotyötä tekevää henkilöä. Johtopäätösten mukaan työn voimavaroista merkittävimmiksi työssäjaksamisen ja työssä jatkamisen kannalta nousivat hyvät suhteet työtovereihin, toimiva työyhteisö ja asiakkaat. Työn ulkopuolisesta elämästä voimia saatiin mielekkäistä vapaa-ajan puuhista ja läheisistä. Persoonallisuuden voimavaroista keskeiseksi nousi optimistisuus. Eläkkeellä työskentelyaikomusten taustalla olivat usein kokemus työstä nauttimisesta ja hyvä terveys. Toisaalta hyvästä terveydestä haluttiin nauttia myös eläkkeellä.

Eri-ikäisten innovatiivisen työskentelyn johtaminen

Tämän tutkimuksen tarkoituksena on tutkia sitä, miten eri-ikäiset työnteki-jät tulisi huomioida innovatiivisen työskentelyn johtamisessa. Tutkimuk-sessa määritellään, mitä on innovatiivinen työskentely ja miten sitä johde-taan. Innovatiivisella työskentelyllä tarkoitetaan yksilötason toimintaa, jos-sa keskeistä on uusien ideoiden luominen ja tuominen käytäntöön liike-toimintaa hyödyttävällä tavalla. Tutkimuksessa kuvaillaan myös eri-ikäisten ihmisten johtamista ja sen keinoja. Ikäjohtamisen tutkimuksessa on tunnistettu neljä sukupolvea: Z-, Y-, ja X-sukupolvet sekä suuret ikä-luokat. Erot sukupolvien välillä sekä vanhenemisen on tunnistettu ai-heuttavan erilaisuutta työntekijöiden keskuuteen. Tutkimuksessa hyödynnettiin kvalitatiivista tutkimusmetodia ja toteutettiin neljä ryhmähaastattelua, yksi kullekin sukupolvelle. Ryhmähaastatteluis-sa tunnistettiin työyhteisöstä, esimiestyöstä ja ylimmän johdon toiminnas-ta tekijöitä, joilla on vaikutusta eri-ikäisten motivoitumiseen ja innovatiivi-seen työskentelyyn. Tutkimuksessa ei voitu havaita merkittäviä eroja eri-ikäisten innovatiivisen työskentelyn johtamisessa. Iästä riippumatta työn merkityksellisyyden kokeminen on yksilölle tärkeää. Eri-ikäisten innovatii-visen työskentelyn johtamisessa keskeistä on positiivinen johtajuus, jossa hyödynnetään aikaisemmassa innovatiivisen työskentelyn tutkimuksessa esitettyjä johtamisen mekanismeja.

The impact of demographic change and its challenges for the workforce in the European public sectors. Three priority areas to invest in future HRM. EIPA Working Paper 2012/W/01

European public sectors are particularly affected by the demographic challenge and an ageing and shrinking workforce. According to OECD statistics, over 30% of public employees of central government in 13 countries will leave during the next 15 years. Moreover, the public sector has as compared to the private sector to rely on a much older workforce, who will have to work longer in future. Against this background, European governments need to react and re-think major elements of current HR and organisational management in the public sector. Particularly the skills in age management should be improved in order to also maintain in future a highly productive, competent and efficient public sector and to ensure that public employees stay longer ‘employable’, ‘healthy’, ‘fit for the job’ and ‘up to the task’. The survey suggests some solutions by investing more in three priority areas in the field of HRM.

Extending Working Lives: The Case of Denmark. CEPS Working Document No. 404, 17 February 2015

Extending working lives has been a key item on the political agenda in Denmark for at least two decades now. This study details recent and prospective reforms to the voluntary early retirement scheme and the pension age, as well as current policy initiatives to keep older workers in employment. Other aspects central to a long working life, such as health, lifelong learning, age management practices in companies, and elderly workers’ motivation are discussed in depth. Overall, Denmark is in a relatively good state when it comes to older workers’ labour market participation and related job satisfaction. This impacts positively on the public finance challenge linked to population ageing which, given agreed reforms, should be manageable. Ongoing reform implementation is likely to substantially increase the employment of those aged 60 and over. Nevertheless, surveys point to age discrimination as a potential problem and people who fall into unemployment at a late stage of their careers still face challenges to reemployment.

Data for the sustainable management of an emerging fishery: Age, growth and stock structure of Atlantic saury Scomberesox saurus saurus (Walbaum), in the Northeastern Atlantic Ocean

Almost half of Ireland’s commercial stocks face overexploitation. As traditional species decrease in abundance and become less profitable, the industry is increasingly turning to alternate species. Atlantic saury (Scomberesox saurus saurus (Walbaum)) has been identified as a potential species for exploitation. Very little information is available on its biology or population dynamics, especially for Irish waters. This thesis aims to obtain sound scientific data, which will help to ensure that a future Atlantic saury fishery can be sustainably managed. The research has produced valuable data, some of which contradicts previous studies. Growth of Atlantic saury measured using otolith microstructure is found to be more than twice that previously calculated from annual structures on scales and otoliths. This results in a significant reduction of the expected life span from five to about two years. Investigation of maturity stage at age indicates that Atlantic saury will reproduce for the first time at age one and will survive for one or at most two reproduction seasons. It is concluded that a future Irish fishery will target mostly fish prior to their first reproduction. Finally the thesis gives some insights into the population structure of Atlantic saury, by analysis of otolith morphometric. Significant differences are detected between Northeastern Atlantic and western Mediterranean Sea specimens of the 0+ age class (less than one year old). The implications of these results for the management of an emerging fishery are discussed.

