Dissertations / Theses: 'Survey protocols'

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Yang, Ying. "Routing protocols for wireless sensor networks: A survey." Thesis, Mittuniversitetet, Institutionen för informationsteknologi och medier, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-19700.

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Wireless sensor networks(WSNs) are different to traditional networks and are highly dependent on applications, thus traditional routing protocols cannot be applied efficiently to the networks. As the variability of both the application and the network architecture, the majority of the attention, therefore, has been given to the routing protocols. This work surveys and evaluates state-of-the-art routing protocols based on many factors including energy efficiency, delay andcomplexity, and presents several classifications for the various approaches pursued. Additionally, more attention is paid to several routing protocols and their advantages and disadvantages and, indeed, this work implements two of selected protocols, LEACH and THVRG, on the OPNET, and compares them in many aspects based on a large amount of experimental data. The survey also provides a valuable framework for comparing new and existing routing protocols. According to the evaluation for the performance of the routing protocols, this thesis provides assistance in relation to further improving the performance in relation to routing protocols. Finally, future research strategies and trends in relation to routing technology in wireless sensor networks are also provided.

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Tse, Kent. "Survey of Internet security protocols." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape16/PQDD_0002/MQ37174.pdf.

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Zubimendi, Leire. "Survey on video-on-demand broadcasting protocols." Zürich : ETH, Swiss Federal Institute of Technology Zurich, Department of Computer Science, Institute for Pervasive Computing, Information and Communication Systems Research Group, 2008. http://e-collection.ethbib.ethz.ch/show?type=dipl&nr=361.

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Abtin, Houman. "A survey of the irrigation protocols used by dentists in British Columbia, Canada." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/37003.

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The goal of endodontic treatment is to prevent and eliminate infection. This is achieved by mechanical and chemical cleaning of the root canal. Chemical cleaning is a process in which irrigants are introduced in the root canal to eradicate bacteria and flush out debris. A study was conducted to assess the type, concentration of sodium hypochlorite (NaOCl), volume, sequence and method of delivery system of different irrigants used by general practitioners (GP) and endodontists (ENDO) in treating teeth with vital (VP) or non-vital pulp (NVP). We hypothesized that there are no significant differences between the groups regarding the method of irrigation in root canal treatment. Methods: 1) A total of 68 samples of bleach were collected from GP offices in Vancouver. Using titration, the concentration of hypochlorite in these bleach samples was calculated. 2) A questionnaire was sent to 150 GP and 42 ENDO registered with the College of Dental Surgeons of British Columbia. Results: The overall response rate to our questionnaire was 70.3%. Irrigants used in treating teeth with VP were NaOCl: ENDO 93.4%, GP 89.9% (p=0.445), EDTA: ENDO 72.9%, GP 35.1% (p<0.001), and RC-Prep™: ENDO 29.7%, GP 67.2% (p< 0.001). Irrigants used in treating teeth with NVP were NaOCl: ENDO 95.7%, GP 94.2% (p= 0.657), EDTA: ENDO 76.2%, GP 36.2% (p< 0.001), and RC-Prep™: ENDO 31.9%, GP 71.9% (p< 0.001). Majority of the ENDO (82.3%) used 5-6% NaOCl whereas 55% of the GP used 3-5% NaOCl. Commonly used irrigation needle by both groups was stainless steel with a tip size of 27G (ENDO 28.0%, GP 36.0%). The irrigation needle was inserted in the pulp chamber ENDO 79.8%, GP 75.2%, the coronal/mid canal: ENDO 79.8%, GP 85.3%, and the apical area ENDO 50.3%, GP 25.2%. Except for EDTA and saline, there were no statistically significant difference between both groups in their choice of the initial, in-between or final irrigant used. Conclusion: The ENDO and GP followed the recommended “best practice” for irrigation regarding the use of antimicrobial agents, such as NaOCl. However, the use of demineralizing agents for removing the smear layer was less frequent, particularly among the GP.

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Yousef, Paul. "GSM-Security: A Survey and Evaluation of the Current Situation." Thesis, Linköping University, Department of Electrical Engineering, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-2273.

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The Global System for Mobile Communications (GSM) is the most widely used cellular technology in the world. Approximately 800 million people around the world are using GSM for different purposes, but mostly for voice communication and SMS. For GSM, like many other widely used systems, security is crucial. The security involves mechanisms used to protect the different shareholders, like subscribers and service providers. The aspects of security that this report covers are mainly anonymity, authentication and confidentiality.

The important aspects of the system that need protection are described, along with the implementation of mechanisms used for the protection. It appears that many of the very valuable aspects of GSM can be attacked.

The anonymity of a GSM user is compromised resulting in the attacker being able to observe the time, rate, length, sources or destinations of e g calls. Even tracking a subscriber’s movements becomes possible. However, a passive attack is not sufficient to perform these attacks. The attacker needs to mount an active attack using equipment offering base station functionality.

Authentication is a crucial aspect of a wireless communication system due to the nature of the medium used, i e the radio link that is available to every one and not only the legitimate entities. Even the authentication mechanisms are attacked. It is possible to clone a subscription either by having physical access to the smart card or over the air interface. Cloning a subscription over the air requires base station functionality.

The most obvious threat against communication systems is eavesdropping on conversations. The privacy of GSM conversations is protected using some version of the A5 algorithm. There are several impressive cryptanalytical attacks against these algorithms, that break the encryption and make it possible to eavesdrop in real-time. Most of these algorithms require, however, extensive computation power and unrealistic quantities of known plaintext, which make it difficult to use them in practice. Difficulties using cryptanalytical attacks to break the confidentiality of GSM calls does not mean that conversations are well protected. Loopholes in the protocols used in GSM make it possible for an outsider, with access to sufficient equipment, to eavesdrop on conversations in real-time.

In the presence of these threats and vulnerabilities it is justified to wonder whether GSM provides sufficient security for users with very valuable information to communicate. These users may be military organisations, senior management personnel in large companies etc. GSM’s current security model does note provide sufficient protection for these entities. An additional layer of security should be added to the current security model.

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Pumper, Candace. "PROTOCOLS FOR PERIOPERATIVE NUTRITIONAL CARE PRACTICE IN ACCREDITED BARIATRIC SURGICAL CENTERS: A SURVEY OF CURRENT PRACTICE." Kent State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=kent1500560856156472.

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Grinnemo, Karl-Johan. "A Study of Partially Reliable Transport Protocols for Soft Real-Time Applications." Licentiate thesis, Karlstads universitet, Avdelningen för datavetenskap, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-33933.

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The profileration of multimedia applications, such as streaming video, teleconferencing, and interactive gaming has created a tremendous challenge for the traditional transport protocols of the Internet – UDP and TCP. Specifically, many multimedia applications are examples of soft real-time applications. They have often relatively stringent require- ments in terms of delay and delay jitter, but typically tolerate a limited packet loss rate. In recognition of the transport service requirements of soft real-time applications, this thesis studies the feasibility of using retransmission based, partially reliable trans- port protocols for these applications. The thesis studies ways of designing retransmis- sion based, partially reliable transport protocols that are congestion aware and TCP com- patible. Furthermore, the transport protocols should provide a service that, in terms of performance metrics such as throughput, delay, and delay jitter, are suitable for soft real- time applications. The thesis work comprises the design, analysis, and evaluation of two retransmission based, partially reliable transport protocols: PRTP and PRTP-ECN. Extensive simulations have been carried out on PRTP as well as PRTP-ECN. These sim- ulations have in part been complemented by some theoretical analysis. The results of the simulations and the analysis suggest that substantial reductions in delay jitter and improvements in throughput can indeed be obtained with both PRTP and PRTP-ECN as compared to TCP. While PRTP reacted too slowly to congestion to be TCP-friendly and altogether fair, PRTP-ECN was found to be both TCP-friendly and reasonably fair. The thesis work also comprises an extensive survey on retransmission based, par- tially reliable transport protocols. Based on this survey, we have proposed a taxonomy for these protocols. The taxonomy considers two dimensions of retransmission based, partially reliable transport protocols: the transport service, and the error control scheme.

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Holloway, Simon, and n/a. "Survey protocols for the stream-breeding frogs of Far East Gippsland : the application of habitat modelling and an assessment of techniques." University of Canberra. Resource, Environmental & Heritage Sciences, 1997. http://erl.canberra.edu.au./public/adt-AUC20060725.150009.

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This study developed a heirarchical approach to improve the efficiency and reliability of surveys for stream-breeding frogs in the montane forests of south-eastern Australia. Areas with suitable climate for some of these species were first determined by bioclimatic modelling. Landscape and habitat preferences were then determined for the four species commonly found in far East Gippsland, along with an assessment of survey techniques from which effective survey protocols were developed. The climate of localities at which five stream-breeding species had been previously found was modelled using BIOCLIM, and maps of the predicted potential distributions having similar climate were developed. Litoria phyllochroa was found to occur in coastal to alpine areas from Melbourne to Nowra, and potentially further inland, in areas with relatively low temperatures and low summer rainfall. Litoria lesueuri had a slightly larger known and predicted distribution, covering a wide range of values for the temperature and precipitation parameters. Both species had predicted areas inland from Melbourne and the Blue Mountains where they had never been recorded, probably largely due to land clearing. The rare Heleioporus australiacus had a slightly more northerly distribution, closer to the coast and adjacent ranges from Central Gippsland to just north of Sydney, with a generally warmer climate and large range of average annual precipitation values. Litoria citropa occupies an even narrower area along the coast, extending slightly further north again, with a climatic profile of few extremes but with relatively high rainfall particularly in summer. The rare Mixophyes balbus had a more northerly known and predicted narrow range along the NSW coast, just extending into Victoria and Queensland, characterised by the subtropical influence of higher summer rainfall. The southern extension into far East Gippsland appears to have an extreme sub-climate, and is hence considered highly susceptible to climate change. Future monitoring sites for these species can now be systematically chosen to include their full climatic range, so that any negative effects of climate change on amphibian populations may have a greater chance of detection. Four species were found commonly enough in the far East Gippsland study area for more detailed study - the three stream-breeding specialist species, L. phyllochroa, L citropa, and L. lesueuri, along with Crinia signifera which was not restricted to streams but commonly found along them. Three species, L. phyllochroa, L citropa and L. lesueuri, were not found at the few higher altitudes sites on the Errinundra Plateau, however they may have been restricted by habitat requirements other than altitude. Litoria phyllochroa was otherwise widespread, but preferred larger in-stream pools and backwaters for breeding with overhanging vegetation for perch and call sites. The other three species preferred stream reaches characterised by wide bedrock outcrops and associated wide break in the tree canopy, which may allow their preferred perch sites on rocky substrates to retain heat after sunset. Litoria lesueuri tadpoles were found in both unconnected and connected pools, and the common association of this species with bedrock outcrops may explain its range being largely restricted to granitic substratum where these outcrops mostly occurred. Litoria citropa preferred reaches with bedrock and boulder outcrops, although frogs used both rocky and vegetative substrates as perch sites, with tadpoles caught in both unconnected pools and backwaters. Crinia signifera tadpoles were mostly restricted to unconnected pools, with frogs generally only detected within or very close beside these. Habitat models varied in their predictive ability, from 67.5% for L. phyllochroa frogs to 92.7% for L. lesueuri tadpoles. Models developed from normally-distributed habitat variables by discriminant function analysis were generally more predictive than those from logistic regression analysis. The occurrence of frogs and tadpoles of L. phyllochroa, L. citropa and L. lesueuri can be predicted by the measurement of five habitat variables along a 50m reach: average width between the banks, average channel width, an average of the maximum depth of channel cross-sections along the reach, channel slope, and proportion of the stream length as pools. The occurrence of C. signifera along reaches can be predicted with the additional measurement of the proportion of the banks covered in ferns, the maximum cross-sectional channel depth along the reach, and the number of unconnected pools. Several different techniques for surveying frogs were compared for the four species commonly found along the streams. Probability of detection models were derived for each species for each technique, which allowed calculation of the statistical confidence of detecting a species that actually occurred at a site for any given number of surveys. For transect-based techniques, models were also developed which allowed determination of the minimum number of surveys required without detecting a species to be 95 percent statistically confident that the species did not occur there, for various transect lengths. This level of confidence can be obtained for the four common species by four surveys using the reliable night encounter technique along 500m stream transects, during the period from Ocotber to March, with air temperatures above 10°C. The application of habitat models to select favourable 50m reaches for survey also generally improved the detectability of each species. Timer-activated tape recorders, which automatically recorded the calls of frogs for many consecutive nights at a site, were very efficient at detecting all species except the quietcalling L. lesueuri. Night encounter surveys along stream transects detected all species from a reasonable effort, and dip-netting for tadpoles was also effective for most species. Active visual encounter surveys were less reliable, and day encounter surveys detected few frogs but provided some additional data when other activities were being performed along the streams. The findings of this study have important implications for future amphibian surveys and monitoring undertaken in East Gippsland and the south coast of New South Wales. If the standardised survey techniques recommended by this study are used in Environmental Impact Assessments, their results can be objectively assessed and defended. The use of habitat modelling and improvement in survey reliability can also be used more efficiently to find sites with populations suitable for monitoring. The likely amount of effort required by a long-term monitoring program can also be determined so as to largely overcome daily variations in the detection of each species.

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Cunha, Fábio Jorge Costa. "Dirofilariose cardiopulmonar em canídeos domésticos : estudo clínico e retrospectivo, situação em Portugal." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2019. http://hdl.handle.net/10400.5/18073.

