Dissertations / Theses: 'Wounds and injuries – Nursing'

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Moloko, Salaminah S. "Nursing outcome standards for polytrauma patients with traumatic brain injuries in the Mafikeng district." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52372.

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Thesis (MCUR)--University of stellenbosch, 2001.
ENGLISH ABSTRACT: In trauma the priority is given to identifying the life-threatening injuries and immediately implementing treatment (Demetriades, 1993:3). Severe trauma resuscitation and assessment often have to be carried out simultaneously to detect and treat conditions that are rapidly fatal if not attended to immediately and according to priority. Urgent priorities in trauma management include maintaining a clear and patent airway to facilitate respiration and cervical spine protection by avoiding rough manipulation of the head and neck by supporting the neck with a neck immobiliser. Any external bleeding has to be controlled by applying direct pressure to the wound. Cardiovascular problems, for example shock or myocardial infarction, respiratory problems and hypoxia which are detrimental, particularly in the case of head injury, should be excluded. A detailed head-to-toe examination which includes the head, neck, chest, abdomen, back, musculo-skeletal system, rectum and vagina has to be performed. For the head-injured patient, correct any condition, which may complicate the existing head injury, for example hypoxia, shock, pneumothorax and fractures of long bones or pelvis. Implement the A (airway), B (breathing), C (circulation), D (disability, neurological and drugs) and E (environment) for structured management of the patient. Muller's, (1996) two-phase model was utilised to formulate and validate nursing outcome standards. In phase one literature was explored to develop provisional standards on polytrauma patients with traumatic brain injuries. In phase two the provisional standards were validated by experts (doctors and nurses) in critical care, trauma and emergency nursing including nurses and a doctor working in the casualty department of a provincial hospital in Mafikeng. Final standards were formulated and adapted accordingly. Standards for the management of a polytrauma patient with traumatic brain injuries included: A safe environment for patients, nurses and doctors Primary survey in casualty department which includes the maintenance of airway, breathing, circulation, disability/ neurological, drugs and exposure The secondary survey that includes the head to toe examination, definitive orthopaedic care and stabilisation before transfer to the intensive care unit A standard on all relevant equipment which might be needed in case the patient goes into cardiac arrest on the way to the intensive care unit, was also formulated. The standard on documentation included the primary and secondary survey in the casualty department, transport to the intensive care unit, activities and the condition of the patient. The final standards dealt with the accurate handing over of the patient to the intensive care personnel. The following recommendations were made: • Implement the outcome standard by means of a quality improvement programme through a top-down approach. • Provide training: Nurses and doctors have an obligation to render quality care, therefore they have the right to be trained in emergency procedures. • All registered nurses working in the casualty or emergency departmentsshould be trained in at least Basic Life Support (CPR), Advanced Cardiac Life Support (ACLS), Advanced Paediatric Life Support (APLS) and Advanced Trauma Life Support (ATLS) while waiting to be sent for the trauma-nursing course. • Improve infection control measures in the casualty department • Emergency drugs must always be available. • Improve the on-call system. • Formulate a policy on sharing of the equipment by both casualty and ICU staff. • Motivate for the necessary equipment. Implement procedures for debriefing of staff, the evaluation of actions during resuscitation and implement measures for psychological support of the family. • For further research, implement and test a training programme whereby nurses can formulate their own standards. • Evaluate whether the standards have improved the quality of trauma care, and develop standards for leu nursing of the brain injured patient and the rehabilitation of polytrauma patients with traumatic brain injuries The uniqueness of the study lies in the fact that no formal outcomes standard for trauma patients with traumatic brain injuries have been developed in any of the North West Provincial hospitals.
AFRIKAANSE OPSOMMING: Die identifisering van lewensbedreigende beserings en die onmiddellike implementering van behandeling, is in trauma 'n eerste prioriteit (Demetriades, 1993: 3). Resussitasie en die beraming van erge traumagevalle noodsaak in baie gevalle, gelyktydige hantering. Sou hierdie hantering nie gelyktydig en onmiddellik volgens prioriteit plaasvind nie, kan dit noodlottige gevolge inhou. Belangrike prioriteite in traumabehandeling sluit in, die instandhouding van 'n patente lugweg om asemhaling te onderhou asook die beskerming van die servikale rugmurgkolom, deur die ruwe manipulasie van die kop en nek te vermy deur die implementering van 'n nekimmobiliseerder. Kardiovaskulere probleme, byvoorbeeld skok of miokardiale infarksie, asook respiratoriese probleme wat lewensbedreigend vir die pasient met 'n hoofbeseering is, moet uitgesluit word. 'n Gedetailleerde van kop-tot-tone ondersoek, wat die kop, nek, borskas, abdomen, rug, muskulo-sketale stelsel, rektum en vagina insluit, moet uitgevoer word. In die pasient met hoofbeserings moet enige toestand byvoorbeeld frakture van die langbene of die pelvis, skok of 'n pneumothorax, eers behandel word. Implementeer die A (Iugweg - "airway"), B (asemhaling - "breathing"), C (sirkulasie -"circulation"), D (gestremdheid - "disability", neurologies- "neurological" en drogerye-"drugs") en E (omgewing - "environment") vir die gestruktureerde behandeling van die pasient. Die twee fase model van Muller (1996) is gebruik vir die formulering en validering van die verpleeguitkomsstandaarde. In fase een is die literatuur verken om die voorlopige standaarde vir polytrauma pasiente met traumatiese breinbeserings te ontwikkel. In fase twee is die voorlopige standaarde gevalideer deur kundiges (dokters en verpleegkundiges) in kritieke sorg, trauma en noodverpleging. Die verpleegkundiges en dokter wat werksaam is in die ongevalle-eenheid van 'n plaaslike provinsiale hospitaal in Mafikeng is ook ingesluit. Finale standaarde is geformuleer en dienooreenkomstig aanvaar. Die standaarde vir die politrauma pasient met traumatiese breinbeserings, sluit in: 'n Veilige omgewing vir pasiente, verpleegkundiges en dokters. Die prirnere beraming in ongevalle ten opsigte van instandhouding van die lugweg, asemhaling, sirkulasie, gestremdheid, drogerye en blootstelling. Die sekondere beraming: wat behels die kop-tot-tone ondersoek. Definitiewe ortopediese behandeling en stabilisering voor oorplasing na die intensiewe-sorg-eenheid. 'n Standaard met betrekking tot die nodige toerusting wat benodig mag word tydens 'n hart stilstand, oppad na die intensiewe-sorg-eenheid, is ook geformuleer. Die standaard ten opsigte van dokumentasie sluit die primere, en sekondere beraming, vervoer na die intensiewe-sorg-eenheid, aktiwiteite en toestand van die pasient, in. Die finale standaarde is gebaseer op die oorhandiging van die pasient aan die intensiewe-sorg-personeel. Die volgende aanbevelings word gemaak: • Implementeer die uitkomsstandaarde deur middel van 'n gehalteverbeteringsprogram deur gebruik te maak van 'n "top-down" benadering -, • Voorsien opleiding: Verpleegkundiges en dokters het 'n verpligting om gehaltesorg te lewer, hulle het dus 'n reg om onderrig te ontvang in noodprosedures, en verder het die pasient die req op gehalter noodbehandeling. • Aile geregistreerde verpleegkundiges wat in die ongevalle en die noodafdeling werk, behoort opgelei word in ten minste basiese lewensondersteuning (CPR), Gevorderde Trauma Lewens Ondersteuning (ACLS), Gevorderde Pediatriese lewensondersteuning (APLS) en Gevorderde Trauma lewensondersteuning (ATLS), terwyl gewag word om die trauma verpleegkundigekursus te deurloop. • Verbeter mteksiebeheermaatreels in ongevalle. • Noodmedikasie moet ten aile tye beskikbaar wees. • Verbeter die op-roepstelsel ("on cali"). • Formuleer 'n beleid oor die gesamentlike gebruik van toerusting deur beide ongevalle- en intensiewe-sorg-eenheid-personeel. • Motiveer vir die nodige toerusting. • Implementeer prosedures om personeel to te laat vir ontlonting (debriefing), die evaluering van aksies tydens die resusitasie prosedure en implementeer metodes vir die sielkundige ondersteuning van die familie. • Ten opsigte van verdere narvorsing behoort 'n opleidingsprogram qeunplernenteer en getoets te word met betrekking tot verpleegkundiges wat hulle eie standaarde will formuleer. • Evalueer of die standaarde die gehalte van traumasorg verbeter het en ontwikkel standaarde vir intensierwe-sorg-verpleging van die breinbeseerde pasient asook die rehabilitasie van politrauma pasiente met traumatise breinbeesering. Die unieke bydra van die studie word gevind in die feit dat daar nog geen gerformaliseerde uitkomstandaarde vir traumapasiente met breinbeseerings in enige van die Noord Wes Provinsie se hospitale ontwikkel is nie.

