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1
Khalili, Payam. "Risk factors for cardiovascular events and incident hospital-treated diabetes in the population." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-24173.
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Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Well-established risk factors for CVD include increasing age, male sex, sedentary lifestyle, obesity, smoking, diabetes, hypertension, dyslipidaemia and low socio-economic status. Traditional risk factors do, however, not fully explain cardiovascular risk in general. In this thesis we focused on two conventional risk factors (smoking, blood pressure), and two unconventional risk markers (adiponectin, an adipocyte derived protein; and sialic acid (SA), a marker of systemic inflammation) for prediction of CVD events. Aims: In Paper I we examined to what degree smoking habits modify the risk of CVD in relation to systolic blood pressure levels in middle-aged men. In Paper II we investigated the predictive role of adiponectin for risk of CVD as well as the cross-sectional associations between adiponectin and markers of glucose metabolism, also in men. In Paper III we examined if increasing pulse pressure (PP) and increasing levels of SA both increase the risk of CVD and whether their effects act in synergism. In Paper IV the association of SA with risk of incident diabetes mellitus and related complications, resulting in hospitalization, was studied. Subjects and Methods: Two large-scale, population-based, screening studies with long follow-up periods have been used. The Malmö Preventive Project (MPP) was used with 22,444 individuals in Paper I and a sub cohort of 3,885 individuals in Paper II. The Värmland Health Survey (VHS) was used in Papers III and IV with 37,843 and 87,035 individuals, respectively. Results: CVD risk increases with increasing systolic blood pressure levels and this risk is almost doubled in smokers. Total adiponectin level is not associated with increased risk of future CVD but it is inversely associated with markers of glucose metabolism. PP and SA both contribute to risk of future CVD. Adjustment for mean arterial pressure reduces the risk induced by PP. Elevated SA contributes to increased risk of incident diabetes and related complications leading to hospitalization.
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TenNapel, Mindi Joy. "Oxidative stress genes and gender-specific analysis of lifespan, blood pressure, and incident stroke in the Iowa 65+ cohort." Diss., University of Iowa, 2015. https://ir.uiowa.edu/etd/6651.
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Reactive oxygen species are formed internally through cellular metabolism and through external sources including radiation and pollutants. They play an important role in physiologic functions; however, when reactive oxygen species exceed our body’s antioxidant defense system, oxidative stress can occur. Oxidative stress has been implicated in aging and aging-related diseases including cancer and cardiovascular disease. Numerous oxidative stress genes produce antioxidative enzymes to mitigate the effects of reactive oxygen species. Single nucleotide polymorphisms within these genes may impact the functionality of antioxidant enzymes produced leaving the body more susceptible to damage from oxidative stress.
The Iowa 65+ Rural Health Study was one of the four study populations in the Established Population for Epidemiologic Studies of the Elderly (EPESE) project initiated by the intramural Epidemiology, Demography and Biometry Program of the National Institute on Aging in 1980. The Iowa cohort was comprised of Iowa county and Washington county residents aged 65 and older at the time of the baseline interview in 1982. Participants completed three in-person interviews and five telephone interviews over eight years which collected data on habits, lifestyle and disease. During the
in-person Year 06 interview participants were asked to donate a blood sample. The DNA extracted from the samples was used in each of the three aims of this project.
The first aim evaluated single nucleotide polymorphisms in selected oxidative stress genes and their association with lifespan while controlling for aging-associated risk factors such as body mass index, comorbidity, alcohol consumption, smoking, and physical activity. Multivariable linear regression models were fit in the framework of the co-dominant genetic model. The oxidative stress genes selected for this project included the sirtuin family of genes (SIRT1-7), two of the forkhead box genes (FOXO1 and FOXO3), superoxide dismutase 2 and 3 (SOD2 and SOD3), glutathione peroxidase (GPX1), AKT, TP53, and CAMK4. A model was fitted with the risk factors before assessing the impact of each single nucleotide polymorphism. The q-value was used to control for the multiple hypothesis tests. Significant associations were detected between human lifespan and SNPs in genes SIRT3, SIRT5, SIRT6, FOXO3, and SOD3; gender modified the effect of SNPs in SIRT3, SIRT5, and AKT1.
The second aim of this project evaluated single nucleotide polymorphisms in selected oxidative stress genes and their association with blood pressure measures while controlling for known risk factors including body mass index, alcohol consumption, smoking, and physical activity. Blood pressure was measured at the baseline and Year 06 interviews. Systolic pressure and diastolic pressure were used to calculate mean arterial pressure and pulse pressure at baseline and Year 06. Multivariable linear regression was used within the co-dominant genetic framework to determine if single nucleotide polymorphisms in SIRT1-7, FOXO1, FOXO3, SOD2-3, GPX1, AKT, TP53, and CAMK4 were associated with systolic, diastolic, mean arterial, or pulse pressure at baseline or Year 06. To examine longitudinal effects, the difference between each measure (i.e., Year 06 systolic – baseline systolic) was calculated for each individual and used to evaluate if any of the single polymorphisms was associated with change in blood pressure measures over time. Significant associations were detected between SIRT1 and SIRT3 and for males in SIRT1 and various blood pressure measures for females. Gender modified the effect of SIRT1, SIRT3, SIRT6, and FOXO1 variants.
The third aim of this project evaluated if these genetic variants were associated with incident stroke while controlling for known risk factors including blood pressure, diabetes, body mass index, alcohol consumption, smoking, and physical activity. Multivariable logistic regression within the framework of the co-dominant genetic model was used. Individuals with the GPX1 genotype TT had 2.76 times the risk of an incident stroke compared to the CC genotype.
This project identified several associations between single nucleotide polymorphisms within oxidative stress genes and lifespan, blood pressure measures, and incident stroke. Gender modified the association of several single nucleotide polymorphisms and lifespan as well as blood pressure measures. These results suggest genetic variation within oxidative stress genes may play a role in aging, blood pressure and incident stroke.
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Pote, Timothy Ryan. "Optical Measurements of High-Viscosity Materials Using Variations of Laser Intensity Incident on a Semi-Rigid Vessel for use in Additive Manufacturing." Thesis, Virginia Tech, 2016. http://hdl.handle.net/10919/79595.
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Additive manufacturing is a growing field dominated by printing processes that soften and re-solidify material, depositing this material layer by layer to form the printed shape. Increasingly, researchers are pursuing new materials to enable fabrication of a wider variety of associated capabilities. This includes fabrication with high-viscosity materials of many new classes of material compositions, such as doping for magnetic or electrically conducting polymers. These additives complicate the materials deposition process by requiring complex, non-linear calibration to synchronize these new candidate materials with the additive manufacturing software and hardware. In essence, additive manufacturing is highly dependent on identifying the delicate balance between materials properties, hardware, and software-which is currently realized via a time-consuming and costly iterative calibration process. This thesis is concerned with reducing this cost of calibration, in particular by providing a time-based metric based on material viscosity for material retraction at the conclusion of each extrusion. It presents a novel non-contact method of determining the material retraction rate (during reversal of extrusion), by measuring the variation in laser intensity resulting from the deformation of the material reservoir due to change in material pressure. Commercially available laser measurement systems cost more than $20,000 and are limited to 1 μm at a 300 ms (3 Hz) sampling rate. The experimental setup presented in this thesis costs less than $100 and is capable of taking measurements of 1 - 2 μm at a 0.535 ms (1870 Hz) sampling rate. For comparison, the stepper motor driving the material extruder operates at 0.667 ms (1500 Hz). Using this experimental setup, an inverse correlation is shown to exist between the viscosity of a material and the rate at which the material is retracted. Using this correlation and a simplified material analysis process, one can approximate the retraction time necessary to calibrate new materials, thereby significantly improving initial estimated calibration settings, and thus reducing the number of calibration iterations required to ready a new material for additive manufacturing. In addition, the insight provided into the material response can also be used as the basis for future research into minimizing the calibration process.<br>Master of Science
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Touré, Ibrahima. "Calculs d'épaisseurs optiques : Évaluation des flux de diverses composantes au sol du rayonnement solaire, application capteur plan classique et capteur à renforcement de flux incident." Nancy 1, 1987. http://www.theses.fr/1987NAN10320.
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Étude de l'estimation des flux du rayonnement solaire à partir de paramètres météorologiques et géophysiques faciles à évaluer, dans les conditions de la zone sahélienne de l'Afrique de l'ouest. Un nouveau capteur dénommé "bac solaire muni de réflecteurs" est proposé pour surmonter le handicap du faible échauffement du capteur plan classique en début de matinée, et permettant d'obtenir une température de 100**(O)C avant 10 heures
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Oliveira, Saúl Álvaro Azevedo Martins de. "Exchange market pressure and incidence of currency crises in Norway." Master's thesis, Instituto Superior de Economia e Gestão, 2015. http://hdl.handle.net/10400.5/11709.
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Mestrado em Economia Monetária e Financeira<br>Este artigo revê o desenvolvimento da literatura teórica sobre crises cambiais, as suas potenciais causas e sintomas a partir dos principais indicadores. É medido a pressão na taxa de câmbio da Noruega durante o período de 1990 a 2015 com o auxílio do conceito de "Exchange Market Pressure" (EMP) desenvolvido por Kaminsky et al. (1998). O modelo demonstra relevância uma vez que os resultados são consistentes com os episódios de stress/ crise do mercado cambial na Noruega durante o mesmo período. Os resultados mostram que as variáveis macroeconómicas seguem o sinal padrão esperado para Noruega.<br>This paper reviews the development of the theoretical literature on currency crises, their potential causes and symptoms through the study of leading indicators. A case study on the pressure upon the Norwegian exchange rate during the period from 1990 to 2015 is measured using the concept of Exchange Market Pressure (EMP) developed by Kaminsky et al. (1998). The model does a fairly competent estimation, since the results are consistent with the episodes of currency market stress/crisis in Norway during the same period. The results show that macroeconomic variables follow the expected pattern for Norway.
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Benson, Claire Margaret. "Investigations into incidents involving the kindling chain of materials in high-pressure oxygen atmospheres." Thesis, London South Bank University, 2015. http://researchopen.lsbu.ac.uk/525/.
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This thesis is a thorough examination of high-pressure enriched oxygen system design and analysis focussing on material selection and incident investigation. The aims are to develop a model to predict spontaneous ignition temperatures (SIT), enable the use of more accessible measurement apparatus, and to devise a scientific methodology to investigate oxygen incidents. Chapter 1 contains examples of incidents in high-pressure enriched oxygen and outlines current methods of material selection and incident investigation. The major flaws with the current systems are explored and the objectives of this work are identified. Chapter 2 details the current state of the knowledge in relation to oxygen incidents. Materials flammability is explored, and the importance of correct material selection is established. The criteria, standards and test methods currently used to aid this decision are assessed, and the importance of proper oxygen incident investigation is determined. Chapter 3 shows a programme of experimental work with details on the use of different apparatus for the measurement of SITs. Data acquired from the BS 4N 100 bomb test, and pressurised, and ambient, differential scanning calorimetry are recorded. The use of Thermal Desorption/Gas Chromatography is explored to identify polymer evaporation and degradation products. In Chapter 4 a simple model is developed to adapt SIT allowing calculation of the SIT of a non-metal in any pressure or oxygen concentration. Data obtained in chapter 3, and from the literature, is used to validate this model. Data on metals is also collected from the literature to be incorporated into a methodology demonstrating the kindling chain. Chapter 5 covers the development of a ‘tool kit’ for oxygen incident analysis. Understanding of ignition modes, heat transfer modelling, flow diagrams, and the SIT model are used to examine past oxygen incidents, and understand kindling chains. Chapter 6 examines ‘real life’ incidents and applies the Chapter 5 ‘tool kit’ as a clear scientific methodology, identifying likely incident ignition sources and kindling chains. Finally Chapter 7 gives conclusions, identifying the successes and limitations of this work, and points where difficulties were encountered. Areas where further scientific investigation is required are identified.
