Dissertations / Theses: 'Dose intensity'

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Tangboonduangjit, Puangpen. "Intensity-modulated radiation therapy dose maps the matchline effect /." Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20060724.095712/index.html.

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FRUSCIO, ROBERT. "Somministrazione settimanale di cisplatino in pazienti con carcinoma ovarico in stadio avanzato: risultati a lungo termine di uno studio clinico randomizzato." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2010. http://hdl.handle.net/10281/13832.

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OBJECTIVES: to determine the effect of weekly administration of cisplatin as first line chemotherapy for advanced ovarian cancer patients METHODS: Patients with advanced epithelial ovarian cancer were randomly assigned (by a computer system) to the experimental dose-dense first line chemotherapic arm (Pw, cisplatin 50 mg/mq weekly x 6 cycles) or to the standard arm (Pst, cisplatin 75 mg/mq every three weeks x 6 cycles). Planned cumulative dose of cisplatin was 450 mg/m2 in both groups, while dose intensity was doubled in the Pw arm (50 mg/m2/week versus 25 mg/m2/week). The primary objective of the study was to compare the progression free survival (PFS) in the two arms. Secondary objectives were the overall response to chemotherapy and toxicity. RESULTS: between November 1988 and February 1992 285 patients were randomized in the two treatment arms. The two regimens resulted equally feasible. Planned dose intensity was achieved in both treatment groups (median 45 and 23 mg/m2/week). Toxicity was similar in the two groups, with the exception of grade 3-4 leukopenia which was more frequent in the experimental arm (9% vs 3%, p:0.02). Median follow up was 16.8 years. There were no differences between the two treatment arms in terms of PFS (17 months in the Pw arm, 18 in the Pst arm, p:0.57) and in terms of OS (35 months in the Pw arm, 32 in the Pst arm, p:0.97). CONCLUSION: dose-dense cisplatin is well tolerated, but does not seem to bring advantages, in terms of PFS and OS, compared to standard chemotherapy.

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Milette, Marie-Pierre. "Direct optimization of 3D dose distributions using collimator rotation." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/274.

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The primary goal of this thesis is to improve the precision and efficiency of radiation therapy treatment. This goal is achieved by developing and implementing a direct aperture optimization (DAO) platform where the multileaf collimator (MLC) is rotated between each aperture. The approach is referred to as rotating aperture optimization (RAO). A series of tests is performed to evaluate how a final optimized plan depends on MLC parameters. Imposing constraints on the leaf sequence results in increased efficiency and a simplification of the treatment plan without compromising the quality of the dose distribution. It is also shown that an arrangement of equispaced collimator angles takes full advantage of the flexibility associated with collimator rotation. A study including ten recurring nasopharynx cancer patients is used to evaluate the capabilities of RAO compared to other optimization techniques. It is shown that RAO plans require significantly less linac radiation output (monitor units or MU) while maintaining equivalent dose distribution quality compared to plans generated with the conventional fluence based approach. Furthermore with an improved collimator rotation speed, the RAO plans should be executable in the same or less time than plans generated with the fluence-based approach. For the second part of the study it is shown that plans generated with RAO are as good as or better than plans generated with standard fixed collimator DAO. Film and ion chamber measurements indicate that RAO plans can be delivered more accurately than DAO plans. Additional applications of DAO were investigated through collaboration with two PhD students. First, Monte Carlo was used to generate pencil beam dose distributions for DAO inverse treatment planning (MC-DAO). The MC-DAO technique correctly models traditionally difficult treatment geometries such as small fields and tissue inhomogeneities. The MC-DAO also takes advantage of the improved MU efficiency associated with the DAO technique. Secondly DAO is proposed for adaptive radiation therapy. The results show that plan re-adaptation can be performed more quickly than complete plan regeneration thereby minimizing the time the patient has to spend in the treatment room and reducing the potential for geometric errors in treatment delivery.

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Zhang, Pengfei, Neng Fan, Jie Shan, Steven E. Schild, Martin Bues, and Wei Liu. "Mixed integer programming with dose-volume constraints in intensity-modulated proton therapy." WILEY, 2017. http://hdl.handle.net/10150/626184.

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Background: In treatment planning for intensity-modulated proton therapy (IMPT), we aim to deliver the prescribed dose to the target yet minimize the dose to adjacent healthy tissue. Mixed-integer programming (MIP) has been applied in radiation therapy to generate treatment plans. However, MIP has not been used effectively for IMPT treatment planning with dose-volume constraints. In this study, we incorporated dose-volume constraints in an MIP model to generate treatment plans for IMPT. Methods: We created a new MIP model for IMPT with dose volume constraints. Two groups of IMPT treatment plans were generated for each of three patients by using MIP models for a total of six plans: one plan was derived with the Limited-memory Broyden-Fletcher-Goldfarb-Shanno (L-BFGS) method while the other plan was derived with our MIP model with dose-volume constraints. We then compared these two plans by dose-volume histogram (DVH) indices to evaluate the performance of the new MIP model with dose-volume constraints. In addition, we developed a model to more efficiently find the best balance between tumor coverage and normal tissue protection. Results: The MIP model with dose-volume constraints generates IMPT treatment plans with comparable target dose coverage, target dose homogeneity, and the maximum dose to organs at risk (OARs) compared to treatment plans from the conventional quadratic programming method without any tedious trial-and-error process. Some notable reduction in the mean doses of OARs is observed. Conclusions: The treatment plans from our MIP model with dose-volume constraints can meetall dose-volume constraints for OARs and targets without any tedious trial-and-error process. This model has the potential to automatically generate IMPT plans with consistent plan quality among different treatment planners and across institutions and better protection for important parallel OARs in an effective way.

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Ho, Kean Fatt. "Optimising dose escalated intensity modulated radiotherapy (IMRT) in head and neck cancer." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.508596.

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Javedan, Khosrow. "Investigation of Buildup Dose for Therapeutic Intensity Modulated Photon Beams in Radiation Therapy." Scholar Commons, 2010. http://scholarcommons.usf.edu/etd/3449.

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Buildup dose of Mega Voltage (MV) photon beams can be a limiting factor in intensitymodulated radiation therapy (IMRT) treatments. Excessive doses can cause patient discomfort and treatment interruptions, while underdosing may lead to local failure. Many factors which contribute to buildup dose, including the photon beam energy spectrum, scattered or contaminant radiation and their angular distribution, are not modeled well in commercial treatment planning systems. The accurate Monte Carlo method was employed in the studies to estimate the doses. Buildup dose of 6MV photon beams was investigated for three fundamentally different IMRT modalities: between Helical TomoTherapy and traditional opposed tangential beams, solid IMRT and multileaf collimator (MLC)-based IMRT techniques. Solid IMRT, as an alternative to MLC, achieves prescription dose distribution objectives, according to our study. Measurements and Monte Carlo calculations of buildup dose in chest wall treatment were compared between TomoTherapy IMRT and traditional tangential-beam technique. The effect of bolus in helical delivery was also investigated in this study. In addition, measurements and Monte Carlo calculations of buildup dose in solid IMRT and MLC based IMRT treatment modalities were compared. A brass step compensator was designed and built for the solid IMRT. Matching MLC step sequences were used for the MLC IMRT. This dissertation also presents the commissioning of a Monte Carlo code system, BEAMnrc, for a Varian Trilogy linear accelerator (LINAC) and the application in buildup dose calculation. Scattered dose components, MLC component dose and mean spectral energy for the IMRT treatment techniques were analyzed. The agreement between measured 6MV and calculated depth dose and beam profiles was (± 1% or ±1 mm) for 10x10 and 40x40 cm2 fields. The optimum electron beam energy and its radial distribution incident on tungsten target were found to be 6 MeV and 1 mm respectively. The helical delivery study concluded that buildup dose is higher with TomoTherapy compared to the opposed tangential technique in chest wall treatment. The solid and MLC IMRT comparison concluded that buildup dose was up to 7% lower for solid IMRT compared to MLC IMRT due to beam hardening of brass.

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Gordon, Ian R. "Feasibility Study of Intensity Modulation for Low Dose Rate External Beam Radiation Therapy." University of Toledo Health Science Campus / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=mco1290109815.

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Zhang, Tianfang. "Direct optimization of dose-volume histogram metrics in intensity modulated radiation therapy treatment planning." Thesis, KTH, Skolan för teknikvetenskap (SCI), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-231548.

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In optimization of intensity-modulated radiation therapy treatment plans, dose-volumehistogram (DVH) functions are often used as objective functions to minimize the violationof dose-volume criteria. Neither DVH functions nor dose-volume criteria, however,are ideal for gradient-based optimization as the former are not continuously differentiableand the latter are discontinuous functions of dose, apart from both beingnonconvex. In particular, DVH functions often work poorly when used in constraintsdue to their being identically zero when feasible and having vanishing gradients on theboundary of feasibility.In this work, we present a general mathematical framework allowing for direct optimizationon all DVH-based metrics. By regarding voxel doses as sample realizations ofan auxiliary random variable and using kernel density estimation to obtain explicit formulas,one arrives at formulations of volume-at-dose and dose-at-volume which are infinitelydifferentiable functions of dose. This is extended to DVH functions and so calledvolume-based DVH functions, as well as to min/max-dose functions and mean-tail-dosefunctions. Explicit expressions for evaluation of function values and corresponding gradientsare presented. The proposed framework has the advantages of depending on onlyone smoothness parameter, of approximation errors to conventional counterparts beingnegligible for practical purposes, and of a general consistency between derived functions.Numerical tests, which were performed for illustrative purposes, show that smoothdose-at-volume works better than quadratic penalties when used in constraints and thatsmooth DVH functions in certain cases have significant advantage over conventionalsuch. The results of this work have been successfully applied to lexicographic optimizationin a fluence map optimization setting.
Vid optimering av behandlingsplaner i intensitetsmodulerad strålterapi används dosvolym- histogram-funktioner (DVH-funktioner) ofta som målfunktioner för att minimera avståndet till dos-volymkriterier. Varken DVH-funktioner eller dos-volymkriterier är emellertid idealiska för gradientbaserad optimering då de förstnämnda inte är kontinuerligt deriverbara och de sistnämnda är diskontinuerliga funktioner av dos, samtidigt som båda också är ickekonvexa. Speciellt fungerar DVH-funktioner ofta dåligt i bivillkor då de är identiskt noll i tillåtna områden och har försvinnande gradienter på randen till tillåtenhet. I detta arbete presenteras ett generellt matematiskt ramverk som möjliggör direkt optimering på samtliga DVH-baserade mått. Genom att betrakta voxeldoser som stickprovsutfall från en stokastisk hjälpvariabel och använda ickeparametrisk densitetsskattning för att få explicita formler, kan måtten volume-at-dose och dose-at-volume formuleras som oändligt deriverbara funktioner av dos. Detta utökas till DVH-funktioner och så kallade volymbaserade DVH-funktioner, såväl som till mindos- och maxdosfunktioner och medelsvansdos-funktioner. Explicita uttryck för evaluering av funktionsvärden och tillhörande gradienter presenteras. Det föreslagna ramverket har fördelarna av att bero på endast en mjukhetsparameter, av att approximationsfelen till konventionella motsvarigheter är försumbara i praktiska sammanhang, och av en allmän konsistens mellan härledda funktioner. Numeriska tester genomförda i illustrativt syfte visar att slät dose-at-volume fungerar bättre än kvadratiska straff i bivillkor och att släta DVH-funktioner i vissa fall har betydlig fördel över konventionella sådana. Resultaten av detta arbete har med framgång applicerats på lexikografisk optimering inom fluensoptimering.

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Sun, Jidi. "Implementation of 2-Step Intensity Modulated Arc Therapy." Thesis, University of Canterbury. Department of Physics and Astronomy, 2010. http://hdl.handle.net/10092/3844.

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Intensity modulated arc therapy is a novel treatment technique that has shown great potential to be superior to conventional intensity modulated radiotherapy, both in terms of treatment plan quality as well as treatment delivery. Based on previous literature, a simplified technique called two-step intensity modulated arc therapy (2-step IMAT) was implemented into a treatment planning system. In order to automatically generate treatment plans for this technique, a beam portal shaping method was developed to generate beam segments. A sensitivity analysis was carried out on a geometric phantom to determine optimal parameters for the 2-step IMAT implementation for that particular phantom. The segment weights were optimized using the dose-based and dose-volume-based objective functions. The optimal solution search was based on the gradient-descend algorithm. The dose-based objective function was implemented using a so-called lambda-value-dose-based objective function developed in this work in order to increase both speed and flexibility of the optimization. The successful implementation demonstrated the feasibility of automatic 2-step IMAT treatment planning. A comparison of conventional arc therapy and 2-step IMAT showed improvements in the target dose uniformity by about 50% for both geometric phantom and clinical paraspinal tumor case, whilst also improving the organ sparing. The comparisons between the lambda-value-dose-based and dose-volume-based optimizations showed a speed advantage of the former by a factor of over five in the phantom study. The current beam portal shaping approach can be improved by optimizing the segment width and including multiple organs-at-risk in the segment generation algorithm. Future work will also include the implementation of a stochastic optimization to minimize the chance of getting trapped in local minima during the segment weight optimization. In summary, the work of this research showed that the automatic 2-step IMAT planning is a viable technique that can result in highly conformal plans while keeping the treatment planning and delivery simple and straightforward.

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Obata, Yasunori, and Hiroshi Oguchi. "Commissioning of modulator-based IMRT with XiO treatment planning system." AIP Publishing, 2009. http://hdl.handle.net/2237/20613.

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Chen, Zongde. "Depleted CMOS sensor development for pixel particle detectors under high intensity and high radiative dose." Thesis, Aix-Marseille, 2019. http://www.theses.fr/2019AIXM0430.