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陳敏恩 and Man-yan Esther Chan. "A comprehensive intervention for mild head injury patients in accidentand emergency department." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251018.

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Opadotun, Olukemi. "Infection control practices for the prevention of surgical site infections in the operating room." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1017195.

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Infections are a major cause of morbidity and mortality during the post-operative phase of patients’ recovery. Wound infections are the second most commonly encountered type of nosocomial infection. Because wound infections can be introduced by not applying infection control measures and sterile technique principles in the operating room, the implementation of infection control principles is an imperative. The aim of this study was to explore and describe infection control practices related to the prevention of Surgical site infections in the operating rooms in a public health care sector in the Nelson Mandela Bay Municipality. The findings were compared with practices, as indicated in an evidence-based guideline. The research design was quantitative, explorative, descriptive, comparative-descriptive and contextual in nature. The research sample consisted of all the professional nurses, in the operating room. The data were collected by means of a self-administered questionnaire. Descriptive statistics was used to present the data in the form of tables and graphs. Based on the analysis of the data, some recommendations were made for the implementation of infection control practices, in order to prevent Surgical site infections in the operating room.

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Curtis, Kathleen Anne Public Health &amp Community Medicine Faculty of Medicine UNSW. "Trauma nursing case management: impact on patient outcomes." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/33367.

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Aim The purpose of the study was to formally identify trauma care delivery problems at the study institution, implement a solution in the form of trauma case management (TCM), and measure the effect of TCM on staff satisfaction, clinical coding accuracy and patient outcomes, using practice-specific outcome variables such as in-hospital complication rates, length of stay, resource use and allied health service intervention rates. This research also aimed to make a unique contribution to the international trauma literature by addressing the lack of any evidence specifically measuring the impact of trauma case management intervention. Methods St George Hospital is a 600 bed urban Teaching Hospital of the University of NSW. It is a designated Trauma Centre, seeing around 200 severely injured patients and around 2500 injury admissions per year. A series of focus groups and a staff satisfaction survey identified perceived problems associated with trauma care, and a trauma case management program was implemented. A preliminary study was conducted with positive results and funding was obtained to provide TCM seven days a week to all trauma patient admissions. A larger clinical trial was conducted and data from 754 patients were collected over fourteen months after TCM was introduced at the study hospital. These data were compared with 777 matched patients from the previous 14 months as a control group. An audit was conducted on trauma patient clinical coding using the daily progress record kept by the trauma case manager. The data were analysed with SPSS. The statistical tests used were Mann-Whitney U, chi-squared (2) logistic regression and generalised linear models. Results Focus groups and the staff satisfaction survey identified communication and coordination as the main problems associated with trauma care delivery. Following the initial implementation of the program, staff support for TCM was overwhelming. TCM greatly improved the rate of and time to Allied Health intervention (p<0.0001). Results demonstrated a decrease in the occurrence of deep vein thrombosis (p<0.038), coagulopathy (p=0.041) and respiratory failure. A reduced hospital length of stay (LOS), particularly in the paediatric (p<0.05) and 45 - 64 years age group was noted. There were 6621 fewer pathology tests performed (p<0.0001) and the total number of bed days was 483 days less than predicted from the control group. Many hospital clinical coding errors and omissions were highlighted by the TCM record comparison. The use of TCM records resulted in Twenty eight percent of recoded records having their Australian national diagnostic related group (AN-DRG) changed, which resulted in the identification over $39,000 in unidentified funding. Conclusion TCM improves staff satisfaction, communication and clinical coding accuracy. The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution. This initiative demonstrates that TCM results in improvements to quality of care, trauma patient morbidity, financial performance and resource use. This research makes an important and original contribution to the international trauma literature by providing the results of a clinical trial formally measuring the impact of trauma nursing case management intervention.

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Amer, Ramadan Khalifa. "Nursing students' knowledge and practices related to sharp object injury and management at a university in the Western Cape Province." Thesis, Cape Peninsula University of Technology, 2019. http://hdl.handle.net/20.500.11838/2966.