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Onoda, Erik. "Ekonomická analýza nežádoucích událostí ve zdravotnickém zařízení: dekubity." Master's thesis, Vysoká škola ekonomická v Praze, 2009. http://www.nusl.cz/ntk/nusl-71670.
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The purpose of this thesis was to quantify the cost of care and treatment of pressure ulcers in Thomayer University Hospital with polyclinic (FTNsP) in Prague. Present pressure ulcer monitoring system was analyzed and a transformation of the records collected by this systém in the period 2005 - 2010 was performed in order to derive the necessary data - especially the number of patient-days, displayed by severity of the pressure ulcers. Data on expenditure of materials and pharmaceuticals was obtained by questionnaire survey, conducted in 2009 among the nursing staff. The description of the incidence of pressure ulcers in FTNsP, analysis of the effect of the use of anti-decubitus mattress on the incidence of pressure ulcers and bedsores costs per patient and for the entire hospital according to a single component of direct costs and costs of extended hospital stay are the results of the thesis.
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Engler, Lucy Anne. "The relationship between the use of a tool to assess pressure sore risk and the incidence of pressure sore development /." Staten Island, N.Y. : [s.n.], 1993. http://library.wagner.edu/theses/nursing/1993/thesis_nur_1993_engle_relat.pdf.
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Weber, Christina [Verfasser], and S. [Akademischer Betreuer] Grohmann. "Dynamic modelling of incidents for the protection of helium cryostats against excessive pressure / Christina Weber ; Betreuer: S. Grohmann." Karlsruhe : KIT-Bibliothek, 2021. http://d-nb.info/1233359096/34.
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Walden, Alexander. "La vocation internationale des médias et son incidence géostratégique." Lille 2, 2008. http://tel.archives-ouvertes.fr/docs/00/37/25/68/PDF/THESE_Walden.pdf.
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Dans cette thèse ont été analysées les conditions et le contexte de la progression mondiale du phénomène médiatique, d'une part par l'étude des médias d'information à vocation internationale, mais aussi par l'étude des enjeux financiers qui ont transformé l'industrie de la communication en un acteur très puissant de l'économie globale. Cette implication majeure de la chose médiatique dans le système international a donné lieu à l'émergence d'une véritable opinion publique mondiale devenue le théâtre d'entreprises d'influence destinées à orienter les esprits au moyen de l'élaboration de contenus adaptés à leur hétérogénéité. Ont également été étudiés dans cette étude les moyens d'action et de réaction des Etats face à un phénomène médiatique indissociable des relations internationales et faisant fi des représentations classiques du concept de souveraineté. Les Etats eux-mêmes en ont fait un outil de propagande vouée à la mise en valeur de leurs idéologies ou de leurs politiques. De même, une présence croissante des médias dans les conflits militaires, tant comme témoins qu'en tant qu'acteurs directs ou indirects de ces guerres, a été constatée. Les incidences géostratégiques relatives à cette utilisation internationale des médias sont-elles susceptibles d'engendrer l'impuissance des Etats face aux flux d'informations, d'autant qu'un certain nombre de contraintes juridiques, économiques et techniques pèsent dorénavant sur eux ? Cet affaiblissement apparent de l'Etat ne l'a pas laissé sans réactions, certaines étant particulièrement anti-démocratiques, d'autres plus constructives et favorables à la diffusion de la pensée humaine et au progrès des sociétés dans le cadre de la mondialisation<br>The context and the conditions under which the media phenomenon has grown so swiftly on a worldwide basis have been analyzed throughout this thesis. On one hand by the study of international information media, on the other by the study of the financial stakes which transformed the communication industry into a powerful actor of the global economy. This major implication of the media in the international system gave rise to the emergence of a worldwide public opinion being now targeted by operations of influence destined to orient hearts and minds with specific contents. Furthermore, States' actions and reactions facing a media phenomenon, now fully part of international relations, and regardless of classical concepts of sovereignty, have been studied in this work. States themselves used media as a propaganda tool to emphasize their ideologies and policies. Besides, the growing involvement of media in military conflicts, as witnesses or now as direct and indirect actors of these wars, has been established. As a result, is the geostrategic impact due to global use of media likely to generate a growing weakness of States facing relentless flows of information especially since legal, economical and technical aspects have favored this situation? This apparent weakening of States generated reactions, some of which are particularly anti-democratic, but others more constructive and willing to contribute in the diffusion of human thought and in the progress of human societies in the globalization context
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Williams, Angela B. "Incidence and implications of atypical exercise blood pressure responses in adults without diagnosed coronary heart disease." Thesis, Virginia Tech, 1985. http://hdl.handle.net/10919/45657.
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Data were collected from the initial symptomâ limited
maximal exercise tests of 161 patients without. diagnosed
coronary heart disease (CHD). Subjects were grouped
according to their systolic (SBP) and diastolic (DBP) blood
pressure changes between the final two stages of exercise.<br>Master of Science
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Clark, Anna, and Viktoria Clarin. "The Incidence and Associated Geotechnical Issues of Swelling Clay in Stockholm." Thesis, Uppsala universitet, Institutionen för geovetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-256288.
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The Incidence and Associated Geotechnical Issues of Swelling Clay in Stockholm Viktoria Clarin & Anna Clark Previous tunnel failures have shown that inadequate reinforcement in tunnels can lead to cave-ins, whereby swelling clay is one of several factors that can result in these damages. Swelling clay minerals possess the ability to absorb water molecules and cations leading to an increase in volume. Instability in tunnels is a consequence of the mobilised swelling pressure caused by lack of room to accommodate for the change in volume. Several tunnels are projected throughout central Stockholm in the near future, whereby numerous drill cores have been logged. This bachelor thesis will therefore focus on the swelling potential and swelling pressure of clay samples selected from a drill core traversing the Söderström fault system. The samples selected for further analysis were collected from a drill core from Slussen, Stockholm, with the aim of determining the reinforcement requirements for future tunnelling projects. Several samples from the drill core were selected for analysis, whereby free swelling test was conducted to determine the swelling potential for each sample. One sample displayed more than 100% volume increase and was further tested to determine swelling pressure. Tests were performed using an oedometer, resulting in a measured swelling pressure of approximately 155kPa. To identify the clay type several X-ray diffraction tests were performed on the sample. Similar swelling pressures have been measured in tunnels affected by cave-ins in Norway. Due to these previous events, the swelling pressure is of imminent importance when constructing new tunnels. Based on the obtained results, an adequate reinforcement can be estimated and used as a foundation for future tunnel constructions within the area. The tests show that the Söderström fault contains swelling clay and precautions will have to be taken when tunnels are constructed.<br>Förekomsten och geotekniska konsekvenser av svällande lera i Stockholm Viktoria Clarin & Anna Clark Tidigare fall har visat att otillräcklig förstärkning i tunnlar kan leda till ras där svällande lera är en av ett antal faktorer som kan resultera i sådana skador. Svällande lermineral innehar egenskapen att absorbera vatten och katjoner som resulterar i en volymökning. Instabilitet i tunnelkonstruktioner är en konsekvens av det mobiliserande svälltrycket som uppstår då utrymme inte finns tillgängligt för denna volymändring. Ett antal tunnlar är planerade genom centrala Stockholm inom en nära framtid varför flertalet borrkärnor har karterats. Denna kandidatuppsats fokuserar därför på svällningspotential och svälltryck hos prov från en borrkärna som korsar Söderströmförkastningen. Proven som valts ut för vidare analys har sitt ursprung från en borrkärna tagen vid Slussen, Stockholm. Analyserna i denna studie har i syfte att möjliggöra en estimering av förstärkning vid framtida projekt som involverar tunnelkonstruktion. Ett antal prov valdes ut för analys varpå fria svällningsförsök utfördes för att bestämma svällningspotential hos respektive prov. Ett av proven uppvisade en volymökning över 100% varför ytterligare försök utfördes för att fastställa provets svälltryck. Försöken genomfördes med hjälp av en ödometer vilket resulterade i ett svälltryck på ca 155kPa. För identifiering av leran utfördes ett antal analyser med röntgendiffraktion. Likvärdiga svälltryck har uppmätts i tunnlar som drabbats av ras i Norge. Det är därför viktigt att ta hänsyn till detta då de nya tunnelprojekten ska påbörjas. Baserat på resultaten denna rapport redovisar kan godtycklig förstärkning estimeras och användas som grund för framtida tunnlar som byggs i området. Resultaten i denna studie visar att Söderströmsförkastningen innehåller svällande lera vilket kommer måste tas hänsyn till då tunnlar konstrueras.
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Neidel, Tobias, Nicolas Salvador, and Axel R. Heller. "Impact of systolic blood pressure limits on the diagnostic value of triage algorithms." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-231546.
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Background
Major incidents are characterized by a lack of resources compared to an overwhelming number of casualties, requiring a prioritization of medical treatment. Triage algorithms are an essential tool for prioritizing the urgency of treatment for patients, but the evidence to support one over another is very limited. We determined the influence of blood pressure limits on the diagnostic value of triage algorithms, considering if pulse should be palpated centrally or peripherally.
Methods
We used a database representing 500 consecutive HEMS patients. Each patient was allocated a triage category (T1/red, T2/yellow, T3/green) by a group of experienced doctors in disaster medicine, independent of any algorithm. mSTaRT, ASAV, Field Triage Score (FTS), Care Flight (CF), “Model Bavaria” and two Norwegian algorithms (Nor and TAS), all containing the question “Pulse palpable?”, were translated into Excel commands, calculating the triage category for each patient automatically. We used 5 blood pressure limits ranging from 130 to 60 mmHg to determine palpable pulse. The resulting triage categories were analyzed with respect to sensitivity, specificity and Youden Index (J) separately for trauma and non-trauma patients, and for all patients combined.
Results
For the entire population of patients within all triage algorithms the Youden Index (J) was highest for T1 (J between 0,14 and 0,62). Combining trauma and non-trauma patients, the highest J was obtained by ASAV (J = 0,62 at 60 mmHg). ASAV scored the highest within trauma patients (J = 0,87 at 60 mmHg), whereas Model Bavaria (J = 0,54 at 80 mmHg) reached highest amongst non-trauma patients. FTS performed worst for all patients (J = 0,14 at 60 mmHg), showing a lower score for trauma patients (J = 0,0 at 60 mmHg). Change of blood pressure limits resulted in different diagnostic values of all algorithms.
Discussion
We demonstrate that differing blood pressure limits have a remarkable impact on diagnostic values of triage algorithms. Further research is needed to determine the lowest blood pressure value that is possible to palpate at a peripheral artery compared to a central artery.
Conclusion
As a consequence, it might be important in which location pulses are palpated according to the algorithm at hand during triage of patients.
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Jimenez, Zaida Noemy Cabrera. "Índice de pressão tornozelo-braquial em pacientes renais crônicos incidentes em hemodiálise." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5148/tde-01032012-100808/.