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Le trajectographe interne (ITk) de l'expérience ATLAS sera amélioré pour la nouvelle phase de prise de données du grand collisionneur de hadrons du CERN à haute luminosité (HL-LHC) en 2026. Le HL-LHC fonctionnera avec l’énergie nominale de collision est de 14 TeV et la luminosité instantanée maximale de 7,5 x (10)34 cm(−2) s(−1), cinq fois plus élevée qu’à présent. La luminosité accrue se traduira par des niveaux de rayonnement et des débits de données environ dix fois plus élevés. Afin de faire face aux exigences d’ATLAS en termes d’intensite du rayonnement, de vitesse de lecture et de granularité au HL-LHC, le remplacement de l’actuel ATLAS Inner Tracker (ITk) est nécessaire. Deux capteurs CMOS épuisés à grande échelle dans la technologie LF de 150 nm, appelés LF-CPIX et LF-MONOPIX, ont été développés dans le cadre de la mise à niveau ATLAS Inner Tracker (ITK) pour le LHC à haute luminosité. Le travail présenté ici montre la caractérisation de ces trois prototypes, avec des contributions concernant le développement de la configuration, le calibrage source 55 Fe et 90 Sr, les modifications du microprogramme FPGA et le développement de programmes de test. L’enquête sur la dureté du rayonnement pour l’électronique et les composants du capteur a été une préoccupation majeure. Nous montrerons les résultats concernant les caractérisations de ces prototypes dans les performances de laboratoire du CPPM, ainsi que les résultats de multiples campagnes de rayonnement conduites à l’installation de protons IRRAD de 24 GeV du CERN, afin d’étudier les effets de la perte d’énergie non ionisante (NIEL) et du Dose ionisante (TID) sur les prototypes
The Inner Tracker (ITk) system of the ATLAS experiment will be upgraded for the 2026 High Luminosity Large Hadron Collider (HL-LHC) run. The HL-LHC will operate with a center of mass energy of 14 TeV and a peak instantaneous luminosity five times higher than at present. The increased luminosity will result in roughly ten times higher radiation levels and data rates. To cope with the ATLAS requirements in terms of radiation hardness, readout speed and granularity at the HL-LHC, the replacement of the present ATLAS Inner Tracker (ITk) is needed. Two large-scale depleted CMOS sensors in the 150 nm LF-technology called LF-CPIX and LF-MONOPIX, developed in the framework of the ATLAS Inner Tracker (ITK) upgrade for High Luminosity LHC. The work presented here shows the characterization for these three prototypes, with contributions concerning the setup development, 55Fe and 90Sr source calibration, modifications of the FPGA firmware and development of test programs. A main concern was the investigation on the radiation hardness for both the electronics and the sensor parts. We will show results concerning characterizations for these prototypes in the laboratory performance at CPPM, as well as results in multiple radiation campaigns performed at the 24 GeV IRRAD proton facility at CERN, to study the effects of Non-Ionizing Energy Loss (NIEL) and Total Ionizing Dose (TID) on the prototypes

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Wagner, Antoine. "Clinical implementation of a Monte Carlo-based platform for the validation of stereotactic and intensity-modulated radiation therapy." Doctoral thesis, Universite Libre de Bruxelles, 2020. https://dipot.ulb.ac.be/dspace/bitstream/2013/312015/3/ToC.pdf.

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En radiothérapie, le niveau de précision de la dose délivrée au patient au cours de son traitement est d’une importance essentielle dans l’évolution vers une amélioration de la qualité et de la cohérence des données de suivi. L’une des premières étapes vers un système de support à la décision clinique (Clinical-Decision Support System CDSS) est la reconstruction précise de cette dose délivrée, en prenant en compte les nombreux facteurs pouvant générer des déviations significatives entre la dose planifiée visualisée à l’écran par l’utilisateur et la dose réellement accumulée lors des séances de traitement. Ces facteurs incluent les variations de débit de l’accélérateur, les incertitudes d’étalonnage, de calcul de dose, les mouvements du patient et des organes, etc.L’objectif de cette étude est d’implémenter et tester une plate-forme de calcul Monte Carlo pour la validation des systèmes Cyberknife et Tomothérapie installés au Centre Oscar Lambret. L’étude d’un détecteur dédié aux petits faisceaux (la chambre d’ionisation microLion) est également incluse, ce détecteur étant particulièrement adapté aux mesures sur le système Cyberknife.Le contexte et les concepts théoriques sont introduits dans les deux premiers chapitres. Dans le troisième chapitre, la modélisation Monte Carlo du Cyberknife et du détecteur microLion est détaillée. La quatrième partie inclut la description de la plate-forme Moderato et de son module d’évaluation. Dans le dernier chapitre, la modélisation du dernier modèle de Cyberknife (M6) équipé d’un collimateur multi-lames est décrite. Une nouvelle technique est également introduite dans le but d’accélérer la recherche des paramètres du faisceau d’électrons pour un modèle Monte Carlo, permettant une intégration plus simple et automatisée de nouveaux appareils dans Moderato.
In radiation therapy, the accuracy of the dose delivered to the patient during the course of treatment is of great importance to progress towards improved quality and coherence of the outcome data. One of the first steps to evolve towards a Clinical-Decision Support System (CDSS) is to be able to accurately reconstruct that delivered dose, taking into account the range of factors that can potentially generate significant differences between the planned dose visualized on the screen of the dosimetrist, and the actually delivered dose accumulated during the treatment sessions. These factors include accelerator output variations, commissioning uncertainties, dose computation errors, patient and organ movement, etc.The objective of this work is to implement and test a Monte Carlo platform for the validation of the Cyberknife and Tomotherapy systems installed at Centre Oscar Lambret. A study of a small field-dedicated detector (the microLion ionization chamber) is also included, this detector being particularly suited for measurements on the Cyberknife system.The context and theoretical concepts are introduced in the first two chapters. In the third chapter, the Monte Carlo modelling of the Cyberknife and microLion detector is detailed. The fourth part includes the description of the Monte Carlo platform Moderato and its evaluation module. In the final chapter, the modelling of the latest MLC-equipped Cyberknife model (the M6) is described. A new technique is also introduced to accelerate the optimization of the beam electron parameters of a Monte Carlo model, thus allowing for an easier and more automated use of the Moderato system.
Doctorat en Sciences biomédicales et pharmaceutiques (Médecine)
info:eu-repo/semantics/nonPublished

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Launchbaugh, Karen L. "Ecological Implications of Flavor Generalization by Sheep: Role of Flavor Intensity and Variation in Toxin Dose." DigitalCommons@USU, 1992. https://digitalcommons.usu.edu/etd/3542.

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Researchers studying diet selection of ungulate herbivores have generally considered plant palatability independent of animals' dietary history. However, more recent studies demonstrate that experiences within the life of an animal strongly influence plant selection. We are beginning to understand how food preferences and aversions are formed through gastro-intestinal feedback. My research specifically examines factors that influence the formation of conditioned flavor aversions in the generalist herbivore, sheep. I first examined how variability of food toxicity affects the intake of those foods. I determined that sheep apparently have several mechanisms for regulating intake of toxic foods regardless of whether or not toxic variation can be detected through flavor changes. When changes in flavor correspond to changes in toxicity, animals adjusted intake based on an increase or decrease in toxin concentration. When toxic variation was not detectable through flavor, animals adopted a conservative strategy of eating an amount based on the maximum toxin dose they had experienced.' I was also interested in how illness following the consumption of one food influences the selection of other foods. In diet selection, animals may generalize selection responses among foods with similar flavors. Generalization may be particularly important in the selection of novel foods, i.e., a new food may look, smell, or taste like a familiar food that is preferred or avoided. In several experiments on the generalization of flavor aversions I found that: 1) sheep generalize aversions from familiar to novel foods when both foods had a flavor in common; 2) the more sick an animal got after eating a food the greater the aversion formed to the food and the greater the generalization of that aversion to new foods; 3) the salience or intensity of flavor did not affect the strength of conditioned flavor aversions in sheep on the generalization of the aversion, but this may not always be the case; 4) flavor intensity strongly influenced the acceptance of a novel food. A novel food (wheat) with a strong flavor (3% added ground oregano) was more avoided than a novel food (wheat) with a mild flavor (1% oregano added).

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Olofsson, Lennart. "Energy and intensity modulated radiation therapy with electrons." Doctoral thesis, Umeå : Department of Radiation Sciences, Radiation Physics, Umeå University, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-491.

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Wong, Tony Po Yin, and tony wong@swedish org. "Improving Treatment Dose Accuracy in Radiation Therapy." RMIT University. Applied Sciences, 2007. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20080104.144139.

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The thesis aims to improve treatment dose accuracy in brachytherapy using a high dose rate (HDR) Ir-192 stepping source and in external beam therapy using intensity modulated radiation therapy (IMRT). For HDR brachytherapy, this has been achieved by investigating dose errors in the near field and the transit dose of the HDR brachytherapy stepping source. For IMRT, this study investigates the volume effect of detectors in the dosimetry of small fields, and the clinical implementation and dosimetric verification of a 6MV photon beam for IMRT. For the study of dose errors in the near field of an HDR brachytherapy stepping source, the dose rate at point P at 0.25 cm in water from the transverse bisector of a straight catheter was calculated with Monte Carlo code MCNP 4.A. The Monte Carlo (MC) results were used to compare with the results calculated with the Nucletron Brachytherapy Planning System (BPS) formalism. Using the MC calculated radial dose function and anisotropy function with the BPS formalism, 1% dose calculation accuracy can be achieved even in the near field with negligible extra demand on computation time. A video method was used to analyse the entrance, exit and the inter-dwell transit speed of the HDR stepping source for different path lengths and step sizes ranging from 2.5 mm to 995 mm. The transit speeds were found to be ranging from 54 to 467 mm/s. The results also show that the manufacturer has attempted to compensate for the effects of inter-dwell transit dose by reducing the actual dwell time of the source. A well-type chamber was used to determine the transit doses. Most of the measured dose differences between stationary and stationary plus inter-dwell source movement were within 2%. The small-field dosimetry study investigates the effect of detector size in the dosimetry of small fields and steep dose gradients with a particular emphasis on IMRT measurements. Due to the finite size of the detector, local discrepancies of more than 10 % are found between calculated cross profiles of intensity modulated beams and intensity modulated profiles measured with film. A method to correct for the spatial response of finite sized detectors and to obtain the

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Lindberg, Felicia, and Rytterborg Julia Fex. "Anti-stressträning : En kvantitativ tvärsnittsstudie." Thesis, Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:gih:diva-5682.

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Syfte och frågeställningar: Syftet är att studera om träning på olika intensitetsnivåer påverkar upplevd stress hos kvinnor i Sverige. Denna studie kommer svara på dessa frågeställningar:

Is there a difference in perceived stress in women who participate in low-intensity exercise in the form of walking compared to women who participate in high-intensity exercise in the form of running? Is there a difference in perceived stress in women who participate in high-intensity exercise in the form of running compared to women who do not exercise at all? Is there a difference in perceived stress in women who participate in low-intensity exercise in the form walking compared to women who do not exercise at all? Method: The study is a cross-sectional study, through questionnaires, differences in perceived stress have been compared in women with a mean age of 39,03 years (± 14,44), who either exercised with high intensity or with low intensity. The results have been compared to a reference group consisting of non-training women. Perceived Stress Scale-10 (PSS10) together with ten intensity-questions for inclusion in the study was sent out via social media, Facebook. Results: A significant difference was detected in the comparison of the high intensity group and the reference group, (p=0.001), score difference in PSS10; 7,67 points. No significant difference between the high-intensity group and the low-intensity group (p=0.737), the same applied to the low-intensity group and the reference group (p=0,081). Conclusions: Women who participated in high intensity exercise had reduced percieved stress compared to women who did not exercise at all. No difference in percieved stress was observed between women who participated in low intensity exercise and women who participated in high intensity exercise. Similarly, no difference in percieved stress in women who participated in low intensity exercise and women who did not exercise at all.

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Kawamura, Mitsue. "A scoring system predicting acute radiation dermatitis in patients with head and neck cancer treated with intensity-modulated radiotherapy." Kyoto University, 2019. http://hdl.handle.net/2433/244519.

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Bergman, Alanah Mary. "Monte Carlo simulation of x-ray dose distributions for direct aperture optimization of intensity modulated treatment fields." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/30720.

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This thesis investigates methods of reducing radiation dose calculation errors as applied to a specialized x-ray therapy called intensity modulated radiation therapy (IMRT). There are three major areas of investigation. First, limits of the popular 2D pencil beam kernel (PBK) dose calculation algorithm are explored. The ability to resolve high dose gradients is partly related to the shape of the PBK. Improvements to the spatial resolution can be achieved by modifying the dose kernel shapes already present in the clinical treatment planning system. Optimization of the PBK shape based on measured-to-calculated test pattern dose comparisons reduces the impact of some limitations of this algorithm. However, other limitations remain (e.g. assuming spatial invariance, no modeling of extra-focal radiation, and no modeling of lateral electron transport). These limitations directed this thesis towards the second major investigation - Monte Carlo (MC) simulation for IMRT. MC is considered to be the "gold standard" for radiation dose calculation accuracy. This investigation incorporates MC calculated beamlets of dose deposition into a direct aperture optimization (DAO) algorithm for IMRT inverse planning (MC-DAO) . The goal is to show that accurate tissue inhomogeneity information and lateral electronic transport information, combined with DAO, will improve the quality/accuracy of the patient treatment plan. MC simulation generates accurate beamlet dose distributions in traditionally difficultto- calculate regions (e.g. air-tissue interfaces or small (≤ 5 cm² ) x-ray fields). Combining DAO with MC beamlets reduces the required number of radiation units delivered by the linear accelerator by ~30-50%. The MC method is criticized for having long simulation times (hours). This can be addressed with distributed computing methods and data filtering ('denoising'). The third major investigation describes a practical implementation of the 3D Savitzky-Golay digital filter for MC dose 'denoising'. This thesis concludes that MC-based DAO for IMRT inverse planning is clinically feasible and offers accurate modeling of particle transport and dose deposition in difficult environments where lateral electronic dis-equilibrium exists.
Science, Faculty of
Physics and Astronomy, Department of
Graduate

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Ishida, Yuichi. "Intensity-modulated radiotherapy for cervical esophageal squamous cell carcinoma without hypopharyngeal invasion: dose distribution and clinical outcome." Doctoral thesis, Kyoto University, 2020. http://hdl.handle.net/2433/245831.