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Thesis (Master of Nursing)--Cape Peninsula University of Technology, 2019
Background: Like other health care providers, nursing students are unprotected from occupational dangers such as sharp object injuries (SOIs) due to imperfect knowledge and experience. These students face a great risk of exposure to blood borne infections by pathogens such as HIV and the hepatitis B and C viruses while executing their clinical actions in hospitals. SOIs are a significant problem for nursing students, as they increase the risk of contracting blood-borne infections. Purpose: The purpose of this study was to determine nursing students' knowledge and practices related to SOIs and their management at a university in the Western Cape Province. Objectives: The objectives of this study include determining the occurrence of SOIs, and knowledge of risk of SOIs, as well as the reporting and management of SOIs at a university in the Western Cape. Method and sample: A cross-sectional descriptive survey was conducted with nursing students from the second to fourth year of study, registered at a university in the Western Cape Province for the 2017 academic year. Quota sampling was applied to select respondents who, after providing informed consent, then completed and handed the self- administered questionnaires back to the researcher on the same day that they were distributed. Data were obtained from nursing students about whether or not they had experienced an SOI, what they did after the SOI, their perception of the risk, and management of and preventive measures for SOIs. Validity and reliability were ensured, and all ethical principles were adhered to. SPSS was used for the quantitative data analysis. Results: A total of 252 nursing students from the second to fourth years participated in this study. The average age of respondents was 24 years, with a minimum of 19 and maximum of 46 years; 211 (83.7%) of them were females. During their course 63 (25%) respondents experienced SOIs; only 42 (66.67%; N=63) of them reported the occurrence of an SOI, most (25 or 59.52%) reporting it to the professional nurse in charge. The highest occurrence of SOIs was reported by fourth-year students (26 respondents, 41.3%). It was found that 21 (33.3%) of SOIs were not reported, and the main reason for this was because there was little or no perception of associated risk (15, 71.43%). Forty-six (73.02%) respondents experienced a single SOI, while 11 (17.46%) had two SOIs, 4 (6.35%) reported having had three SOIs, and one each (1.59%) had more than four and more than ten SOIs. The activity causing most of the SOIs was administration of medication by injection (48 cases, 76.2%), and in most cases (57, 90.47%) the instruments causing injury were needles or hollow-bore needles. Most of the affected respondents squeezed the puncture site after the SOI (42, 66.7%), followed by washing the area with water and soap (40; 63.5%), and cleaning the site with antiseptic (15, 23.8%). Among those students exposed to SOIs, only 22 (52.4%) had undergone blood tests, and very few of them took post-exposure prophylaxis or treatment (16, 25.40%). The emotion that most of them felt after the SOI was fear (42, 66.7%), and the main reason for not getting treatment was fear of side effects (18, 38.29%). Also, only 61 (24.2%) respondents reported recapping needles after use, while most reported incomplete vaccination against hepatitis B (195, 77.38%). The main reason for not using personal protective equipment (PPE) was noted as the unavailability thereof at the institution (43, 49.4%). Conclusion: This study documented a low rate of reporting SOIs among nursing students. It is plain that there are inadequate levels of knowledge and practice related to SOI management among these students at a university in the Western Cape. One would imagine that because the majority of nursing students had a measure for the practice of universal precautions and used PPE, their management after exposure to SOIs during work training in hospital would be efficient. This was not the instance in this study, where application of these actions in their practical training was poor.

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Degani, Gláucia Costa. "Trauma em idosos: características e evolução." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-28112011-164940/.