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Doença cardiovascular é uma causa importante de morte em pacientes em diálise. Doença arterial obstrutiva periférica (DAOP) é um fator prognóstico de doença cardiovascular. Índice de pressão tornozelo-braquial (ITB) é um método não invasivo usado para o diagnóstico de DAOP. A diferença entre ITB pré e pós diálise ainda não foi formalmente testada e foi um dos objetivos deste estudo. Além disso, nós avaliamos o ITB como marcador de mortalidade em pacientes incidentes em hemodiálise. ITB foi obtido por método oscilométrico automático em uma população de pacientes incidentes em hemodiálise. Este estudo foi desenhado para testar a aplicabilidade da determinação do ITB com o uso de 2 aparelhos oscilométricos simultâneos de pressão arterial (Omron Corp 705 CP Corp, Tokyo, Japan) comparando pré e pós diálise assim como lados direito e esquerdo. 123 pacientes (85 homens e 38 mulheres) idade 53±19 anos foram incluídos. Medidas de pressão arterial do lado direito e do lado esquerdo apresentaram médias semelhantes (p=0,565), assim como em 3 sessões consecutivas de diálise, tempo 1, 2 e 3 (coeficiente de variação menor que 5). Nenhuma diferença foi encontrada entre ITB pré e pós diálise, tanto no lado direito quanto no lado esquerdo, assim como nos tempos 1, 2 e 3. Em pacientes com história de DAOP, o ITB pré vs. pós diálise teve uma tendência a ser significante no lado direito (p=0,088). Durante o período de acompanhamento, 31 pacientes morreram. Estes pacientes eram mais velhos e apresentaram maiores níveis de cálcio. Diabetes, hipertensão e qualquer outro fator de risco cardiovascular não estiveram associados com mortalidade. Pacientes com ITB baixo (<0,9) e alto (>1,3) apresentaram maior mortalidade que pacientes com ITB normal (0.9-1.3). Foi concluído que medidas de ITB pré e pós diálise mostraram baixa variabilidade. O ITB em pacientes com história de DAOP deve ser avaliado com mais atenção. A presente técnica usada neste estudo pode ser usada como marcador de mortalidade em pacientes incidentes em hemodiálise<br>Cardiovascular disease is an important cause of death in patients on dialysis. Peripheral arterial disease (PAD) is a prognostic factor for cardiovascular disease. Ankle-brachial index (ABI) is a non-invasive method used for the diagnosis of PAD. The difference between ABI pre and post dialysis was not yet formally tested, and it was one objective of this study. In addition, we evaluate the ABI in predict mortality in incident patients on hemodialysis. ABI was assessed by automated oscillometric device in incident patients on hemodialysis. This study was designed to assess the applicability of ABI determination with the employment of two automated oscillometric blood pressure devices simultaneously (Omron Corp 705 CP Corp, Tokyo, Japan), comparing pre and post dialysis as well right and left side. The measurements were done by using two oscillometric devices simultaneously to measure blood pressure in upper and lower extremities. 123 patients (85 men and 35 women), age 53±19 years were enrolled. Blood pressure measurements on the right side and on the left side presented similar means (p=0,565), as well in the consecutive sessions, times 1, 2 and 3, (coefficient of variation lower than 5). We found no difference in ABI pre and post dialysis, either on the right or left side, as well in times 1, 2 and 3. In patients with history of PAD, the ABI pre vs. post dialysis was of borderline significance on the right side (p=0.088). During the follow-up period, 31 patients died. These patients were older and presented higher calcium level. Diabetes, hypertension and any other cardiovascular risk factor were not associated with mortality. Patients with either low ABI or high ABI (<0.9 and >1.3, respectively) presented higher mortality than patients with normal ABI (0.9-1.3). We concluded that ABI measured pre and post dialysis offered low variability. The ABI in patients with history of PAD should be evaluating with caution. The current method applied in this study can predict mortality among incident patients on hemodialysis
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Hamrat, Fatma-Zohra. "Le rôle du Times durant l'occupation britannique d'Égypte (1882-1956)." Thesis, Montpellier 3, 2017. http://www.theses.fr/2017MON30065.
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L’occupation de l’Égypte en 1882 marque le début d’une longue période pendant laquelle l’Angleterre vas enter en permanence de conserver sa présence militaire et de justifier, par la même occasion, sa politique devant l’Europe et l’Égypte. L’Angleterre n’a pas cessé d’insister sur le caractère temporaire de cette occupation; en effet, il était impossible de se retirer de l’Égypte tant que le canal de Suez représentait la voie maritime la plus courte vers les colonies indiennes. Au cours de cette entreprise colonial, le rôle de la presse a été significatif, contribuant à la diffusion accélérée des nouvelles provenant de l’empire britannique. Ainsi notre étude se penche sur le rôle que la presse a pu jouer en vue de soutenirL’empire et de conforter occupation. Cette recherche est centrée sur le quotidien britannique The Times, journal connu pour son vaste réseau de correspondants dans le monde et notamment en Égypte. Par l’étude des articles publiés pendant la période de l’occupation, à partir du bombardement d’Alexandrie jusqu’à la crise du canal de Suez, nous identifierons et analyserons les différentes stratégies du Times pour justifier et consolider la présence de l’Angleterre en Égypte. Nous examinerons l’évolution du Times vis-à-vis des politiques suivies en Égypte par le gouvernement britannique. Notre objectif est, d’une part, de montrer l’influence du Times sur les décisions politiques prises par le gouvernement et d’autre part, de montrer que la ligne éditoriale du journal a pu aussi être soumise à l’impact des événements qui ont jalonné les relations entre la Grande Bretagne et l’ Égypte<br>This research is about The Times newspaper’s coverage of the situation in Egypt during the British occupation, that is from1882 to 1956. The historical context extends from a period when the Empire was at its apogee to its nadir. It is an attempt to suggest a new reading of the events that shaped the British policy in Egypt through the press, more precisely The Times. The objective is to determine the reactions of The Times to the evolution of the “Egyptian Question” and eventually the British policy. It will focus the imperial westward expansion in parallel with the evolution of journalism. The aim is also to approach the press from another angle, that of a press that may have an impact on, and be impacted by, political events. In other words, this study is an attempt to provide some key elements to answer the following questions: What was the role of The Times during the British occupation of Egypt? Can we consider an imperial commitment on the part of The Times? How did the editorial policy of The Times influence political decisions? What was the importance given to the “Thunderer” by policy makers? Finally, can we consider The Times as a means of conquest, a means of criticism or just a purveyor of news? We hope that this research will shed some light on the role of The Times in the construction and the maintaining of the British empire in Egypt
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Neidel, Tobias, Nicolas Salvador, and Axel R. Heller. "Impact of systolic blood pressure limits on the diagnostic value of triage algorithms." BioMed Central, 2017. https://tud.qucosa.de/id/qucosa%3A30689.
Full textAbstract:
Background
Major incidents are characterized by a lack of resources compared to an overwhelming number of casualties, requiring a prioritization of medical treatment. Triage algorithms are an essential tool for prioritizing the urgency of treatment for patients, but the evidence to support one over another is very limited. We determined the influence of blood pressure limits on the diagnostic value of triage algorithms, considering if pulse should be palpated centrally or peripherally.
Methods
We used a database representing 500 consecutive HEMS patients. Each patient was allocated a triage category (T1/red, T2/yellow, T3/green) by a group of experienced doctors in disaster medicine, independent of any algorithm. mSTaRT, ASAV, Field Triage Score (FTS), Care Flight (CF), “Model Bavaria” and two Norwegian algorithms (Nor and TAS), all containing the question “Pulse palpable?”, were translated into Excel commands, calculating the triage category for each patient automatically. We used 5 blood pressure limits ranging from 130 to 60 mmHg to determine palpable pulse. The resulting triage categories were analyzed with respect to sensitivity, specificity and Youden Index (J) separately for trauma and non-trauma patients, and for all patients combined.
Results
For the entire population of patients within all triage algorithms the Youden Index (J) was highest for T1 (J between 0,14 and 0,62). Combining trauma and non-trauma patients, the highest J was obtained by ASAV (J = 0,62 at 60 mmHg). ASAV scored the highest within trauma patients (J = 0,87 at 60 mmHg), whereas Model Bavaria (J = 0,54 at 80 mmHg) reached highest amongst non-trauma patients. FTS performed worst for all patients (J = 0,14 at 60 mmHg), showing a lower score for trauma patients (J = 0,0 at 60 mmHg). Change of blood pressure limits resulted in different diagnostic values of all algorithms.
Discussion
We demonstrate that differing blood pressure limits have a remarkable impact on diagnostic values of triage algorithms. Further research is needed to determine the lowest blood pressure value that is possible to palpate at a peripheral artery compared to a central artery.
Conclusion
As a consequence, it might be important in which location pulses are palpated according to the algorithm at hand during triage of patients.
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Rogenski, Noemi Marisa Brunet. "Estudo sobre a prevalência e a incidência de úlceras de pressão em um Hospital Universitário." Universidade de São Paulo, 2002. http://www.teses.usp.br/teses/disponiveis/7/7138/tde-21012011-090804/.
Full textAbstract:
As úlceras de pressão (UP) representam um grave problema para os pacientes hospitalizados, especialmente em termos de sofrimento pessoal e econômico, e um desafio não só para os enfermeiros, mas para toda a equipe interdisciplinar. Os objetivos deste estudo foram identificar e analisar os índices de prevalência e incidência de UP, nas unidades de Clínica Médica, Cirúrgica, UTI e Semi Intensiva do Hospital Universitário da USP, bem como, estabelecer as possíveis associações com as características sócio demográficas e clínicas da clientela. Após aprovação do Comitê de Ética e Pesquisa do HU, procedeu-se à coleta de dados em duas etapas: enquanto os dados da prevalência foram levantados num único dia da semana, os relacionados à incidência, durante três meses consecutivos. Para tanto, o exame físico de todos os pacientes internados e de todos os pacientes em risco para o desenvolvimento de UP, era realizado, respectivamente para os estudos da prevalência e incidência. A avaliação de risco para o desenvolvimento de UP foi feita através da Escala de Braden, tendo como nota de corte o escore inferior ou igual a 16. No estudo da prevalência, dos 102 pacientes avaliados, 19 desenvolveram UP, acarretando índice de 18,63%. Dentre os pacientes que apresentavam UP, houve predomínio do sexo feminino (52,63%), da raça branca (89,47%), de pacientes não fumantes (68,42%), com tempo de internação superior a 10 dias, principalmente por doenças do sistema cardiovascular ou respiratório (por doenças de base ou associadas), além de lesões no estágio I (51,85%) e na região sacra (22,22%). A idade média de 71,53 (DP=15,75) anos e o tempo médio de internação (12,31) dos pacientes com UP mostraram-se significativamente superiores àqueles exibidos pelos pacientes sem UP (p<0,001 e p=0,044, respectivamente). No estudo da incidência, dos 211 pacientes de risco acompanhados, 84 desenvolveram um total de 134 UP, acarretando índice de 39,81%. Os pacientes com UP caracterizaram-se por predomínio do sexo masculino (52,28%), da raça branca (80,95%) e de não fumantes (73,81), e as úlceras predominaram no estágio II (52,98%) e também em região sacra (33,58%), não sendo observadas UP nos estágios III ou IV. A idade média desses pacientes foi de 70,31 anos (DP=16,44), e houve diferença estatisticamente significante entre as idades dos pacientes com e sem UP, mostrando-se novamente superiores para os pacientes com UP. Além disso, a idade apresentou ainda, correlações estatisticamente significativas, positiva com a incidência e negativa com a umidade, ambas de fraca intensidade, sugerindo que as maiores incidências ocorrem entre os pacientes idosos e que estes tendem a apresentar maiores escores na sub escala umidade da escala de Braden. Embora a maioria dos pacientes com UP (50 ou 59,52%) tenha apresentado escore menor ou igual a 16, ou seja, risco para desenvolvimento de UP, os índices de prevalência e incidência encontrados neste estudo, quando comparados aos estudos internacionais, mostram-se elevados. Os resultados indicam não somente a urgente necessidade da implantação de um programa de prevenção e tratamento de UP na instituição, como contribuem, metodologicamente, para que outros serviços possam estabelecer tal tipo de investigação, para a ampliação do conhecimento acerca desse problema no país.<br>Pressure Ulcer (PU) represents a great problem for hospitalized patients, especially concerning economic and personal suffering, and this is a hallenge not only for registered nurses (RN) but also for the interdisciplinary staff. The goals for this study are to identify and to analyze the PU prevalence and incidence in the clinical, surgical, intensive care unit and semi-intensive units at the University Hospital of Sao Paulo University, as well as establish possible association with social demographic and clinical characteristics of the patients. After approval of the Ethical and Research Committee of the University Hospital, the collection of data took place in two stages. While the prevalent information was surveyed in only one day, the incidence took three months to accomplish. A physical examination was performed on all the interned patients and all the others that had a risk of developing the PU to study the predominance of the occurrence. An evaluation of the chance of developing PU was assessed using the Braden Scale with a cutoff score of less than or equal to 16. In this study of prevalence,from the 102 patients, 19 developed PU, an index of 18.63%. Among those patients that developed PU, 52.63% were female, 89.47% white race, 68,42% non-smoker patients, with more than 10 days of internment period mainly with cardiac or respiratory diseases (or associated illnesses), beside the lesions at stage I (51.85%) and on the sacral region (22.22%). The average age was 71,53 years old (DP=15.75) and the average time of internment was 12,31 days for the patients with PU, and it was significantly greater than those patients without the PU (p<0,001 and p=0,044 respectively). In the incidence study of 211 patients with risks to develop PU, 84 developed it, with a total of 134 PU, an index of 39.81%, Those with PU were predominant male (52.38%), of white race(80.95%), and non-smokers (52.98%). The ulcers were predominant at stage II, and also on the sacral region (33.58%), not having been found PU at stages III and IV. The average age of these patients was 70.31 years old (DP=16.44). The results showed significant statistical difference between the ages of patients with and without PU, again superior for those patients with PU. Besides, the age presented positive correlation statistically significant and negative with moisture, both with low intensity, suggesting that there are more incidences occurring with elderly patients who tend to present bigger score in the Moisture Subscale of the Braden Scale. Although, the majority of the patients with PU (50 or 59.52%) presented a score of 16 or less, it means, risk to develop PU, the prevalence and incidence indexes found in these studies were high when compared with the international studies. The results indicate, not only, an urgent need of implantation of a preventive program and treatment of PU in the institution, but also contribute, methodologically, that other services be established, like type of investigation, to amplify the knowledge of this problem in the country.