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Dissertação de Mestrado Integrado em Medicina Veterinária
A dirofilariose cardiopulmonar (DCP) é causada pelo nemátode Dirofilaria immitis, transmitido por vetores (mosquitos culicídeos) e é capaz de infetar uma grande variedade de hospedeiros, sendo os seus alvos preferenciais, canídeos domésticos e selvagens. Em Portugal, a espécie D. immitis é endémica e tem grande relevância no panorama nacional, especialmente nas bacias fluviais do Tejo, Douro, Sado, Mondego e na região autónoma da Madeira. Os objetivos deste estudo foram a determinação da prevalência de D. immitis em cães com proprietário no concelho de Sintra, avaliar os fatores de risco que possam estar associados à sua transmissão e os protocolos de prevenção que eram praticados nos cães submetidos a este estudo. O estudo consistiu na recolha de amostras sanguíneas de 50 cães, que foram analisadas com recurso a testes rápidos Uranoteste® Dirofilaria e ao teste de Knott modificado, para pesquisa da presença de dirofilárias adultas e microfilárias, respetivamente. Foram também preenchidos presencialmente 50 inquéritos pelos proprietários dos animais que participaram no presente estudo. Neste estudo não foram detetados animais positivos à DCP pelos dois métodos de deteção utilizados. Em relação a comportamentos de risco, 12%(6/50) dos animais vivia permanentemente em quintal, 16%(7/44) dos inquiridos passeava o seu animal em zonas com cursos de água, 93,2%(41/44) fazia-o em período noturno e 81,8%(35/44) dos animais contactava com animais fora do ambiente familiar e de estatuto sanitário desconhecido. Dos animais que entraram no estudo, apenas 28%(14/50) não fazia prevenção contra a DCP. No entanto, os proprietários que a faziam, utilizavam um protocolo que se encontra no limiar do aconselhado pela maioria dos autores para a desparasitação interna (4 vezes ao ano). No entanto, o recomendado pelo European Scientific Counsel Companion Animal Parasites (ESCCAP) para prevenção de D. immitis é um tratamento mensal. Tendo em conta que existe ainda hoje uma grande proporção de tutores que não tem informação, nem conhecimento, sobre protocolos eficazes contra doenças parasitárias, é de extrema importância, especialmente se estivermos a falar de doenças de carácter zoonótico, que sejam criadas medidas para que as pessoas tenham melhor e mais fácil acesso à informação. Com este objetivo em mente, é necessário contar com a colaboração do médico veterinário, presencialmente, para que este tenha um papel ativo durante a consulta em matérias de desparasitação, mas também ao referenciar plataformas digitais que contenham essa informação para consulta gratuita, como é o caso do site da ESCCAP a nível europeu.
ABSTRACT - Cardiopulmonary Dirofilariosis in domestic dogs- a clinical and retrospective study - Heartworm disease (HWD) is caused by a nematode of the species Dirofilaria immitis, which is transmited by vectors (Culicidae mosquitoes) and is capable of infecting a wide varieaty of hosts, with its preferential targets being both domestic and wild dogs. In Portugal, D. immitis is endemic and has a great relevance in the national panorama, especially in the river basins of Tejo, Douro, Sado and Mondego and in the autonomous region of Madeira. The goals of this study were to determine the prevalence of D. immitis in dogs with owner in the county of Sintra, evaluate the risk factors that might be associated with its transmission and the preventive protocols that were practiced in the dogs included in this study. This research consisted in the collection of blood samples from 50 dogs, which were analyzed using Uranoteste® Dirofilaria rapid tests and modified Knott test for assessing the presence of adult heartworms and microfilariae, respectively. The 50 animal owners who participated in this study also answered a face-to-face questionary. There were no heartworm positive animals in this study using both detection methods. In relation to the risk behaviors, 12% (6/50) of the animals lived permanently in the backyard, 16% (7/44) of the owners said that they walked with their animals in areas with water courses, 93.2% (41/44) walked at night, 81.8% (35/44) of the animals were in contact with animals outside family enviroment and of unknown health status. Of all the animals in this study, only 28% (14/50) did not have any prevention against HWD, although those who did, used a protocol at the threshold of the suggested by most authors for internal parasite deworming (4 times a year). However, being European Scientific Counsel Companion Animal Parasites (ESCCAP) recommends a monthly preventive treatment for D. immitis. If we take in consideration that a large number of people who does not have neither the information, nor the knowledge, regarding effective protocols against parasitic deseases, it is of paramount importance, especially if we are talking about zoonotic deseases, that measures are taken, so that the population has better and easier access to information. With this objective in mind, it is necessary to rely on the veterinarian's cooperation, personally, so that he can have an active role during the medical consultation on the deworming subject, but also when referring to digital plataforms containing free, reliable and independent information, for later consultation, like the ESCCAP site at the European level.
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Tuyisenge, Livinus. "CoVEceVé - Collecte des données Véhicule/Environnement et remontée avec réseau Cellulaire et réseau Véhiculaire. Network Architectures in Internet of Vehicles (IoV): Review, Protocols Analysis, Challenges and Issues Handover Mechanisms in Internet of vehicles (IoV): survey, Trends, Challenges, and Issues." Thesis, Reims, 2019. http://www.theses.fr/2019REIMS023.

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Le transfert vertical intercellulaire est l’une des technologies clés qui facilitera le déploiement de véhicules connectés et autonomes. Aujourd’hui, l’émergence des réseaux véhiculaires : les communications de véhicule à véhicule (V2V), véhicule à infrastructure (V2I) et de véhicule à tout (V2X) a permis de nouvelles applications telles que les Systèmes de Transport Intelligents Coopératifs (C-ITS), les applications temps réel (par exemple, la conduite autonome), applications de gestion du trafic routier et applications de confort. Cependant, ces réseaux se caractérisent par une grande mobilité et de fréquents changements de la topologie, ce qui génère des réseaux épars et nécessitant des mécanismes de transfert pour le maintien de la continuité de session.Pour résoudre ce problème, nous avons proposé le PMIP-MIVH, une approche basée sur le PMIP et qui profite des avantages de l’utilisation d’une interface logique dans le traitement du transfert vertical intercellulaire. Pour améliorer et étendre notre approche, une méthode multicouche de sélection du meilleur réseau disponible, basée sur la logique floue a également été proposée. Les résultats analytiques et les résultats des simulations montrent tous que les solutions proposées sont performantes comparées aux autres méthodes de transfert existantes et améliorent efficacement la gestion de la mobilité dans les réseaux véhiculaires
Vertical handover is one of the key technologies that will facilitate the connected and autonomous vehicles deployment. Today, the emergence of Vehicular Ad hoc NETworks (VANETs): Vehicle to Vehicle (V2V) communications, Vehicle to Infrastructure (V2I) and Vehicle-to-Everything (V2X) has enabled new applications such as Cooperative Intelligent Transport Systems (C-ITS), real-time applications (for example, autonomous driving), road traffic management applications and comfort applications. However, these networks are characterized by a high level of mobility and dynamic change in the topology, which generates scattered networks and requires handover mechanisms for maintaining ongoing session continuity. To address this problem, we have proposed a PMIP-based Mobile Internal Vertical Handover (PMIP-MIVH) approach which takes advantage of the use of a logical interface in handling handover. To improve and extend our approach, a cross-layer and fuzzy logic-based selection method of the best available network has been also proposed. Analytical results and conducted simulation results all show that the proposed solutions overperform the existing handovers and enhance efficiently the handover management in the VANETs field

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Sousa, Cláudio Tavares Silveira. "Protocolo de solicitação de cirurgias eletivas pelos médicos das unidades da estratégia saúde da família no município de Goiânia." Universidade Federal de Goiás, 2014. http://repositorio.bc.ufg.br/tede/handle/tede/5462.

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The advancement of the Family Health Strategy was a gradual process and were numerous the results achieved as to reducing child mortality, reducing hospitalizations by conditions sensitive to Primary Health Care and the improvement of socio-economic indicators of the population. However, we must emphasize that the service performed depends on a rear of medium complexity, and tests of high complexity, with procedures and diagnostic purpose elective surgical procedures. In this sense, the completion of the main proposal "provision of health services" suffers the action of different variables, being the health service's regulation a way to mediate the existing demand with the supply of services, with the capacity to intervene promptly as a mediator in the process leading up to the final act. In relation to the elective surgeries in Goiânia, observed numerous cases that the medical professional of the FHS, due to lack of standards or guidelines, has had difficulties in defining the form that the patient should continue its assistance in the health system in cases that is concluded a diagnosis which indicates a surgical treatment. When evaluate the need of improvements in the services provided by the FHS, with the demand of the Organization and operation of networks and flows combined with policies of support and stimulus to expand the user's access by Health Ministry this study proposes a requesting protocol of elective surgeries by medical professionals of the FHS.
O avanço da Estratégia Saúde da Família foi um processo gradativo e foram inúmeros os resultados alcançados como a redução da mortalidade infantil, a diminuição de internações por condições sensíveis à Atenção Primária à Saúde e a melhoria de indicadores socioeconômicos da população. Porém devemos ressaltar que o atendimento realizado depende de uma retaguarda de exames de média complexidade, e de alta complexidade, procedimentos com finalidade diagnóstica e procedimentos cirúrgicos eletivos. Nesse sentido a efetivação da proposta principal “prover serviços de saúde” sofre a ação de diferentes variáveis, sendo a regulação em saúde uma forma de intermediar a demanda existente com a oferta de serviços, com capacidade de intervir pontualmente como mediadora nos processos que antecedem ao ato final. Em relação às cirurgias eletivas em Goiânia, observamos inúmeros casos que o profissional médico da ESF, por falta de normativas ou orientações, tem dificuldade em definir a forma que o paciente deverá continuar sua assistência no sistema de saúde nos casos que for finalizado um diagnóstico cujo tratamento é cirúrgico. Ao avaliar a necessidade de aprimorar cada vez mais o atendimento prestado pela ESF, com a demanda de organização de fluxos e funcionamento de redes e aliada com políticas de incentivo e estímulo de ampliação de acesso ao usuário pelo Ministério da Saúde este estudo propõe um protocolo de solicitação de cirurgias eletivas pelos profissionais médicos da ESF.

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Ramos, Priscila Zonzini 1987. "Estudo da etiologia da perda auditiva em amostra de individuos brasileiros : diretrizes para protocolo de conduta clínica." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/316704.

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Orientadores: Edi Lúcia Sartorato, Arthur Menino Castilho
Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: A surdez é considerada a doença sensorial mais prevalente em humanos, causada por uma variedade de fatores ambientais e genéticos. No Brasil, não há dados oficiais referentes à prevalência e à etiologia das deficiências auditivas, mas sabe-se que os fatores ambientais ainda superam os de origem genética. No diagnóstico etiológico da surdez, a realização concomitante de exames laboratoriais, de imagem e genéticos, embora amplie a chance diagnóstica, onera o Sistema de Saúde, devido ao alto custo. Deste modo, o objetivo do presente estudo foi avaliar a eficácia dos exames de imagem e genéticos e seu impacto em Saúde Pública, bem como estabelecer um protocolo diagnóstico, visando maior eficiência e redução de custos na determinação da etiologia das perdas auditivas. Foi realizada a análise de 100 indivíduos com perda auditiva neurossensorial, atendidos no Ambulatório de Otorrinolaringologia do Hospital das Clínicas da UNICAMP, no período de 2002 a 2010, e que foram submetidos ao implante coclear. Uma investigação detalhada foi realizada nos pacientes, incluindo exames de imagem, genéticos e laboratoriais (em casos específicos). Após a realização dos exames específicos, o número de casos com a etiologia não esclarecida foi reduzido de 72 para 42, representando redução de 42%. Alterações radiológicas foram identificadas em 29 pacientes, enquanto alterações moleculares foram encontradas em 31 indivíduos, incluindo a c.35delG, p.V27I, p.M34T, p.V37I, p.E47X, p.L90P, p.V95M, p.K168R, p.W172X no gene GJB2, a del(GJB6-D13S1830) no gene GJB6 e a m.1555A>G no gene mitocondrial MTRNR1. Os exames de imagem e genéticos contribuíram, respectivamente, para o diagnóstico etiológico de 20% e 19% dos casos analisados. A etiologia não foi esclarecida em 42% dos pacientes, em 25% foi de origem ambiental, 19% genética, e em 14% dos casos decorrente de malformações ou outros problemas na orelha interna. Pôde-se concluir que tanto os exames de imagem quanto os genéticos foram importantes para a identificação da etiologia das perdas auditivas, no entanto, os testes moleculares contribuíram principalmente para o diagnóstico dos pacientes com surdez congênita, enquanto os exames radiológicos tiveram maior contribuição para os casos com perda progressiva ou abrupta. A alta prevalência de mutações no gene GJB2 foi confirmada, especialmente da mutação c.35delG, nos casos de perda auditiva neurossensorial severa a profunda bilateral. A pesquisa molecular teve importante contribuição no diagnóstico etiológico da surdez, além de possibilitar o aconselhamento genético e sugerir melhor prognóstico para o implante coclear, como observado em estudos prévios. O TaqMan® OpenArray® Genotyping é uma técnica promissora para o diagnóstico molecular da perda auditiva, pois permite a análise de diversas mutações em vários pacientes de uma só vez, o que implica em um diagnóstico mais rápido a um custo mais baixo. O protocolo sequencial permite a otimização do diagnóstico etiológico e redução dos custos, ao contrário da realização concomitante de exames de imagem, laboratoriais e genéticos. Por fim, mesmo com uma investigação detalhada, a etiologia desconhecida continuou prevalecendo, o que aponta para a necessidade de estudos moleculares mais aprofundados, para que a real causa possa ser esclarecida
Abstract: Deafness is considered the most prevalent sensory disorder in humans, caused by a variety of environmental and genetics factors. In Brazil, there are no official data regarding the prevalence and etiology of hearing impairment, but it is known that environmental factors are among the major causes. Although a simultaneous testing approach, including clinical exams, audiological, laboratorial, imaging and genetic expands the etiological diagnosis, overloads the healthcare system due to high costs. Thus, the goal of the present study is to evaluate the effectiveness of imaging and genetics tests and their impact on public health, aiming to increase efficiency and reduce costs of the etiological diagnosis of hearing loss. It was conducted an analysis of 100 patients with sensorineural hearing loss, from Department of Otorhinolaryngology of the State University of Campinas (UNICAMP), submitted to cochlear implantation between 2002 and 2010. A detailed investigation was performed in patients, including imaging and genetics analysis. After specific tests, the number of individuals with unknown cause was reduced from 72 to 42 (42% of reduction). Radiologic abnormalities were identified in 29 of the patients, while molecular alterations were found in 31 individuals, including c.35delG, p.V27I, p.M34T, p.V37I, p.E47X, p.L90P, p.V95M, p.K168R, p.W172X in the GJB2 gene, del(GJB6-D13S1830) in the GJB6 gene and m.1555A>G in the MTRNR1 mitochondrial gene. Genetic and imaging results contributed to the etiological diagnosis of 19% and 20% of the cases, respectively. The etiology remained unknown in 42% of the patients, was due to environmental factors in 25%, genetics in 19% and inner ear malformations or other defects in 14% of the cases. It was concluded that both imaging and genetic analysis were important to identify the etiology of hearing loss, however, molecular tests contributed mainly for diagnosis of patients with congenital deafness, while radiologic exams had greater contribution for diagnosis of cases with progressive or sudden hearing loss. The high prevalence of mutations in the GJB2 gene was confirmed, especially the c.35delG mutation, in cases of sensorineural severe to profound bilateral hearing loss. The molecular research had an important contribution to the etiology of deafness, besides providing genetic counseling and a better prognosis for cochlear implantation, as suggested by previous studies. The TaqMan® OpenArray® Genotyping is a promising technique for molecular diagnostic of hearing loss, because it allows the analisys of many mutations in several patients at once, which implies in a faster diagnosis at a lower cost. The sequential protocol enables an optimization of the etiological diagnosis and cost reduction, as opposed to simultaneously holding imaging, laboratory and genetic tests. Finally, even with a careful investigation, the unknown etiology prevailed as main cause which points to the need of carrying out detailed genetic studies in those cases with idiopathic hearing loss in order to elucidate the diagnosis
Mestrado
Genetica Animal e Evolução
Mestre em Genética e Biologia Molecular