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O trauma desponta como mais uma doença a que os idosos podem estar vulneráveis. Além disso, tendo em vista o aumento desta faixa etária, é possível que, em breve, a realidade do trauma nesta população também cresça. Dessa forma, é fundamental que os profissionais dos serviços de saúde conheçam as alterações que ocorrem com o processo de envelhecimento e as características específicas do trauma, com a finalidade de melhor assistir esta população. Assim, os objetivos deste estudo foram: identificar o perfil sociodemográfico de idosos, vítimas de trauma; caracterizar as doenças preexistentes e os medicamentos em uso; descrever as características do trauma e sua evolução; verificar a existência de associação entre variáveis sociodemográficas, doenças preexistentes, características e evolução do trauma; verificar a existência de correlação entre dias internados em CTI e ISS. Trata-se de um estudo não experimental, retrospectivo e exploratório. Realizado a partir da análise de dados de natureza secundária contidos em um banco de dados do Núcleo Hospitalar de Epidemiologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, referentes às notificações dos pacientes, vítimas de trauma, atendidos na Unidade de Emergência, deste hospital, no período de 2008 a 2010. Dessa forma, a coleta dos dados seguiu as informações contidas no referido banco, além da busca nos prontuários médicos para identificação de doenças preexistentes, do uso de medicamentos em domicílio e das complicações clínicas após o trauma. Foram estudados 131 idosos, vítimas de trauma, média de idade 69,9 anos (s=7,7); 73,3% eram homens; 55,1%, casados; 54,7%, aposentados; 65,6% possuíam doenças preexistentes, sendo 38,9% hipertensão arterial sistêmica e 19,8% etilismo, média de doenças 2,3 (s=1,4); 48,9% tomavam medicação em domicílio, média 3,2 medicamentos (s=2,3). Quanto às características do trauma, para 31,3%, o mecanismo de trauma foi queda e para 28,2%, pedestre; 83,2% por trauma contuso; 59,5% possuíam lesão em cabeça/pescoço, 45,8% em extremidades e ossos da pelve, média 1,8 (s=1,0); 44,3% obtiveram ISS entre 9 e 15 (trauma moderado) e 30,5% ISS de 25 ou mais (trauma muito grave); 80,2% apresentaram TRISS entre 51% ou mais (francas condições de se evitar o óbito). Com relação à evolução do trauma, 30,5% internaram em CTI, média de 4,2 dias; 62,6% desenvolveram complicações clínicas, sendo 43,5% infecciosas e 30,5% cardiovasculares; 46,1% foram submetidos à cirurgia ortopédica; 66,4% sobreviveram ao trauma, 47,3% receberam alta hospitalar com limitações moderadas e 33,6% faleceram, sendo 36,4% por traumatismo cranioencefálico e 22,7% por sepse. Houve associação entre mecanismo do trauma e doença preexistente (p=0,01) e associação entre mecanismo do trauma e sexo (p=0,03); a presença de doenças aumentou em 3,10 a chance para desenvolver complicações em relação aos que não apresentavam doenças (p=0,02); para os internados em CTI, a chance de ter complicações aumenta em 28,2 (p<0,01); conforme aumenta o índice de gravidade do trauma, maiores são as chances de complicações, odds = 3,07 entre ISS 16 e 24 (grave) e odds = 6,50 com ISS 25+ (muito grave) em relação ao ISS 9 a 15 (moderado); para idosos com complicações, a chance de morte aumenta em 5,56, quando comparados com aqueles que não apresentaram (p<0,01); para idosos com TRISS <50% (sobrevida inesperada), a chance de óbito foi de 10,13 em relação àqueles com TRISS >=50% (morte evitável) (p<0,01); a correlação entre os dias de internação no CTI e os escores do ISS foi fraca e positiva (r=0,18), indicando que quanto maior o número de dias de internação no CTI maiores são os índices de gravidade do trauma (p=0,03). O conhecimento das características e da evolução do trauma pode possibilitar aos profissionais de saúde o planejamento de medidas preventivas, além de viabilizar melhor atendimento aos idosos na atenção intra-hospitalar e após a alta, com vistas a melhorar a qualidade de vida.
Trauma emerges as another condition to which elderly individuals are vulnerable. Considering the increase in this population, trauma events are also likely to increase among older individuals. Hence, it is essential that health care providers are aware of changes that may occur with the aging process and the specific characteristics of trauma aiming to better care for this population. This study identifies the sociodemographic profile of elderly trauma victims; characterizes pre-existent diseases and used medications; describes the characteristics of trauma and its progression; verifies potential correlation between days hospitalized in ICU and Injury Severity Score (ISS). This non-experimental, retrospective and exploratory study was based on secondary data collected from a database of the Hospital Epidemiology Center at the Hospital das Clinicas, Medical School, University of São Paulo at Ribeirão Preto concerning reports of elderly trauma victims cared for in the hospital\'s emergency department from 2008 to 2010. Data collection was based on information contained in the database and search on medical charts to identify pre-existent diseases, medication used at home, and clinical complications after the trauma. A total of 131 elderly trauma victims participated in the study: 69.9 years old in average (sd=7.7); 73.3% men; 55.1% married; 54.7% retired; 65.6% with pre-existent diseases: 38.9% systemic arterial hypertension, and 19.8% alcoholism; average of diseases 2.3 (sd=1.4); 48.9% took medication at home, average of 3.2 medications (sd=2.3). In relation to the characteristics of trauma: 31.3% was caused by falls and 28.2% pedestrian; 83.2% was contusion trauma; 59.5% had head and neck injury; 45.8% had limbs and pelvic bones affected, average 1.8 (sd=1.0); 44.3% obtained ISS between 9 and 15 (moderate trauma) and 30.5% ISS was 25 or above (very severe trauma); 80.2% presented Trauma and Injury Severity Score (TRISS) between 51% or above (real conditions to avoid death). In relation to trauma progression, 30.5% was hospitalized in ICU, 4.2 days in average; 62.6% developed clinical complications: 43.5% infections and 30.5% cardiovascular; 46.1% was submitted to orthopedic surgery; 66.4% survived, 47.3% was discharged with moderate impairment and 33.6% died: 36.4% due to brain injury and 22.7% due to sepsis. An association between the mechanism of trauma and pre-existent diseases was found (p=0.01) as well as association between mechanism of trauma and gender (p=0.03). Pre-existent diseases increased 3.10 times the chance of complications comparing to those with no pre-existent diseases (p=0.02). The chances of complications increased 28.2 times for those hospitalized in ICU (p<0.01); the higher the index of trauma severity, the greater the chances of complications, odds = 3.07 between ISS 16 to 24 (severe) and odds = 6.50 with ISS 25+ (very severe) in relation to ISS 9 to 15 (moderate). The chances of dying increased 5.56 times for those with complications compared to those with no complications (p<0.01); chances of death was 10.13 times higher for individuals with TRISS <50% (unexpected survival) in relation to those with TRISS >=50% (evitable death) (p<0.01). Correlation between duration of hospitalization in ICU and ISS scores was weak and positive (r=0.18) indicating that the longer the hospitalization in ICU, the higher the trauma severity index (p=0.03). Knowledge concerning the trauma characteristics and progression can enable health care providers to plan preventive measures and provide better care to elderly individuals both at the hospital and after discharge aiming to improve their quality of life.

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Butler, Mary, and n/a. "Care ethics and brain injury." University of Otago. Department of Philosophy, 2008. http://adt.otago.ac.nz./public/adt-NZDU20080214.134301.

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It is generally supposed that a supportive family can have an influence on outcomes for an adult with severe brain injury, but there is very little known about what effective families actually do. In this research the families of five such individuals were involved in an ethnographic project that lasted for one year. The literature review brought together insights from brain injury, care ethics, disability studies and anthropology. These insights were combined with a process of reflective equilibrium that was applied to the ethnographic material in order to determine the ethics of the carers. Ethics of care in this setting was conceived of as a positive practice ethic, rather than as a series of negative conundrums posed by the brain injury. The practice ethic shared by carers meant that they all conceived of the need created by brain injury in humanistic terms, rather than in terms of pathology. Carers demonstrated virtues appropriate to their practice as they helped the adult with brain injury to connect with aspects of ordinary life. The best outcomes for the adult with brain injury included being able to engage in productive activity and to make a place in the world. These outcomes could only be achieved with due regard for their safety and subsistence. The practice ethic of carers was demonstrated in the skills and concern that ensured a satisfactory outcome for the adult with brain injury. This research is a departure from recent research about families affected by brain injury, which has focused on the burden involved in care. An examination of what carers achieve suggests that burden may be associated with the development of caring practice. The transformative capacity of care, for both the carer and the adult with brain injury, is emphasized. However contextual factors, such as adequate compensation, are connected to the capacity of the carer to engage in good practice and these are explored also in this thesis. In particular, relevant aspects of the relationship between families and the Accident Compensation Corporation are explored.

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Harper, Jane. "Improving Estimation of Resting Energy Expenditure in Seriously Injured Individuals." University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1241571769.

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Pulido, Kelly Cristina Strazzieri. "Adaptação cultural e validação do instrumento \"Star Skin Tear Classification System\", para a língua portuguesa no Brasil." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-23122010-103305/.