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D, Costa Punam. "Incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries in Bangladesh." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29427.
Full textAbstract:
Pressure injuries are a common complication of spinal cord injury (SCI) particularly following discharge from hospital. They are believed to be more prevalent in low-and-middle-income countries (LMICs) than high-income countries (HICs). Pressure injuries are a leading cause of premature death particularly in LMICs. Despite the problems pressure injuries pose for people with SCI in LMICs, there are few accurate data about the incidence and severity of pressure injuries from these countries: the focus of my thesis.
My thesis includes a cohort study that was embedded in a clinical trial. One hundred and eighty-six participants were contacted by telephone 39 times and assessed in person 4 to 6 times over the two years following discharge as part of the cohort study. At each point of contact the presence and severity of pressure injuries were determined using the Pressure Ulcer Scale for Healing (PUSH). Survival analyses were done to determine the time course of development of pressure injuries and recovery from pressure injuries. Lasso regression was used to construct multivariate prediction models.
Seventy-seven participants (41%; 95% CI 34% to 49%) developed at least one pressure injury, 21 participants (11%) developed two pressure injuries, and 18 participants (10%) developed three or more pressure injuries in the first two years after discharge. The incidence rate was 0.27 per person-year (95% CI 0.22 to 0.34). Most pressure injuries were on the sacrum (23%). Pressure injuries took a median (interquartile range, IQR) of 40 days (29 to 57) days to heal. The median peak PUSH score was 11/17 (8 to 13.5). The multivariate prediction models had poor predictive properties (maximum c-statistic 0.75).
My study proves that pressure injuries are still a very common and severe complication of SCI in LMICs like Bangladesh. Interestingly, it is very difficult to predict who are likely to develop pressure injuries at the time of discharge from hospital.
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Rogenski, Noemi Marisa Brunet. "Avaliação da implementação de um protocolo de prevenção de úlceras por pressão." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/7/7140/tde-30052011-082158/.
Full textAbstract:
Esta pesquisa é um estudo de caso com os objetivos de: avaliar a implementação de um protocolo de prevenção de Úlcera por Pressão (UP) por meio do estudo da Prevalência e da Incidência de UP nas unidades de Clinica Médica, Clinica Cirúrgica e Terapia Intensiva Adulto, do Hospital Universitário da Universidade de São Paulo; apreender a percepção das enfermeiras multiplicadoras no processo de implementação do protocolo e propor um processo de avaliação, sistematizado e contínuo da adoção do protocolo de UP. Após aprovação do Comitê de Ética em Pesquisa do HU, procedeu-se à coleta de dados. Optou-se, na metodologia, pelo desenvolvimento da pesquisa em dois momentos. O primeiro, na abordagem quantitativa, realizado em duas etapas, para o levantamento da prevalência e da incidência de UP nas unidades do estudo. A avaliação de risco para o desenvolvimento de UP foi feita por meio da Escala de Braden, tendo como nota de corte o escore inferior ou igual a 16. No estudo da prevalência, dos 87 pacientes avaliados, 17 desenvolveram UP, acarretando prevalência de 19,5%. No estudo da incidência, dos 190 pacientes de risco acompanhados, 35 desenvolveram um total de 51 úlceras, acarretando incidência de 18,4%. Para o segundo momento, na abordagem qualitativa, os dados foram coletados por meio das técnicas de Entrevista e Grupo Focal, realizadas com as enfermeiras que participaram, como multiplicadoras, do processo de implementação do protocolo. Adotou-se a análise de conteúdo de Bardin como referencial de análise do conteúdo das Entrevistas e do Grupo Focal. A análise interpretativa dos dados qualitativos das entrevistas possibilitou o resgate de Unidades de Significado e conseqüente construção de três Categorias e respectivas Subcategorias. Na Categoria Gerenciamento da Assistência, constituída pelas subcategorias Protocolo assistencial e Protocolo na dinâmica de trabalho, as enfermeiras abordaram o protocolo como instrumento de trabalho adotado e avaliado segundo as experiências vividas no desempenho da assistência de enfermagem. A categoria Gerenciamento de Recursos Humanos composta pelas subcategorias Profissionais com restrição física; Quantitativo de pessoal e Capacitação de pessoal apontou como dificuldades encontradas para a adoção do protocolo, os problemas relativos aos profissionais com restrição física, as vagas não repostas no quadro de pessoal e a necessidade de capacitação do pessoal. Na Categoria Gerenciamento de Materiais, as enfermeiras discorreram sobre os materiais disponíveis nas unidades para a implementação do protocolo. Nas reuniões do Grupo Focal foram sugeridas estratégias e medidas facilitadoras para a continuidade da adoção do protocolo. Para a concretização das estratégias sugeridas neste estudo e, para que as enfermeiras se apoderem efetivamente desta proposta é imprescindível a realização de reuniões com a participação das enfermeiras e das chefes das unidades, a fim de tornar o protocolo cada vez mais compatível com as necessidades dos pacientes, dos profissionais e da instituição.<br>This research is a case study with the following objectives: to evaluate the implementation of pressure ulcer prevention protocol (PU) by means of studying the Prevalence and Incidence of PU in the units of Medical Clinic, Surgical Clinic and Intensive Adult Care of the University Hospital, at the University of São Paulo; to apprehend nurses\' perceptions as multiplier agents in the implementation process of the protocol and to propose a systematic and continuous evaluation process in the applicability of the PU protocol. After approval by the Ethics Committee in Research of the University Hospital, collect of data was preceded. The research was performed in two moments. The first, in a quantitative approach, carried out in two phases, to survey the prevalence and incidence of PU in the units of study. The evaluation of risk to develop PU was performed by means of the Braden scale, with a cutoff score of less than or equal to 16. In the Prevalence study, 17 out of the 87 patients developed PU, resulting in a prevalence of 19.5%. In the Incidence study, 35 out of the 190 patients developed a total of 51 ulcers, leading to an incidence of 18.4%. In the second moment, a qualitative approach, data were collected using the techniques of interviews and focus group conducted with the nurses who participated as multiplier agents, in the process to implement the protocol. Content analysis of Bardin was used as a reference for analysis of the Interviews content and Focus group. The interpretative analysis of qualitative data from interviews allowed rescuing the Units of Meaning and consequent construction of three categories and their subcategories. In the Management Assistance category, consisting of the sub-categories Assistance Protocol and Protocol in work dynamics, in which nurses approached the protocol as an adopted working instrument and evaluated it according to their experiences in nursing care. The Human Resource Management Category consisted of the subcategories Professionals with physical restraint; Quantitative of staff and Personnel Training as difficulties found in the adoption of the protocol, problems related to professionals with physical restraint, job postings not fulfilled and the need to training personnel. Regarding the Material Management Category, nurses mentioned about the materials available in the units to implement the protocol. In the Focus Group, strategies and measures were suggested to facilitate the continuous adoption of the protocol. For the implementation of the strategies suggested in this study, and for nurses to effectively take hold of this proposal, it is imperative to perform meetings with the participation of nurses and unit heads in order to make the protocol more compatible with the needs of patients, professionals and the institution.
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Habib, Allah Laila. "Pressure ulcer : prevalence, incidence, risk factors and the predictive validity of the Braden Q and the Glamorgan Risk Assessment Scales in paediatrics." Thesis, De Montfort University, 2013. http://hdl.handle.net/2086/9037.
Full textAbstract:
Background: There is a paucity of research related to the problem of pressure ulcer in paediatrics. Variable incidence and prevalence rates have been reported, although, critically ill paediatric patients have proved to be at higher risk than those in general wards. Few investigations of contributing factors have been based on rigorous methods, and most existing risk assessment scales are either adult-based or depend simply on experience or observation. Objectives: Two separate studies were conducted as part of this research. A prevalence study aimed to measure the prevalence, location and categories of pressure ulcer, as well as pressure ulcer patients' characteristics in general inpatient paediatric wards. An incidence study was set up to measure the incidence, most affected locations, and categories of pressure ulcer, as well as significant risk factors for pressure ulcer development in critically ill children and neonates. It also aimed to compare the predictive validity of the Braden Q and the Glamorgan RASs in critical care areas. Design: One point prevalence study with a descriptive cross-sectional design and one observational cohort incidence study with longitudinal prospective design were conducted. Setting: All paediatric in-patient wards for the prevalence survey, and four paediatric critical care units (PICU, NICU, GIMU, and GICU) were surveyed in one university-affiliated hospital in Jordan. Paediatric patients in burn, isolation, and psychiatric wards were excluded. Sample: A total of 107 paediatric patients aged from birth up to 18 years old for the prevalence survey, and a total of 212 critically ill paediatric patients without pre- existing pressure ulcer for the incidence study, were recruited. Methods: All patients who met the inclusion criteria were included and assessed for pressure ulcer existence in one day for the prevalence study. Patients eligible for the incidence study were observed up to three times a week for two weeks, then once a week until critical care unit discharge, death, or when the eight week follow-up period ended. In both studies, data was collected by the primary investigator. Main Results: All identified pressure ulcers in both studies were categorised according to the European Pressure Ulcer Advisory Panel classification system. Eight patients (7.5%) had 13 PUs in the prevalence study and, of these, the majority were inpatients in critical units (87.5%, n= 7), had device-related ulcers (75%, n= 6), were female (62.5%, n= 5), younger than one year old (62.5%, n= 5), and had experienced longer stays hospital than pressure ulcer -free patients (Median (IQR)= 11 (27) vs. 4 (7)). Most of the ulcers seen were of partial thickness (category I and II) (n=6, 75%), while only two patients developed category III ulcers (25%), and none had category IV ulcers. If category I PUs were excluded, this would result in a prevalence rate of 2.8% (n= 3). The sites most frequently affected by pressure ulcer were the face (38.5%, n= 5), followed by the occiput and 'neck and shoulders', each with 15.3% prevalence (n=2). In the incidence study, 19 patients (9%) developed 29 ulcers, and as low as 5.2% when category I ulcers were excluded. Forty one per cent of pressure ulcers were category I, 48.3% category II, while only 10.3% were category III and none were category IV. The 'chest and shoulders' were the most affected areas with ulcers (20.7%, n= 6), followed by areas labelled 'other' (which included the arms, back and buttocks, as well as ears) (17.2%, n= 5), and four ulcers were located in each of the mouth, nose, 'feet and ankles' areas concurrently (13.8% for each). Based on a multivariate analysis, significant predictors of pressure ulcer were shown to be the mobility sub-item of the Glamorgan scale, and being on mechanical ventilation for 4 days or longer. The Glamorgan scale was more sensitive yet less specific than the Braden Q scale; however, neither of the scales was superior to the other in terms of its predictive validity. Conclusion: Pressure ulcers do exist in Jordanian paediatric patients, and with higher rates among those who are critically ill, thus would have its impact on changing the practice of Jordanian nurses to prevent or reduce its occurrence. Critical care unit paediatric patients most at risk include those who are supported on mechanical ventilation for longer periods, and those who are immobile. Both the Glamorgan and the Braden Q risk scales are valid tools to predict pressure ulcer among critically ill children, but neither is clearly superior to the other.