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Felix, Lidiany Galdino. "Protocolo de orientação para o autocuidado de pacientes submetidos à cirurgia bariátrica: atuação do enfermeiro." Universidade Federal da Paraíba, 2009. http://tede.biblioteca.ufpb.br:8080/handle/tede/5057.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Bariatric Surgery is currently being considered more effective treatment of morbid obesity. In the face of increased the number of surgeries performed in the country and the complexity of patient care, this study obeso was a main building guidance Protocol for the client self-care in the pre and post surgery Bariatric Surgery, substantiated in the General Theory of Orem self-care. The methodological kind of research was used and it is made up of four phases: first stage: identification of empirical indicators for therapy of self-care demand carried out through a systematic review of the literature on nursing care to the patient undergoes Bariatric Surgery, which resulted in the structuring of the data collection form, adapted the theory of self-care of Orem; second stage: determination of deficits of self-care (DAC) achieved through an exploratory study and descriptive qualitative approach, with the following-31 customers, being 26 Bariatric Surgery candidates and 06 patients wait were included in bariatric surgery group of a teaching hospital, in the city of João Pessoa PB, during the period from April to June 2009. Data collection has led to the identification of gaps of self-care and consequently to nursing diagnoses based on taxonomy Nanda-I; third stage: Nursing systems development for DAC identified-the nursing care planning, with the determination of the goals, objectives, aid method, type of system and nursing interventions; fourth stage:structuring of nursing care protocol and guidance for self-care patient pre and post surgery Bariatric Surgery constructed from self-care demands identified. Demonstrated the importance of education and the patient staging self-care represent for the recovery of the patient and the achievement of the success of surgery. It is hoped that this study will contribute to improving the quality of nursing care to the patient bariátrico and serves as a parameter to that other health institutions to develop their own assistive protocols.
Atualmente a Cirurgia Bariátrica vem sendo considerada o tratamento mais eficaz para o controle da obesidade mórbida. Diante do aumento do número de cirurgias realizadas no país e da complexidade do cuidado do paciente obeso, o presente estudo teve por objetivo principal construir um Protocolo de Orientação para o autocuidado de clientes no pré e pós-operatório de cirurgia bariátrica, fundamentado na Teoria Geral do Autocuidado de Orem. Para o alcance desse objetivo, realizou-se uma pesquisa do tipo metodológica, constituída por quatro etapas: primeira fase: identificação dos indicadores empíricos para a demanda terapêutica de Autocuidado realizada por meio de uma revisão sistemática da literatura sobre os cuidados de enfermagem ao paciente submetido à cirurgia bariátrica, a qual resultou na estruturação do formulário de coleta de dados, adaptado a Teoria do Autocuidado de Orem; segunda fase: determinação dos Déficits de Autocuidado (DAC) realizada através de um estudo exploratório e descritivo de abordagem quanti-qualitativa, com 31 clientes, sendo 26 candidatos à cirurgia bariátrica e 06 pacientes que estavam em pós-operatório, inscritos no Grupo de Cirurgia Bariátrica de um hospital de ensino, na cidade de João Pessoa-PB, no período de abril a junho de 2009. A coleta de dados possibilitou a identificação dos déficits de autocuidado e, consequentemente, dos diagnósticos de enfermagem, baseados na Taxonomia II da NANDA-I; terceira fase: desenvolvimento dos Sistemas de Enfermagem para os DAC identificados - foi elaborado o planejamento da assistência de enfermagem, com a determinação das metas, objetivos, método de ajuda, tipo de sistema e intervenções de enfermagem; quarta fase: estruturação do Protocolo de assistência de enfermagem e do Manual de orientação para o autocuidado do paciente em pré e pós-operatório de cirurgia bariátrica construído a partir das demandas de autocuidado identificadas. Demonstrou-se a importância que a educação e o preparo do paciente para o autocuidado representam para a recuperação do paciente e para o alcance do sucesso da cirurgia. Espera-se que o presente estudo contribua para a melhoria da qualidade da assistência de enfermagem ao paciente bariátrico e sirva como parâmetro para que outras instituições de saúde desenvolvam seus próprios protocolos assistenciais

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Jigo, U. (Uchenna). "State of the art of survey on congestion control protocol in constrained networks." Master's thesis, University of Oulu, 2016. http://urn.fi/URN:NBN:fi:oulu-201602031103.

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Congestion in wireless sensor networks (WSNs) has always been a serious problem for all kinds of communication networks. It causes severe information loss and shortens the life time of the sensor nodes. Congestion also leads to excessive energy consumption due to large number of retransmission and packet loss which lowers throughput. In WSNs congestion need to be controlled in order to have high energy-efficiency, to prolong system life time, improve fairness and improve quality-of-service in terms of packet loss ratio with the packet delay and link utilization. Most of the designs of WSN depend on the applications and the environment in which the sensor nodes are deployed. It has important applications such as remote environment monitoring, target tracking, military and surveillance, etc. The placement of the nodes is often done randomly or in a pre-planned manner. These sensors are equipped with wireless interfaces with which they can communicate with one another to form a network. WSNs can be an event driven which can be routed to detect or monitor data at the base station depending on their degree of priority since the data in the sensor networks has different importance. WSNs face challenges in dealing with the issues of congestion due to their constraint nature and complex algorithms. During the last decade, the tremendous congestion control algorithms and schemes have been proposed to solve the issue of congestion by ensuring fair delivery of packets to the base station. This thesis explores the different congestion detection algorithms and schemes, which are especially targeted for the WSNs and presents a survey of congestion control mechanisms used in WSNs. In addition, the study in this thesis would find out the common features which may help in the future research.

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Denis, Alice S. "Impacts de l'anthropisation sur la diversité odonatologique au sein des cours d'eau : vers une meilleure prise en compte des espèces de la directive habitats faune flore." Thesis, Toulouse 3, 2018. http://www.theses.fr/2018TOU30104/document.

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Dans un contexte d'effondrement global de la biodiversité, concilier le développement des activités industrielles et agricoles, génératrices de richesses, avec la préservation du patrimoine naturel constitue un enjeu majeur. Les acteurs économiques de nos sociétés sont ainsi légalement astreints à éviter, réduire et compenser leurs impacts sur les espèces protégées. Ils se trouvent cependant démunis lorsque les connaissances mobilisables sur ces espèces sont insuffisantes pour évaluer l'ampleur de ces impacts ou pour mettre en place des mesures d'évitement et de compensation réellement efficaces. C'est notamment le cas sur les cours d'eau, écosystèmes soumis à de nombreuses pressions du fait de leurs usages par les sociétés humaines (i.e. ressource en eau et nourriture, transport, production d'énergie, loisirs). L'objet de ce travail de thèse est donc d'améliorer la connaissance de trois espèces d'Odonates protégées par la Directive Habitats Faune Flore et inféodées aux cours d'eau : la Cordulie à corps fin Oxygastra curtisii (Dale, 1834), le Gomphe de Graslin Gomphus graslinii Rambur, 1842 et la Cordulie splendide Macromia splendens (Pictet, 1843), afin de mieux appréhender les impacts de l'anthropisation des cours d'eau sur leurs populations. Nous avons cherché en particulier à (1) améliorer la prise en compte de ces espèces dans les études d'impacts, la gestion des cours d'eau et au sein des sites Natura 2000 où elles sont présentes via la proposition d'un protocole standardisé de suivi, (2) évaluer les conséquences de l'artificialisation de leurs habitats, notamment le réchauffement de l'eau, sur leur phénologie et leur morphologie, et (3) caractériser et évaluer l'impact des ouvrages hydrauliques présents sur les cours d'eau, considérant d'une part les petits ouvrages que sont les chaussées liées à d'anciennes minoteries ou à d'autres usages et, d'autre part, les ouvrages hydroélectriques de plus grandes dimensions. Ce travail est centré sur la région Midi-Pyrénées, région qui héberge encore des populations de ces trois espèces. Il a été réalisé en partenariat étroit entre le Conservatoire d'Espaces Naturels de Midi-Pyrénées, structure animatrice du Plan régional d'actions en faveur des Odonates, et le laboratoire d'Ecologie fonctionnelle EcoLab afin d'assurer un transfert direct des connaissances scientifiques acquises vers les gestionnaires, les aménageurs et les services de l'état en charge de la préservation de la biodiversité
In a context of global biodiversity crisis, reconciling the development of wealth-generating industry and agriculture with nature conservation is a crucial issue. Economic stakeholders are legally obliged to apply the mitigation hierarchy doctrine and thus "avoid, mitigate, and compensate" for their project's impacts. However, for invertebrate protected species, and particularly dragonfly species, basic knowledge on their ecology and population dynamics is lacking. It is thus difficult to accurately anticipate the impacts and propose efficient avoidance and compensation measures. This is particularly true on rivers, which are ecosystems under high pressure owing to their utility for human beings (e.g. water and food resources, transport, energy production, leisure). The aim of this work is to improve knowledge of three protected riverine species of dragonflies: the Orange-spotted emerald Oxygastra curtisii (Dale, 1834), the Pronged clubtail Gomphus graslinii Rambur, 1842, and the Splendid cruiser Macromia splendens (Pictet, 1843), and to provide better assessment methods to evaluate the impacts of the anthropisation of streams on their populations. We sought in particular (1) to improve environmental impact assessments and management of these species within Natura 2000 sites by proposing a standardised survey protocol, (2) to assess the consequences of habitat change, especially water temperature warming, on their phenology and morphology, and (3) to describe and evaluate the impacts of weirs and hydroelectric dams on their populations. This work took place in the Midi-Pyrénées region in southern France, where populations of these three species are still present. It was carried out in close partnership with the Conservatoire d'Espaces Naturels de Midi-Pyrénées, which coordinates the Regional Action Plan for Odonata, and the Functional Ecology Laboratory EcoLab to ensure direct transfer of the scientific knowledge acquired to the ecosystems managers, economic stakeholders and public authorities responsible for biodiversity conservation

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Rodrigues, Luciana Falci Theza. "Nascentes de Mata Atlântica: panorama e ecologia da fauna de Oligochaeta (Annelida) e implicações para conservação." Universidade Federal de Juiz de Fora (UFJF), 2018. https://repositorio.ufjf.br/jspui/handle/ufjf/7120.