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京都大学
0048
新制・課程博士
博士(医学)
甲第22146号
医博第4537号
新制||医||1039(附属図書館)
京都大学大学院医学研究科医学専攻
(主査)教授大森孝一, 教授富樫かおり, 教授武田俊一
学位規則第4条第1項該当
Doctor of Medical Science
Kyoto University
DFAM

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20

Naik, Mehul S. "Dose calculation of megavoltage IMRT using convolution kernels extracted from GafChromic EBT film-measured pencil beam profiles : a dissertation /." San Antonio : UTHSC, 2006. http://proquest.umi.com/pqdweb?did=1251893631&sid=1&Fmt=2&clientId=70986&RQT=309&VName=PQD.

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21

Lynch, Daniel P. "The effect of polymer dose and mixing intensity on sludge dewatering with a plate and frame filter press." Thesis, Virginia Tech, 1989. http://hdl.handle.net/10919/44124.

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Experiments were performed with anaerobically digested sludge and a plate and frame filter press to determine filter press performance over a range of polymer doses and under a variety of sludge and polymer mixing conditions. In addition, bench-scale polymer dosing and mixing experiments were conducted with the same sludge samples to determine the relationship between the bench-scale tests and actual plate and frame filter press performance. Dewatering rate was measured in bench- scale experiments with a Capillary Suction Time (CST) device and dewatering rate in pilot-scale experiments was quantified by measuring the volume of filtrate from the plate and frame press. The dimensionless quantity, Gt, was used to measure total mixing intensity input where G was the mean velocity gradient and t was the mixing time for the sludge and polymer.

The performance of the plate and frame filter press was optimized by predicting polymer dose with a bench-scale mixing device. For the plate and frame filter press used in this study, the polymer dose was selected by finding the optimum polymer dose for the bench-scale mixing system set at a Gt value of 30,000. The sludge and polymer were mixed with a Gt value of 5000 prior to introduction to the filter press. The polymer dosing and mixing scheme that was developed for the filter press in this study indicates that the filter press imparts some shear (G) on the sludge and that polymer must be provided to reagglomerate fractured sludge particles. An estimate of the Gt value for the filter press that was used in this study is 15,000 to 40,000.

Master of Science

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22

Helal, Azza Mahmoud. "The effect of patient anatomy on optimised intensity modulated radiotherapy dose distributions for head and neck and prostate cancer." Thesis, University of Nottingham, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.438639.

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23

Peet, Samuel. "Out-of-field dosimetry in contemporary radiation therapy." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/234916/1/9325565_samuel_peet_thesis.pdf.

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Radiation therapy is a beneficial treatment for approximately half of all people diagnosed with cancer. This project improved the safety of radiation therapy for several vulnerable cohorts: pregnant patients, patients with electronic implants such as pacemakers, and young people at risk of developing secondary cancers later in life. In doing so, this research furthered equitable access to safe, high-quality health care.

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24

Starks, Michael Anthony. "The effects of a 600 mg dose of soy phosphatidylserine on cortisol, growth hormone and testosterone response to moderate intensity exercise /." Full text available from ProQuest UM Digital Dissertations, 2008. http://0-proquest.umi.com.umiss.lib.olemiss.edu/pqdweb?index=0&did=1850459371&SrchMode=1&sid=1&Fmt=2&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1279306653&clientId=22256.

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Thesis (Ph.D.)--University of Mississippi, 2008.
Typescript. Vita. "May 2008." Major professor: Scott Owens Includes bibliographical references (leaves 93-104). Also available online via ProQuest to authorized users.

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25

Foley, Jessica Lynne. "High-intensity focused ultrasound as a novel method of nerve conduction block : dose-dependent effects range from partial to complete block /." Thesis, Connect to this title online; UW restricted, 2006. http://hdl.handle.net/1773/7981.

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26

Inokuchi, Haruo. "Clinical effect of multileaf collimator width on the incidence of late rectal bleeding after high-dose intensity-modulated radiotherapy for localized prostate carcinoma." Kyoto University, 2016. http://hdl.handle.net/2433/215942.

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27

Moreno, Miriam Zarza. "Monte Carlo simulations for dosimetric verification in photon and electron beam radiotherapy." Doctoral thesis, Faculdade de Ciências e Tecnologia, 2012. http://hdl.handle.net/10362/7835.

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Dissertação para obtenção do Grau de Doutor em Engenharia Biomédica
One of the primary requirements for successful radiotherapy treatments is the accurate calculation of dose distributions in the treatment planning process. Monte Carlo (MC) dose calculation algorithms are currently recognized as the most accurate method to meet this requirement and to increase even further dose accuracy. The improvements in computer processor technology and the development of variance reduction techniques for calculations have led to the recent implementation and use of MC algorithms for radiotherapy treatment planning at many clinical departments. The work conducting to the present thesis consists of several dosimetric studies which demonstrate the potential use of MC dose calculations as a robust tool of dose verification in two different fields of external radiotherapy: electron and photon beam radiotherapy. The first purpose of these studies is to evaluate dose distributions in challenging situations where conventional dose calculation algorithms have shown some limitations and it is very difficult to measure using typical clinical dosimetric procedures, namely in regions containing tissue inhomogeneities, such as air cavities and bones, and in superficial regions. A second goal of the present work is to use MC simulations to provide a detailed characterization of photon beams collimated by a multileaf collimator (MLC) in order to assess the dosimetric influences of these devices for the MC modeling of Intensity Modulated Radiotherapy (IMRT) plans. Detailed MC model of a Varian 2100 C/D linear accelerator and the Millenium MLC incorporated in the treatment head is accurately verified against measurements performed with ionization chambers and radiographic films. Finally, it is also an aim of this thesis to make a contribution for solving one of the current problems associated with the implementation and use of the MC method for radiotherapy treatment planning, namely the clinical impact of converting dose-to-medium to dose-to-water in treatment planning and dosimetric evaluation. For this purpose, prostate IMRT plans previously generated by a conventional dose algorithm are validated with the MC method using an alternative method, which involves the use of non-standard CT conversion ramps to create CT-based simulation phantoms.
Fundação para a Ciência e Tecnologia; Centro de Física Nuclear da Universidade de Lisboa

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28

Sperl, Jonathan Immanuel [Verfasser], Mathias [Akademischer Betreuer] Richter, Sibylle [Akademischer Betreuer] Ziegler, and Martin [Akademischer Betreuer] Brokate. "Optimized Intensity Modulation for Dose/Noise Reduction in X-ray Computed Tomography / Jonathan Immanuel Sperl. Gutachter: Mathias Richter ; Sibylle Ziegler. Betreuer: Martin Brokate." München : Universitätsbibliothek der TU München, 2011. http://d-nb.info/1016035063/34.

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29

Vieira, Wilson Albieri. "Avaliação da ototoxicidade em pacientes portadores de meduloblastoma submetidos à radioterapia com reforço de dose com intensidade modulada do feixe (IMRT)." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-19122011-115428/.

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INTRODUÇÃO: A combinação de radioterapia e altas doses de cisplatina no tratamento do meduloblastoma tem se mostrado causa de importante ototoxicidade. Com a introdução da técnica de intensidade modulada do feixe (IMRT), tornou-se possível diminuir a dose média de radiação no aparelho auditivo. OBJETIVOS: O objetivo é determinar se com a radioterapia com reforço de dose com IMRT, é possível atingir índices menores de perda auditiva e se há um limite de dose no ouvido para a mesma. Analisar também se o volume de ouvido contornado durante o planejamento inverso influencia o resultado. MÉTODO: Quarenta e um pacientes com meduloblastoma (idade mediana, 10 anos) com audição normal ao início da radioterapia com IMRT foram avaliados retrospectivamente. O último seguimento e a última audiometria realizada após o término da radioterapia foram considerados. A função auditiva foi graduada em uma escala de 0 a 4 de acordo com os critérios de toxicidade do Pediatric Oncology Group (POG). As doses mínima, máxima, média e mediana recebidas pelo aparelho auditivo, bem como o volume contornado no planejamento do IMRT foram correlacionados com o grau de função auditiva. Foi realizada análise univariada e multivariada dos dados. RESULTADOS: O seguimento mediano foi de 41 meses (12,8 a 71) para avaliação audiométrica e 44 meses (14-72) para a sobrevida global. As doses medianas mínima, máxima, média e mediana recebidas pelo aparelho auditivo foram respectivamente de: 3785 (589,4 a 4758,2), 4832,5 (3724 a 5447,9), 4366,5 (2808,5 a 5097,3) e 4360,5 (2878 a 5031,1). Sete pacientes (17%) apresentaram perda auditiva graus 3 e 4. A análise univariada entre as variáveis não mostrou diferença com significância estatística, exceto para a dose de cisplatina (P < 0,03). Na análise multivariada com regressão logística, a dose mediana no aparelho auditivo foi um fator significativo para a perda auditiva graus 3 e 4 (P < 0,01), ao passo que a dose cumulativa de cisplatina apresentou tendência à perda graus 3 e 4 (P = 0,075). Não houve correlação entre o volume contornado no planejamento a perda auditiva. Perda auditiva graus 3 e 4 foi incomum com dose mediana no aparelho auditivo menor que 42 Gy (P = 0,063) e dose cumulativa de cisplatina abaixo de 375 mg/m² (P < 0,01). Nenhum paciente que recebeu carboplatina em substituição à cisplatina apresentou perda auditiva grave. Não houve associação, com significância estatística, entre as variáveis analisadas e a ototoxicidade, quando estes pacientes foram excluídos da análise. Quatro pacientes morreram e dois apresentaram recidiva no momento do estudo, levando a uma sobrevida global de 90% e uma sobrevida livre de doença de 85% em 44 meses. CONCLUSÕES: Os resultados mostram que o tratamento com IMRT leva a uma baixa taxa de perda auditiva grave, mesmo com um seguimento maior, o que é consistente com outros estudos. Acreditamos ser seguro contornar somente a cóclea e que uma dose mediana para a mesma deve ser mantida abaixo de 42 Gy. A quimioterapia com cisplatina continua a ter um papel importante no tratamento, no entanto a dose cumulativa não deve exceder 375 mg/m². A sobrevida foi impressionante neste estudo, uma vez que 21 (51,2%) foram classificados como alto risco
INTRODUCTION: The combination of radiation therapy and cisplatin chemotherapy for the treatment of medulloblastoma is a known cause of important ototoxicity. With the introduction of intensity-modulated radiation therapy (IMRT), it became possible to deliver less radiation to the auditory apparatus. PURPOSE: To determine if boost radiotherapy with IMRT can achieve a lower rate of hearing loss and if theres a cutoff dose for it. Also, to analyze whether the auditory apparatus volume contoured in inverse planning influences the outcome. METHODS: Forty-one pediatric medulloblastoma patients (median age, 10 years) with normal hearing at the time of radiation with IMRT were retrospectively evaluated. The last audiogram and follow-up from the completion of radiation were considered. Hearing function was graded on a scale 0 to 4 according to Pediatric Oncology groups toxicity criteria. Minimum, maximum, mean and median doses to the inner ear and its volume contoured in IMRT planning, as well the cisplatin dose were recorded and correlated with hearing function. Univariate and multivariate data analysis were performed. RESULTS: The median follow-up was 41 months (range 12.8-71.0 months) for audiometric evaluation and 44 months (range 14-72 months) for survival. Median doses for minimum, maximum, mean and median in the inner ear were respectively: 3785 (range, 589.4 to 4758.2), 4832.5 (range 3724 to 5447.9), 4366.5 (range 2808.5 to 5097,3) and 4360,5 (range 2878 to 5031,1). Seven patients (17%) have experienced Grade 3 or 4 hearing loss. Univariate analysis showed no difference among the variables with statistical significance, except for cisplatin dose (P < 0.03). In multivariate analysis with logistic regression, median dose in inner ear was a significant factor for hearing loss grade 3 or 4 (P < 0,01), meanwhile cisplatin dose had a trend to hearing loss grade 3 or 4 (P = 0.075). There was no relationship between the auditory apparatus volume contoured in planning and hearing loss. Grade 3 or 4 hearing loss were uncommon with median dose to the inner ear bellow 42 Gy (P = 0.063) and cisplatin dose less than 375 mg/m² (P < 0.01). None of the patients who received carboplatin in lieu of cisplatin had severe hearing loss. There was no statistically significant association between ototoxicity and the variables, when these patients were excluded from the analysis. Four patients died and two have recurred at the time of the study with a 90% overall survival rate and 85% disease free survival in 44 months. CONCLUSIONS: Our findings shows that IMRT treatment leads to a low rate of serious hearing loss even with a longer follow-up, which is consistent with others trials. We believe that is safe to contour only the cochlea and that a median dose to it should be kept below 42Gy. Cisplatin chemotherapy continues to have an important role in treatment, however doses should not exceed 375 mg/m². Survival rates were impressing in this trial given the fact that 21 (51.2%) patients were classified as high risk

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30

Ashida, Ryo. "Impact of interfractional anatomical variation and setup correction methods on interfractional dose variation in IMPT and VMAT plans for pancreatic cancer patients: A planning study." Doctoral thesis, Kyoto University, 2020. http://hdl.handle.net/2433/259002.

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京都大学
0048
新制・課程博士
博士(医学)
甲第22734号
医博第4652号
新制||医||1046(附属図書館)
京都大学大学院医学研究科医学専攻
(主査)教授妹尾浩, 教授増永慎一郎, 教授川口義弥
学位規則第4条第1項該当
Doctor of Medical Science
Kyoto University
DFAM

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31

Aizawa, Rihito. "Increased risk of disease progression in younger men: Analysis of factors predicting biochemical failure and castration-resistant prostate cancer after high-dose intensity-modulated radiation therapy for nonmetastatic prostate cancer." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/263542.