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O objetivo do estudo foi realizar a adaptação cultural do STAR Skin Tear Classification System, para a língua portuguesa no Brasil e testar a validade de conteúdo e a confiabilidade inter-observadores da versão adaptada. O estudo é do tipo metodológico com abordagem quantitativa. A adaptação cultural foi desenvolvida em três fases: tradução, avaliação por comitê de juízes e retro-tradução. Foram testadas duas propriedades de medida: validade de conteúdo e confiabilidade inter-observadores. Para as análises estatísticas foi utilizado o índice kappa ponderado. A versão adaptada para o português obteve um nível regular de concordância (kw = 0,286), embora estatisticamente significativo (p = 0,000), quando de sua aplicação por enfermeiros em fotografias de lesão por fricção. Quando de sua aplicação na prática clínica, a versão adaptada em português obteve um nível moderado e estatisticamente significativo de concordância (kw = 0,596; p < 0,001). O estudo sobre o processo de adaptação cultural e validação das propriedades de medida do STAR Skin Tear Classification System possibilitou atestar a validade de conteúdo e a confiabilidade inter-observadores da versão adaptada para uso na língua portuguesa do Brasil
This study aims to perform a cultural adaptation of the STAR Skin Tear Classification System, to the Portuguese language spoken in Brazil and to test its contents validity and the reliability in the translated version. This is a methodological type of study with a quantitative approach. The cultural adaptation was developed in three stages: translation, evaluation by a judges committee and back translation. Two measures were tested: validity and reliability. The statistical analysis used the weighted kappa index. The adapted version had a regular concordance level (kw = 0,286), although statistically significant (p < 0,000) when tested by nurses in skin tears photographs. When tested in clinical practice, the adapted version achieved a moderate and statistically significant concordance level (kw = 0,596; p < 0,001). The study about the cultural adaptation process and validation of the measurements properties of the STAR Skin Tear Classification System confirmed the adapted Brazilian Portuguese version content validity and reliability

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Patterson, Michele M. Tervo. "Adolescent Experience with Trauma and Orthopedic External Fixation: A Dissertation." eScholarship@UMMS, 2007. https://escholarship.umassmed.edu/gsn_diss/7.

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Over 13 million adolescents sustain traumatic injuries yearly, resulting in functional disability, disfigurement, psychosocial problems and fractures. These fractures are increasingly being treated with orthopedic external fixation devices (EFDs). The purpose of this study was to describe the experience of traumatically injured adolescents treated with EFDs. The 4 aims of the study focused on the circumstances leading to the traumatic event, experiences following the traumatic event, the impact of EFD treatment, and adolescents’ role in pin-care self-management, which is crucial to preventing infection. This longitudinal, qualitative descriptive study used purposive sampling to recruit 5 male and 4 female adolescents, 13-20 years old, from a New England level-1 trauma center. Participants were injured in motor vehicle crashes (including an all-terrain vehicle), falls, by gunshot, trampoline and football trauma. Interview questions were framed by two themes from a study of adult recovery from physical injury, i.e., the event and fallout. Participants were interviewed within days of the injury, 2 weeks after returning home, and within one month of EFD removal. Data were coded from verbatim transcripts using NVIVO and organized into themes guided by the principles of qualitative analysis. An overarching theme of “old self no more; forever changed” emerged from 26 interviews. The participants’ experience affected all tasks of adolescence: independence from parents, accepting body image, peer relations, and forming an identity. Major themes included “what risk?”, regarding circumstances leading to the traumatic event, mastering the environment, was 2 part first, processing the event, where determining fault and realizing everything has changed, they were ambivalently lucky, and not invincible. Secondly “suck it up and deal with it”, where strategies to deal with traumatic injury emerged (i.e. medication, channeling outlets, and slow caution). EFD experience revealed “Space age robot” and “they’ll do it themselves” as emergent themes. EFDs were described as painless, robotic, no big deal and necessary. One draining pin-site was noted. Findings related to use of self-administered analgesics, information technology, recall of detail, and gender differences in coping may lead to future interventions. These findings lay the groundwork for future studies that may improve care of adolescents during acute recovery from traumatic injury.

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Rodrigues, Juliana. "Idosos vítimas de trauma: uma proposta de predição de risco." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/83/83131/tde-20092011-092425/.

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O Brasil cada vez mais torna-se um país de cabelos brancos, e, este processo traz reflexos para a sociedade brasileira e para a assistência à saúde desta população. Destaca-se as causas externas como um problema de saúde pública que oferecem grande impacto na saúde dos idosos. Estes têm capacidade reduzida de recuperação e permanecem hospitalizados por maior tempo. Portanto, nesta investigação buscou-se identificar a relação entre o idoso vítima de trauma e os fatores de risco envolvidos no acidente. Objetivo Geral: Desenvolver indicadores de predição de risco para o trauma em idosos. Objetivos Específicos: Caracterizar o perfil dos idosos vitimas de trauma atendidos no pronto-socorro; Verificar quais os mecanismos de trauma sofrido pelos idosos; Conhecer os fatores que contribuíram para a ocorrência do trauma; Analisar os fatores de risco para a ocorrência do trauma em idosos. Estudo quantitativo, transversal realizado no prontosocorro (PS) de dois hospitais da cidade de Curitiba, sendo aprovada por suas Comissões de Ética em Pesquisa. Os critérios de inclusão foram os seguintes: pacientes com 60 anos ou mais, de ambos os gêneros, vítimas de trauma, que estavam sendo atendidos no PS e que aceitaram participar da pesquisa de maneira voluntária ou por autorização de cuidadores ou familiares, em caso de déficit cognitivo e/ou auditivo. A coleta de dados foi realizada à beira do leito por meio de uma entrevista estruturada; os dados obtidos foram organizados em planilha Excel e analisados por meio do programa computacional Statistical Package for the Social Sciences - SPSS versão 15.0. Os resultados foram descritos por frequências e percentuais. Para avaliação da associação entre duas variáveis qualitativas, foi considerado o teste de Qui-quadrado ou o teste exato de Fisher. Para avaliação conjunta da associação de fatores com o mecanismo do trauma (queda ou outros eventos), foi ajustado um modelo de Regressão Logística (stepwise backward). A partir do ajuste, foram estimados os valores de odds ratio com respectivos intervalos de confiança de 95%. Os sujeitos foram 261 idosos que atenderam aos critérios de inclusão, sendo 148 mulheres (56,7%) e 43,3% homens. A faixa de idade variou de 60 a 103 anos, e a média foi de 72,6 ± 9,3 anos. Grande parte da amostra tinha idade abaixo de 70 anos (44,8%). Com relação ao estado civil, 43,3% dos pacientes eram casados; 35,2%, viúvos; 13%, separados, amasiados; e 8,4%, solteiros. Os mecanismos de trauma mais frequentes foram: queda (75,9%), atropelamento (9,6%), trauma direto (5,4%) e acidente automobilístico (3,8%). O medicamento mais utilizado foi o anti-hipertensivo (45,2%). A análise multivariada permitiu afirmar que, independentemente das outras variáveis incluídas no modelo, o gênero feminino, a presença de cuidador, medicação de uso contínuo e a presença de problemas auditivos aumentam significativamente a probabilidade de trauma por queda. Problemas de visão sem uso de óculos e idosos com renda de até 3 salários mínimos tendem a 7 ter maior probabilidade de trauma por queda. Esses resultados permitem estabelecer que os fatores que mais interferem no trauma em idosos podem, se avaliados durante a consulta de enfermagem, possibilitar ações de saúde para a sua prevenção.
Brazil is becoming more and more a country of white hair and this process brings consequences for Brazilian society and the health care of its population. The highlights are the external causes as a matter of public health that offers great impact on the health of the elderly. The aged have their ability of recovery reduced and remain hospitalized for longer periods of time. Therefore, this research aimed to identify the relation between the aged victim of trauma and the risk factors involved in the accident. General objective: develop indicators of risk prediction for trauma in the aged. Specific objectives: describe the profile of aged victims of trauma seen in the emergency room; Check which mechanisms of trauma are suffered by the aged; Learn the factors that contributed to the occurrence of the trauma; Analyze the risk factors for the occurrence of the trauma in the aged. Quantitative cross study, held in the emergency department of two hospitals in Curitiba, which was approved by their Research Ethics Committees. The inclusion criteria were as follows: patients of 60 years old or more, both gender, victims of trauma that were being seen at the emergency room and accepted to participate in the research voluntarily or under authorization of caregiver or family in case of cognitive or/and hearing deficit. The data collection was made through a semi-structured interview by the bed; the data obtained were organized in an excel spreadsheet and analyzed by computer program Statistical Package for the Social Sciences - SPSS version 15.0. The results were described by frequencies and percentages. To evaluate the association between two qualitative variables, it was considered the Chisquare test or the Fishers exact test. To jontly evaluate the factors associated with the mechanism of trauma (fall and other events), it was adjusted a logistic regression model (stepwise backward). As from the ajustment, it were estimated the odds ratio values with respective confidence intervals of 95%. The subjects were 261 elderly people that met the inclusion criteria, 148 women (56,7%) and 43,3% men. The age ranged from 60 to 103 years old, and the average was 72,6 ± 9,3 years old. The great majority of the sample was under 70 years old (44,8%). Regarding to marital status, 43,3% of patients were married; 35,2%, widowed; 13%, separated, in cohabitation and 8,4%, single. The mechanisms of trauma more frequent were: fall (75,9%), running over (9,6%), direct trauma (5,4%) and car accident (3,8%). The medicament most used was the anti-hypertensive (45,2%). The multivariate analysis allowed to say that, independently of other variables included in the model such as the female gender, the presence of the caregiver, the continued use of medication and the presence of hearing problems increased significantly the probability of trauma by fall. Sight problems without wearing glasses and aged with incomes up to 3 minimal wages tend to have higher probability of trauma by fall. These results allowed establishing that the factors that most interfere in trauma in the aged may, if evaluated during the nursing consultation, enable health actions for its prevention.