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Brindle, Christopher T. "Incidence and Predictor Variables of Pressure Injuries in Patients Undergoing Ventricular Assist Device and Total Artificial Heart Surgeries: An Eight-Year Retrospective Review." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/6038.
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BACKGROUND
Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.
OBJECTIVES
To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year retrospective study of all patients undergoing VAD-TAH surgery at a large academic university medical center.
METHODS
The preferred reporting items for systematic reviews and meta-analyses or PRISMA statement guided this systematic review. Quality of evidence was determined using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Two reviewers independently appraised manuscripts matching the eligibility criteria for study inclusion. Four databases including PubMed, CINAHL, Web of Science, Google Scholar, and hand searches of journals based on reference lists from included studies were utilized. Initial results of this primary search revealed zero studies that met inclusion and this search methodology was confirmed by medical librarian consultation. Therefore, a follow up retrospective study was necessary to identify incidence of PI in the VAD-TAH population. However, a secondary search, dropping keywords of VAD-TAH and instead focusing on studies of on-pump cardiac surgery and mixed surgical studies where cardiac surgery patients were included, was conducted to establish variables to guide a retrospective study of all VAD-TAH surgeries between 2010-2018. The retrospective study evaluated the incidence of pressure ulcers by case, patient and incidence density for each of the respective 1000 patient days during the study period. Univariate statistics are reported by four different VAD-TAH devices. Variables significant in bivariate analysis were entered in a stepwise logistic regression model.
RESULTS
In the systematic review, 312 articles were identified from the databases with eight additional articles from hand searches. Following abstract review, 208 were excluded for not meeting inclusion criteria or study quality metrics. 77 articles were read in full, with 61 excluded, leaving 16 articles for inclusion. 31 risk factors were identified for PI development in on-pump cardiac surgery patients with 11 risk factors which were identified as significant in multivariate analysis for inclusion in the retrospective study.
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Sayed-Noor, Arkan Sam. "Greater trochanteric pain after total hip arthroplasty : incidence, clinical outcome, associated factors, tenderness evaluation with algometer and a new surgical treatment." Doctoral thesis, Umeå universitet, Ortopedi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1882.
Full textAbstract:
Greater trochanteric pain (GTP) is a regional pain syndrome characterized by lateral hip pain and tenderness. Its incidence after total hip arthroplasty (THA) is variable. Bursal inflammation, degenerative changes of the attachment of the gluteal muscles, direct operative trauma and biomechanical disturbance of the operated hip have been discussed as being related to GTP. The diagnosis is purely clinical because radiological and laboratory investigations show no definite pathology. Although most treatment modalities are conservative, some patients may develop refractory complaints leading to surgical intervention. In study I we studied the incidence of GTP in 172 consecutive patients who underwent THA during 2002 at Sundsvall Hospital. Patients with GTP (n=21, incidence 12%) were matched with controls from the same cohort. The THA outcome was assessed using the Western Ontario and McMaster Universities Arthrosis (WOMAC) Index. Trochanteric tenderness was studied using an electronic pressure algometer. We found an association between the occurrence of GTP and postoperative uncorrected lengthening of the operated limb of ≥ one centimetre. The WOMAC index revealed a reduction of the clinical outcome in the GTP group. In Study II we tested the value of using an algometer in the diagnosis of GTP after THA. We measured the pressure-pain threshold (PPT) over the greater trochanter and ilio-tibial band in 18 patients and 18 matched controls. Both groups were evaluated using the visual analogue scale (VAS). We found the algometer to have a good predictive validity and reproducibility. However, there was large inter-individual variability across subjects. The PPT ratio of 0.8 (affected vs. unaffected side) can be used as a cutoff ratio to establish GTP. There was no correlation between PPT measurements and VAS. Because of a low positive predictive value and large inter-individual variability, the pressure algometer has a limited value as a screening tool. In study III we proposed a new surgical treatment for refractory GTP after THA consisting of distal lengthening of the ilio-tibial band (ITB) by Z-plasty under local anaesthesia. This method was used in 12 women between March 2004 and June 2006. The patients were followed up by phone interview 3-4 months postoperatively and by an EQ-5D questionnaire and clinical examination including evaluation with the algometer at 1-3 years postoperatively. We found that the patients‘ quality of life was markedly improved following the operation (EQ-5D = 0.26 preoperatively vs. 0.67 postoperatively; p <0.005). There were no postoperative complications. In study IV we evaluated the accuracy of a commonly used clinical method of LLD measurement (anterior superior iliac spine-medial malleolus) by comparing it to a reliable radiological method (tear drop-lesser trochanter) in 139 patients before and after THA. We found the correlation between the clinical and radiological methods to be weak preoperatively (r=0.21, ICC= 0.33) while the correlation was moderate postoperatively (r= 0.45, ICC=0.62). It is therefore recommended that the radiological method be used to measure leg length discrepancy in patients who undergo THA.
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Kebe, Mouhamadou. "Incidence de traitements thermiques sur le parenchyme de Pomme (Malus Domestica) et diffusion des composés phénoliques." Thesis, Avignon, 2014. http://www.theses.fr/2014AVIG0253/document.
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La pomme (Malus Domestica Borkh.), fruit largement répandu dans les pays tempérés est beaucoup consommée. Elle représente une source importante en composés phénoliques. Cette étude s’est intéressée aux polyphénols des tissus du parenchyme. La problématique s’oriente sur les effets de la texture sur la diffusion de ces molécules. L’originalité de l’approche repose sur l’association de la texture, de la pression osmotique et la diffusion des polyphénols. Les méthodes de caractérisations physiques et biochimiques ont permis de mesurer les changements à l´échelle macroscopique et les modifications chimiques qui s’opèrent dans les matrices végétales. Les résultats de l’étude du transfert de matière ont permis de mettre en évidence les différents facteurs pouvant influer sur les valeurs des coefficients de diffusion. La texture, l’épaisseur, la variété du fruit et la pression du milieu diffusant, constituent des facteurs pouvant influencer le transfert de matière. L’étude de l’évolution de composant de la paroi a montré des changements qui s’opèrent au cours de la diffusion. Des analyses microscopiques ont relevé les modifications à l’échelle cellulaire de la diffusion de procyanidines, polyphénols majoritaires et des interactions avec les composants pariétaux<br>Apple (Malus domestica Borkh. ) fruit widespread in temperate countries, is much consumed.It represents an important source of phenolic compounds. This study was interestedin polyphenol content of apple tissue parenchyma. The problem concerns effects of texturedegradation on the diffusion of polyphenols molecules. The originality of the approach isbased on the combination of texture, osmotic pressure and polyphenol leaching. Physicaland biochemical methods were used to measure changes at macroscopic scale and chemicalchanges occurring in the parenchymateous tissue . The study of mass transfer highlightedvarious factors that may affect apparent coefficient diffusion. The result showed that thedisintegration of texture , thickness, apple variety and osmotic pressure of leaching mediacan influence mass transfer yield. The study of the Cell walls components showed changesthat occur during leaching process. Light microscopic analysis revealed changes at cellularscale, procyanidins the major polyphenols, leaching phenomena and also interactionswith cell walls matrix
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Ekström, Curt. "Studies on the Epidemiology of Open-angle Glaucoma." Doctoral thesis, Uppsala University, Department of Neuroscience, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8323.
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<p>Glaucoma is a common disease in the elderly population. Open-angle glaucoma (OAG) is the predominant form of glaucoma. Chronic simple glaucoma and capsular glaucoma, characterized by the occurrence of pseudoexfoliation in the anterior eye segment, are the most frequent types of OAG. The purpose of the present thesis was to study the epidemiology of OAG in the municipality of Tierp, whose population has a high exposure to pseudoexfoliation.</p><p>In a case-finding study, the prevalence of known cases of OAG by December 31, 1983 was estimated to 1.4% in people ≥45 years of age. Sixty-three percent of all cases had capsular glaucoma. Patients with advanced glaucoma were older, had had the disease for longer, had higher mean initial intraocular pressure, and had more extensive visual field defects at the time of diagnosis.</p><p>A population survey of people 65–74 years of age was conducted in 1984–86. The prevalence of OAG was 5.3%. Pseudoexfoliation was found in 17%, being more common in females. Pseudoexfoliation was associated with OAG only in people previously diagnosed with the disease (odds ratio = 16). In cases detected at the survey, an intraocular pressure ≥20 mmHg was a serious risk factor of having OAG (odds ratio = 9.7).</p><p>In a 5-year follow-up study of participants in the population survey, increased intraocular pressure and pseudoexfoliation were recognized as independent risk factors for the development of OAG (standardized risk ratios = 3.4 and 9.8, respectively). Interaction between increased intraocular pressure and pseudoexfoliation was indicated. By May 2006, the incidence of OAG was estimated to 7.1 per 1,000 person-years. The incidence of capsular glaucoma was more than twice that of chronic simple glaucoma.</p><p>The prevalence and incidence of OAG was higher than that reported from other studies conducted on Caucasian populations. The probable explanation for this finding is exposure to pseudoexfoliation.</p>
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Pulido, Kelly Cristina Strazzieri. "Incidência de úlcera por pressão em Unidade de Terapia Intensiva." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-09052017-164118/.