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32

Peris, Melanie Ellen. "A Boot Camp Approach to Remediating Interdental /s/ in a School-Aged Child." BYU ScholarsArchive, 2013. https://scholarsarchive.byu.edu/etd/3891.

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The relationship between speech articulation therapy dose (frequency, intensity, duration) and treatment outcomes are poorly understood. Identifying optimal therapy doses for specific articulation disorders is essential to providing efficient clinical care. Recent research indicates that intensive speech therapy doses-known as boot camps-may promote rapid improvement and generalization for certain speech disorders. Therefore the present investigation examined the effects of a boot camp speech therapy approach to remediate interdental /s/ production in an 8-year-old male. The boot camp included two days of speech therapy involving visual, tactile, and auditory feedback approaches. Therapy was administered 5.5 hours per day across morning and afternoon sessions. Treatment outcomes were evaluated using auditory-perceptual ratings of pre- and post-treatment word pairs. The results indicated that /s/ production improved significantly immediately following the boot camp and improvements were sustained at one week post-treatment (p < 0.05). Medial and final /s/ productions improved more so than the initial /s/ productions. These findings suggest that the speech therapy boot camp approach may be effective for certain individuals with speech sound disorders. Future research should explore dose-response relationships among speech articulation therapy dose in other children with speech sound disorders.

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33

Leveque, Emilie. "Modélisation statistique de l'intensité des expositions prolongées en étiologie du cancer : application au tabac, à l'amiante, au cancer du poumon, et au mésothéliome pleural." Thesis, Bordeaux, 2018. http://www.theses.fr/2018BORD0315/document.

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L'association entre le tabac et le cancer du poumon ou entre l'exposition professionnelle à l'amiante et le mésothéliome pleural ont largement été étudiées. Cependant, comme pour de nombreuses autres relations expositions prolongées-cancer, le rôle de l'intensité d'exposition tout au long de la vie a été peu étudié. La prise en compte de la variation de l'intensité au cours de la vie et de son effet dépendant du temps dans les analyses statistiques des données cas-témoins pose en effet quelques défis méthodologiques. Les objectifs de la thèse étaient 1) d'étudier l'effet dépendant du temps de l'intensité d'exposition au cours de la vie sur le risque de cancer et 2) d'identifier les profils de trajectoires d'intensité d'exposition sur la vie entière et comparer les risques de cancer associés. Pour répondre à ces deux objectifs, nous avons utilisé un indice cumulé d'exposition pondéré flexible déjà existant et nous avons développé un nouveau modèle conjoint à classes latentes, pour analyser les données de deux études cas-témoins françaises sur le mésothéliome pleural et le cancer du poumon. Les résultats montrent la contribution importante de l'intensité de la consommation de tabac récente pour le cancer du poumon et des expositions professionnelles anciennes à l'amiante pour les deux cancers. Ils confirment l'importance de considérer l'aspect temporel des expositions pour évaluer l'association avec le risque de cancer et illustrent l'intérêt des approches statistiques considérées
The association between smoking and lung cancer or between occupational exposure to asbestos and pleural mesothelioma have been extensively investigated. Nevertheless, as for many protracted exposures-cancer relationships, the role of exposure intensity over lifetime has been rarely addressed. Accounting for individual variation of intensity over lifetime and investigating time-dependent effect in the statistical analysis of case-control data indeed raise several methodological issues. The thesis objectives were 1) to study the time-dependent effect of exposure intensity over lifetime on the risk of cancer and 2) to identify lifetime profiles of exposure intensities and to compare their associated risks of cancer. To address these objectives, we used an existing flexible weighted cumulative index of exposure and we developed a new joint latent class mixed model, to analyze the data from two French case-control studies on lung cancer and pleural mesothelioma. The results show the important contribution of recent smoking intensity for lung cancer and distant intensity of exposure to asbestos for both cancers. They confirm the importance of the timing of exposure in the association with the risk of cancer and illustrate the relevance of the proposed statistical approaches

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Bane, Maria H. "Vocal Function Exercises for Normal Voice: The Effects of Varying Dosage." UKnowledge, 2016. http://uknowledge.uky.edu/commdisorders_etds/8.

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The primary purpose of this investigation was to explore the effects of variable doses of home practice Vocal Function Exercises (VFEs) on attainment of pre-established maximum phonation time (MPT) goals in individuals between the ages of 18 and 25 with normal voice. A secondary purpose was to monitor for potentially toxic effects of high doses of VFEs. Three experimental groups completed a six-week VFE protocol and practiced twice daily. The low dose group performed each exercise once, the traditional group twice, and the high dose group four times. Results indicated significant change in VFE MPT for all three groups and higher goal attainment in the high dose group. Low doses appear insufficient to produce substantial change in voice production. Acoustic MPT improved most in the traditional dosage group, which also exhibited best maintenance and best overall outcomes. No toxic effects in vocal fold condition or phonation were observed or measured secondary to high VFE exposure.

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35

Watanabe, Érika Yumi. "Comparação da técnica de radioterapia em arco modulada volumetricamente (VMAT) em relação à técnica de radioterapia de intensidade modulada (IMRT) para tumores de próstata e cabeça e pescoço." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-12042016-151104/.

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As técnicas de radioterapia vem sendo constantemente modificadas com a implementação de novas tecnologias visando aumentar a eficiência e diminuir a toxicidade dos tratamentos com radiação ionizante. Esse trabalho visa comparar as técnicas de radioterapia de intensidade modulada (IMRT) e a radioterapia em arco modulada volumetricamente (VMAT) em termos dosimétricos para o alvo e órgãos em risco além de avaliar a diferença do tempo de tratamento utilizando cada técnica. Para assegurar que os planejamentos seguiriam um padrão aceitável para ambas as técnicas, realizou-se primeiramente os planejamentos sugeridos pelo TG 119 da Associação Americana de Física Médica e compatibilidade dos resultados obtidos comparados com os dados da literatura. Tal comparação permitiu prosseguir para uma próxima etapa que consistiu da utilização de imagens de pacientes reais que foram submetidos a tratamentos de próstata e cabeça e pescoço, para a realização dos planejamentos utilizando as técnicas de IMRT e VMAT. A qualidade dosimétrica dos planejamentos utilizando ambas as técnicas foi avaliada em termos de conformidade e homogeneidade da dose no alvo e para os casos de pacientes com câncer de próstata, foram investigados os limites de dose em reto, bexiga e cabeça de fêmur, sendo avaliada a associação entre o volume de intersecção de reto e bexiga com o alvo. Para os casos de pacientes com câncer de cabeça e pescoço, em termos dos limites de dose em medula, tronco cerebral e parótidas. Os planejamentos nos quais fez se uso da técnica de VMAT apresentaram valores semelhantes aos dos planos de IMRT. A análise dos tempos de tratamento para cada técnica avaliada mostrou que a VMAT reduz significativamente o tempo, até 67% para os casos de pacientes com câncer de próstata e até 36% para os casos de pacientes com câncer de cabeça e pescoço
The goal of this study was to compare the dosimetric aspects of volumetric-modulated arc therapy (VMAT) with those of intensity-modulated radiotherapy (IMRT) and to evaluate the delivery time and monitor unit differences between the two techniques, for applications in prostate and head and neck cancer treatment. First of all, to assure an acceptable pattern of treatment planning using both techniques, the TG119 of American Association of Medical Physics instructions were followed and the results of plans were compared to TG119 published data. The next step consisted of using real patients\' images, whose underwent prostate radiotherapy or head and neck radiotherapy, to planning IMRT and VMAT. The dosimetric quality of plans using both techniques was evaluated in terms of target dose conformity and target dose homogeneity The dose constraints for rectum, bladder and femoral head were analyzed and the association between the rectum intersection volume and bladder intersection volume to the target volume were evaluated for the prostate cases. The dose constraints for spinal cord, brainstem and parotids were investigated for the head and neck cases. Best or similar values were obtained for the VMAT plans in relation to IMRT plans. The analysis of treatment time indicated a significant reduction using VMAT, until 67% to the prostate cases and 36% to the head and neck cases

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Silva, Stella Marys Rigatti. "Características dos recém-nascidos pré-termo com peso inferior a 1.500g e sepse neonatal tardia." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/106934.

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O aumento da sobrevida dos recém-nascidos de muito baixo peso elevou a taxa de sepse tardia nas Unidades de Terapia Intensiva Neonatal. Esses recém-nascidos necessitam de longos períodos de internação e são submetidos a diversos tratamentos que os colocam em risco de adquirir infecção. Na sepse tardia, os sintomas ocorrem a partir do quarto dia de vida ─ ou com mais de 72 horas de vida ─ e está relacionada com fatores neonatais, acometendo mais frequentemente recém-nascidos prematuros de baixo peso, que se encontram internados nas Unidades de Terapia Intensiva Neonatal, sendo os agentes responsáveis de origem hospitalar. Este estudo teve o objetivo de caracterizar os recém-nascidos pré-termo com peso inferior a 1.500g identificando a incidência de sepse neonatal tardia. Trata-se de um estudo observacional, descritivo e prospectivo, cuja amostra foi composta por 30 recém-nascidos pré-termo com peso inferior a 1.500g, internados em Unidade de Terapia Intensiva Neonatal de um Hospital de Universitário de Porto Alegre. A coleta de dados foi realizada por meio de um instrumento, registrando-se prospectivamente os dados dos pré-termos do período de 01 de janeiro de 2013 a 31 de dezembro de 2013. O estudo foi aprovado pela Comissão de Ética e Pesquisa da Instituição em que se desenvolveu a pesquisa. Os resultados demonstraram que dentre os 30 neonatos incluídos no estudo, 14 desenvolveram sepse neonatal tardia, representando 47% do total de RNMBP, prevalecendo o S. coagulase negativo em 12 recém nascidos, o que representou 86% de hemocultura positiva com S. coagulase negativo na amostra com sepse neonatal tardia. A maioria dos neonatos nasceu de cesariana (78%), com média de 28 ± 2 semanas de idade gestacional, sendo que 50% dos pré-termos foi classificado como pequeno para idade gestacional. O tempo de hospitalização dos recém-nascidos teve uma média de 62 ± 27 dias. O presente estudo sugere que incidência de sepse neonatal tardia em RN com peso inferior a 1.500g representa uma preocupação constante dos profissionais devido a vulnerabilidade desses pré-termos por necessitarem de tecnologias de intensivismo. Estudos futuros são necessários para investigar a população de pré-temos com peso inferior a 1.500g, buscando os fatores de riscos associados e sepse neonatal tardia a fim de elaborar e testar estratégias que promovam a prevenção da infecção nosocomial.
The increased survival of preterm low birth weight infants, results in ongoing risk of infection on Neonatal intensive care units. Very low birth weight (VLBW) neonates are in need of extra care for longer time in Neonatal intensive care units due to higher risk of infection. Late-onset sepsis’s symptoms can be detected 72 hours after the birth. This type of sepsis is healthcare-associated and is especially more easily acquired by low birth weight preterm infants. Its objective was to evaluate risk factors of late-onset sepsis in 30 preterm newborns who weigh less than 1.500g. This is an observational, prospective and descriptive study which was held in a University hospital’s Neonatal intensive care units. It was used a research tool to prospectively collect preterm neonates’ data from January, 01 2013 to December, 01 2013. The study was approved by the Institution’s Ethics and Research Committee. Results demonstrate that 14 of 30 newborns developed late-onset sepsis, which represents 47% of the Very low birth weight infants. Presence of Coagulasenegative staphylococci prevailed in 12 Very low birth weightneonates, which depicts 86% of positive blood culture for Coagulase-negative staphylococci. The majority of the infants (78%) were born by cesarean section at 28 ± 2 weeks average of gestational age. Half of the newborns (50%) were classified as small for gestational age. Neonates were hospitalized for 62 ± 27 days average. Future studies should continue investigating Very low birth weight newborns in order to develop the research on risk factor associated to late-onset sepsis, which also aims at preventing nosocomial infections in that population.
El aumento de la supervivencia de los recién nacidos con muy bajo peso elevó la taja de sepsis tardía en las Unidades de cuidados intensivos neonatales. Estos recién nacidos necesitan de períodos de internación prolongados y suelen ser sometidos a varios tratamientos que los ponen en riesgo de contraer infecciones. En la sepsis tardía, los síntomas se producen a partir del cuarto día de vida – o con más de 72 horas de vida – y están relacionados con factores neonatales, que acometen más a menudo los niños prematuros de bajo peso al nacer, que son hospitalizados en las Unidades de cuidados intensivos neonatales, siendo los agentes responsables de origen hospitalario. Este estudio tuve el objetivo de caracterizar los recién nacidos prematuros con peso inferior a 1.500g cuanto a los factores de riesgo para la sepsis neonatal tardía. Se trata de un estudio observacional, descriptivo y prospectivo, cuya amuestra fue compuesta por 30 recién nacidos prematuros con peso inferior a 1.500g, hospitalizados en la Unidades de cuidados intensivos neonatales de un Hospital Universitario de la ciudad de Porto Alegre. La captura de dados fue realizada por medio de un instrumento que registraba prospectivamente los dados de los prematuros, el periodo comprendido entre el 01 Enero 2013 hasta 31 de diciembre 2013. El estudio fue aprobado por la Comisión de Ética y Pesquisa de la institución donde la pesquisa fue desenvuelta. Los resultados mostraron que entre los 30 recién nacidos, 14 desarrollaron sepsis neonatal tardía, lo que representa 47% del total de recién nacidos con muy bajo peso, con prevalencia de S. coagulase negativo en 12recién nacidos con muy bajo peso, que representó 86% de hemocultivo positivo en las amuestras de sangre con sepsis neonatal tardía. La mayoría de los prematuros nació por cesárea (78%), con edad gestacional media de 28 ± 2 semanas y 50% de estos niños fueron clasificados como pequeños para la edad gestacional. El tiempo de hospitalización de los recién nacidos con muy bajo peso tuve una duración media de 62 ± 27 días. Otros estudios futuros son necesarios para investigar la población de prematuros con peso inferior a 1.500g, buscando los factores de riesgo asociados a la sepsis neonatal tardía, con la intención de elaborar y testar estrategias para la promoción de la prevención de la infección hospitalaria.