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Santos, Antonio Adriano Rodrigues dos. "O ensino da temática feridas no Curso de Graduação em Enfermagem da Universidade Federal da Paraíba." Universidade Federal da Paraíba, 2012. http://tede.biblioteca.ufpb.br:8080/handle/tede/5087.

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This dissertation is based on teaching under the thematic of injuries in a nursing course. It was a documental study, descriptive, exploratory and of qualitative nature, carried out at the campus I of UFPB (João Pessoa - PB). This study is aimed at analyzing the teaching of the subject injuries in the undergraduate course of nursing at UFPB. The collection of data was divided into two stages The first stage focused on the apprehension and analyzing the course plans of the compulsory subjects of the undergraduate Nursing course (Bachelorhood). Secondly, a taped interview was conducted with the teachers, through a semi-structured guide and was focused on the identification of pedagogical approaches, teaching strategies, the career, the teacher-student teaching relationship, the teaching techniques used in order to motivate the study of the topic in question and the difficulties encountered in teaching-learning process. The Nursing Undergraduate course at UFPB is made up of 54 course plans, but we only obtained 48 course plans, because due to administrative problems 06 were not provided. In obedience to inclusion criteria, the first stage sample was made up of 10 subjects. In the second stage, the population consisted of all the teachers responsible for teaching the subjects identified in the first stage, a total of 37 teachers. After the definition and application of the inclusion criteria, the sample consisted of 18 teachers. Data collection was conducted between the months of August and December 2011. The data was subjected to Bardin content analysis technique. This research gave us the opportunity of evaluating how the subject theme injuries is been taught at UFPB, either from a more traditional or a more problematical approach. Academic training should be able to provide the students with sufficient knowledge for their professional life as to caring for patients with injury. This aspect is possible from a consistent and higher education which provides the student with the theoretical support which is essential for their proper professional performance, which of the teachers better preparation and pedagogical theory for teaching the subject injuries. Several key points were observed, such as the approaches, strategies and teaching techniques which might influence the idea of what is best thing for nurse training in relation to the theme injuries. It was concluded that more research is still needed on the subject, as well as a further curricula adaptation so that this subject theme might be addressed more effectively during the undergraduate course in Nursing at UFPB.
A presente dissertação tem como tema central o ensino da temática feridas no curso de enfermagem. Trata-se de um estudo documental, descritivo-exploratório e de natureza qualitativa, desenvolvido no Campus I da UFPB (João Pessoa PB). Teve como objetivo geral analisar o ensino da temática feridas no curso de graduação em enfermagem da UFPB. A coleta de dados foi dividida em duas etapas. A primeira se deteve na apreensão e análise dos planos de curso das disciplinas obrigatórias do curso de graduação em Enfermagem (Bacharelado). Na segunda etapa, foi realizada uma entrevista gravada com os docentes, por meio de um roteiro semi-estruturado, e concentrou-se na identificação das abordagens pedagógicas, das estratégias de ensino, da trajetória profissional, da relação pedagógica professor-aluno, das técnicas de ensino utilizadas para motivar o estudo da temática em questão e das dificuldades no processo ensino-aprendizagem. Na primeira etapa, a população foi composta por todos os planos de curso das disciplinas do curso de Graduação em Enfermagem da UFPB, totalizando 54 planos. Porém, obtivemos apenas 48 planos de curso, pois, devido a problemas administrativos, 06 não foram fornecidos. Em obediência aos critérios de inclusão, a amostra da primeira etapa foi composta por 10 disciplinas. Na segunda etapa, a população foi composta por todos os docentes responsáveis por ministrarem aulas sobre os conteúdos identificados nas disciplinas da primeira etapa, totalizando 37 professores. Após a definição e a aplicação dos critérios de inclusão, a amostra compôs-se de 18 professores. A coleta foi realizada entre os meses de agosto e dezembro de 2011. Os dados foram submetidos à técnica de Análise de Conteúdo de Bardin. Essa pesquisa nos permitiu avaliar como a temática vem sendo ensinada na UFPB, seja a partir de uma abordagem mais tradicional ou mais problematizadora. A formação acadêmica deve prover ao aluno conhecimentos suficientes para a sua vida profissional, ao cuidar de pacientes portadores de lesão. Tal aspecto é viabilizado a partir de uma formação superior consistente e que forneça ao estudante o suporte teórico necessário ao bom desempenho profissional, o que requer dos professores uma melhor preparação pedagógica e teórica para o ensino da temática feridas. Foi possível identificar diversos pontos fundamentais, tais como as abordagens, estratégias e técnicas de ensino, que influenciam no alcance do que é o ideal para uma excelente formação do enfermeiro no que diz respeito à referida temática. Conclui-se, ainda, que são necessários mais estudos sobre o tema, além de uma adequação curricular mais aprofundada para que o mesmo seja abordado de forma mais efetiva durante o Curso de Graduação em Enfermagem da UFPB.