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Objetivo: determinar e analisar a incidência de úlcera por pressão e os fatores de risco para o seu desenvolvimento, assim como sua relação com a carga de trabalho de enfermagem, em pacientes internados em unidade de terapia intensiva. Métodos: como parte do projeto de pesquisa intitulado Segurança do paciente em unidades de terapia intensiva: influência dos recursos humanos de enfermagem na ocorrência de eventos adversos, o presente estudo constituiu uma coorte retrospectiva, realizado em nove unidades de terapia intensiva e uma semi-intensiva, de dois hospitais-escola da cidade de São Paulo. A amostra foi composta por 766 pacientes, sem úlcera por pressão 24 horas após a admissão nas unidades do estudo. As variáveis de interesse foram extraídas do banco de dados do estudo original e dos prontuários digitalizados dos pacientes que participaram do estudo. Para as análises estatísticas foram utilizados incidência cumulativa, Qui-quadrado de Pearson, Mann-Whitney e Regressão logística (Stepwise Forward). Resultados: a incidência de úlcera por pressão foi de 18,7%. Pacientes em ventilação mecânica apresentaram 3,5 vezes maior chance de úlcera por pressão (OR 3,479; IC 95% 2,190-5,528; p < 0,001); estar em cuidados paliativos aumentou a chance de úlcera por pressão em 7,8 vezes (OR 7,829; IC 95% 1,927-31,817; p = 0,004); cada dia a mais de internação aumentou em 10,1% a chance de úlcera por pressão (OR 1,101; IC 95% 1,071-1,132; p < 0,001); cada ponto do Nursing Activities Score aumentou a chance de úlcera por pressão em 1,5% (OR 1,015; IC 95% 1,003-1,027; p = 0,016); entre 60 e 84 anos a chance foi 2,3 vezes maior de úlcera por pressão do que aqueles com menos de 45 anos (OR 2,331; IC 95% 1,283-4,236; p = 0,005) e a partir dos 85 anos, a chance foi 2,7 vezes maior de úlcera por pressão do que aqueles com menos de 45 anos (OR 2,695; IC 95% 0,945-7,683; p < 0,064). Conclusão: admitindo-se que a UP é um evento adverso e que sua ocorrência está relacionada a baixa qualidade da assistência, a incidência de 18,7% aqui encontrada pode ser considerada alta. Muito ainda precisa ser feito no âmbito da prevenção, no intuito de alcançar índices mais aceitáveis.<br>Objective: To determine and to analyze pressure ulcers incidence and risk factors, and their relationships with nursing work-load in critical care patients. Methods: As a part of the research project named \"Patient safety in intensive care units: the influence of nursing personnel in adverse events occurrence\", a retrospective cohort study was taken in nine intensive care units and one semi-intensive care unit in two university hospitals in Sao Paulo. A total of 766 pacients without pressure ulcer 24 hours after their admission in the units were studied. The variables of interest for this study were collected in digitalized records. The statistical analysis were done using cumulative incidence, Pearson´s Chi-Square, Mann- Whitney´s and Logisitic regression (Stepwise Forward) tests. Results: the incidence of pressure ulcers was 18.7%. Patients under mechanical ventilation had a chance 3.5 times higher for developing of pressure ulcer (OR 3.479; IC 95% 2.190-5.528; p < 0.001); being under paliative care augmented 7.8 times the chance for developing pressure ulcer (OR 7.829; IC 95% 1.927-31.817; p = 0.004); for each day more of stay in ICU, the chance of developing pressure ulcers were 10.1% higher (OR 1.101; IC 95% 1.071-1.132; p < 0.001); each point of Nursing Activities Score rose the chance of developing pressure ulcer in 1.5% (OR 1.015; IC 95% 1.003-1.027; p = 0.016); patients between 60 and 84 years-old had a 2.3 higher chance of developing pressure ulcers than patients younger than 45 years-old (OR 2.331; IC 95% 1.283- 4.236; p = 0.005) and, after the age of 85, the chance for developing pressure ulcers were 2.7 times higher than in patients younger than 45 years-old (OR 2.695; IC 95% 0.945-7.683; p < 0.064). Conclusion: admitting that pressure ulcers are an adverse effect and that their occurrence is related with poor assistance quality, we can consider the incidence of 18,7% found in this cohort as high. Prevention actions must be enforced to guarantee a decrease in these figures.
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Vendé, Pierre-Emmanuel. "Incidence de l'implémentation d'un système de pulvérisation de gouttelettes d'eau sur l'efficacité d'un groupe de production de froid embarqué." Thesis, Sorbonne université, 2018. http://www.theses.fr/2018SORUS463.
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La brumisation du condenseur à air d’une machine frigorifique permet une augmentation des échanges thermiques avec l’évaporation de l’eau dans l’air ou en paroi, ce qui augmente la puissance frigorifique et diminue le travail de compression. Ce phénomène est appliqué dans le cadre automobile afin d’abaisser la consommation supplémentaire de carburant induite par la climatisation lorsque le véhicule est à l’arrêt ou roule à faible vitesse. Un dispositif de brumisation autosuffisant en eau, peu énergivore et peu encombrant a ainsi été implémenté afin d’impacter le condenseur du système de climatisation d’un véhicule. Une étude de dimensionnement a montré que le dispositif ne devait pas consommer plus de 1 kg.h-1 récupérés à partir des condensats de l’évaporateur. Les buses étudiées (cône creux et jet plat) ont été choisies en fonction de ce critère. Le condenseur de la machine frigorifique a été isolé dans une maquette expérimentale afin de caractériser et optimiser l’effet de la brumisation. Une méthode d’analyse thermique des surfaces impactées a été développée pour caractériser le phénomène de bouchage étant donné que l’échange thermique se fait à la fois par impact sur la surface de l’échangeur et par l’évaporation du film d’eau. Il a ainsi été montré que, sur le long terme, si la surface frontale de l’échangeur est bouchée à 17 %, cela entraîne 45 % de pertes de charge supplémentaires et 20 à 25 % de transfert thermique en moins. Mais le bouchage peut être bénéfique et stocker de l'énergie thermique lorsque la durée de pulvérisation ne dépasse pas 25 minutes. Enfin, au terme de l’étude, le dispositif de brumisation a été implémenté sur le véhicule et des premiers essais ont montré un réel gain apporté par la brumisation, ce qui est encourageant pour une éventuelle industrialisation du dispositif<br>Spraying the air condenser of a refrigerating unit increases the heat exchange thanks to the evaporation of water in the air or on the wall, which increases the cooling capacity and decreases the compression work. This phenomenon is applied to the automotive context in order to lower the additional fuel consumption induced by the air conditioning when the vehicle is stopped or is at low speed. A self-sufficient, low-energy, space-saving spraying device was thus implemented in order to impact the condenser of the air conditioning system of a vehicle. A sizing study showed that the spraying device should not consume more than 1 kg.h-1 recovered from the condensates on the evaporator. The studied nozzles (hollow cone and flat fan) were therefore chosen according to this criterion. The condenser of the refrigerating unit was isolated in an experimental device to characterize and optimize the water spraying effect. A thermal analysis method of impacted surfaces has been developed to characterize the clogging phenomenon as the heat is exchanged mainly by the surface impact of the exchanger followed by the water film evaporation. For the long term spraying, 17 % clogging area of the exchanger front surface induces 45 % additional pressure drop and around 25 % degradation in the heat transfer. But clogging can be beneficial and store thermal energy when the spraying time does not exceed 25 minutes. Finally, at the end of the study, the spraying device was implemented on the vehicle and first tests showed a real gain brought by spraying, which is encouraging for a possible industrialization of the device
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Silva, Maria do Livramento Neves. "Incidência, Prevalência e Fatores Associados às Úlceras por Pressão em Unidade de Terapia Intensiva." Universidade Federal da Paraíba, 2013. http://tede.biblioteca.ufpb.br:8080/handle/tede/5107.
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Previous issue date: 2013-03-12<br>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior<br>Introduction: The vulnerability of patients hospitalized in an intensive care environmental makes them more inclined toward to the risk of developing pressure ulcers than those ones that are in other wings of the same institution. Objectives: Analyze the incidence, prevalence and factors associated with pressure ulcers in an intensive care unit; Check the risk of developing PU in patients, using the Braden Scale; analyze the risk scores association of the Braden subscales with the development of pressure ulcers and verify the association of socio-demographic and clinical data and the risk factors with the pressure ulcers development. Method: This is a descriptive study, prospective, performed in an intensive care unit of a public hospital in João Pessoa. The study population consisted of all patients admitted during the period from July 17 to October 17, 2012. The sample was composed by 45 patients who fulfilled the inclusion criteria established. The study has been approved by the Ethics Committee of the UFPB Health Sciences Center, under protocol 0237/12. Data were collected through physical examination of patients by application of the Braden scale and by reviewing the medical files. Results: of 45 patients followed in the study 09 were already admitted with the injury and 08 developed during ICU stay, corresponding to an incidence of 8 (22.2%) and the prevalence of 17 (37.8%). In the prevalence it was verified the predominance of males, white and over the age of 70 years. The incidence recorded 4 (50%) for each gender, 5 (62.5%) for whites and 4 (50%) aged until 50 years. Regarding the identified baseline diseases has been observed the presence of one or more diseases in 75% of patients, being the most prevalent in the group with PU stroke 3 (100%) and COPD 5 (60%). In this same group 6 (54.5%) made use of corticoids, 13 (43.3%) of antibiotics and 6 (40%) receiving intravenous drugs. Regarding patients' physical examination with PU 9 (52.9%) were sedated, 12 (70.6%) connected to mechanical ventilation, 9 (52.9%) with thin or delicate skin and 9 (52.9%) with decreased turgor and elasticity. The hospitalization period varied from 5 to 48days in patients without PU and from 5 to 39in those who had presented the injury. Regarding the elapsed time for the development of injury 7 (87.5%) of cases occurred up to 10 days. Concerning the risk PU through the Braden Scale, was observed that 30 (66.6%) of the patients were classified as high risk, and those with PU 15 (88.2%) with the categories activity (bedridden) and friction and shear (problem) as Braden subscales most affected in this group. Conclusion: The incidence and prevalence of PU identified in the study are similar to the reality described in some scenarios of intensive care units in Brazil, but depicting an incidence rate lower than that found in most studies in the same population. It is suggested to invest in job training through continuing education in service and building and deploying protocols for prevention and treatment of these injuries.<br>a vulnerabilidade dos pacientes internados em ambiente de terapia intensiva torna-os mais propensos ao risco de adquirir úlcera por pressão (UPP) do que aqueles de outras alas da mesma instituição. Objetivos: identificar a incidência e prevalência das úlceras por pressão em pacientes internados na unidade de terapia intensiva de um hospital público; estimar o risco para desenvolvimento de úlceras por pressão através da Escala de Braden; verificar a associação dos dados sociodemográficos e clínicos e dos fatores de risco com o desenvolvimento de úlceras por pressão. Métodos: Trata-se de um estudo de coorte, prospectivo, realizado em uma UTI de um hospital público de João Pessoa-PB. A população do estudo foi constituída por todos os pacientes internados na unidade, no período de 17 de julho a 17 de outubro de 2012. A amostra foi composta por 45 pacientes que preencheram os critérios de inclusão estabelecidos. O estudo foi aprovado pelo Comitê de Ética do Centro de Ciências da Saúde da UFPB, sob protocolo nº 0237/12. Os dados foram coletados através do exame físico dos pacientes, pela aplicação da escala de Braden e por meio de revisão nos prontuários. Resultados: Dos 45 pacientes acompanhados no estudo 09 foram admitidos já com a lesão e 08 desenvolveram durante internação na UTI, correspondendo a uma incidência de 22,22% e prevalência de 37,77%. Na prevalência verificou-se o predomínio do gênero masculino, de cor banca e com idade acima de 70 anos. A incidência registrou (50%) para cada gênero, (65%%) para os brancos e (50%) com idade até 50 anos. Com relação às doenças de base identificadas, verificou-se a presença de uma ou mais patologias em 75% dos pacientes, sendo as mais prevalentes no grupo com UPP AVC (100%) e DPOC (60%). Nesse mesmo grupo (54,54%) fizeram uso de corticoides, (43,33%) de antibióticos e (40%) de drogas vasoativas. Quanto ao exame físico dos pacientes com UPP (52,94%) estavam sedados, (70,58%) conectados à ventilação mecânica, (52,94%) com pele fina ou delicada e (52,94%) com turgor e elasticidade diminuído. O tempo de internação variou de 3 a 75 dias nos pacientes sem UPP e de 11 a 120 dias nos que apresentavam a lesão. Quanto ao tempo decorrido para o desenvolvimento da lesão (87,5%) dos casos ocorreram em até 10 dias. Concernente ao risco para UPP pela Escala de Braden observou-se (66,66%) dos pacientes em alto risco e para aqueles que apresentavam UPP (88,23%), tendo as categorias atividade (acamado) e fricção e cisalhamento (problema) como as subescalas de Braden mais afetadas nesse grupo. Conclusão: Os resultados permitiram traçar um delineamento da realidade institucional sobre as úlceras por pressão e chamam a atenção para os desafios diante de tão complexa iatrogenia, uma vez que mesmo com todos os investimentos, continuam presentes em nossa prática.
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Paiva, Lucila Corsino de. "?lcera de press?o em pacientes internados em um hospital universit?rio em Natal/RN: condi??es predisponentes e fatores de risco." Universidade Federal do Rio Grande do Norte, 2008. http://repositorio.ufrn.br:8080/jspui/handle/123456789/14657.