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Alves, Aline Soares. "O perfil dos recém-nascidos de risco internados na unidade de terapia intensiva neonatal do hospital universitário dr. Miguel Riet Corrêa Jr." reponame:Repositório Institucional da FURG, 2005. http://repositorio.furg.br/handle/1/5981.

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Este estudo descritivo, exploratório com abordagem quantitativa foi desenvolvido com 61 recém-nascidos (RN) de risco internados na Unidade de Tratamento Intensivo Neonatal do Hospital Universitário Dr. Miguel Riet Corrêa Jr. - cujas famílias eram residentes no município do Rio Grande/RS. Os dados foram colhidos no período de abril a setembro de 2005, utilizando-se uma entrevista semiestruturada aplicada às mães durante o período de internação de seus filhos. O estudo buscou identificar os fatores pré e perinatais que influenciaram as condições de nascimento levando à necessidade de internação do RN. Dentre estes foram investigadas as características socioeconômicas, demográficas e biológicas maternas, a história gestacional e reprodutiva da mãe e as condições de nascimento da criança, propriamente ditas. Após a análise dos dados verificou-se que 60,7% dos RN que fizeram parte do estudo apresentaram baixo peso ao nascimento (BPN) e 49,2% eram pré-termos. Dos RNs avaliados 62,3% nasceram por cesariana, sendo que destas 14,8% foram referidas como eletivas pelas mães. Quanto à situação socioeconômica 85,2% das mães relatou renda familiar per capta inferior a dois salários mínimos, sendo que 75,4% delas não exercia atividade remunerada. Das entrevistadas 83,6% vivia com companheiro e 47,5% possuía mais de oito anos de estudo. A maioria das mulheres era de cor branca (68,9%) e tinha entre 20 e 34 anos (59%). Salienta-se que 26,2% das mães tinha idade inferior a 19 anos. Das mulheres que souberam informar seu peso pré-gestacional (56), 84,4% relatou peso superior a 50 Kg. Entre as mães entrevistadas 41% eram primíparas e 23% referiram já ter tido três ou mais gestações. Das mulheres com história de gestação anterior (36), 38,9% já havia tido no mínimo uma gestação finalizada em aborto e 25% referiu ter tido natimortos. História de BPN e pré-termos prévios foi referida por 27,8% e 38,9% dessas mães, respectivamente. A maioria das mulheres (93,4%) realizou o pré-natal, sendo que 59,6% referiu seis ou mais consultas. Das mulheres assistidas 66,7% iniciaram o pré-natal no 1º trimestre de gestação. Entre as patologias mais prevalentes na gestação destacam-se a infecção urinária, a anemia e a hipertensão arterial relatadas por 49,2%, 44,3% e 23% das mulheres. Sem desconsiderar o aspecto socioeconômico das famílias dos RNs que fizeram parte do estudo, os resultados mostram que apesar da cobertura ser elevada, a assistência pré-natal no município necessita ser revista em sua qualidade para reduzir sobretudo a ocorrência de patologias maternas durante a gestação e o nascimento de RNs pré- termos e/ou com BPN, devendo ser redrobada a atenção durante o pré-natal às mulheres com história de desfechos gestacionais desfavoráveis. Outro aspecto a ser ressaltado é o índice elevado de cesarianas. Estes resultados servem de alerta aos enfermeiros e demais profissionais de saúde e autoridades responsáveis pela saúde do município do Rio Grande, ressaltando a importância da adoção de medidas para prevenir os principais fatores que levam aos desfechos indesejáveis.
This descriptive and exploratory study with quantitative boarding it was developed with 61 newborn children of risk interned in the neonatal intensive care unit of the University Hospital Dr. Miguel Riet Corrêa Jr. located at Rio Grande City - whose families were resident in the city of Rio Grande/RS. The data had been harvested in the period of April the September of 2005, using a semi-structured interview applied to the mothers during the period of internment of its children. The study it searched to identify the factors pre and perinatais that had influenced the birth conditions leading to the necessity of internment of the newborns. Amongst these they had been investigated the mothers social economic characteristics, demographic and biological, and the gestational and reproductive history of the mother and the conditions of birth of the child had been investigated, properly said. After the analysis of the data was verified that 60.7% of the newborn children that had been part of the study they had presented low weight to the birth and 49.2% were pre-terms. Of the newborns evaluated 62.3% they had been born for cesarean, being that of these 14.8% had been related as elective by the mothers. How much to social economic situation 85.2% of the mothers told familiar income to per catches inferior the two minimum wages, being that 75.4% of them did not exert remunerated activity. Of interviewed 83.6% told that lived with a partner and 47.5% had eight years of study. The majority of the women was of white color (68.9%) and had between 20 and 34 years (59%). Salient that 26.2% of the mothers had inferior age of 19 years. Of the women whom they had known to inform its weight before gestational period (56), 84.4% told to superior weight the 50 kg between interviewed mothers 41% were first pregnancy and 23% had related that already had three or more gestations. Of the women with history of previous pregnancy(36), 38.9% already had at least a pregnancy finished in abortion and 25% related to had an infant borned dead. History of BPN and previous pre-terms was related by 27, 8% and 38, 9% of these mothers, respectively. The majority of the women (93.4%) carried through the prenatal medical care, being that 59.6% related six or more consultations. Of attended women 66.7% they had initiated prenatal medical care in 1º the trimester of pregnancy. Between the pathologies most prevalent in the pregnancy is distinguished: Urinary Infection, anemia and the arterial hypertension for 49, 2%, 44.3% and 23% of the women. Without disrespecting the socio and economic aspect of the families of the newborns who had been part of the study, the results show that although the covering to be raised, the prenatal medical assistance in the city need to be reviewed in its quality to reduce over all the occurrence of the maternal pathologies during the gestation and the birth of pre-terms newborn children and/or with BPN, having to be redoubled the attention during the prenatal care to the women with history of favorable pregnancies outcomes. Another aspect to be salient is the high index of cesareans. These results serves as an alert to the nurses and of health and responsible authorities for the health of the city of Rio Grande, standing out the importance of the adoption of measures to prevent the main factors that lead to the outcomes undesirable.
Este estudio descriptivo, exploratorio con abordaje cuantitativo se desarrolló con 61 recién nacidos (RN) de riesgo internados en la Unidad de Tratamiento Intensivo Neonatal del Hospital Académico Dr. Miguel Riet Corrêa Jr. – cuyas familias eran residentes en el distrito municipal de Río Grande/RS. Los datos se escogieron en el período de abril a septiembre de 2005, usándose una entrevista segmentada aplicada a las madres durante el período de la internación de sus niños. El estudio buscó identificar los factores de antes y alrededor del nacimiento que influyeron en las condiciones del parto que arrebatan en la necesidad de internación del RN. Entre estos se investigó las características socioeconómica, demográfica y biológica maternas, el periodo de gestación y reproductivo de la madre y las condiciones del nacimiento del niño, bien marcadas. Después del análisis de los datos se verificó que 60,7% de RN que eran parte del estudio presentaron el peso bajo al nacimiento (BPN) y 49,2% eran los prematuros. De RNs estimados 62,3% nacieron por cesárea, y de estos 14,8% fueron electivas por las madres. En lo que pese a la situación socioeconómica 85,2% de las madres dijeron recibir sueldo familiar per capta inferior a dos sueldos mínimos, y 75,4% de ellas no ejercían actividades que generasen dinero. De las entrevistadas 83,6% de ellas residían con compañero y 47,5% tenían más de ocho años de estudio. La mayoría de las mujeres eran de color blanco (68,9%) y tenían entre 20 y 34 años (59%). Está puntiagudo fuera eso 26,2% de las madres tenían la edad inferior a 19 años. De las mujeres que conocieron informar su peso antes de la gestación (56), 84,4% decían obtener el peso superior a 50 Kg. Entre las madres entrevistadas 41% eran primíparas y 23% refirieron haber tenido tres o más gestaciones. De las mujeres con la historia de gestación anterior (36), 38,9% ya habían tenido por lo menos una gestación terminada en aborto y 25% referirán haber tenido nacido muerto. La historia de BPN y prematuros previos fue referida por 27,8% y 38,9% de esas madres, respectivamente. La mayoría de las mujeres (93,4%) realizó el prenatal, y 59,6% refirieron seis o más consultas. De las mujeres asistidas 66,7% empezaron el prenatal en el 1° trimestre de gestación. Entre las patologías más frecuentes en la gestación se destacan la infección urinaria, la anemia y la hipertensión arterial dicen 49,2%, 44,3% y 23% de las mujeres. Sin desconsiderar el aspecto socioeconómico de las familias de RNs que eran parte del estudio, los resultados muestran que además de la cobertura ser elevada, la asistencia prenatal en el municipio necesita de revisión en su cualidad para disminuir la ocurrencia de patologías maternas durante la gestación y el nacimiento de RNs prematuros y/o con BPN, siendo de demasiada atención durante el prenatal a las mujeres con resultados de gestaciones desfavorables. Otro aspecto a ser destacado es el índice alto de cesáreas. Estos resultados sirven como alarma a los enfermeros y otros profesionales de salud y a las autoridades responsables para la salud del distrito municipal de Río Grande, dando énfasis a la importancia de la adopción de medidas para prevenir los factores principales que resultan a los fines indeseables.

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Alyafai, Ayoob. "CEO Power and Audit Quality: Does Monitoring Intensity Matter?" Thesis, Curtin University, 2021. http://hdl.handle.net/20.500.11937/88693.

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The thesis examines whether chief executive officers (CEOs) use their power to influence audit quality, proxied by audit fees and the likelihood of receiving a going-concern opinion. In addition, this thesis examines the moderating role of internal and external monitoring on the association between CEO power and audit quality to assess whether monitoring intensity can counterbalance CEO power. The findings of this study have several implications for regulators, auditors, investors, and academic researchers.

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Guerrer, Francine Jomara Lopes. "Estresse dos enfermeiros que atuam em unidades de terapia intensiva no Brasil." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-20042007-102303/.

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O presente estudo propõe um levantamento do nível de estresse e dos principais estressores presentes entre enfermeiros de unidades de terapia intensiva (UTI) das regiões geográficas do Brasil. A população estudada foi constituída por 263 enfermeiros atuantes nas UTIs dos diversos hospitais de alta complexidade das capitais dos Estados brasileiros. Os dados foram coletados utilizando-se a Escala Bianchi de Stress, constituída por caracterização sociodemográfica e 51 itens que versam sobre as atividades desempenhadas pelos enfermeiros. A análise estatística foi descritiva e inferencial, foi utilizado o alfa de Cronbach para avaliar a confiabilidade dos dados, os testes não-paramétricos de Man-Whitney e Kruskall-Wallis para testar a diferença nas classificações de grupos independentes, e a análise de variância ANOVA, quando o valor do teste foi significativo. Com a finalidade de promover a comparação e estudo dos dados, foi realizado o escore de estresse em 6 domínios, englobando o relacionamento (A), funcionamento da unidade (B), administração de pessoal (C), assistência de enfermagem (D), coordenação da unidade (E) e condições de trabalho (F). Os níveis obtidos foram classificados em baixo (até 3,0), médio (de 3,1 a 4,0), alerta (de 4,1 a 5,9) e alto (acima de 6,0). A amostra foi eminentemente feminina (91,6%), jovem (80,2% com menos de 40 anos), sendo a maioria da população com 2 a 5 anos de formado (34,6%), atuantes na UTI há aproximadamente 5 anos, sendo 87,8% enfermeiros assistenciais, 71,5% atuantes de UTI geral, 74,5% com pós-graduação Latu-Sensu, 38,8% atuantes na Região Nordeste. Os enfermeiros obtiveram escore individual de estresse entre 2,41 e 5,21, porém a maioria ficou entre médio e alerta. Considerando-se o escore de estresse por Região, obteve-se que SE>CO>N>NE>S para a análise dos 6 domínios, obteve-se C>F>E>D>B>A, independentemente da região geográfica a que pertencia o enfermeiro. A presença de uma pós-graduação para os domínios C e D apresentaram relação estatisticamente significante (p < 0,05), na qual foi encontrada diferença para os enfermeiros da Região Sudeste que apresentaram níveis mais elevados comparados aos da Região Nordeste. Fica patente que a resposta aos estressores da UTI depende da avaliação individual e que a administração de pessoal é um estressor presente em todas as Regiões Brasileiras
This study suggests a lift of stressors among Brazilian nurses who work at Intensive Care Units (ICU) of Brazilian´s area. The sample was constituted by 263 nurses who work at high complexity hospitals in the capitals of Brazilian States. Data was obtained using a Bianchi Stress Inventory´ that enclosed socio-demographic data and 51 items which turn on the activities developed by nurses. Statistical analysis was described and inferential, using Cronbach alpha to evaluate the reliability of data, the Man-Whiney and Kruskall-Wallis non-parametric tests in order to check the difference in the classifications of independent groups, and the analysis of variance by ANOVA, when the value was significant. In order to promote the comparison and the study of data, it was used a score of stress and classified into 6 areas: relationship (A), unit functioning (B), staff administration (C), nursing assistance (D), unit coordination (E) and work conditions (F). The stress level was classified in low (under 3,0), medium (from 3,1 to 4,0), alert (from 4,1 to 5,9) and high (above 6,0). The sample was eminently feminine (91,6%); young (80,2% under 40 years old); from 2 to 5 years after finishing a graduation course (34,6%); has worked at ICU for 5 years as assistant nurses (87,8%), has worked in general ICU (71,5%), Latu-Sensu post-graduated (74,5%), and 38,8% has worked in Northeast States. The individual score stress of nurses varied from 2,41 to 5,21 considered from medium to alert. The stress score among Regions in decrescent order was: Southeast > Center-West > North > Northeast > South. After analyzing the six areas, the classification was: C > F > E > D > B > A, and it was independent of geographical localization. Having an after-graduation to areas C and D was statically significant (p<0,05) in which was found difference to nurses of Southeast with high level of stress comparing to the ones in Northeast. Then the answer to stressors in ICU depends on the individual evaluation and staff administration is a stressor in all Brazilian Regions

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Guerrer, Francine Jomara Lopes. "Estresse e enfrentamento dos familiares de pacientes internados em unidades de terapia intensiva." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-04112013-145806/.