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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Nascentes são importantes elementos da paisagem pela sua relevância econômica, social e ecológica. Tendo em vista a crescente degradação desses ecossistemas, aliado ao pouco conhecimento sobre a sua biodiversidade em regiões tropicais, esta tese tem como objetivo geral ampliar o conhecimento sobre nascentes de regiões tropicais e prover um estudo sobre a diversidade e aspectos ecológicos de oligoquetas aquáticos nesse ecossistema. A fim de confirmar a carência de estudos em nascentes, especificamente sobre a fauna de oligoquetas, foi feito um levantamento bibliográfico sobre os estudos realizados em 30 anos (1985-2015) nos mais diversos ambientes aquáticos continentais em todo o mundo. A pesquisa mostrou que nascentes estão entre os ecossistemas menos estudados, juntamente com corpos d’água de cavernas e pântanos. Também realizamos coletas da fauna, medimos variáveis físicas e químicas e aplicamos um protocolo de avaliação rápida (PAR) em nascentes localizadas em diferentes municípios de Minas Gerais, tanto em Unidades de Conservação (UCs) quanto em áreas públicas e particulares. Os resultados mostraram que a composição de espécies de oligoquetas de nascentes que emergem de forma difusa formando uma área alagada (helocreno), é diferente daquela de nascentes que formam riachos (reocreno) e poças (limnocreno), provavelmente devido à sua maior heterogeneidade. Também verificamos que a diversidade beta foi alta nas três tipologias, indicando que os esforços para a conservação desses ecossistemas devem incluir um grande número de nascentes de todas as tipologias. Os resultados desse estudo também enfatizam, após a aplicação do PAR, que, apesar da maioria das nascentes serem classificadas como ótimas, nascentes localizadas em áreas urbanas foram classificadas como razoável ou ruim, mesmo estando algumas delas em UCs. Isso mostra a importância das UCs na preservação das nascentes, assim como sua vulnerabilidade quando inseridas em ambientes urbanos. Concluímos que este estudo sobre as nascentes contribui não apenas para o conhecimento do tema, mas também para a gestão ambiental, pois direciona para os habitats e locais que mais carecem de estudo, mostra a importância de se preservar diferentes tipos de nascentes para a manutenção da diversidade e aponta para a necessidade de maior fiscalização e cumprimento dos dispositivos legais, a fim de evitar maiores alterações nas condições naturais desses ambientes.
Springs are important landscape elements due to its economic, social and ecological importance. In view of the increasing degradation of these ecosystems, added to low knowledge about their biodiversity in tropical regions, the main goal of this study is to increase the knowledge about springs in tropical regions and to provide information on the diversity and ecological aspects of aquatic oligochaetes in this ecosystem. To confirm the lack of studies in springs, specifically considering freshwater oligochaetes, a bibliographic survey has was made basead on the studies carried in a period of 30 years (1985-2015) in various continental aquatic environments around the world. The survey showed that spring are one of the least studied ecosystems, together with cave water bodies and swamps. For this study, fauna was collected, physical and chemical variables were measured, and a rapid assessment protocol (RAP) were applied at spring located in different cities of Minas Gerais State, either in Conservation Units or in public and private areas. The results showed differences among the oligochaetes species composition found in spring that rises diffusely forming a flooded area (helocrene), in comparasion to spring that forms streams (rheocrene) and that ones that forms a pond (limnocrene). Probably, it is due to the high heterogeneity of this kind of spring. We also verified that beta diversity was high at the three types of springs, suggesting that efforts to conserve these ecosystems should include many spring systems of all types. After applying RAP, this study emphasized that, besides the major numbers of spring, water have been classified as optimum also the springs located in urban areas were classified as moderate or poor, even when some of them were located in Conservation Units. This result highlights importance of Conservation Units on spring preservation, and also the vulnerability of these systems when inserted in urban environments. This study contributes not only for academic knowledge, but also for environmental management, once it points out the habitats and places that need more studies, showing the importance of preserving different types of spring systems for the maintenance of diversity. It also indicate the requirements for major inspections and the legal enforcement provisions needed, in order to avoid further transformations in the natural conditions of these systems.

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Hughes, Michael John. "Enhanced recovery after liver surgery." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/22803.

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Introduction Liver resection offers curative treatment to a number of malignant conditions. It has traditionally been associated with poor post-operative outcomes. More recently a mortality rate of less than five per cent has become established but morbidity remains high. Enhanced Recovery After Surgery (ERAS) has become established practice in a number of surgical specialties and has shown improvement in post-operative outcomes. ERAS has been introduced for liver resection however practice is less well established and liver surgery has several complexities that need to be accommodated in order to optimise post-operative care. The following thesis aims to identify areas that require clarification and investigate peri-operative care components to establish optimum practice. Methods Systematic review and meta-analysis were performed to identify areas that required clarification and were lacking in sufficient evidence to guide practice. A randomised controlled trial was performed to compare established areas of practice. Prospective observational studies were performed when exploratory investigation was required. Retrospective analysis of a prospectively collected database was performed to identify risk factors for post-operative morbidity. Patients included in the above trials underwent liver resection at the Royal Infirmary of Edinburgh, UK, between December 2012 and August 2014. Results Post-operative analgesia after liver resection was identified as being an area that was controversial. Continuous wound infiltration was shown to offer improved recovery times when compared to epidural with no significant associated disadvantages. After retrospective review of 603 liver resections, extended resection was observed to be associated with high morbidity rates. It was hypothesised that post-operative nutritional requirements might be higher in these patients. This was not found to be the case but post-operative energy requirements were found to be difficult to predict after liver resection, suggesting the benefits of real-time monitoring of energy expenditure. Finally acetaminophen metabolism was suspected of being altered after major resection. An observational study suggested that despite altered metabolism, glutathione deficiency was not observed after major resection and so liver volume was not a contra-indication to acetaminophen administration. Summary Liver resection offers a complex set of conditions on which to base an enhanced recovery protocol. Current ERAS literature does not completely address these issues. This thesis has investigated several aspects of care unique to liver surgery in an attempt to optimise peri-operative care and improve post-operative outcome after liver surgery.

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Lewis, Graham Allan. "Development of a protocol for sampling arthropod diversity in areas of native vegetation /." Title page, contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09ACH/09achl674.pdf.

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19

Warden, C. "Management of left-sided malignant colonic obstruction : an audit of a stent based protocol." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11006.

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Includes abstract.
Includes bibliographical references.
Colonic self-expanding metallic stents (SEMS) are proven to be safe and effective in the management of selected cases of malignant colonic obstruction. Since 2005, we have used endoscopic decompression with SEMS as the primary treatment of all patients with left-sided obstructing colorectal cancer, in the absence of perforation. The purpose of the study was to assess the safety and efficacy of this management protocol.

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Agha, Riaz Ahmed. "Developing evidence-based plastic surgery : the role of research registration, protocols and reporting quality." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:e09e93bd-6856-4108-8e4b-9bb48fb52bc2.

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BACKGROUND: Evidence-based medicine has had a profound impact on healthcare. In the field of Plastic surgery, powerful examples include; less radical skin cancer excision margins and skin-sparing or even nipple-sparing mastectomies and microsurgical reconstruction. Sustained progression of the field, relies on the development of a high-quality evidence base, with strong use of peer-reviewed research protocols, which are publicly registered and completed studies transparently reported. The extent of compliance with these principles is currently unknown and the author hypothesised that it would be low. The author further hypothesised that registration could be improved by the development of a new global research registry and reporting quality can be improved by the mandatory implementation of reporting guidelines in a journal. METHODS: This thesis incorporated 11 studies. The first two studies used a literature review to determine; the levels of evidence, rates of study registration and protocol publication in the recent Plastic Surgery literature. Thirdly, the design, build and launch of a new global research registry to boost compliance with registration and to determine barriers to it using a survey amongst users. This would be followed by systematic reviews to determine compliance with the STROBE and PRISMA guidelines respectively. An analysis of each guide for authors (GFA) of the surgical journals listed in the Thomson Reuters journal citation report for surgery to determine support for reporting guidelines. The impact of the mandatory implementation of reporting guidelines in a surgical journal would be assessed using a before and after design. Finally, to develop a reporting guideline for surgical case reports (SCARE) and surgical case series (PROCESS) using a DELPHI consensus exercise amongst an expert panel. RESULTS: Protocols were registered in 4% of 595 recent research studies and 0.5% were published. There was a mean compliance of 12/22 for the STROBE guideline (n=94) and 16/27 for the PRISMA guideline (n=79). The Research Registry® was launched in February 2015. Analysis of the first 500 previously unregistered studies, showed they came from 57 countries and included 1.77 million patients. Key barriers to registration were a lack of awareness of the need to register and lack of time (n=149). In addition, 45% registered their study at the time of journal submission. The GFA analysis showed 62% didnât mention reporting guidelines at all (n=193). Subsequent mandatory implementation in a single surgical journal, increased compliance with STROBE by 12% (n=152), with CONSORT by 40% (n=13) and with PRISMA by 58% (n=28). The SCARE and PROCESS reporting guidelines were developed and published in late 2016. According to Google Scholar, they have accumulated over 200 citations at the time of writing. CONCLUSION: Study registration, protocol use and reporting quality are poor in plastic surgery. Potential solutions to these long-standing problems have been developed and explored within this thesis. These include the development and use of the Research RegistryÂ® and the mandatory implementation of reporting guidelines, with both measures front-loaded within a gatekeeper framework for journals. It is now for Plastic Surgeons and the wider surgical community to pick up the gauntlet and drive forward high-quality research, evidence-based surgical practice and better outcomes for their patients and society at large.

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Nery, Caio Vinicius da Silva. "A elaboração de um protocolo de reserva de Concentrado de Hemácias para cirurgias eletivas realizadas em um hospital público do Distrito Federal como ferramenta para otimização do uso racional do sangue." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/17/17155/tde-13092018-142500/.

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A transfusão de sangue continua a ser uma importante ferramenta terapêutica, porém como qualquer outra, apresenta riscos. O sangue após coletado é processado e origina os hemocomponentes, dentre eles o Concentrado de Hemácias (CH). O CH é o hemocomponente mais utilizado na prática clínica. É indicado para o tratamento de anemias e em casos de hemorragia aguda ocorridas em cirurgia ou em decorrência de doenças ou traumas. Dentre os principais riscos da transfusão de CH estão a aloimunização e as reações transfusionais, imediatas ou tardias. Deve-se avaliar a real necessidade de se transfundir um paciente, principalmente, no período intra operatório. A transfusão de CH no intra operatório está associada a um pior prognóstico, maior tempo de internação, sobrevida menor e aumento do risco de infecção. Este estudo tem por objetivo analisar as solicitações de reserva de CH, e a partir desta análise, elaborar um protocolo de reservas cirúrgicas de CH com a finalidade de determinar o quantitativo de bolsas a serem reservadas ou não para a realização procedimentos cirúrgicos realizados no Hospital Regional de Ceilândia, no Distrito Federal. Para a elaboração do protocolo, foi realizado o levantamento de dados referentes às solicitações de reservas realizadas neste hospital entre março e agosto de 2017. Baseado nestes dados, calculou-se o Índice de Pacientes Transfundidos (IPT) que definiu o percentual das reservas que foram utilizadas. Verificou-se que a maioria das reservas solicitadas não foi utilizada. Do total de 216 pacientes que tiveram reservas preparadas, para as quais foram compatibilizadas 438 bolsas, apenas 48 destas bolsas foram transfundidas, ou seja, somente 10,95%. A partir do resultado do IPT, foi definida uma conduta hemoterápica cirúrgica para cada tipo de cirurgia. E, a partir destas, foi elaborado, um protocolo de reservas de CH para cirurgias, com o intuito de racionalizar a solicitação de reservas para ser implementado no hospital. Podendo assim ser um instrumento, para a equipe médica e para a agência transfusional, contribuindo para a economia de recursos financeiros e de sangue.
Blood transfusion continues to be an important therapeutic tool but it presents risks. The blood after collection is processed originating the blood components, among them the Red blood cells (RBC). RBC is the most widely used blood component in clinical practice. It is indicated for the treatment of anemias and in cases of acute hemorrhage occurring in surgery or due to pathologies or traumas. Among the main risks of RBC transfusion are alloimmunization and transfusion reactions. The actual need to transfuse a patient, especially during the intraoperative period, should be evaluated. Intraoperative RBC transfusion is associated with a worse prognosis, longer length of stay, shorter survival and increased risk of infection. The aim of this study was to analyze the RBC reserve requests and then to elaborate a protocol of RBC surgical reserves in order to determine the quantity of blood bags to be reserved or not for surgical procedures performed at the Regional Hospital de Ceilândia (HRC), in the Federal District. For the elaboration of this protocol, the data of the reservations requests performed in HRC March 2017 to August 2017 was carried out. The transfusion Index was calculated from the data, which defined the percentage of reservations that were used. It was found that most of the requested reserves were not used. Of the total of 216 patients who had prepared reservations, for which 438 bags were compatibilized, only 48 of these bags were transfused, that is, only 10.95%. From the result of the transfusion Index, so for each elective surgical procedures a guide surgical hemotherapy was defined. In addition, a reserve protocol of RBC for surgeries was elaborated, with the purpose of rationalizing the reservation request to be implemented in the hospital. This can be an instrument for the medical team and for the transfusion agency, contributing to the rational use of financial and blood resources.

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Masterson, Lisa M. "Implementing a Glycemic Management Protocol with Surgical Patients." Mount St. Joseph University Dept. of Nursing / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=msjdn1619806592278265.

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Gao, Jing. "Transcostal focused ultrasound surgery : treatment through the ribcage." Thesis, University of Dundee, 2012. https://discovery.dundee.ac.uk/en/studentTheses/878abd1a-9d12-4f9a-b8ab-7336c59a7097.