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Previous issue date: 2008-04-28<br>The pressure ulcers (PU), also known as decubitus ulcers, are defined as injuries caused by the constant pressure exerted on a particular point of the body, causing impairment of blood supply with a decrease or interruption of tissue irrigation, causing occlusion of blood vessels and capillaries, ischemia and cell death. This is a descriptive study with longitudinal design, and panel type, with quantitative approach that aimed to examine the association between predisposing conditions (PC), intrinsic factors (IF) and
extrinsic factors (EF) with the occurrence of PU, in hospitalized patients in the Intensive Care Unit (ICU), pain clinical, surgical clinical and neurology wards of a university
hospital. The study population was composed of all patients who were restricted to bed during the period from December 2007 to February 2008. The study was approved by
the Ethics Committee of HUOL / UFRN (No 135/07). The data-collection took place through a structured formulary of observation, data from medical records and physical
examination of patients skins. The results were organized in SPSS 15.0 software, tabulated, categorized and analyzed by descriptive and inferential statistics. Of the 30
patients studied, 43.3% had been hospitalized in the pain clinical and surgical clinic wards, 20.0% in the ICU, 20.0% in the ICU / ward and 16.7% in neurology, being the
length of hospitalization in those units of 7 to 18 days (63.3%) and from 19 to 30 days (36.7%), predominantly female and aged ≥ 60 years (60.0%). 19 PU were diagnosed in
43.3% of patients monitored, being 38.5% with one PU between 7 to 18 days and 46.2% with two or more between 19 to 30 days of hospitalization, showing significant
relationship (ρ-value = 0029) between length of hospital stay and the number of PU. Was found an association of 35.7% of the PC (cardio-respiratory, hematological,
metabolic and psychogenic), IF (age group, oedema, skin changes in humidity and change of body temperature) and EF (type of mattress and strength of body pressure) for all patients studied, statistically significant (ρ-value = 0001), between the average scores in patients with and without PU, with reason chance to 12.0 for the development of PU and there was moderate correlation ( r = 0618) in the presence of this association. Results show the influence of the multiplicity of factors and conditions on the occurrence of PU, which brings us to reflect on the assistance focused on prevention and reduction of these injuries which will encourage the reduction of hospitalization length, physical and psychological suffering, and the possibility of improving the clinical condition of the patient.<br>As ?lceras de press?o (UP), denominadas tamb?m ?lcera de dec?bito, s?o definidas como les?es causadas pela constante press?o exercida sobre um determinado ponto do corpo, ocasionando comprometimento do aporte sangu?neo com diminui??o ou interrup??o da irriga??o tissular, ocasionando oclus?o de vasos e capilares, isquemia e morte celular. Trata-se de um estudo descritivo com delineamento longitudinal, tipo painel, com abordagem quantitativa que objetivou analisar a associa??o existente entre condi??es predisponentes (CP), fatores intr?nsecos (FI) e fatores extr?nsecos (FE) com a ocorr?ncia de UP, em pacientes internados em Unidade de Terapia Intensiva (UTI), enfermarias de cl?nicas m?dica, cir?rgica e neurologia de um hospital universit?rio. A popula??o do estudo foi composta por todos os pacientes que estiveram acamados durante o per?odo de dezembro de 2007 a fevereiro de 2008. O estudo foi aprovado pelo Comit? de ?tica do HUOL/UFRN (no 135/07). A coleta de dados realizou-se por meio de um formul?rio estruturado de observa??o, dados dos prontu?rios e exame f?sico da pele dos pacientes. Os resultados foram organizados no programa SPSS 15.0, tabulados, categorizados e analisados por meio de estat?stica descritiva e inferencial. Dos 30 pacientes pesquisados, 43,3% encontravam-se internados na enfermaria de cl?nica m?dica e cl?nica cir?rgica, 20,0% na UTI, 20,0% na
UTI/enfermaria e 16,7% na neurologia, sendo o tempo de interna??o nessas unidades de 7 a 18 dias (63,3%) e de 19 a 30 dias (36,7%), com predomin?ncia do sexo feminino
e faixa et?ria ≥ 60 anos (60,0%). Foram diagnosticadas 19 UP em 43,3% dos pacientes acompanhados, 38,5% com uma UP entre 7 a 18 dias e 46,2% com duas ou mais entre 19 a 30 dias de interna??o, mostrando rela??o significativa (ρ-valor = 0,029) entre tempo de interna??o e o n?mero de UP. Verificou-se associa??o de 35,7% das CP
(cardio-respirat?rias, hematol?gicas, metab?licas e psicog?nicas), FI (faixa et?ria, edema, altera??o na umidade da pele e altera??o da temperatura corporal) e FE (tipo
de colch?o e for?a de press?o do corpo) no conjunto dos pacientes pesquisados, estatisticamente significante (ρ-valor = 0,001), entre as m?dias dos escores nos
pacientes com e sem UP, com raz?o de chance de 12,0 de desenvolvimento de UP e exist?ncia de moderada correla??o (r = 0,618) na presen?a dessa associa??o. Os resultados denotam a influ?ncia da multiplicidade de fatores e condi??es na ocorr?ncia de UP, o que nos remete a refletir acerca da assist?ncia voltada para preven??o e diminui??o dessas les?es o que ir? favorecer a redu??o do tempo de internamento, sofrimento f?sico e psicol?gico, bem como a possibilidade de melhora do estado cl?nico do paciente.
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Macêdo, Martina Bolz de Jesus. "Der Stand der Demokratisierung und der Herausbildung einer Zivilgesellschaft in Ägypten am Beispiel des Diskurses über die autochthone christliche Minderheit der Kopten." Doctoral thesis, Humboldt-Universität zu Berlin, Philosophische Fakultät III, 2009. http://dx.doi.org/10.18452/16017.
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Die Meinungen über die Chancen einer Demokratisierung im Nahen und Mittleren Osten sind geteilt. Diese Arbeit versucht für Ägypten eine Einschätzung zu geben. Als bevölkerungsreichstes und eines der politisch bedeutsamsten Länder der Region könnte es eine Vorbildfunktion einnehmen. Die Dissertation untersucht an einem Fallbeispiel, den Ausschreitungen zwischen Muslimen und Christen in einem oberägyptischen Dorf 1999/ 2000, in welcher Form und in welchem Ausmaß sich staatliche Akteure, religiöse Institutionen und die Bürger zum heiklen Thema der Gefährdung der Rechte von Minderheiten im öffentlichen Diskurs zu Wort melden und dabei das Kriterium des Pluralismus, im Sinne von Toleranz und Ablehnung von Gewalt, erfüllen. Pessimistische Stimmen versagen dem Nahen und Mittleren Osten insbesondere wegen der dort vorherrschenden Religion eine Reformierbarkeit der politischen Kultur und stigmatisieren den Islam als Demokratisierungshindernis. Diese Arbeit beobachtet jedoch, dass es empirisch bereits einige Merkmale gibt, die auf eine Zunahme von Pluralismus in der ägyptischen Gesellschaft hindeuten. Sie zeigt die Anzeichen für die Herausbildung einer freien Öffentlichkeit und einer Zivilgesellschaft auf, die langfristig auf die Konsolidierung von Demokratie und nicht auf deren Zerstörung hinarbeitet. Gleichzeitig ist diese Arbeit eine Art in Szene gesetztes, lebendiges „Who is who?“ der gegenwärtigen Minderheiten- und Menschenrechtsbewegung in Ägypten. 1<br>The current status of democratization and civil society development in Egypt through the example of the discourse on the indigenous Christian minority of the Copts. Opinions regarding the chances of democratization in the Middle East are divided. The thesis attempts to give an evaluation in the case of Egypt. As the most populous and one of the politically most influencing countries of that region Egypt could take the function of a role model. The dissertation investigates, on the basis of a case study – the clashes between Muslims and Christians in an Upper Egyptian village in 1999/ 2000 - in what form and to what extent state actors, religious institutions and citizens take a stand in public discourse on the sensitive issue of endangering the rights of minorities and thereby meet the criteria of pluralism in the sense of tolerance and rejection of violence. Pessimistic voices deny the Middle East a reformability of its political culture particularly with regard to the predominating religion there and stigmatize Islam as an obstacle to democratization. This study however, shows empirically that there are already some indications that point towards an increase of pluralism in Egyptian society and towards the development of a free public sphere and a civil society that in the long term can lead to the consolidation of democracy and not to its destruction. At the same time this study is a kind of status report and “Who’s who?” of the current minority – and human rights movement in Egypt.
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Upadhyay, Anil Kumar. "Blast Loading on Plain and Perforated Tubes with High Explosives." Thesis, 2019. http://etd.iisc.ac.in/handle/2005/4342.
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According to the assessments of the United Nations, there are more than 100 million mines
lying buried in various conflict zones of many countries in the world. As per their assessment,
many thousand casualties happen every year. Most of the demining operations are generally
carried out after the conflicts end. This task is one of the most challenging and always a risky
operation. There are various demining equipment available world-wide to perform this job in
addition to the manual demining of minefield by trained soldiers.
Explosive loading on machine components of service vehicles during military operations is a
complex process. The complexity stems from unpredictable detonation, complicated component
geometry and geographical terrain, debris effects etc. Consequently, the damage on structural
components becomes highly unpredictable. There are too many other environmental parameters
contributing to the final damage. In this context, both high explosive loading and material
response behave like independent random variables.
Blast loading on tubes and plates is vital in the design of combat and demining equipment of
real life situations. Therefore, study of plain circular tubes (PCT), perforated circular tubes
(PRCT) and plates subjected to blast loading due to explosion of high explosives such as TNT,
RDX and TETRYL has been considered in the present thesis. Due to various design constraints,
it is extremely difficult to design these components for desired service life for high quantum of
blast load. This thesis explains the uses of perforations for handling this inevitable and extreme
condition of loading on the target components. It is pertinent to note that the various blast
parameters such as time of sight, overpressure, impulse etc. available in the literature are not
reliable for close range of explosion of high explosive for scaled distance in order of 0.40
m/kg1/3. Therefore, it is essential to establish and quantify some of these parameters for close
range blast, which will be useful for real life design problems.
Accordingly, the present thesis covers experimental and numerical study of plain circular
tube (PCT) and perforated circular tube (PRCT) under blast loading of high explosive.
iv
CONWEP code has been used for numerical simulation of PCT and PRCT subjected to blast
loading. Some important blast parameters have been established in this research. It has been
shown that there is approximately 58 % reduction in blast impact on the tube due to use of
perforation. Square and hexagonal pattern of perforation has been studied. Theory of strong
explosion has been discussed in the present thesis. Non-dimensional time and length scale has
been proposed in place of scaled distance. Also, simplified empirical formula has been proposed
for estimation of time of sight for close range blast covering scaled distance 0.40 m/kg1/3 - 0.45
m/kg1/3.<br>Defence Research & Development Organisation (DRDO)
31
Vowden, Kath, V. Warner, and Jane B. Collins. "Pressure ulcer incidence: do patients retain information." 2016. http://hdl.handle.net/10454/14727.
Full textAbstract:
No<br>Many service commissioners are demanding a reduction in pressure ulcer prevalence and regard pressure ulceration as a key indicator of care quality. Within our area of practice, local commissioners have indicated that all health care providers in the district should work together to reduce pressure ulceration across the local health care economy. Health care professionals clearly have a critical role to play in patient assessment, risk categorisation, care planning and equipment provision. However, this alone will not be sufficient to achieve the reduction targets which will involve effective patient engagement.
National and International guidelines all recognise the importance of patient education in care and recognise the significance of patient involvement in personalised care planning and service provision. Hartigan et al have demonstrated the value of education leaflets in supporting pressure ulcer prevention in an elderly population. Patient support applications running on mobile phones and tablets are also available to assist in pressure ulcer prevention and patient education but are not widely used in a hospital setting. This study examines how effective standard verbal and written information is at delivering patient education for pressure ulcer prevention.
Local hospital policy is that all patients identied as being at risk of developing pressure ulceration are provided with information on what a pressure ulcer is, what constitutes risk and how to assist staff in pressure ulcer prevention. The policy includes patient and carer involvement in care planning, and encouragement to report skin changes and pain to staff.