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A hospitalização de um membro da família pode ser percebida como um estressor, já que o estresse é uma reação particular entre a pessoa e o ambiente, podendo gerar desorganização no núcleo familiar, exigindo adaptação. Com o intuito de minimizar o estresse vivenciado, os indivíduos desenvolvem estratégias para enfrentar o estressor, no caso, a hospitalização de seu familiar. A proposta deste estudo foi levantar o nível de estresse e as estratégias de enfrentamento dos familiares de pacientes internados em unidades de terapia intensiva no primeiro dia, após a realização de cirurgia cardíaca. É um estudo descritivo, exploratório, transversal de campo e de análise quantitativa. A coleta de dados foi realizada em um hospital governamental, de grande porte da cidade de São Paulo, utilizando um instrumento de coleta de dados socioeconômico, a escala de estresse percebido (PSS) e o inventário de enfrentamento de Jalowiec. A amostra foi composta por 282 familiares que aceitaram participar da pesquisa, mediante a assinatura do Termo de Consentimento Esclarecido. O perfil demográfico da população do estudo foi: 169 (59,9%) filhos dos pacientes; 191 (67,7%) gênero feminino; 86 (30,5%) com idade entre 31 e 40 anos; 189 (67%) casados; 99 (35,1%) com ensino médio completo; 129 (45,7%) com vínculo empregatício e 105 (38,2%) renda de 1 a 2 salários-mínimos. O nível de estresse de 99 (35,1%) familiares na escala PSS foi considerado baixo. Não houve diferença estatisticamente significante no estudo das variáveis sexo e estado de saúde do paciente visitado. Obteve-se significância estatística em relação à idade; familiares mais idosos utilizam mais estratégias de enfrentamento comparado aos mais jovens e os estilos mais utilizados foram: Confrontivo, Paliativo e Sustentativo; os familiares solteiros utilizam menos estratégias de enfrentamento comparado aos casados, e o estilo Sustentativo foi o mais utilizado. Observou-se também que os familiares casados apresentaram menores níveis de estresse. Os familiares com baixa renda salarial usaram mais estratégias de enfrentamento comparados aos de renda mais elevada. E o estilo mais empregado foi o Otimista. Comparando-se aos de renda mais elevada, os familiares de baixa renda utilizaram mais o estilo Fatalista. Concluiu-se que o nível de estresse do familiar depende de sua característica individual que da situação de saúde do familiar e das estratégias de enfrentamento por ele usadas. Recomenda-se que o enfermeiro tenha um papel importante e imprescindível na orientação e acompanhamento desse familiar, para o sucesso e segurança do tratamento do paciente sob seus cuidados.
The hospitalization of a Family member can be perceived as a stressor, once stress is a particular reaction between the person and the environment, it may disorganize the Family nucleus somehow, demanding adaptation. In order to minimize the stress faced, the individuals develop strategies to cope the stressor, in this case, the hospitalization of their Family member. The purpose of this study was to identify the stress level and the strategies of these Family members to deal with their inpatients in intensive care units on the first day after the cardiac surgery. It is a descriptive, exploratory, cross-field and quantitative analysis study. The data collection was performed in a large-sized public hospital in the city of Sao Paulo, using a social-economic data collection tool, the perceived stress scale (PSS) and the Jalowiec coping inventory. The sample consisted of 282 family members who accepted to attend this research by signing the informed consent form. The populations demographic profile of this study was: 169 (59,9%) patients children; 191 (67,7%) female; 86 (30,5%) with age between 31 and 40 years old; 189 (67%) married; 99 (35,1%) with complete high school level; 129 (45,7%) with employment link; 105 (38,2%) with an income of 1 or 2 minimum wages. The stress level of 99 (35,1%) members in the PSS scale was considered low. There were no statistically significant differences in the study of the variables gender and health status of the visited patients. There was an statistical significance related to age, elderly relatives use more coping strategies than the younger ones and the most used styles were: confrontive, palliative and supportant uses; the single ones use less coping strategies compared to the married ones and the most used style was the supportant one. It was also observed that the married relatives presented lower stress levels. The relatives with low income use more coping strategies than the ones with higher income and the most used style is the Optimistic one. Comparing to the ones with higher income, the ones with lower income use more the Fatalistic one. Its concluded that the stress level of the Family member depends more on their individual characteristic than on the health status of the relative and their coping strategies. Its recommended that the nurse play an important and essential role in the orientation and follow-up of these Family members for the success and safety of the patients treatment in his/her care.

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Silva, Ana Paula de Andrade. "Educação permanente: uma estratégia para redução dos incidentes no preparo e administração dos medicamentos intravenosos na terapia intensiva." Universidade Federal Fluminense, 2016. https://app.uff.br/riuff/handle/1/4247.

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Mestrado Profissional em Ensino na Saúde
O objeto do estudo é a educação permanente em saúde a partir de aspectos técnicos observados no preparo e administração de medicamentos intravenosos na terapia intensiva. O objetivo geral foi analisar incidentes no preparo e administração da terapia medicamentosa intravenosa, como estratégia de educação permanente. Os objetivos específicos foram descrever a prática laborativa da equipe técnica na terapia medicamentosa intravenosa no cenário do estudo; analisar as características da assistência prestada pela equipe técnica de saúde que se associam ao aparecimento dos incidentes no preparo e administração dos medicamentos no setor investigado; e propor programa na perspectiva da educação permanente em saúde baseados nos incidentes encontrados no preparo e administração dos medicamentos intravenosos. Material e Método: Pesquisa descritiva, com abordagens qualitativa e quantitativa e observação participante, tendo sido aprovada pelo Comitê de Ética em Pesquisa da UFF sob parecer nº 1.118.304. Foi desenvolvida em um Centro de Tratamento Intensivo de Adulto na Região do Médio Paraíba, no Estado do Rio de Janeiro. Os sujeitos do estudo foram os Auxiliares e Técnicos de Enfermagem que aceitaram participar e concordaram com os procedimentos éticos disciplinados pela Resolução nº 466/12. Toda a observação realizada utilizou como instrumento um roteiro sistematizado, tipo check-list. Critério de inclusão: medicações intravenosas preparadas e administradas por Auxiliares e Técnicos de Enfermagem sob prescrição médica. Critério de exclusão: medicações administradas por ordem verbal. Resultados: Foram totalizadas 169 doses. Conclusão: A frequência mostra que os ofensores incidem na técnica de assepsia, na utilização do equipamento de proteção individual, na limpeza da bancada, na identificação do medicamento, na técnica de administração do medicamento e na técnica de antissepsia para administrar o medicamento. Desta forma, a pesquisa contribui com instrumento para direcionar as condutas na fase de preparo e administração de medicamentos intravenosos
The object of study is Health permanent education based on technical aspects observed during preparation and administration of intravenous medication on intensive care unit. The main goal consisted in analyzing incidents during preparation and administration of intravenous medication, as a strategy to permanent education. The specific goals consisted in describing the work activity, on the study context, of the technical team during intravenous medication therapy; analyzing the characteristics of care provided by the technical health team which is associated to the occurrence of incidents during preparation and administration of medication on the sector under study; and proposing a program about permanent health education based on the incidents that occurred during preparation and administration of intravenous medication. Material and Method: Descriptive research, having qualitative and quantitative approaches and participant observation, which was approved by the UFF’s Ethics on Research Committee under the statement nº 1.118.304. It was developed on an Adult Intensive Care Unit in Médio Paraíba Region, in Rio de Janeiro State. The subjects of study were Nursing Assistants and Technicians who accepted to participate and agreed with the ethic procedures registered on Resolution nº 466/12. The instrument used by the observation was a systemized guide, as a check-list. Inclusion Criteria: intravenous medications prepared and administrated by nursing assistants and technicians on medical prescription. Exclusion criteria: medication administration in verbal order. Results: In total 169 shots. Conclusion: The frequency shows that the errors occur on: asepsis technique, individual protection equipment utilization, work surface cleaning, identification of the medication, and antisepsis technique to the medication administration. Therefore, the research contributes as an instrument to guide how to behave during preparation and administration of intravenous medication

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Manara, Marcos Antonio. "Medida dos parâmetros respiratórios na admissão da UTI pode predizer necessidade de suporte ventilatório, tempo de internação e mortalidade." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5150/tde-08092009-150335/.

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INTRODUÇÃO: Existe uma dúvida na literatura médica se a monitorização respiratória do paciente crítico internado na Unidade de Terapia Intensiva contribuiria para melhora de seu prognóstico. OBJETIVO: Avaliar de maneira prospectiva se a mensuração de parâmetros respiratórios na admissão dos pacientes em ventilação espontânea na Unidade de Terapia Intensiva estaria relacionada com a necessidade de suporte ventilatório, duração da internação dos pacientes na UTI e com a mortalidade hospitalar. MÉTODOS: Foram avaliados prospectivamente 195 pacientes admitidos respirando espontaneamente (37,4% do total das admissões no período do estudo) na Unidade de Terapia Intensiva Adultos do Hospital Israelita Albert Einstein. No momento da admissão, foram medidos o VC espontâneo, a FR, a Pimax, a Pemax, FiO2, SpO2 , FC e foi investigado se o paciente apresentava causa pulmonar para a insuficiência respiratória. Os pacientes foram acompanhados até a alta hospitalar ou óbito. Um modelo de regressão logística por etapas progressivas e um modelo de regressão linear múltipla foram aplicados para avaliação das associações entre os parâmetros mensurados à entrada dos pacientes na UTI e a necessidade de suporte ventilatório, tempo de internação na UTI e mortalidade intrahospitalar. RESULTADOS: A média de idade dos 195 pacientes foi de 62,36±18,67, 77 mulheres. Trinta dos 195 pacientes necessitaram de suporte ventilatório (15,38%) e 20 pacientes morreram durante sua internação no hospital (10,25%). O tempo médio de internação na UTI foi de 5,1±5,8 dias. O modelo de regressão logística selecionou a Pimax (OR=1,04, p=0,018), doença respiratória primária (OR=2,8, p=0,036), FC (OR=1,03, p=0,022) e FiO2 (OR=1,04, p=0,043) como as variáveis relacionadas à necessidade de suporte ventilatório e o volume corrente espontâneo inicial (OR=0,92, p=0,000) como a variável relacionada à mortalidade intrahospitalar. O modelo de regressão linear múltipla selecionou a FC (Coeficiente=0,005, p=0,000), FR (Coeficiente =0,009, p=0,004), VC (Coeficiente = - 0,006, p=0,000) e sexo (Coeficiente =0,128, p=0,009) como as variáveis relacionadas ao tempo de internação na UTI. CONCLUSÃO: Em pacientes admitidos na UTI respirando espontaneamente, uma FC aumentada, necessidade de altas FiO2, Pimax diminuída e a presença de doença respiratória primária estiveram relacionadas com necessidade de suporte ventilatório. Pacientes do sexo masculino, com uma FC aumentada, FR aumentada e um baixo VC espontâneo apresentaram tempo de internação prolongado na UTI. A mensuração de VC espontâneo diminuído à admissão na UTI esteve fortemente relacionada a um aumento da mortalidade hospitalar.
INTRODUCTION: There is a doubt in the medical literature if the patients respiratory monitoring at ICU admission could improve their prognosis. OBJECTIVE: To measure respiratory parameters in patients admitted at ICU in spontaneous ventilation and relate them to the necessity of ventilatory support, length of ICU stay and hospital mortality. METHODS: We prospectively evaluated 195 patients admitted to the Adult ICU of the Albert Einstein Hospital in spontaneous ventilation (37.4% of total study period admissions). At ICU entry, we measured tidal volume (TV), respiratory rate (RR), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), FiO2, SpO2, heart rate (HR) and we verified if the patient had a primary pulmonary disease. The patients were followed till hospital discharge or death. A stepwise logistic regression and multiple linear regression models were built to evaluate the relation of the respiratory parameters at ICU entry and the necessity of ventilatory support, ICU length of stay and intra-hospital mortality. RESULTS: The 195 patients mean age was 62.36±18.67, 77 females. Thirty of 195 patients needed ventilatory support (15.38%) and 20 died in the hospital (10.25%). The mean ICU length of stay was 5.1±5.8 days. The logistic regression model selected MIP (OR=1.04, p=0.018), primary respiratory disease (OR=2.8, p=0.036), HR (OR=1.03, p=0.022) and FiO2 (OR=1.04, p=0.043) as the variables related to the necessity of ventilatory support and the initial TV (OR=0.92, p=0.000) as the variable related to intra-hospital mortality. The multiple linear regression model selected the HR (Coefficient=0.005, p=0.000), RR (Coefficient =0.009, p=0.004), VT (Coefficient = - 0.006, p=0.000) and sex (Coefficient =0.128, p=0.009) as the variables related to the ICU length of stay. CONCLUSION: In spontaneous ventilated patients at ICU admission, a higher HR, higher FiO2, a lower MIP and a primary respiratory diagnosis were related to the necessity of ventilatory support. Male patients with a higher HR, higher RR and lower TV had a prolonged ICU length of stay. The initial measurement of a low spontaneous TV was strongly related to an increase in hospital mortality.