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Two issues hindering the clinical application of image-guided transcostal focused ultrasound surgery (FUS) are the organ motion caused by cardiac and respiratory movements and the presence of the ribcage. Intervening ribs absorb and reflect the majority of ultrasound energy excited by an acoustic source, resulting in insufficient energy delivered to the target organs of the liver, kidney, and pancreas. Localized hot spots also exist at the interfaces between the ribs and soft tissue and in highly absorptive regions such as the skin. The aim of this study is to assess the effects of transmitted beam distortion and frequency-dependent rib heating during trans-costal FUS, and to propose potential solutions to reduce the side effects of rib heating and increase ultrasound efficacy. Direct measurements of the transmitted beam propagation were performed on a porcine rib cage phantom, an epoxy rib cage phantom and an acoustic absorber rib cage phantom, in order of their similarities to the human rib cage. Finite element analysis was used to investigate the rib cage geometry, the position of the target tissue relative to the rib cage, and the geometry and operating frequency of the transducer. Of particular importance, frequency-dependent heating at the target and the intervening ribs were estimated along with experimental verification. The ratio of ultrasonic power density at the target and the ribs, the time-varying spatial distribution of temperature, and the ablated focus of each sonication are regarded as key indicators to determine the optimal frequency. Following that, geometric rib-sparing was evaluated by investigating the operation of 2D matrix arrays to optimize focused beam shape and intensity at target. Trans-costal FUS is most useful in treating tumours that are small and near the surface of the abdominal organs, such as the liver, kidney and pancreas. However, for targets deep inside these organs, severe attenuation of acoustic energy occurs, suggesting that pure ultrasound thermal ablation with different heating patterns will have limited effects in improving the treatment efficacy. Results also demonstrate that the optimal ultrasound frequency is around 0.8 MHz for the configurations considered, but that it may shift to higher frequencies with changes in the axial and lateral positions of the tumours. In this work, I aimed to reduce the side effects of rib heating and increase the ultrasound efficacy at the focal point in trans-costal treatment. However, potential advanced techniques need to be explored for further enhanced localized heating in trans-costal FUS.

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Castanera, Duro Aaron. "Valoración y control del dolor del paciente postoperado de cirugía cardíaca pre y post implantación de una guía práctica de cuidados enfermeros que incluye un protocolo analgésico." Doctoral thesis, Universitat de Girona, 2017. http://hdl.handle.net/10803/461859.

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Pain control is an important objective, although postoperative pain continues to be observed in hospitals. We performed a quasi-experimental study with a non-equivalent control group applying a Nursing Care Guide that includes an analgesic protocol and pain control every 4 hours, with a sample of 117 Control Group (GC) and 124 Study Group (GE) patients after surgery. of cardiac surgery. The main objective of the study is to describe the degree of pain experienced by the patients according to the Numerical Rating Scale(NRS),in the first 32 hours of stay in the Intensive Care Unit and to establish possible differences between the GC and GE. The patients who underwent cardiac surgery presented values ≤3 for the NRS scale. The patients undergoing combined surgery, coronary revascularization and without cardiopulmonary-bypass (CPB) showed more pain. The patients to whom the guide was applied experienced less pain and shorter hospital stay
El control del dolor es un objetivo importante, aunque, continúa observándose dolor postoperatorio en los hospitales. Se realizó estudio cuasi experimental con grupo control no equivalente aplicando una Guía de Cuidados enfermeros que incluye un protocolo analgésico y el control del dolor cada 4 horas, con una muestra 117 pacientes del Grupo Control (GC) y 124 Grupo Estudio (GE) postoperados de cirugía cardíaca. El objetivo principal del estudio es describir el grado de dolor que experimentan los pacientes según la Escala Verbal Numérica (EVN) en las primeras 32 horas de estancia en la Unidad de Cuidados Intensivos y establecer posibles diferencias entre el GC y GE. Los pacientes intervenidos de cirugía cardiaca presentaron valores ≤3 para la escala EVN. Los intervenidos de cirugía combinada, revascularización coronaria y sin Circulación Extracorpórea manifestaron más dolor. Los pacientes a los que se les aplicó la guía experimentaron menos dolor y menor estancia hospitalaria.

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Lewis, Kerrie Anne. "Effect of 4 Analgesic Protocols on Comfort and Sedation of Dogs for 24 hours after Stifle Surgery." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1366606136.

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Haro, Tyah Jo. "Enhanced Glycemic Recovery After Cardiac Surgery: A Quality Improvement Project." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/338757.

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Hyperglycemia in adult cardiac surgery may result in post-operative sternal wound infections, pneumonia, renal failure, increased length of stay, and cost. The Surgical Care Improvement Project (SCIP) (2006) requires blood glucose control in cardiac surgery at 6:00 am on post-operative day one (POD1) and post-operative day two (POD2) to be 200mg/dL or less. Enhanced Recovery After Surgery (ERAS) guidelines use a Maltodextrin 12.5% carbohydrate beverage six hours and two hours pre-operative of general surgery to improve post-operative outcomes, cost, and length of stay. One study replicated ERAS guidelines in adult coronary artery bypass grafting surgery patients finding patients had decreased length of stay and improved glycemic control six hours postoperatively. The purpose of this quality improvement project is to outline a proactive approach to the modifiable risk factor of pre-operative fasting. This quality improvement project describes a pre-operative fasting carbohydrate protocol for non-emergent, adults, scheduled for cardiac surgery at 10:00am or later, with a hemoglobin A1C of 8.4% or less, and a body mass index of 35 or less. The protocol is named the Hungry Sweet Heart Protocol and an implementation plan is described for a community hospital located in Tucson, AZ. Updating practices of strict NPO status prior to cardiac surgery is a proactive measure to improve glycemic control and adherence to SCIP guidelines post-operatively. Interdisciplinary teams, including DNPs, are perfectly suited to guide this implementation.

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Kribel, Jacob Robert George. "Long Term Permanent Vegetation Plot Studies in the Matoaka Woods, Williamsburg, Virginia : Establishment and Initial Data Analysis of Plots Established with the North Carolina Vegetation Survey Protocol, Resampling of Single Circular Plots and a Comparison of Results from North Carolina Vegetation Survey Protocol and Single Circular Plot Methods." W&M ScholarWorks, 2003. https://scholarworks.wm.edu/etd/1539624378.

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Rahmig, Jan, Matthias Kuhn, Hermann Neugebauer, Eric Jüttler, Heinz Reichmann, and Hauke Schneider. "Normothermia after decompressive surgery for space-occupying middle cerebral artery infarction: a protocol-based approach." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-231552.

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Background Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment. Methods We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression. Results We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12). Conclusions Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed.

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Rahmig, Jan, Matthias Kuhn, Hermann Neugebauer, Eric Jüttler, Heinz Reichmann, and Hauke Schneider. "Normothermia after decompressive surgery for space-occupying middle cerebral artery infarction: a protocol-based approach." BioMed Central, 2017. https://tud.qucosa.de/id/qucosa%3A29678.

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Background Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment. Methods We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression. Results We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12). Conclusions Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed.

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Jardim, Daniela Lopes. "Protocolo assistencial de enfermagem de prevenção de tromboembolismo venoso em pacientes cirúrgicos." Universidade do Vale do Rio dos Sinos, 2015. http://www.repositorio.jesuita.org.br/handle/UNISINOS/4902.

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Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-10-26T14:23:08Z No. of bitstreams: 1 Daniela Lopes Jardim.pdf: 816363 bytes, checksum: b7a8c78372004043d222796dbc02face (MD5)
Made available in DSpace on 2015-10-26T14:23:08Z (GMT). No. of bitstreams: 1 Daniela Lopes Jardim.pdf: 816363 bytes, checksum: b7a8c78372004043d222796dbc02face (MD5) Previous issue date: 2015-07-10
UNISINOS - Universidade do Vale do Rio dos Sinos
O tromboembolismo venoso é responsável por um grande número de complicações hospitalares, ocasionando aumento na média de permanência hospitalar dos pacientes. São duas as condições mais frequentes de tromboembolia venosa, a trombose venosa profunda e o tromboembolismo pulmonar, sendo esta a causa de morte evitável mais comum no paciente hospitalizado. OBJETIVO: Elaborar um protocolo assistencial de enfermagem para a prevenção de tromboembolismo venoso profundo em pacientes cirúrgicos. MATERIAL E MÉTODO: Estudo exploratório de revisão sistemática, com busca em banco de dados da Cochrane, Medical Literature Analysis and Retrieval Sistem Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e da Scientific Electronic Library Online. Foram utilizados para a busca os descritores e MESH: Venous Thromboembolism, Risk Factores, Guideline, cirurgic patient, surgery, cardiologic surgery e vascular surgery. Para a sistematização das informações foi utilizado o método PICO (Paciente, Intervenção, Comparação e desfechos) e para a análise dos dados o sistema de classificação de Nível de Evidência do Oxford Center for Evidence Based Medicine e a Classificação do Grading of Recommendations Assessment, Development and Evaluation. RESULTADOS: Dos 9.727 artigos, foram selecionados 6.111 da Cochrane, 3.535 do MEDLINE, 55 LILACS e um artigo do Scielo. Após a leitura dos títulos e resumos, 123 artigos encontrados, sendo selecionados 27 artigos da Cochrane, 73 artigos do MEDLINE, um artigo do Scielo e 22 artigos do LILACS. Após aplicar os critérios de inclusão e exclusão, foram selecionados para o estudo 25 artigos. CONCLUSÃO: a construção deste protocolo assegurará qualidade e padronização da avaliação e procedimentos de enfermagem na sistematização do tromboembolismo venoso. Sua efetivação se dará após sua validação e implantação.
Venous thromboembolism is accountable for a large number of hospital complications, while implicating an increased average hospital stay of patients. There are two most common conditions of venous thromboembolism: deep vein thrombosis, and pulmonary embolism, being such thromboembolisms the most common cause of preventable death in hospital patients. PURPOSE: Prepare a clinical protocol of nursing for the prevention of deep venous thromboembolism in surgical patients. MATERIALS AND METHODS: Exploratory study of systematic review, with search in databases as Cochrane, Medical Literature Analysis and Retrieval Sistem Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e da Scientific Electronic Library Online. For the searching were used the MeSH descriptors Venous Thromboembolism, Risk Factors, Guideline, Surgical Patient, Surgery, Cardiac Surgery, and Vascular Surgery. For the systematization of the data was used the PICO-method (P-patient, I-intervention, C-comparation, O-outcomes), and, for the data analysis, the classification system of the Oxford Centre for Evidence-based Medicine/Levels of Evidence, and the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Among 9,727 articles, 6,111 were selected from Cochrane, 3,535 from MEDLINE, 55 from LILACS, and 1 from SciELO. After the reading of titles and summaries, 123 articles were taken into account, 27 being selected from Cochrane, 73 from MEDLINE, 1 from SciELO, and 22 from LILACS. Having applied the inclusion and exclusion criteria, 25 articles were selected for the study. CONCLUSION: The construction of this protocol will ensure quality and standardization of the assessment and nursing procedures in the systematization of venous thromboembolism. Its effectiveness will take place after its validation and implementation.

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Lam, Cheuk-fan, and 林卓凡. "Evidence-based intervention protocol of using biofeedback therapy for minimizing post surgery bowel incontinence for adult patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48335538.

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In Hong Kong, the number of colon cancer patients has increased over the years. But at the same time, early detection of colon cancer has also become more readily available due to the recent technological advancement and increased accessibility to medical care. In recent years, more patients have become eligible for having curative sphincter saving operation and one of the objectives of this operation is to preserve continence function without stoma formation. However, colon cancer patients’ journeys do not finish after their operation. For instance, they may have bowel disorder after the operation, namely ‘Anterior Resection Syndrome’. This debilitating condition may not be amenable by surgical technique or medical therapy and it affects the bio-psycho-social wellbeing of the patient. One of the responsibilities of nurses is to promote the general wellbeing of the clients. Therefore, in this study, the possible methods of alleviating the condition of Anterior Resection Syndrome among colon cancer patients were inspected. By using strategic search of current evidences, this study found that several primary studies support the use of biofeedback to alleviate the condition. After conducting a comprehensive review of the selected studies, the biofeedback treatment was considered as an appropriate recommendation for the current clinical setting. After assessing the implementation potential of the current practice, an evidence-based protocol with considerations of local factors was established. In addition, in order to minimize resistance on the change of current practice, plans on communicating with stakeholders, pilot study and evaluation were carefully established. The purpose of this study is to provide professional nursing care by using evidence based practice for those in need.
published_or_final_version
Nursing Studies
Master
Master of Nursing

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32

Yuzda, Edward Stephen. "Chromaffin cell grafts to the cerebral cortex of nucleus basalis magnocellularis-lesioned rats : tissue specificity, duration of placement and establishment of immunocytochemical protocols." Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=55404.

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Cell transplantation to the brain and spinal cord is a well-established tool for studies on cellular and molecular mechanisms involved in development and plasticity. Experimental data from animals has suggested that restoration or preservation of function through cell transplantation has potential as a useful therapeutic approach in neurodegenerative disorders. Experimental evidence of graft-induced behavioral ameliorations has raised the question of the applicability of this technique to the cognitive neurodegenerative disorder, Alzheimer's disease (AD).
This present study is based on previous work from our lab that has indicated a potential for cortical grafts of chromaffin cells of the adrenal medula to alleviate nucleus basalis magnocellularis (nbm) lesion-induced cognitive and neurochemical deficits; such lesions produce deficits which mimic certain of the deficits seen in AD. This study has found that chromaffin cell grafts ameliorate behavioral deficits and that a neurochemical recovery occurs in the cortex consequential to it. This particular behavioral improvement was evidenced 6 weeks but not 5 days post-graft, indicating a gradual effect by the graft. Additionally, in this behavioral test, control grafts of kidney cells were found to have no ameliorating effects. A final objective to establish immunocytochemical techniques for detection of graft constituents was also actualized.

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33

Saleeba, Elizabeth Constance. "Patient compliance and spontaneous movements while following an early active motion protocol after a flexor tendon repair." University of Western Australia. School of Surgery, 2010. http://theses.library.uwa.edu.au/adt-WU2010.0050.