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Panwar, Rakshit. "Individualized blood pressure targets and the incidence of new-onset acute kidney injury among critically ill patients with shock." Thesis, 2021. http://hdl.handle.net/1959.13/1434542.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)<br>Each year over 10,000 Australians who are treated for shock in intensive care unit (ICU) develop acute kidney injury (AKI). According to some series, up to half of these patients could die before leaving hospital. The annual burden of death due to shock with AKI is nearly thrice that of the annual road toll. Development of AKI during shock is an independent predictor of mortality, and its attributable excess treatment cost in Australia exceeds $80 million annually. Strategies that may help prevent AKI or expedite recovery from AKI are much needed. Maintaining an adequate blood pressure (BP) is one of the fundamental tenets of management of shock, and therefore it may potentially have an impact on the development or progression of new-onset AKI. However, optimal BP targets that can minimize risk of AKI among individual patients are not that clear. In particular, there is paucity of data on the concept of relative hypotension, that is the BP deficit between a patient’s usual pre-illness resting BP and the achieved BP in ICU whilst on vasopressor support. The overarching goal of this research program is to test the hypothesis whether BP targets that are individualized and based on patients' usual pre-illness resting BP may have an association with or may have an impact on the incidence of new onset AKI or major adverse kidney events (MAKE) amongst critically ill patients with shock. As one of the first steps to address this goal, a conceptual scoping review (chapter 7) was conducted to synthesize current knowledge and lay down existing evidence for BP targets. The review discussed the physiological rationale for individualized BP targets that aim to minimize the degree of relative hypotension during vasopressor therapy. This review demonstrated the lack of quality evidence on this concept and indicated that untreated relative hypotension may be associated with adverse outcomes such as new AKI. Notably, at the time of this review, none of the contemporary standard resuscitation protocols specifically mentioned or recommended targeting an individual patient’s own pre-illness BP as a potential target for vasopressor therapy. The novel contribution of this review was to put a spotlight on this under-recognized concept, spark further discussion on the merits of treating relative hypotension, and advance the argument for further quality research. This program of research began with a preliminary single-center retrospective proof-of-concept study (chapter 8), which investigated the incidence of untreated relative hypotension in patients with shock during vasopressor therapy at a tertiary care academic ICU. Since both mean arterial BP (MAP) and central venous pressure (CVP) could impact on the net perfusion pressure for the vital organs, so the mean perfusion pressure (MPP= MAP−CVP) was considered a key hemodynamic variable in this study. The MPP achieved in ICU (achieved-MPP) was compared to the patients’ pre-illness resting BP (basal-MPP) and the time-weighted average MPP-deficit – i.e., the difference between basal-MPP and achieved-MPP – was derived as a measure of overall burden of relative hypotension. An a priori specified and preset protocol was followed to estimate basal-MPP. The novel aspect of this study was that the time-weighted average achieved-MPP and the magnitude of MPP-deficit in current practice during the vasopressor therapy for ICU patients with shock were comprehensively described for the first time. This study showed that the achieved-MPP among ICU patients with shock had no relationship to their basal-MPP, and BP targets were not usually individualized during management of shock among ICU patients. In this single center retrospective study, both the degree and the duration of MPP-deficit appeared to have an association with subsequent AKI. However, this was not high-quality evidence, and therefore these findings were considered as hypothesis-generating. These results emphasized the need to replicate this study in a broader clinical practice. Before embarking further, since a patient’s basal-MAP is considered a useful reference point for assessing degree of relative hypotension, it was also important to assess whether the study protocol for estimating basal MAP was reliable and valid. To answer this question, a study (chapter 9) was conducted to assess mean bias between the basal-MAP estimated using a preset protocol based on up to five recent pre-morbid clinic BP measurements (as used in this research program) and the basal-MAP measured with the nighttime ambulatory BP monitoring (ABPM), among a cohort of patients who recently underwent an ABPM test through the hospital service. This study showed that the protocol-estimated MAP values, on average, approximated the actual ABPM-measured MAP values, with an overall mean bias of less than 1 mmHg. This led to the conclusion that, where a recent ABPM is unavailable, a standardized protocol that is based on recent available clinic BP measurements can be used to estimate a patient’s basal MAP. To address the lack of any high-quality evidence or prospective multicenter studies exploring the relationship between relative hypotension and adverse kidney-related outcomes among critically ill patients with shock, a multicenter prospective cohort study (chapter 10) was conducted. This study enrolled 302 patients at seven tertiary Australian ICUs over a period of four years. The aim of this study was to assess the degree of BP-deficit in conventional practice during vasopressor-support among critically ill patients with shock, and to determine whether such BP-deficit during first five days of vasopressor therapy could have any relationship with the incidence of new significant AKI or MAKE within 14 days of vasopressor-initiation. In this multicenter prospective cohort study, among ICU patients with shock, a significant degree of relative hypotension was observed, perhaps subliminally accepted, during vasopressor support; and multivariable-adjusted analyses showed that the odds of developing new significant AKI and MAKE-14 increased significantly with increasing degree and duration of relative hypotension. These findings imply that a strategy that adjusts BP targets based on patients’ pre-illness basal BP may have a potential to improve outcomes among ICU patients with shock and need to be tested in future interventional trials. The next phase (chapter 11) of this research program would consist of interventional trials comparing standard care to a strategy of targeting patients' pre-illness BP during management of shock in ICU. A multicenter pilot randomized controlled trial (RCT) that will enroll 50 patients is underway. This RCT will investigate whether targeting patients' pre-illness BP during vasopressor support is a safe and efficacious strategy in reducing the incidence of new-onset AKI among vasopressor-treated patients with shock. This RCT will provide pivotal data on the effects of individualizing BP targets in ICU and may pave way for a definitive RCT in future.
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Mutaganzwa, Christine. "Predictors, incidence of hypertension and trajectories of blood pressure during a five year period among HIV-infected and uninfected Rwandan women." Thesis, 2016. http://hdl.handle.net/10539/21192.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Masters of Science
In Epidemiology and Biostatistics
Johannesburg, January 2015<br>Introduction:
The Human Immunodeficiency Virus (HIV) and Acquired Immune-deficiency Syndrome (AIDS) epidemic is one of the most devastating health crises of the modern time, affecting mostly the African continent. Non-communicable diseases such as hypertension (HTN) are also becoming increasingly important health threats in Sub-Saharan Africa (SSA) linked to a rapid epidemiological transition. In this study, the incidence of HTN and risk factors associated with blood pressure (BP) changes in HIV+ and uninfected (HIV-) Rwandan women were determined.
Method:
Participants were recruited in 2005 as an observational cohort, and measurements taken every six months to assess the effectiveness and toxicity of HAART in HIV+ women in Kigali, Rwanda. Clinical examination was conducted and socio-demographic information, blood pressure readings, anthropometric and laboratory risk factors were collected in 710 HIV+ and 224 HIV- women aged 22 – 78 years. Of these, 662 HIV+ and 202 HIV- women met the inclusion criteria for this study. HTN incidence rates were estimated from 2005 to 2011. Generalized estimating equations were used to determine risk factors associated with systolic and diastolic blood pressure (SBP/DBP) changes over time.
Results:
In this analysis of 864 women, 202 (23%) were HIV- and 662 (77%) were HIV+ HAART-naïve at recruitment. Of the HIV+ participants, 497 (75%) were initiated on treatment by the end of the study in February, 2011. HIV- participants were significantly older than the HIV+ participants (median age 43 (33.8-49.4) vs. 35 (30.6-39.5) years; p < 0.001) and had on average higher SBP (119 SD (15) versus 116 SD (10) mmHg, p = 0.012) and higher DBP (73.3 SD (10.4) versus 71.2 SD (7.5) mmHg, p = 0.0013) measurements at recruitment.
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The incidence rate (IR) of HTN from 2005 to 2010 in HIV + participants on antiretroviral treatment was 7 cases per 1000 per person-years at risk (95% CI 4.2 – 10.9); for HIV- women the IR was 23 cases per 1000 person-years (95% CI 15.3 – 36) and for HIV + patients HAART naive the IR was 3 cases per 1000 person-years (95% CI 0.47 – 23.72).
Being underweight was associated with a 3.1 mmHg decrease in mean SBP compared to being normal weight (95% -5.48 – (-0.68); p = 0.012) for HIV + participants on HAART. For every unit increase in monthly income, SBP increased by 2.34 mmHg (95 % CI 0.077- 4.75; p = 0.058) for the HIV + HAART naïve and by age (p < 0.0001) and income (p < 0.0001) for the HIV-. Being underweight decreases DBP by 1.59 mmHg compared to being normal weight (95% CI -3.17 – (-0.013); p = 0.048) for the HIV+ on HAART. Being employed was associated with 5.1 mmHg decrease in DBP (95% CI -9.06 – (-1.14); p = 0.012) compared to not being employed for the HIV+ HAART naïve and for every year increase in age the HIV-, DBP increased by 0.2 mmHg (95 % CI 0.018 – 0.327; p = 0.028) and with every unit increase in depression score, DBP decreased by 0.02 mmHg (95 % CI -0.35 – (-0.02); p = 0.025).
Conclusion:
Incidence rates of HTN were higher in HIV- compared with HIV+ participants, most likely due to the older age of the HIV- study participants. The findings also show that socio-economic factors such as income and employment status and lifestyle factors such as BMI and depression were also associated with blood pressure changes. Therefore, efforts should be made in raising the awareness of potential modifiable risks, such as lifestyle factors, for prevention of HTN and blood pressure control.<br>MT2016
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Wu, Tso-Kuang, and 吳祚光. "The Incidence of Pressure Sore and Cost-Effectiveness Analysis of Applying High-Density Foam versus Action Pads for Patients During Spinal Surgery." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/13338047500185872007.
Full textAbstract:
碩士<br>國立陽明大學<br>護理學系暨研究所<br>96<br>The purpose of this study was focused on evaluating the effect of high-density foam and action pad on the prevention of pressure sore during spinal surgery and their economical costs. The research is an experimental design conducted in an operating room of a medical center in northern Taiwan. The pressure at chest and iliac pressure points were measured by Xsensor and presented as mmHg. The stage of pressure was evaluated according to pressure scale published by IAET(International Association of Enterostomal Therapy) and NPUAP (National Pressure Ulcer Advisory Panel) . Thirty healthy adults were firstly enrolled as the pilot study to adjust the placement and measurement of Xsensor prior to enroll the 30 adult subjects receiving spine surgery in prone position for longer than 3 hours. The exclusive criteria were: emergency surgery, whom have diabetes mellitus or peripheral arterial occlusive disease, operating time less than three hours, Braden scale less than 16 points, no skin break before surgery. Measures underwent comparison were: the average pressure, the highest pressure, and the contact area of the two chest pressure points and two iliac pressure points. For each subject, the right chest and iliac were supported by two high-density foams, and the left chest and iliac were supported by two action pads. Subjects who presented pressure sore change were follow-up at 30 minutes, 24hours, 48 hours and then 72 hours after surgery. Data was processed by SPSS (Statistics Package for Social Science 12.0 for Windows) and the major statistical procedures applied were: descriptive statistic, Chi-square, Pearson’s correlation, independent T-test, Pair T-test and logistic regression. A p value less than .05 was taken as significant.
The results indicated that there were 9 out of 120 points (7.5%) developed pressure sores at 30 minutes after surgery, eight were at first grade and one were at second stage. All the pressure sores were resolved at 48 hours after surgery. Body weight was the most significant determinant of pressure sore. Iliac bone prominence, woman, age of 65 or under, weight under 50kg, and surgery over four hours were more risky to develop pressure sore. The mean and peak pressures measured from action pads were significantly less than the ones from high-density foams. However, the prevalence rate of pressure sores was not significantly different between high-density foam and action pad groups.
Since the cost of action pad is 250 times of the high-density foam, the results of this research suggest that the use of action pad is considered when risk to develop pressure sore is high. It requires further research to prove which pressure-relieving cushion is the most effective with reasonable cost.
Keywords: spine surgery; pressure sores; pressure interface,
pressure-relieving material