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Secco, Ligia Maria Dal. "Levantamento do custo do procedimento de hemodiálise veno-venosa contínua em Unidades de Terapia Intensiva." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/7/7131/tde-18102006-084027/.

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O procedimento dialítico em Unidade de Terapia Intensiva (UTI) tem evoluído muito nos últimos anos e exigido equipamentos precisos, materiais específicos e profissionais devidamente treinados. Tem havido um aumento progressivo desses procedimentos, sobretudo da Hemodiálise Veno-Venosa Contínua (CVVHD), o que tem gerado questionamentos, pois a limitação de recursos na área da saúde é um problema que atinge as organizações, gerando a necessidade de conhecer os custos da assistência prestada. Este trabalho teve como objetivos: caracterizar a clientela submetida ao tratamento dialítico com CVVHD em UTIs; levantar o tempo de duração dos procedimentos; calcular o custo de mão-de-obra dos enfermeiros e estimar o custo médio direto dos procedimentos. A pesquisa foi do tipo exploratória, descritiva, retrospectiva, documental com abordagem quantitativa. O estudo foi desenvolvido em um hospital-escola público no Município de São Paulo. A amostra constituiu-se de 93 procedimentos realizados em 50 pacientes. Para a coleta de dados, foi elaborado 1 instrumento com 2 partes: uma para o levantamento dos dados da clientela e duração do procedimento e outra para o levantamento e cálculo dos materiais, medicações e soluções utilizadas. Os resultados mostraram predominância do sexo masculino (62%), a idade média foi de 60,8 anos e o tempo de permanência na UTI foi em média 19,2 dias. A insuficiência renal aguda esteve presente em 76% dos pacientes e 24% apresentaram insuficiência renal crônica. Os principais motivos de internação na UTI foram: insuficiência respiratória (30%), rebaixamento do nível de consciência (18%), pós operatório (16%) e choque séptico (12%). A média de procedimentos foi de 1,9 por paciente e 86% evoluíram a óbito. A duração média foi de 26,6 horas variando de 1 a 80 horas. O custo total médio do procedimento foi de R$ 2.065,36 variando de R$ 733,65 a R$ 6.994,18. O custo de mão-de-obra direta do enfermeiro foi em média R$ 592,04 variando de R$ 22,50 a R$ 1.800,00 e representou 28,7% do custo total. O custo médio do material, medicação e solução foi R$ 1.473,32 com variação de R$ 711,15 a R$ 5.194,18 representando 71,3% do custo total. Houveram variações de custo em relação a quantidade de instalação/desligamento, quantidade de trocas de sistema, quantidade de trocas de dialisador capilar, tipos de soluções e anticoagulantes utilizados. Pelos resultados observa-se uma grande variabilidade dos custos desse procedimento.
Dialitic procedures performed in Intensive Care Unit ( ICU) have been showing continuous advances and consequently demanding appropriate and precision equipment, specific materials, and the most adequately trained professionals.Even though procedures as the continued veno-venous hemodialysis ( CVVHD)are routinely applied , they have been generating high financial expenditures within the healthcare system and thus affecting healthcare institutions which have to carefully assess the provided healthcare costs. The present study was intended to characterize patients submitted to dialitic treatment with CVVHD in ICUs; monitor procedure- time duration; estimate nurses´ labor wages; estim...ate the direct procedures mean costs. This investigation, of an exploratory, descriptive, retrospective and quantitative-documental nature was developed in a public teaching hospital located in the municipality of São Paulo, Brazil .Ninety-three procedures performed in 50 patients were analyzed. Data collection made use of a two-part instrument: one for the patients´data survey and procedure-duration, and the othe one , directed to analysis and cost estimatives of materials, medications, and used solutions. Findings showed the predominance of male patients ( 62%), mean age, 60.8 years, and mean ICU hospitalization time, 19.2 days; 76% of the patients presented acute renal insufficiency while 24% showed chronic renal insufficiency. Main reasons for ICU hospitalization were respiratory insufficiency ( 30%), reduced conscience level ( 18%), post-surgical referral (16%), and septic schock ( 12%). Median of procedures was of 1.9 per patient and 86% death occurrences. Mean procedure duration was 26.6 hours, ranging from 1 ( one) to 80 hours. Mean total expenditure was R$ 2.065,36, with varying amounts of R$ 733,65 to R$ 6.994,18. Direct nurses´wages was approximately R$ 592,04 which showed variations from R$22,50 to R$ 1.800,00, and represented 28.7% of total costs. Mean expenditures with material, medications, and solutions were R$1.473,32, varying from R$ 711,15 to R$ 5. 194,18, representing 71.3% of total costs. Cost variations were observed in the amount of times the equipment was set up and swithched off, number of system changes, number of capillary dialyzer changes, types of used solutions and anticoagulant administration. Viewing the described results, the high variability level involving those procedure costs could be observed.

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Geddes, Donald Robert. "Quality management intensity during IS development : does it influence end-user satisfaction? /." Available to subscribers only, 2007. http://proquest.umi.com/pqdweb?did=1407501711&sid=14&Fmt=2&clientId=1509&RQT=309&VName=PQD.

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Ribeiro, Pâmela Teixeira. "A terminologia dos equipamentos médicos utilizados nas Unidades de Terapia Intensiva (UTIs): uma proposta de estudo." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/8/8142/tde-16032016-150010/.

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O objetivo geral do estudo proposto é analisar a terminologia presente em manuais de empresas fabricantes de equipamentos médicos utilizados nas Unidades de Terapia Intensiva UTIs, cujo tema foi definido em parceria com os especialistas do Grupo de Engenharia Biomédica da UNIFEI. Primeiramente, levantamos a lista dos equipamentos médicos utilizados em UTIs, com o auxílio dos especialistas, e formamos um corpus de estudo. Verificamos a existência de possíveis variantes denominativas no corpus constituído e, posteriormente, analisamos as relações semânticas estabelecidas entre os termos validados. A identificação e a extração dos termos presentes nos manuais foram realizadas por meio da plataforma Terminus, desenvolvida pelo Grupo IULATERM, do Institut Universitari de Lingüística Aplicada da Universitat Pompeu Fabra. A partir dos dados coletados, pudemos verificar a existência de muitas variantes e propusemos uma análise das relações semânticas existentes entre eles. Para esta pesquisa, adotamos a perspectiva teórica veiculada pela Teoria Comunicativa da Terminologia TCT, que considera que as unidades terminológicas são parte da língua geral e apresentam as mesmas características desta, comportando variações denominativas e outros fenômenos.
The overall goal of the proposed study is to analyze the terminology used in manuals of manufacturers of medical equipment used in Intensive Care Units ICUs, theme established in partnership with UNIFEI´s Group of Experts on Biomedical Engineering. First, with the support from experts, a list of medical devices used in ICUs was raised and a study corpus generated. We searched possible denominational variants in the constituted corpus and then analyzed the semantic relations between the validated terms. The identification and extraction of these terms from the manuals were made by the Terminus platform developed by IULATERM Group, Institute for Applied Linguistics at Universitat Pompeu Fabra. From the data collected, we could confirm the existence of many variants and, therefore, propose an analysis of the semantic relationships among them. For this research, we adopted the theoretical perspective conveyed by the Communicative Theory of Terminology, which considers that the terminological units are part of the general language and have the same characteristics, comprising denominational variations and other phenomena.

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Tonini, Tanise Finamor Ferreira. "PERCEPÇÃO DOS ENFERMEIROS DE TERAPIA INTENSIVA SOBRE O CONTROLE DA INFECÇÃO HOSPITALAR." Universidade Federal de Santa Maria, 2013. http://repositorio.ufsm.br/handle/1/7396.

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This study had as main objective to know the perception of nurses regarding the management control of nosocomial infection in Intensive Care Unit Adult and specific objectives to characterize the workers of Adult Intensive Care Unit , to identify how nurses manage the inpatient unit with risk of nosocomial infection , discuss the advantages and difficulties reported by the nurses in the control of hospital infection and to identify the strategies used by nurses in the control and prevention of nosocomial infection. This project is a descriptive qualitative study . The research scenario was the Adult Intensive Care Unit , University Hospital of Santa Maria - Rio Grande do Sul, and the subjects nurses about this place. Data collection was conducted from August to September 2013 using semi - structured interview . Data analysis was by thematic analysis of Minayo , all ethical aspects are respected in accordance with Resolution No. 196/ 96 of the National Health Council Results The following categories were listed : multiplicity of competing demands in the labor process in nursing management control of nosocomial infection in adult intensive care unit and hospital infection control in adult intensive care unit : facilities , difficulties and strategies for prevention . The findings point to the importance of the nurse manager at the hospital infection control , both in patient care , as the actions developed with the nursing staff , so it is expected to contribute to the work of nurses in the Intensive Care Unit and Adult Control Hospital Infection .
Este estudo teve como objetivo geral conhecer a percepção dos enfermeiros acerca do gerenciamento do controle da infecção hospitalar em Unidade de Terapia Intensiva Adulta e como objetivos específicos caracterizar os trabalhadores da Unidade de Terapia Intensiva Adulta; identificar como os enfermeiros gerenciam a unidade com pacientes internados com risco de infecção hospitalar; discutir as facilidades e dificuldades relatadas pelos enfermeiros no controle da infecção hospitalar e identificar as estratégias utilizadas pelos enfermeiros no controle e prevenção da infecção hospitalar. Este projeto é uma pesquisa descritiva de abordagem qualitativa. O cenário da pesquisa foi a Unidade de Terapia Intensiva Adulta do Hospital Universitário de Santa Maria Rio Grande do Sul, e os sujeitos os enfermeiros deste local. A coleta de dados foi realizada nos meses de agosto a setembro de 2013, por meio de entrevista semi-estruturada. A análise de dados foi por meio de análise temática de Minayo, sendo respeitados todos os aspectos éticos conforme Resolução nº196/96 do Conselho Nacional de Saúde. Os resultados foram elencadas as seguintes categorias: multiplicidade de demandas simultâneas no processo de trabalho em enfermagem; gerenciamento do controle de infecção hospitalar em unidade de terapia intensiva adulta e o controle de infecção hospitalar em unidade de terapia intensiva adulta: facilidades, dificuldades e estratégias de prevenção. As conclusões apontam a importância do enfermeiro gerente no controle das infecções hospitalares, tanto no cuidado do paciente, quanto nas ações desenvolvidas junto a equipe de enfermagem, espera-se assim contribuir para o trabalho dos enfermeiros na Unidade de Terapia Intensiva Adulta e no Controle de Infecção Hospitalar.

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Ruivo, Luís Guilherme Antunes Rodrigues. "Produção de suínos em regime intensivo e gestão dos seus efluentes : estudo de caso na região de Leiria." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2017. http://hdl.handle.net/10400.5/14532.

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Dissertação de Mestrado Integrado em Medicina Veterinária
O setor suinícola tem uma forte importância económica e social na região de Leiria, pela sua elevada concentração num pequeno território. Além de benefícios também acarreta graves problemas. Os consumidores e habitantes da região revelam preocupação, nomeadamente, com a poluição ambiental que se estende não só a nível da poluição atmosférica como também da poluição dos cursos de água em que as descargas de efluentes suinícolas são prática frequente. Para fazer face às margens de comercialização mais pequenas, que foram sendo impostas ao longo dos anos, os produtores de suínos têm vindo a tornar-se mais competitivos, unindo-se entre si e formando explorações maiores e mais eficientes. Por vezes, o crescimento económico não acompanha o crescimento na preocupação ambiental e leva a grandes impactes ambientais. Neste trabalho pretende-se dar alguma visibilidade, contribuir para um aprofundamento sobre este tema e apontar possíveis medidas de resolução. Nesse sentido, será feita uma descrição da indústria suinícola, com particular enfoque, na região de Leiria. É tomado com exemplo uma exploração de suínos de dimensão média no concelho de Leiria. Seguidamente, será feita uma caracterização e justificação de vários parâmetros relacionados com este tipo de produção pecuária, como a escolha da genética utilizada, os principais tipos de produção de suínos, neste caso, a produção de leitão de assar e de porco de abate, o respetivo plano de produção, os tipos de alimentação e instalações com referência às regras de bem-estar animal e a importância da biossegurança na produção animal. Em termos ambientais, será feita uma revisão sobre as técnicas aplicadas atualmente na gestão e tratamento de efluentes de forma a minimizar o seu impacte ambiental. Em conclusão, há várias medidas que podem ser adotadas, em primeiro lugar a nível individual como a promoção do uso eficiente da água, que reduzirá o consumo de água e consequentemente, reduzirá o volume de efluente final. O problema da região de Leiria é caracterizado por uma elevada produção de matéria orgânica associada à falta de área disponível para o seu aproveitamento agrícola. A nível regional pode optar-se por uma estratégia concertada, com a produção apenas de leitão de assar ou leitão de engorda que implique a deslocalização das engordas para territórios onde a matéria orgânica seja deficitária, com várias vantagens associadas, como sejam o aumento de produção e diminuição do impacte ambiental. Por outro lado, o investimento numa estação de tratamento de efluentes para as freguesias com maior produção de suínos parece ser uma solução viável, com produção de mais-valias, como a venda de energia elétrica e biofertilizante.
ABSTRACT - INTENSIVE PIG PRODUCTION AND PIG SLURRY MANAGEMENT: CASE STUDY IN THE LEIRIA REGION - The swine sector has a strong economic and social importance in the Leiria region, for its concentration in a small territory. On the other hand, consumers and the inhabitants of the region are worried about the environmental impact associated with this kind of production, namely atmospheric and water pollution, as pig slurry leaks are often reported. To cope with the smaller market margins that have been imposed over the years, pig producers have become more competitive, joining together and forming larger and more efficient farms. Sometimes, economic growth does not follow the same pace as the growth in environmental concerns and leads to major environmental impacts. This document intends to contribute to raising awareness this topic and to point out possible solutions. Thus, a description of the pig industry will be made, with particular focus, in the region of Leiria. Taking as example a medium-sized pig farm in the municipality of Leiria. Beginning with a characterization and justification of several parameters related to livestock production, such as the choice of genetics used, the main types of pig production, in this case, the production of piglets and slaughter pigs, their plan of production, types of feeding and housing with reference to animal welfare rules and the importance of biosecurity in animal production. Regarding the environment, a review of the techniques currently applied in the management and treatment of pig slurry in order to minimize their environmental impact will be made. In conclusion, there are several measures that can be taken, first at the individual level such as promoting the efficient use of water, which will reduce water consumption and consequently, reduce the final slurry volume. The region of Leiria is characterized by a high production of organic matter associated to the lack of available area for its agricultural use, which raises many environment problems. At regional level, a concerted strategy can be adopted, with the production of only piglets, which will imply the relocation of fattening phase to areas where organic matter is insufficient, with several associated advantages such as increased production and reduction of environmental impact. On the other hand, investment in a slurry treatment plant for municipalities with higher pig production seems to be a viable solution, with the production of capital gains, such as the sale of electricity and biofertilizer.
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PERON, GILDA M. M. "Avaliacao dos efeitos do laser em baixa intensidade pela forca de mordida apos os separadores ortodonticos." reponame:Repositório Institucional do IPEN, 2010. http://repositorio.ipen.br:8080/xmlui/handle/123456789/9630.