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Compliance to strict home exercise programs is understood to be a mainstay of post-surgical flexor tendon rehabilitation. Therapists recognise the potential of poor compliance (overuse or under-use of prescribed exercise) and spontaneous movements during rehabilitation. Some therapists may suggest that compliance to specific exercise regimens and control of spontaneous or general movements are fundamentally important in optimising the rehabilitation outcomes and minimising the potential of adverse events. Yet there is little objective data to document the actual levels of exercise or spontaneous finger movement performed outside the clinical setting. The purpose of this study was to document both diary and instrumented methods of reporting finger movement during a 48hr period. Following surgical repair of the flexor tendon, subjects attending a private hand therapy clinic provided consent and reported subjective diary (n=16) data of sets and repetitions of exercise for up to 6 weeks post-operatively. Nine subjects also had instrumented data logged on 3 occasions during the first 6 weeks of rehabilitation and were not fully aware of the purpose of the instrumentation. All subjects were instructed to perform 10 passive followed by 10 active exercises every waking hour, for the first 6 weeks and were assessed on range of motion, DASH, pain and strength. Results demonstrated that patients reported, via their diaries, that they are on average 80% compliant. Parallel data logger information suggests that this figure is more likely to reflect 50% compliance. A significant (p< .05) increase in spontaneous movements in the last 2 weeks of the 6 week assessment period was detected. No significant correlation between patient's level of compliance or spontaneous movement and their outcome were detected.

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Chibaudel, Benoist Gramont Aimery de. "Evaluation de la pause thérapeutique dans le cancer colo-rectal métastatique." Créteil : Université de Paris-Val-de-Marne, 2005. http://doxa.scd.univ-paris12.fr:80/theses/th0234859.pdf.

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35

Heriot, Jody L. "Implementation of a Beta Blocker Protocol." UNF Digital Commons, 2012. http://digitalcommons.unf.edu/etd/415.

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Background: Beta blockers are recommended by the American College of Cardiology/American Heart Association Guidelines for high and intermediate-risk cardiac patients undergoing non-cardiac surgery. Beta blockers are a class of drugs that moderate the effects of increased catecholamine levels on the heart by selectively blocking beta receptors in the heart and blood vessels, resulting in a lower heart rate and blood pressure. Beta blocker use perioperatively has been shown to reduce the risk of ischemia and infarction. Purpose: The purpose of this project is to address beta blocker use in a group of anesthesia providers who routinely attend to high-risk and intermediate-risk cardiac patients undergoing non-cardiac surgery in a medium-sized private hospital in suburban South Florida. There are barriers to the implementation of the published guidelines for beta blocker administration, including lack of awareness of the best current practice and a lack of a formal beta blocker protocol at the institutional level. Methods: A simple and inexpensive beta blocker protocol was implemented and evaluated by various means. Beta blocker administration practices were examined and documented prior to and after protocol implementation. Beta blocker usage was examined prior to and after protocol implementation Findings/Implications: It was hypothesized that increased anesthesia provider awareness would lead to increased administration of perioperative beta blockers to high-risk and intermediate-risk cardiac patients undergoing non-cardiac procedures. Although there was a knowledge increase related to the new beta blocker protocol, no change in practice was observed.

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Lopes, Diana Rosado. "Estudo comparativo entre dois protocolos de profilaxia antibiótica em procedimentos odontológicos realizados em pacientes imunossuprimidos." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-12032010-164202/.

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Estudos sobre profilaxia antibiótica em pacientes imunossuprimidos submetidos a procedimentos cruentos odontológicos são bastante escassos, no entanto já existe um consenso de que estes pacientes são sabidamente de risco para infecção de sítio cirúrgico odontológico e que, portanto, necessitam de profilaxia antibiótica. Não é definido, no entanto, o regime profilático ideal para estes pacientes. O objetivo deste estudo é comparar a duração de antibioticoprofilaxia através de dois esquemas para prevenção de infecção após procedimentos odontológicos cruentos em pacientes imunossuprimidos transplantados renais ou hepáticos e em pacientes imunossuprimidos por quimioterapia. Este ensaio clínico foi randomizado e avaliou pacientes consecutivos com neoplasia e que fizeram uso de quimioterapia anti-neoplásica no último mês e pacientes transplantados de órgãos sólidos com medicação imunossupressora anti-rejeição, que necessitavam de exodontia e/ou raspagem periodontal como tratamento odontológico. O atendimento foi realizado na Divisão de Odontologia do Hospital das Clínicas da Faculdade Medicina da Universidade de São Paulo e foram incluídos pacientes da rotina do ambulatório que atendiam aos critérios de inclusão para participarem do protocolo da pesquisa e que concordaram em participar, assinando o Termo de Consentimento Livre e Esclarecido. Os pacientes foram randomizados para um dos dois grupos de regime profilático (grupo 1 - uma cápsula de 500mg de amoxicilina duas horas antes do procedimento odontológico; grupo 2 duas cápsulas de 500mg de amoxicilina, sendo a primeira duas horas antes do procedimento e a segunda oito horas após a primeira) e realizaram exame de sangue para avaliação da cultura hematológica após a realização do procedimento, sendo acompanhados durante um mês. A amostra calculada foi de 414 pacientes, sendo 207 em cada grupo. Os dados foram analisados através do programa SPSS Windows (versão 13.0, Chicago IL) e a partir daí foi obtida uma tabela descritiva e utilizado o teste qui-quadrado para comparação das variáveis entre os dois grupos. O nível de significância foi de p< ou = 0,05. Foi realizada também uma análise multivariada. A amostra foi analisada durante o período de novembro de 2006 a novembro de 2007. Não ocorreram os seguintes desfechos: infecção do sítio cirúrgico, antibiótico introduzido pelo médico no pós-operatório em até 30 dias após o procedimento odontológico e morte até o 15º dia após o procedimento odontológico. Os desfechos encontrados foram: necessidade de tomar analgésico após o 3º dia e até o 15º dia após o procedimento (3 no grupo 1 e 1 no grupo 2) e internação hospitalar até o 15º dia após o procedimento (2 no grupo 1 e 1 no grupo 2). A análise multivariada não alterou os resultados. Este estudo não demonstrou uma diferença entre utilizar uma ou duas doses de amoxicilina como profilaxia em procedimentos invasivos dentários em pacientes imunosuprimidos
Studies about antibiotic prophylaxis in immunosuppressed patients submitted to odontological invasive procedures are scarse, however there is already a consensus that these patients are in risk for post-operative infection in dentistry and that, therefore, they need antibiotic prophylaxis. It is not defined, however, the best prophylactic regimen for these patients. The aim of this study was to compare two regimens of antimicrobial prophylaxis in dental invasive procedures in immunosuppressed patients by chemotherapy for cancer or solid organ transplants. This is a randomized controlled study and it evaluated consecutive patients with cancer and that were submitted to chemotherapy in the last month and solid organ transplanted patients who needed exodontia or periodontal scaling and root planning as odontological treatment. This study was done in the Divisão de Odontologia of Hospital das Clínicas of Faculdade Medicina of the Universidade de São Paulo and it was included patients from the routine of the ambulatory who presented all the inclusion criteria and signed the informed consent. Patients were randomly assigned to one of the groups of prophylactic regimens (group 1 amoxicillin 500mg administered orally two hours before the procedure; group 2 amoxicillin 500mg administered orally two hours before the procedure and a second dose eight hours later) and had blood sample collected for culture immediately after the procedure, being followed up for one month. The total sample size was of 414 patients, being 207 in each group. Data were analyzed using the software SPSS Windows (version 13.0, Chicago IL). The characteristics of the patients of the 2 groups were compared using the chi-square test. The two groups were compared as to each outcome. A multivariate analysis was performed evaluating the groups as to the occurrence of any of the outcomes, by multiple logistic regression. The sample was evaluated between november of 2006 and november of 2007. The following outcomes did not occur: surgical site infection; systemic use of an antimicrobial drug within 30 days after the procedure and death by any reason within 15 days after the procedure. The other outcomes were: use of medication against pain after 3rd day after the procedure (three in group 1 and one in group 2) and hospitalization for any reason within 15 days after the procedure (two in group 1 and one in group 2). The multivariate analyses did not alter the results. This study did not demonstrate a difference between using one or two doses of amoxicillin as prophylaxis in invasive odontological procedures in immunosuppressed patients

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Horta, Carolina Campos Machado Marques. "Efeitos de uma intervenção comportamental sobre a adesão ao protocolo pré e pós-operatório de uma revisão da artroplastia de substituição total da articulação do quadril." Pontifícia Universidade Católica de São Paulo, 2018. https://tede2.pucsp.br/handle/handle/21639.

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Treatment adherence has become a recurrent debate and research topic during the last 40 years. Poor adhesion is one of the main reasons for unsatisfactory results in the treatment of a disease. One of the main problems found by health professionals in the area of hip orthopedy is the poor adhesion to the preoperative and postoperative protocols for the total hip joint replacement arthroplasty, which reduce the patient's quality of life and waste health resources. This study aimed to develop and evaluate a behavioral intervention to increase the adhesion to the preoperative and postoperative protocols for the total hip joint replacement arthroplasty addressed to a patient which presented poor adhesion to the protocol in his first surgery. We used: (a) two surveys: one to evaluate the adhesion of the patient to the protocols, and the other to verify if the patient knew how to detect and describe relevant signals that should be reported to health professionals after the surgery; (b) two logs: one to evaluate the answers given by the patient in face-to-face meetings, and the other to evaluate the verbal report about his behavior in the last 24 hours in phone interviews; (c) an educational booklet with written instructions and images to guide the patient on the appropriate behavior before and after the surgery; and (d) three videos with examples of the exercises that should be executed before and after the surgery and appropriate movements of the body. In the initial meeting with the patient, we evaluated whether he fulfilled all the criteria to participate in the study. Before the intervention the researcher evaluated which behaviors were already a part of the patient's behavioral repertoire. During the intervention, the researcher used several strategies to increase the probability of adhesion to the surgical protocol, including shaping, modeling, instructions and positive reinforcement, in face-to-face meetings and in telephone interviews. After the intervention, the researcher repeated the same steps carried in before the intervention, besides phone interviews. During this phase the patient also filled a survey similar to the one used in the initial meeting. The results showed that the intervention produced a positive effect on patient's adherence to the surgical protocols. After the study, the patient presented a more complete adhesion to the items in the protocol to which adhesion was initially only partial
A adesão ao tratamento tornou-se objeto de intensas investigações e debates nos últimos 40 anos. Um dos grandes problemas encontrados pelos profissionais de saúde, na área da ortopedia do quadril, é a pobre adesão ao protocolo pré e pós-operatório da artroplastia de substituição total do quadril (ATQ), o que causa prejuízos à qualidade de vida e à saúde do paciente e desperdiça recursos de saúde. O presente estudo teve como objetivo desenvolver e avaliar uma intervenção comportamental para aumentar a adesão ao protocolo cirúrgico da revisão da artroplastia de substituição total da articulação do quadril (ARQ) por um paciente que apresentou pobre adesão ao protocolo na primeira cirurgia. Foram utilizados (a) dois questionários, um para avaliar a adesão do participante ao protocolo cirúrgico, e outro para avaliar a identificação e descrição de sinais relevantes que devem ser descritos à equipe de saúde após a cirurgia, utilizado nas fases Pré-Intervenção, Intervenção e Seguimento; (b) duas folhas de registro, uma para avaliar as respostas apresentadas pelo participante em encontros presenciais com a pesquisadora, outra para avaliar o relato sobre a ocorrência de adesão apresentada pelo participante nas últimas 24 horas em entrevistas por telefone; (c) um livreto educativo com instruções escritas e imagens relacionadas à cirurgia para orientar o participante sobre os comportamentos que devem ser apresentados no pré e no pós-operatório da ARQ e (d) três vídeos para oferecer modelos dos exercícios que devem ser executados no pré-operatório, dos movimentos apropriados após a cirurgia e dos exercícios que devem ser praticados no pós-operatório. No Encontro Inicial avaliou-se se o participante preenchia os critérios para participação no estudo. Na Pré-intervenção, a pesquisadora avaliou os comportamentos de adesão que já faziam parte do repertório comportamental do participante. Na fase Intervenção, a pesquisadora utilizou estratégias para aumentar a probabilidade de ocorrência de comportamentos de adesão ao protocolo cirúrgico, a saber, modelagem, modelação, instruções e reforçamento positivo, em encontros presenciais e em entrevistas por telefone. No seguimento a pesquisadora repetiu o mesmo procedimento da fase Pré-intervenção acrescido de entrevistas por telefone utilizadas na Intervenção e do Questionário de adesão ao protocolo cirúrgico utilizado no Encontro Inicial. Os resultados mostraram que a intervenção produziu um efeito positivo sobre a adesão do participante ao protocolo cirúrgico. Ao final do estudo o participante passou a apresentar uma adesão mais completa aos itens do tratamento para os quais a adesão era inicialmente apenas parcial

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Cateriano-Alberdi, Maria Paula, Cecilia D. Palacios-Revilla, and Eddy R. Segura. "Survey of Diagnostic Criteria for Fetal Distress in Latin American and African Countries: Over Diagnosis or Under Diagnosis?" Glorigin LifeSciences, 2017. http://hdl.handle.net/10757/622212.

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Girotto, Marcos Antonio. "Estudo comparativo de dois protocolos farmacologicos em exodontias de terceiros molares mandibulares inclusos." [s.n.], 2003. http://repositorio.unicamp.br/jspui/handle/REPOSIP/290794.