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Carlsson, Marcus, and Niklas Forsberg. "Smärtskattning av barn i förskoleåldern inom prehospital akutsjukvård : En integrerad systematisk litteraturöversikt." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-12317.

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Det är känt att ambulanspersonalens omhändertagande av barns smärta kan bli bättre. Akut smärta hos barn är en vanlig orsak till att barn söker ambulanssjukvård. Barn i för- skoleålder utgör en utmaning på grund av bristerna i den språkliga och kognitiva ut- vecklingen, som gör det svårt för dem att kommunicera kring sin egen smärta. Att ge- nomföra en adekvat smärtskattning hos barn är ett sätt att mäta deras smärta och därige- nom utföra en lämplig behandling, samt kunna utvärdera effekten av genomförd be- handling. Idag är VAS det vanligaste smärtskattningsinstrument som används i ambu- lansen, det är endast validerat från barn > 8 år. Syfte: Att undersöka hur smärtskattning av barn i åldrarna tre till sex år inom prehospital akutsjukvård genomförs och vilka för- utsättningar som finns för att genomföra smärtskattning. Studien är en integrativ littera- turstudie. Tio artiklar ingår i studien, åtta kvantitativa och två kvalitativa. Sökning efter vetenskapliga artiklar skedde i databaserna Pubmed, Cinahl och Embase. Artiklarna granskades med SBU:s granskningsmall. Resultatet visar på olika sätt hur ambulansper- sonal försöker förstå barns smärta, men att det i dagsläget finns mer att önska. Smärt- skattning kan utföras oftare men kunskap och erfarenhet saknas om hur och varför man ska smärtskatta. Behandlingsriktlinjer räcker inte för att öka frekvensen samt förbättra utförandet av smärtskattning. I ambulansmiljö saknas det validerade instrument till barn i förskoleåldern. Förutsättningar för att använda validerade smärtskattningsinstrument visade sig vara kunskap och erfarenhet. Både personalen och verksamheten har ett an- svar för att skapa förutsättningar till smärtskattnings. Det för att öka chansen till en hållbar vårdrelation.

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Menzel, Nancy Nivison. "Manual Handling Workload and Musculoskeletal Discomfort in Nursing Personnel." [Tampa, Fla. : s.n.], 2001. http://purl.fcla.edu/fcla/etd/SFE0000020.

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Spies, Jennifer. "The relationship between occupational stressors, occupational stress and burnout among trauma unit nursing staff." Diss., Pretoria : [s.n.], 2004. http://upetd.up.ac.za/thesis/available/etd-03162005-152554.

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Lo, Ka-yee, and 盧嘉儀. "Childhood injury prevention: the attitudes, knowledge and practices of emergency nurses." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31972962.

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Franck, Ednalda Maria. "Alterações de pele em pacientes em cuidados paliativos na terminalidade da doença e final da vida: coorte prospectiva." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-17052017-112324/.

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Introdução: Os pacientes com doenças avançadas, ameaçadoras da vida, de qualquer etiologia, podem apresentar intercorrências ao longo do curso da doença e nem sempre é fácil para o profissional diferenciar rapidamente se ele está em terminalidade da doença ou fase final de vida, pois a piora do quadro clínico pode ser devida a algo reversível. Tendo em vista que a pele é considerada o maior órgão do corpo humano, assim como ocorre com os demais órgãos, pode sofrer disfunção quando a pessoa está em fase final de vida. Nesse contexto, a disfunção da pele está relacionada à diminuição da perfusão cutânea, que leva à hipóxia localizada, e por não conseguir manter sua função normal, alterações inevitáveis podem ocorrer. Objetivo: Identificar e analisar a incidência de alterações de pele e seus fatores preditivos em pacientes hospitalizados em cuidados paliativos, na terminalidade da doença e na fase final de vida. Métodos: Estudo de coorte prospectiva, realizado em uma unidade de internação de cuidados paliativos. Vinte e quatro pacientes foram acompanhados até a alta, transferência ou óbito. Os instrumentos Edmonton Symptom Assessment System, Malnutrition Screening Tool, Palliative Performance Scale, Escala de Braden e Pressure Ulcer Scale for Healing foram utilizados para a avaliação inicial e seguimento. Empregaram-se os testes U de Wilcoxon-Mann- Whitney, Qui-quadrado e Fisher, Curva de Kaplan-Meier e Log-rank além da Classification and Regression Tree para análise dos dados. Resultados: A maioria da amostra foi de mulheres (13/ 54,2%) e idade média de 67,6 (DP=21,8), a maioria dos pacientes (23/ 95,8%) tinha funcionalidade prejudicada (50%) e algum grau de desnutrição (15/ 62,5%). A incidência de alterações de pele foi 16,7%, ocorrendo colorações acinzentada (n=2) e amarelo-esverdeada (n=1) da pele e lesões por pressão (n=9). O número de pacientes com alterações de pele que faleceram foi significativamente maior do que aqueles sem essas alterações (p=0,035); e pacientes com essas alterações apresentaram 17 vezes mais chances de falecer comparativamente àqueles sem as alterações. Idade 50 anos foi preditiva de alterações de pele na amostra estudada. Conclusão: Trata-se do primeiro estudo nacional que investiga as alterações de pele em pacientes hospitalizados em final de vida. Em coorte de 24 pacientes, constatou-se incidência de 16,7% de alterações, predominando as lesões por pressão. Verificou-se ainda que os pacientes com essas alterações de pele no final da vida tem mais chances de falecer quando comparados àqueles sem tais alterações.
Background: Patients with advanced life-threatening diseases of any etiology may experience complications over the course of the disease and is not always easy for the professional to rapidly differentiate if the patient is in the terminal phase of the disease or at the end of life, because the worsening of symptoms may be due to a reversible state. The skin is considered the largest organ of the body and, as other organs, may become dysfunctional at the end of life. In this context, skin dysfunction is associated with decreased cutaneous perfusion, which leads to local hypoxia, and for failing to maintain its normal function, inevitable changes may occur. Aim: To estimate and evaluate the incidence and predictors of skin changes in hospitalized patients in the terminal phase of the disease and at the end of life, who were receiving palliative care. Methods: This prospective cohort study was conducted in an inpatient palliative care unit. Twenty-four patients were followed until discharge, transfer, or death. Some instruments were used in the initial and follow-up assessments of patients, including the Edmonton Symptom Assessment System, Malnutrition Screening Tool, Palliative Performance Scale, Braden Scale, and Pressure Ulcer Scale for Healing. The Wilcoxon-Mann-Whitney U-test, chi-square test, Fishers test, Kaplan-Meier curve, Log-rank test, and Classification and Regression Tree analysis were performed for data analysis. Results: Most patients were women (13/ 24, 54.2%), the mean age was 67.6 years (SD=21.8), the majority of patients (23/ 24, 95.8%) had lost 50% of their functional capacity, and had some degree of malnutrition (15/ 24, 62.5%). The incidence of skin changes was 16.7%; cases of grayish skin (n=2), yellow-greenish skin (n=1), and pressure ulcers (n=9) were detected. The number of patients who died was significantly higher among those with skin changes than among those without such changes (p=0.035), and patients with skin changes were 17 times more likely to die than those without changes. Age 50 years was predictive of skin changes in the study population. Conclusion: This was the first Brazilian study to investigate skin changes in hospitalized patients near and at the end of life. In a cohort of 24 patients, the incidence of skin changes was 16.7%, with predominance of pressure ulcers. It was also found that patients with skin changes at the end of life were more likely to die when compared to those without such changes.