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Made available in DSpace on 2014-10-09T12:28:52Z (GMT). No. of bitstreams: 0
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Dissertacao (Mestrado Profissionalizante em Lasers em Odontologia)
IPEN/D-MPLO
Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP; Faculdade de Odontologia, Universidade de Sao Paulo, Sao Paulo

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Lara, Thiago Martins. "Estudo dos indicadores durante o desmame da ventilação mecânica em pacientes submetidos à cirurgia cardíaca." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-17102013-143944/.

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Introdução: Desmame da ventilação mecânica representa um importante desafio no ambiente de terapia intensiva. Os preditores ao desmame têm se mostrado pouco sensíveis e a falência na extubação pode determinar prolongada ventilação mecânica, aumento do tempo de permanência na UTI, na internação hospitalar, com consequentemente aumento nos custos hospitalares e aumento da morbidade e mortalidade. O objetivo do estudo foi verificar se novos indicadores: BNP (peptídeo natriurético Tipo-B), CPO (cardiac power out put) e VeRT (tempo de recuperação do volume minuto), são mais sensíveis em comparação aos preditores já utilizado para o desmame ventilatório. Método: Foram prospectivamente avaliados 101 pacientes no pós-operatório de Revascularização do Miocárdio. As variáveis respiratórias analisadas foram: freqüência respiratória, volume corrente, volume minuto, índice de respiração rápida e superficial, complacência estática, índice de oxigenação (PaO2/FiO2). As variáveis hemodinâmicas e metabólicas foram: FC, PAM, PVC, PCP, DC, IC, Lactato, SvO2, ERO2, D(a-v)O2, DO2 e VO2. Foram também testados os novos indicadores CPO, BNP e VeRT. Consideramos aptos para extubação os pacientes que apresentaram nível de consciência adequado e critérios positivos para o desmame corriqueiramente utilizados em U.T.I. Resultados: No total de 713 pacientes observados, 105 pacientes foram incluídos no estudo, desses pacientes quatro não foram extubados por desconforto respiratório, dos 101 pacientes acompanhados, 88 (88%) evoluíram com sucesso ao desmame e 12 (12%) evoluíram com insucesso. Não houve diferença estatisticamente significante entre os grupos, no que diz respeito aos dados antropométricos. As variáveis: freqüência respiratória, volume corrente, volume minuto, índice de respiração rápida e superficial, complacência estática, PaO2/FiO2, FC, PAM, PVC, PCP, DC, IC, DO2, VO2, Lactato e os novos indicadores CPO e VeRT, não foram sensíveis como preditores de sucesso ao desmame. Na análise multivariada o grupo sucesso apresentou até o momento pré-extubação, um menor tempo de permanência de U.T.I. (3,9 x 10,33, p=0, 024), menor tempo de internação hospitalar (11,29 x 16,08, p=0,047), menor necessidade de inotrópico dobutamina (12,90 x 16,67, p=0,049), uma maior SVO2 (69,18 x 61,67, p 0,002), menor ERO2 (0,45 x 0,62, p=0,03), menor D(a-v)O2 (4,34 x 5,10, p=0,039), e um menor nível de BNP (98,94 x 303,33, p=0,020), quando comparado com grupo insucesso, nesta ultima variável BNP à análise da curva ROC, mostrou uma sensibilidade de 83% e especificidade 87%. Conclusão: A prevalência de insucesso ao desmame ventilatório no pósoperatório de cirurgia cardíaca foi de 12%, os pacientes que evoluíram com insucesso apresentaram maior tempo de U.T.I., maior tempo de internação hospitalar e maior necessidade de inotrópico. No momento pré-extubação altos níveis de BNP, D(a-v)O2, ERO2 e baixo valores de SvO2, são preditores de sucesso ao desmame. Com isso a adequada otimização hemodinâmica prévia a extubação deve ser alcançada nessa população para se conseguir um seguro e precoce desmame da ventilação mecânica
Introduction: Weaning from mechanical ventilation represents a major challenge in the intensive care setting. The weaning predictors have shown little sensitivity and extubation failure may determine prolonged mechanical ventilation, prolonged ICU stay and prolonged hospitalization, with a consequent increase in hospital costs and increased morbidity and mortality. The objective of this study was to determine whether new indicators (BNP, CPO and VeRT), are more sensitive compared with predictors already used for weaning. Method: We prospectively evaluated 101 patients in post-operation stage of Myocardial Revascularization. Respiratory variables were analyzed: respiratory rate, tidal volume, minute volume, index of rapid shallow breathing, static compliance, oxygenation index (PaO2/FiO2). The hemodynamic and metabolic variables were: HR, MAP, CVP, PCWP, DC, IC, Lactate, SvO2, ERO2, D(a-v)O2, DO2 and VO2. We also tested the new indicators CPO, BNP and VeRT. We considered suitable for extubation patients that had appropriate levels of awareness and positive criteria for weaning routinely used in ICU. Results: From a total of 713 patients observed, 105 patients were included in the study; from these patients 4 were not extubated because of respiratory distress. From the 101 patients enrolled, 89 (88%) had successful weaning and 12 (12%) developed failure. There was no statistically significant difference between groups with respect to demographics. The variables: respiratory rate, tidal volume, minute volume, index of rapid shallow breathing, static compliance, PaO2/FiO2, HR, MAP, CVP, PCWP, DC, CI, DO2, VO2, lactate and new indicators CPO and VeRT were not as sensitive predictors of successful weaning. In multivariate analysis the group that had success until the pre-extubation stage a shorter length of stay in ICU (3.9 x 10.33, p = 0 024), shorter hospital stay (11.29 x 16.08, p = 0.047), less need for inotropic dobutamine (12.90 x 16.67, p = 0.049) greater SVO2 (69.18 x 61.67, p <0.002), lower ERO2 (0.45 x 0.62, p = 0.03), lower D(a-v)O2 (4.34 x 5.10, p = 0.039), and a lower level of BNP (98.94 x 303.33, p = 0.020) when compared to the failure group; this last variable BNP, in the ROC curve analysis, showed a sensitivity of 83 % and specificity of 87%. Conclusion: The prevalence of failure in ventilatory weaning in post-operatory of cardiac surgery was 12%; patients who developed failure had longer ICU and hospital stay and greater need for inotropic medicine. Upon pre-extubation high levels of BNP, D(a-v)O2, ERO2 and low values of SvO2 are strong predictors of successful weaning. With that, adequate hemodynamic optimization prior to extubation in this population must be reached to achieve a safe and early weaning from mechanical ventilation

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Amado, Elaine. "Educação interprofissional e prática colaborativa em terapia intensiva: perspectiva dos profissionais da saúde." Universidade Federal de Alagoas, 2016. http://www.repositorio.ufal.br/handle/riufal/1439.

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Before the assumptions of SUS (THE Brazilian Unified Health System), the hospital must apply integrality as an organizing axis to the health practice as well as stimulate values among professionals that support its greater concept, requiring a closer relationship between team workers and interprofessional colaboration. This academic work contains a cientific article, as a result of field research for the master’s degree program and also a technical product regarding the subject. The study, from which the article had been born, has as its main aim to investigate the availability and readiness towards Interprofessional Education and colaborative practice in Intesive Therapy. It has been a transversal research, with both quantitative and qualitative approaches and it took place at the ICU (Intensive Care Unit) of a public hospital for emergencies. Forty-three professionals amongst doctors, nurses, psychologists, nutritionists and physiotherapists had taken part in the research, those from the muiltiprofessinal team at the intensive care unit for adults. During data collection, LIKERT questionnaires have been adopted, The Readiness for Interprofessional Learning Scale (RIPLS), also two theme open-ended questions have been analyzed. The RIPLS, validated by PEDUZZI & NORMAN 2012 is composed by 26 assertive disposed in three dimensions: Team work and Collaboration; Professional identity and Patient care, respectively. In order to perform quantitative data analysis, there has been used descriptive statistics and co-relations. The qualitative data has been submitted to theme analysis. On the subjects profile within the research, it has bee made clear that most were female, average age 36,7 year-old and 12 years graduated. The responses to RIPLS have shown readiness from the team towards Interprofessional work and collaborative practice in two dimensions: Team work and Collaboration and Patient care. However, a worrying situation has been shown regarding Professional identity. There have also been disagreements between qualitative and quantitative data on the following dimension: Team work and Collaboration. The study apprehended the relevance of Interprofessional education in the intensive care practice, aiming at better professional conditions to deal with health care, once it potentiates the development of the referred skills, better Interprofessional communication, leading to attention to the subject through the integrality perspective. Although the same team ignores the importance of such education during the formation of the team work itself, showing some attachment to Professional Identity. From these results were developed three technical products: 1) Reflective feedback through a meeting the coordinators of professional categories and managers of the sectors education and development of people, human resource and study center; 2) Technical Report 3) Scientific publications. The products were designed to promote reflection on the results of research carried out, contribute to the development of educational and enhancement to collaborative and interprofessional practice. The results presentation has qualified the up mentioned research, enabling self-criticism and also providing with and efficient dialogic and healthy atmosphere. Besides, it has allowed reaching the purpose of the professional Master’s degree, showing an opportunity to self-criticism that transforms the educational praxis.
Diante das premissas do Sistema Único de Saúde, o hospital deve instituir a integralidade como um eixo organizador das práticas de saúde e estimular nos profissionais valores que sustentem seu conceito ampliado, que requer um estreito relacionamento entre os membros da equipe e a colaboração interprofissional. Este trabalho acadêmico de conclusão de curso consta de um artigo científico, oriundo de uma pesquisa desenvolvida no campo de trabalho da mestranda, e de três produtos técnicos voltados para o tema. O estudo que gerou o artigo científico teve como objetivo conhecer a disponibilidade e prontidão dos profissionais de saúde para a educação Interprofissional e para prática colaborativa em terapia intensiva. Trata-se de uma pesquisa de caráter transversal, com abordagens quantitativa e qualitativa, realizada na Unidade de Terapia Intensiva de um Hospital Público de Urgência e Emergência. Participaram da pesquisa 43 profissionais, dentre estes, médicos, enfermeiros, fisioterapeutas, psicólogos e nutricionistas integrantes das equipes multiprofissionais da unidade de terapia intensiva adulto. No processo de produção de dados, utilizaram-se o questionário, tipo Likert, The Readiness for Interprofessional Learning Scale (RIPLS), e a análise temática de duas perguntas abertas. O RIPLS, validado por Peduzzi e Norman (2012), composto por 26 assertivas dispostas em três dimensões: Trabalho em Equipe e Colaboração, Identidade profissional e Cuidado Centrado no Paciente. Para a análise dos dados quantitativos utilizaram-se estatística descritiva e correlações. Os dados qualitativos foram submetidos à análise temática. No perfil dos sujeitos da pesquisa evidenciouse que a maioria era do sexo feminino, idade média de 36,7 anos e tempo médio de formados de 12 anos. As respostas ao RIPLS mostraram uma prontidão da equipe ao trabalho interprofissional e prática colaborativa em duas dimensões: trabalho em equipe e colaboração e atenção centrada no paciente; e uma situação preocupante para a dimensão identidade profissional. Observaram-se também discordâncias no diálogo entre os dados quanti e qualitativos na dimensão Trabalham em Equipe e Colaboração, e concordância para identidade profissional. O estudo apreendeu a relevância da educação interprofissional na prática da unidade de terapia intensiva, visando a um melhor preparo dos profissionais para o cuidado em saúde, uma vez que potencializa o desenvolvimento de competências referentes a práticas colaborativas, à comunicação interprofissional e ao cuidado com o sujeito na perspectiva da integralidade. Porém, a mesma equipe desconhece a importância dessa educação na formação do grupo para o trabalho em equipe, apresentando aprisionamento à identidade profissional. A partir destes resultados foram desenvolvidos três produtos técnicos: 1) Feedback Reflexivo através de uma reunião os coordenadores das categorias profissionais e gestores dos setores educação e desenvolvimentos de pessoas, recursos humanos e centro de estudos; 2) Relatório Técnico e 3) Publicações Científicas. Os produtos tiveram o intuito de promover uma reflexão sobre os resultados da pesquisa realizada, contribuíssem com o desenvolvimento de ações educativas e de aprimoramento para prática colaborativa e interprofissional. O momento para apresentação dos resultados foi uma iniciativa que qualificou a pesquisa realizada, possibilitando a autocrítica e favorecendo para um ambiente de diálogo eficiente e saudável. Além disso, permitiu atingir os propósitos do Mestrado Profissional, demonstrando uma oportunidade de avaliação crítica e transformadora nos espaços de prática educativa.

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