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Orientador: Eduardo Dias de Andrade
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: No planejamento das exodontias de terceiros molares mandibulares inclusos, talvez a maior preocupação do operador esteja relacionada com o controle da dor e edema pós-operatórios, redução do grau de ansiedade dos pacientes e prevenção de infecção da ferida cirúrgica. Neste sentido, o presente trabalho teve por objetivo avaliar a eficácia de dois protocolos farmacológicos que pudessem atender às necessidades citadas. Para tal, foram selecionados 20 sujeitos saudáveis, com indicação para a remoção bilateral dos terceiros molares mandibulares inclusos, em posição similar. Para o controle da dor, receberam rofecoxib 50 mg ou betametasona 4 mg, uma hora antes de cada intervenção, de forma aleatória, duplo-cega e cruzada. No mais, em ambas as intervenções, os pacientes receberam o mesmo tratamento farmacológico complementar: diazepam 5 mg como ansiolítico e aplicação local de uma solução aquosa de digluconato de c1orexidina 0,12% para prevenir complicações infecciosas da ferida cirúrgica. Foi prescrito paracetamol 750 mg para o caso de dor residual após a intervenção. A dor pós-operatória foi avaliada por um período de 24 horas, por meio de uma escala verbal descritiva e pelo consumo de analgésico no período pós-cirúrgico. O grau de ansiedade foi avaliado por meio da aplicação da Escala de Ansiedade de Corah (modificada). A incidência de infecção pós operatória foi caracterizada pela presença de dor aguda e trismo. Os resultados mostraram que o rofecoxib e a betametasona são drogas eficazes na prevenção da hiperalgesia. O diazepam por sua vez, parece ter contribuído para a redução da ansiedade em apenas parte dos sujeitos da amostra. Nenhuma complicação infecciosa foi observada no período pós operatório, como efeitos adversos da medicação empregada. Concluiu-se que ambos os protocolos farmacológicos são eficazes e seguros para serem empregados em cirurgias de terceiros molares mandibulares inclusos
Abstract: On planning the mandibular impacted third molar surgery, one of the major maybe concerns of the surgeons is related to the prevention of swelling, pain control, decreasing of the patients' anxiety degree and prevention of the infection of the surgical wound. This way, the aim of the present work was to assess the efficacy of two pharmacological protocols that could attend the previously mentioned needs. For that, 20 healthy people, that had been scheduled to undergo removal of bilateral impacted mandibular third molars, in the same position. One hour before the surgery the patients were randomly given either 4 mg betamethasone or 50 mg rofecoxib, to the pain control in a double blind crossed-over study. Furthermore, in both procedures, patients were given the same additional pharmacological treatment: 5 mg diazepam, as ansiolitic drug and 0.12% chlorhexidine digluconate rinses to prevent possible infection complications in the surgical wound. When considered necessary, it was advised the intake of 750 mg paracetamol to relief the residual pain after surgery. The postoperative pain was assessed in a period of 24 hours, by a 4 verbal rating scale and through of analgesic intake after the surgery. The "Corah modified" anxiety scale was used to evaluate the anxiety degree. The postoperative infection incidence was expressed by acute pain and trismus. The results showed that both rofecoxib and betametasona are efficacious to prevent hiperalgesia also that diazepam seemed to have contributed to the reduction of anxiety in just part of the sample subjects. No infectious complications were observed, also adverse drugs effects. We carne to the conc1usion that both protocols are safe and effective to be used in mandibular impacted third molar surgery
Doutorado
Farmacologia, Anestesiologia e Terapeutica
Doutor em Odontologia

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Guimarães, Lucas de Melo. "Proposta de técnicas para reserva de canal e atenuação do problema de surdez de antenas em comunicações direcionais." reponame:Repositório Institucional da UnB, 2013. http://repositorio.unb.br/handle/10482/13557.

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Dissertação (mestrado)—Universidade de Brasília, Departamento de Ciências da Computação, 2013.
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O uso de antenas direcionais acopladas a dispositivos que permitam a comunicação sem o tem sido considerada uma alternativa para melhorar a utilização do espaço aéreo, a vazão e a redução de interferência. Apesar de prover um melhor uso do espaço aéreo, a utilização de antenas direcionais possui algumas limitações. Tais limitações decorrem das próprias características das comunicações direcionais, assim como do fato de que a mai- oria dos protocolos de controle de acesso ao meio (MAC) projetados para comunicações direcionais serem baseados no padrão IEEE 802.11. Apesar do padrão em questão ser am- plamente adotado na literatura correlata, ele foi projetado para suporte a comunicações omnidirecionais. Dessa forma, os protocolos MAC direcionais baseados no padrão IEEE 802.11 acabam herdando características do padrão que limitam o desempenho quando se considera o uso de comunicações direcionais. Este trabalho realiza um estudo e propõe melhorias para as técnicas relativas às comunicações direcionais. A principal contribuição deste trabalho é a proposta de uma técnica de reserva de canal otimizada para comunica- ções direcionais. A técnica proposta permite a realização da reserva de canal em menos tempo do que o gasto com o uso dos mecanismos tradicionais. Utilizando sinais pulse e tone, a técnica proposta (DPTCR) é avaliada tanto de maneira analítica como empírica. O DPTCR foi capaz de prover uma vazão até 40% maior do que as técnicas existentes. A segunda contribuição deste trabalho está na proposta de integração do DPTCR com técnicas direcionais já existentes, permitindo assim um melhor aproveitamento das ca- racterísticas das comunicações direcionais. A referida integração foi avaliada, indicando ganhos no que diz respeito à quantidade de transmissões simultâneas. Embora provenha diversos ganhos, a utilização de comunicações direcionais incorre em problemas ainda em estudo pela literatura correlata. Neste sentido, pode-se destacar o problema de surdez de antenas que pode acarretar situações de injustiça na distribuição dos recursos da rede. A terceira contribuição deste trabalho reside na proposta de um mecanismo (DPTCR-DA) que visa mitigar o problema de surdez em antenas direcionais. Este mecanismo de atenuação de surdez utiliza como base o DPTCR aliado à estimativa da ocorrência de surdez a partir de informações de uxos de tráfego. Nas avaliações apresentadas, o DPTCR-DA revela o seu potencial tanto no que tange à justiça na distribuição dos recursos da rede, quanto no que diz respeito à vazão de comunicações iniciadas pelo receptor. ______________________________________________________________________________ ABSTRACT
The use of directional antennas attached to devices that enable wireless communi- cations has been considered an alternative to improve spatial reuse and throughput. Although the use of directional antennas provides better spatial reuse, it also imposes constraints on network performance. These constraints are inherited from directional communications characteristics, as well as the fact that most medium access control (MAC) protocols designed for directional communications are based on the IEEE 802.11 standard. Although the IEEE 802.11 standard is widely used, it was designed for omnidirectional communications. Thus, the directional MAC protocols based on the IEEE 802.11 standard inherit characteristics that limit the performance when considering the use of directional communications. This work aims to perform a study and propose improvements to techniques related to directional communications. The main contribution of this work is to propose a channel reservation technique which is designed for directional communications. The proposed technique performs channel reservation in less time than traditional schemes. Based on pulse and tone signals, the proposed technique (DPTCR)is evaluated from empirical and analytical perspectives. The results show that DPTCR is able to provide a throughput up to 40% higher than traditional schemes. Another contribution of this work is to incorporate packet scheduling techniques in order to better explore directional communications characteristics. The referred integration was eval- uated, improving the amount of simultaneous transmissions. Despite of its advantages, directional communications also impose severe constraints which are commonly addressed in related works. One of these shortcomings is the deafness problem, which may lead to an unfair assignment of network resources. The third contribution of this work is to propose a deafness mitigation technique (DPTCR-DA) that aims to minimize the deafness prob- lem. This technique is based on DPTCR coupled with the use of tra c ow information to estimate deafness occurrence. Performance evaluations reveal DPTCR-DA's potential in terms of fairness and throughput.

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Fecteau, Annie. "The effect of donor-specific transfusion 24 hours pre-transplant and cyclosporin on allograft survival : a clinically relevant induction protocol for cadaveric small bowel transplantation." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=56981.

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The combination of pretransplant donor specific transfusion (DST) and cyclosporin (Cys) has proven to be an effective mode of immunomodulation in numerous allograft models. Our experiments were designed to study the effect of clinically applicable protocols using DST and low-dose cyclosporin in an heterotopic, fully allogenic model of small bowel transplantation in the rat.
A 1 ml systemic DST 24 hours pretransplant with Cys (10 mg/kg day $-$1, 5 mg/kg POD 0 to 7, 2.5 mg/kg POD 8 to 14) was shown to be more effective than DST or Cys alone in prolonging graft survival (p $<$ 0.05). Adding successive post-transplant DST (POD 7,14,21) had no effect on graft survival. Portal transfusion and Cys was the most effective mode of antigen presentation (p = 0.01 vs systemic DST), with 33% of the animals having prolonged survival. Adding successive post-transplant DST was deleterious to the portal DST effect. The adjunct of anti-lymphocyte serum to the DST-Cys combination was ineffective.

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Evers, Patrick D. M. D. "Prenatal Heart Block Screening in Mothers With SSA/SSB Auto-antibodies: Targeted Screening Protocol is a Cost-Effective Strategy." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1552379621451565.

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Spieth, Peter M., Andreas Güldner, Christopher Uhlig, Thomas Bluth, Thomas Kiss, Marcus J. Schultz, Paolo Pelosi, Thea Koch, and de Abreu Marcelo Gamba. "Variable versus conventional lung protective mechanical ventilation during open abdominal surgery: study protocol for a randomized controlled trial." BioMed Central, 2014. https://tud.qucosa.de/id/qucosa%3A28659.

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Background: General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventilation. Methods/Design: The PROtective VARiable ventilation trial ('PROVAR') is a single center, randomized controlled trial enrolling 50 patients who are planning for open abdominal surgery expected to last longer than 3 hours. PROVAR compares conventional (non-variable) lung protective ventilation (CV) with variable lung protective ventilation (VV) regarding pulmonary function and inflammatory response. The primary endpoint of the study is the forced vital capacity on the first postoperative day. Secondary endpoints include further lung function tests, plasma cytokine levels, spatial distribution of ventilation assessed by means of electrical impedance tomography and postoperative pulmonary complications. Discussion: We hypothesize that VV improves lung function and reduces systemic inflammatory response compared to CV in patients receiving mechanical ventilation during general anesthesia for open abdominal surgery longer than 3 hours. PROVAR is the first randomized controlled trial aiming at intra- and postoperative effects of VV on lung function. This study may help to define the role of VV during general anesthesia requiring mechanical ventilation.

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Condiracci, Courtney N. "Return to Play Decision Making with Concussed Athletes: Sports Medicine Practitioners’ Responses." Antioch University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1533053587483438.

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Silva, Thiago da. "Elaboração de um protocolo assistencial para dor de pacientes adultos cirúrgicos." Universidade do Vale do Rio dos Sinos, 2014. http://www.repositorio.jesuita.org.br/handle/UNISINOS/4395.

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OBJETIVO: identificar e analisar as melhores evidências cientifica como suporte teórico para a elaboração de um protocolo assistencial para o manejo da dor de pacientes adultos cirúrgicos. METODOLOGIA: trata-se de estudo exploratório, realizado em bases de dados através dos descritores obtidos no MeSH/Decs: Acute pain; chronic pain; General surgery; Analgesics; Clinical protocols; Practice guideline; Pain measurement; Pain; Post-Surgery; Post-Operative. A busca foi realizada nas bases de dados PubMed, LILACS e COCHRANE, utilizando-se o método PICO, compreendendo artigos escritos em inglês ou português, a partir de 2001 e classificados conforme o sistema de classificação de Nível de Evidência do Oxford Center for Evidence Based Medicine e o grau de recomendação e o nível de evidência no enfoque tratamento, prevenção, etiologia e diagnóstico, do Grading of Recommendations Assessment, Development and Evaluation ? GRADE. Todos os direitos autorais foram preservados. RESULTADOS: dos 424 artigos encontrados, 29 foram selecionados. Identificaram-se evidências quanto à classificação da intensidade da dor conforme o tipo de cirurgia, os instrumentos para sua avaliação e os principais agentes farmacológicos para o seu manejo. Os resultados mostraram que a maioria dos artigos são do Brasil e Estados Unidos, sendo a maior produção em 2013 (8 artigos), 2009 (5 artigos) e 2010 (4 artigos). As melhores evidências encontradas foram 16 ensaios clínicos randomizado e seis revisões sistemáticas de ensaios clínicos randomizado. A escala de mensuração da dor mais utilizada é a Escala Visual Analógica. Deve ser classificada conforme sua intensidade e seu manejo deve ser adequado de acordo com a potência do analgésico prescrito. CONCLUSÃO: os estudos identificaram inúmeras fragilidades, não existindo um planejamento farmacológico adequado ao paciente cirúrgico. A criação deste protocolo propiciou um caminho seguro e uma base científica de qualidade para o manejo da dor e vêm ao encontro das diretrizes estabelecidas pela Agência Americana de Pesquisa e Qualidade em Saúde Pública, e a Sociedade Americana da Dor.
OBJECTIVE: to identify and analyze the best scientific evidence and theoretical support for the development of a protocol assistance for pain management of surgical adult patients. METHODOLOGY: this is an exploratory study conducted in databases obtained through the descriptors in MeSH / Decs: Acute pain; chronic pain; General surgery; Analgesics; Clinical protocols; Practice guideline; Pain measurement; Pain; Post-Surgery; Post-Operative. The search was performed in PubMed, LILACS and COCHRANE data, using the PICO method, comprising articles written in English or Portuguese, from 2001 and classified according to the classification system LoE of the Oxford Centre for Evidence Based Medicine and grade of recommendation and level of evidence approach in treatment, prevention, etiology and diagnosis, the Grading of Recommendations Assessment, Development and Evaluation - GRADE. All copyrights are preserved. RESULTS: among the 424 articles found, 29 were selected. We identified evidence for the classification of pain intensity according to the type of surgery, the instruments for their assessment and the main pharmacologic agents for its management. The results showed that most of the articles are from Brazil and the United States, with the largest production in 2013 (8 articles), 2009 (5 items) and 2010 (4 articles). The best evidence found were 16 randomized clinical trials and systematic reviews of six randomized clinical trials. The measurement scale is the most widely used pain Visual Analog Scale. Should be classified according to their intensity and their management should be appropriate according to the prescribed analgesic potency. CONCLUSION: the studies identified numerous weaknesses, with no adequate pharmacological planning to surgical patients. The creation of this protocol provided a safe journey and a scientific basis for quality pain management and come to meet the guidelines established by the American Agency for Research and Quality in Public Health, and the American Pain Society.