Age over 40 years increases the failure rate of non-operative management of blunt splenic injuries

Objective: Non-operative management (NOM) of blunt splenic injuries (BSI) is nowadays considered the standard treatment. The study aimed to determine the criteria applied for NOM and to identify risk factors for its failure. Methods: Review of all adult patients with BSI treated at the University Hospital Bern, Switzerland, between 2000 and 2008. Results: There were 206 patients (146 men, 70·9%) with a mean age of 38·2 ± 19·1 years and an Injury Severity Score of 30·9 ± 11·6. The American Association for the Surgery of Trauma classification of the splenic injury was: grade I, n=43 (20·9%); grade II, n=52 (25·2%); grade III, n=60 (29·1%); grade IV, n=42 (20·4%) and grade V, n=9 (4·4%). 47 patients (22·8%) required immediate surgery. Five or more units of red cell transfusions (P<0·001), Glasgow Coma Scale<11 (P=0·009) and age ≥55 years (P=0·038) were associated with primary operative management (OM). 159 patients (77·2%) qualified for NOM, which was successful in 89·9% (143/159). The overall splenic salvage rate was 69·4% (143/206). Multivariate analysis found age ≥40 years to be the only factor independently related to the failure of NOM (P=0·001). Conclusion: Advanced age is associated with an increased failure rate ofNOM in patients with BSI.

Facteurs de risque fracturaire, nouveaux traitements: comment evolue la prise en charge de l'ostéoporose de la personne agée [Fracture risk, new treatments: how does the management of the osteoporosis of elderly change?]

Osteoporosis of elderly is a growing medical, economic and health-care problem. It is due to the increase of the life expectancy and the number of osteoporotic fractures. With the new Swiss-specific tool FRAX and the development of inpatients fracture trajectory, we can better identify patients with high risk of fracture. An appropriate treatment can be proposed more quickly. The follow-up of bone markers increases the treatment efficiency. With a better identification, treatment and follow-up of osteoporosis of elderly patients, we can ameliorate the patient's quality of life and decrease the number of osteoporotic fractures with a good cost-effectiveness ratio.

Advanced age increases the failure rate of non-operative management of blunt splenic injuries

Introduction: Non-operative management (NOM) of blunt splenic injuries in hemodynamically stable patients is nowadays considered the standard treatment. Material and Methods: The aim was to clarify the criteria used for primary operative management (OM) and planned NOM. Furthermore, the study aimed to identify risk factors for failure of NOM. All adult patients with blunt splenic injuries treated from 2000-2008 were reviewed and a logistic regression analysis employed. Results: There were 206 patients (146 men, 70.9%). Mean age was 38.2 ± 19.1 years. The mean Injury Severity Score (ISS) was 30.9 ± 11.6. The American Association for the Surgery of Trauma (AAST) classification of the splenic injury was: grade I, n = 43 (20.9%); grade II, n = 52 (25.2%); grade III, n = 60 (29.1%), grade IV, n = 42 (20.4%) and grade V, n = 9 (4.4%). 47 patients (22.8%) required immediate surgery (OM). More than 5 units of red cell transfusions (odds ratio [OR] 13.72, P < 0.001), a Glasgow Coma Scale < 11 (OR 9.88, P = 0.009) and age ? 55 years (OR 3.29, P = 0.038) were associated with primary OM. 159 patients (77.2%) qualified for a non-surgical approach (NOM), which was successful in 89.9% (143/159). The overall splenic salvage rate amounted to 69.4% (143/206). Multiple logistic regression analysis found age ? 40 years to be the only factor significantly and independently related to the failure of NOM (OR 13.58, P = 0.001). Conclusion: Advanced age is associated with an increased failure rate of NOM in patients with blunt splenic injuries.

An analysis of the moderating effects of age in the acceptance of Learning Management Systems. 'Análisis del efecto moderador de la edad en la aceptación de sistemas e-learning LMS'.

Resumen basado en el de la publicación

Water management in Minoan Crete, Greece: the two cisterns of one Middle Bronze Age settlement

The two earliest structures of Minoan Crete that may be considered as large cisterns were both built in the first half of the second millennium BC (the time of the first Minoan palaces) at Myrtos-Pyrgos (lerapetra). A considerable feat of engineering and social management, they remain a most unusual attribute of a Minoan settlement, all the more so since the Myrtos river is/was available to supply water at the foot of the hill of Pyrgos. This paper presents these cisterns, briefly, in terms of geology and technology, the history of their use and re-use, and their relevance to understanding the culture and society (at local and regional levels) of Crete in the time of the Old Palaces, as well as their possible contribution to the political and military history of the period. I then review possible precursors of, and architectural parallels to, the Pyrgos cisterns at Knossos, Malia and Phaistos (none of which has been proved to be a cistern), and the later history of cisterns in Bronze Age Crete. Since only three others are known (at Archanes, Zakro and Tylissos, of Late Bronze Age date), the two cisterns of Myrtos-Pyrgos are an important addition to our still rudimentary knowledge of how the Bronze Age Cretans managed their water supplies.