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Schultz, Jurek, Susann Leupold, Xina Grählert, Roland Pfeiffer, Uta Schwanebeck, Percy Schröttner, Barbara Djawid, Wladislav Artsimovich, Karol Kozak, and Guido Fitze. "Study protocol for a randomized controlled pilot-trial on the semiocclusive treatment of fingertip amputation injuries using a novel finger cap." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-231693.

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Fingertip amputation injuries are common in all ages. Conservatively treated fingertips can regenerate skin and soft tissues to form a functionally and cosmetically excellent new fingertip. Little is known about this ability that, in humans, is confined to the fingertips. Even less is known about the role of the bacteria that regularly colonize these wounds without negative impact on regeneration and healing. As an alternative to surgery, self-adhesive film dressings are commonly used to establish a wet chamber around the injury. These dressings leak malodorous wound fluid eventually until the wound is dry. Having that into consideration, we have therefore developed a silicone finger cap that forms a mechanically protected, wet chamber around the injury for optimal regeneration conditions. It contains a puncturable reservoir for excess wound fluid, which can be thus routinely analyzed for diagnostic and research purposes. This study protocol explains the first randomized controlled trial (RCT) on the semiocclusive treatment of fingertip amputations in both children and adults comparing traditional film dressings with the novel silicone finger cap. Being the first RCT using 2 medical devices not yet certified for this indication, it will gather valuable information for the understanding of fingertip regeneration and the design of future definitive studies.

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Schultz, Jurek, Susann Leupold, Xina Grählert, Roland Pfeiffer, Uta Schwanebeck, Percy Schröttner, Barbara Djawid, Wladislav Artsimovich, Karol Kozak, and Guido Fitze. "Study protocol for a randomized controlled pilot-trial on the semiocclusive treatment of fingertip amputation injuries using a novel finger cap." Lippincott Williams & Wilkins, 2017. https://tud.qucosa.de/id/qucosa%3A30698.

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Fingertip amputation injuries are common in all ages. Conservatively treated fingertips can regenerate skin and soft tissues to form a functionally and cosmetically excellent new fingertip. Little is known about this ability that, in humans, is confined to the fingertips. Even less is known about the role of the bacteria that regularly colonize these wounds without negative impact on regeneration and healing. As an alternative to surgery, self-adhesive film dressings are commonly used to establish a wet chamber around the injury. These dressings leak malodorous wound fluid eventually until the wound is dry. Having that into consideration, we have therefore developed a silicone finger cap that forms a mechanically protected, wet chamber around the injury for optimal regeneration conditions. It contains a puncturable reservoir for excess wound fluid, which can be thus routinely analyzed for diagnostic and research purposes. This study protocol explains the first randomized controlled trial (RCT) on the semiocclusive treatment of fingertip amputations in both children and adults comparing traditional film dressings with the novel silicone finger cap. Being the first RCT using 2 medical devices not yet certified for this indication, it will gather valuable information for the understanding of fingertip regeneration and the design of future definitive studies.

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Costa, Cristiane Ferreira da. "Utilização de corrente microgalvânica para o desenvolvimento de dois protocolos para tratamento de estrias albas." Universidade Tecnológica Federal do Paraná, 2016. http://repositorio.utfpr.edu.br/jspui/handle/1/2739.

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O desenvolvimento de estrias durante a gestação é considerado a alteração fisiológica mais comum do tecido conjuntivo e poucas são as alternativas de tratamento destinadas a suavizar a aparência dessa alteração. O presente estudo desenvolveu e aplicou dois protocolos para o tratamento de estrias albas surgidas durante o período gestacional utilizando a corrente microgalvânica e verificando seus efeitos. Tratou-se de um estudo exploratório, experimental, de abordagem quantitativa e qualitativa, composto por 26 voluntárias com faixa etária entre 20 e 35 anos divididas igualmente em dois grupos. Iniciou-se o estudo após a assinatura do Termo de Consentimento Livre e Esclarecido. Ambos os grupos receberam 15 sessões de tratamento com a corrente microgalvânica modulada em 100µA (microampères) sendo uma sessão a cada 12 dias de intervalo. O grupo A recebeu o tratamento com a técnica de punturação longitudinal e o grupo B recebeu a técnica de punturação transversal. Todas as voluntárias responderam a um questionário relatando a intensidade da dor, tipo de dor e a satisfação com o tratamento, e passaram por avaliação fisioterapêutica no início, após a quinta, décima e décima quinta sessão do protocolo de tratamento proposto. Todas as estrias foram tratadas, contudo, três estrias de cada voluntária foram selecionadas para serem acompanhadas, sendo fotografadas e tendo sua área, comprimento e largura analisados por meio do software ImageJ, da planimetria manual e da paquimetria. A cada cinco sessões houve uma comparação dos resultados obtidos dentro de cada um dos grupos e também entre os grupos a fim de avaliar qual o melhor protocolo e qual a quantidade necessária de sessões para aproximar a aparência das estrias escolhidas à da pele considerada normal. O grupo A apresentou diferença significativa após cinco sessões de tratamento enquanto o grupo B necessitou de 15 sessões para apresentar resultado semelhante ao grupo A na redução do tamanho das estrias. Todavia, os dois protocolos aplicados foram efetivos na redução do tamanho das estrias. Na comparação entre grupos para intensidade da dor foi encontrado diferença estatisticamente significativa (p=0,000) para o grupo A que apresentou dor maior em relação ao grupo B. Relativamente à satisfação das mulheres com o tratamento não houve diferença estatisticamente significativa entre os grupos. No grupo A 38,4% das voluntarias relataram muita satisfação, 53,8% satisfação e 7,7% pouca satisfação com o tratamento. O grupo B relatou 38,4% de muita satisfação, 46,5% satisfação e 15,4% de pouca satisfação com o tratamento.
The development of stretch marks during pregnancy is considered the most common physiological change of connective tissue and there are few alternative treatments designed to soften the appearance of this change. This study developed and applied two protocols for the treatment of striae alba arising during pregnancy using microgalvanic current and checking its effects. This was an exploratory study, experimental, quantitative and qualitative approach, consisting of 26 volunteers aged between 20 and 35 years also divided into two groups. It began the study after signing the Statement of Consent. Both groups received 15 treatment sessions with the microgalvanic current modulated 100μA (microamps) being a session every 12 days apart. Group A received the treatment with the longitudinal puncturing technique and the B group received the cross puncturing technique. All participants answered a questionnaire on the intensity of pain, type of pain and satisfaction with treatment, and underwent physical therapy evaluation at the beginning, after the fifth, tenth and fifteenth session of the proposed treatment protocol. All streaks were treated, however, three streaks of each volunteer was selected to be monitored being shot and having its area, length and width analyzed using the ImageJ software, manual planimetry and pachymetry. The five sessions was a comparison of the results within each group and between groups in order to assess what is the best protocol and wherein the required amount of sessions to approximate the appearance of the striae chosen to be normal skin. Group A showed significant differences after five treatment sessions while the B group needed 15 sessions to present results similar to group A in reducing the size of stretch marks. However, the two applicable protocols were effective in reducing the size of striae. In the comparison between groups for pain intensity was found statistically significant (p = 0.000) for group A which showed greater pain than in group B. With regard to women's satisfaction with the treatment, there was no statistically significant difference between groups. In group A, 38.4% of voluntary reported great satisfaction, 53.8% and 7.7% satisfaction little satisfaction with treatment. The B group reported 38.4% of great satisfaction, 46.5% and 15.4% satisfaction low satisfaction with treatment.

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Teixeira, Robert Sousa. "Protocolo de atuação de admissão e alta de doentes num recobro cirúrgico: precioso ou prescindível?" Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2015. http://hdl.handle.net/10400.26/10688.

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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica
Este relatório de trabalho de projeto contém, tendo por base as competências do enfermeiro especialista em EMC e de mestre em enfermagem, um Projeto de Intervenção em Serviço subordinado ao tema: Protocolo de atuação de admissão e alta de doentes num recobro cirúrgico: precioso ou prescindível? O mesmo surgiu pelo facto de exercermos no Serviço de Urologia/Cirurgia Vascular de um Hospital da Margem Sul, onde se verifica a inexistência de critérios estabelecidos de entrada e saída dos doentes do recobro e da sistematização de cuidados, sendo que o próprio recobro não é visto como uma unidade de cuidados pós-cirúrgicos diferenciada, mas como uma extensão da "enfermaria". Para o diagnóstico da situação, realizámos uma análise SWOT dos critérios existentes de entrada e de saída dos doentes do recobro. Recorreu-se à escala modificada de Aldrete, utilizada para a alta do doente nas unidades de cuidados pós-anestésicos, e à Escala de Etxebarria, utilizada no transporte de doente crítico. As principais conclusões a que chegamos prendem-se com a constatação de que a existência de um Protocolo com critérios de admissão e alta de doentes do recobro proporcionam a melhoria da qualidade dos cuidados prestados aos doentes no recobro de um Serviço de Urologia/Cirurgia Vascular, num Hospital da Margem Sul.
Abstract: This report contains, based on the master’s skills, one Intervention Project in service the subject of the admission of action Protocol and high of patients in a surgical recovery room: Precious or dispensable? The same came in that we exercise in the Urology Service / Vascular Surgery Hospital in Region of Lisbon of the South Rim, where he observed a lack of established criteria for entry and exit of patients in the recovery room and the systematization of care, and the recovery room itself is not seen as a unit of differentiated post-surgical care, but as an extension of "nursery". To assess the situation, we conducted a SWOT analysis of the existing criteria for entry and exit from the recovery room patients. Resorted to scale modified Aldrete, used for high patient in the post-anesthesia care units, and Etxebarria Scale, used in the transport of critically ill patients. The main conclusions reached relate to the finding that the existence of a Protocol to the criteria for entry and recovery room of patients output are based on improving the quality of care provided to patients in the recovery room of a Urology / Surgery Service Vascular, a Hospital of the South Rim.

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Belo, Luís Filipe Mendes Mendonça. "Avaliação da eficácia de dois protocolos de assepsia pré-cirúrgica da pele como medida preventiva de infeções do local cirúrgico em Canis familiaris." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2017. http://hdl.handle.net/10400.5/13993.

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Dissertação de Mestrado Integrado em Medicina Veterinária
A assepsia pré-cirúrgica da pele é uma das medidas preventivas de infeções do local cirúrgico. A maioria das infeções do local cirúrgico é provocada por agentes comensais e patogénicos provenientes da microbiota do doente. O aumento da disseminação de bactérias resistentes a antibióticos é uma realidade atual. A lâmina de bisturi poderá constituir um fomite de contaminação exógena de bactérias, veiculando-as para o interior do local cirúrgico. Os objetivos do presente estudo foram 1) avaliar a eficácia de dois protocolos de assepsia pré-cirúrgica da pele e 2) avaliar o papel da lâmina de bisturi como fomite de bactérias para os órgãos internos. Utilizou-se uma amostra de 46 canídeos (N=46), escolhidos aleatoriamente e divididos em 2 grupos de acordo com o protocolo de assepsia utilizado: solução aquosa de iodopovidona a 7,5% ou solução alcoólica de clorexidina a 2%. Para cada indivíduo foram recolhidas três amostras em tempos diferentes: pré-assepsia (to), pós-assepsia (t1) e lâmina de bisturi após incisão da pele (t2). A quantificação e identificação da microbiota utilizou os meios de cultura BHI agar e MRSA agar cromogénico modificado. As espécies de staphylococci foram identificadas recorrendo a API® staph. A distribuição das reduções logarítmicas promovidas por ambos os antissépticos foi muito semelhante, não apresentando diferenças estatisticamente significativas, sugerindo que ambos os protocolos apresentam eficácia semelhante na assepsia e na eliminação de bactérias resistentes à meticilina em cirurgia veterinária, especificamente em canídeos.
ABSTRACT - EVALUATION OF THE EFFECTIVENESS OF TWO PRE-SURGICAL SKIN ASEPSIS PROTOCOLS AS A PREVENTIVE MEASURE OF SURGICAL SITE INFECTIONS IN CANIS FAMILIARIS - The skin pre-surgical asepsis is one of the preventive measures of the surgical site infections. Most of these infections are caused by commensal and pathogenic agents from the patient’s microbiota. The increase in the dissemination of antibiotic-resistant bacteria is a current topic. The surgical blade could constitute a source of exogenous contamination of bacteria to the interior of the surgical site. The objectives of this study were 1) evaluating the effectiveness of two pre-surgical skin asepsis protocols and 2) evaluate the presence of bacteria in the surgical blade. A sample of 46 dogs (N=46) was studied, which were randomly assigned for an asepsis protocol with aqueous solution of 7,5% povidone-iodine or for a protocol based on an alcoholic solution of 2% chlorhexidine. For each dog, three samples were collected at different times: pre-asepsis (t0), post-asepsis (t1) and surgical blade (t2) after skin incision. For the quantification and identification of the microbiota, were used the BHI agar and the MRSA agar modified chromogenic mediums, respectively. The staphylococci species were identified using API® Staph. The logaritmic reduction promoted by both antiseptics was very similar, not representing statistically significant differences, suggesting that both protocols present similar effectiveness in surgical asepsis and in the elimination of methicillin resistant bacteria in veterinary surgery, specifically in dogs.
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