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Nogueira, Lilia de Souza. "Vítimas de trauma admitidas em unidade de terapia intensiva: características e fatores associados à carga de trabalho de enfermagem." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-11102013-160138/.

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A complexidade da assistência à vítima de trauma na Unidade de Terapia Intensiva (UTI) repercute na carga de trabalho de enfermagem, sendo fundamental à equipe o conhecimento de aspectos que a influenciam para o planejamento de sua atuação. Diante disso, foram objetivos deste estudo caracterizar as vítimas de trauma admitidas na UTI, identificar um possível padrão de intervenções realizadas nos pacientes e os fatores associados à alta carga de trabalho no primeiro dia de internação, além de elaborar um modelo de estimativa da carga de trabalho de enfermagem requerida pelos sobreviventes na alta da unidade. Trata-se de um estudo quantitativo, do tipo coorte prospectivo, realizado em UTI especializada para assistência de vítima de trauma em hospital de referência para esse atendimento. A carga de trabalho de enfermagem, variável dependente, foi mensurada pelo Nursing Activities Score (NAS). Estatísticas descritivas, testes de associação e correlação e análises multivariadas foram realizados no tratamento dos dados. A casuística compôs-se de 200 vítimas, a maioria do sexo masculino (82,0%), com idade média de 40,7 anos (dp=18,6), procedente do Centro Cirúrgico (70,0%) e submetida à cirurgia não programada (66,5%). A média do índice de comorbidade de Charlson foi 0,6 (dp=1,4). Os acidentes de transportes (57,5%) prevaleceram na amostra, assim como o trauma contuso (94,5%). Na análise da gravidade do trauma, a média do Injury Severity Score foi 19,3 (dp=9,1) e do New Injury Severity Score (NISS), 27,1 (dp=9,9). O número médio de lesões Abbreviated Injury Scale (AIS) 3 foi 3,1 (dp=1,8) e de regiões corpóreas acometidas, 2,7 (dp=1,3). Cabeça ou pescoço foi a região mais gravemente lesada (64,0%) e que apresentou maior frequência de lesões AIS 3 (65,5%). Quanto à gravidade do paciente, a média do risco de morte variou de 21,1% a 25,6%, segundo diferentes índices, e as insuficiências pulmonar (76,5%) e neurológica (69,0%) prevaleceram na casuística. A média do NAS na admissão da UTI foi 71,3% (dp=16,9) e dos sobreviventes, na alta da unidade, 45,2% (dp=9,1). O tempo médio de permanência na UTI foi de 13,6 dias (dp=14,6) e a taxa de mortalidade na unidade crítica, 19,0%. Foi identificado um grupo de 136 pacientes que apresentavam similaridade de intervenções na admissão da UTI. Destacou-se, nesse grupo, monitorização/controles e mobilização/posicionamento como atividades que requereram maior complexidade e ocuparam mais tempo que a rotina normal das unidades críticas. Gênero, insuficiência pulmonar, número de regiões corpóreas acometidas e risco de morte pelo Simplified Acute Physiology Score (SAPS II) foram fatores associados à alta carga de trabalho de enfermagem na admissão da UTI. O modelo de estimativa da carga de trabalho de enfermagem requerida pelos sobreviventes na alta da UTI foi expresso pela seguinte fórmula: NAS alta= 37,171 + 0,188 (risco de morte SAPS II) + 0,193 (NISS). Os resultados obtidos nesta investigação fornecem subsídios às equipes de enfermagem que prestam assistência à vítima de trauma, durante ou após a alta da UTI, que facilitarão o planejamento dos cuidados, adequação do quantitativo de pessoal e distribuição de tarefas, com enfoque na excelência da assistência ao traumatizado.
The complexity posed by the assistance offered to trauma victims at Intensive Care Units (ICU) affects the nursing workload and, for this reason, information on the aspects impacting the workload and its planning is crucial. This study aimed to characterize trauma victims admitted to ICU, to identify a possible pattern of procedures performed in those patients, and the factors associated with high workload on the first hospitalization day, as well as to elaborate an estimate model of nursing workload required by the survivors on ICU discharge. This cohort quantitative study was prospective and carried out at an ICU specialized in assistance to trauma victims in a reference hospital for this service. The nursing workload, the dependent variable, was measured using the Nursing Activities Score (NAS). Descriptive statistics, association and correlation tests as well as multivariate analyses were performed. The sample consisted of 200 victims, mainly male (82.0%), with an average age of 40.7 years (SD=18.6), transferred from the surgery room (70.0%) and submitted to unscheduled surgery (66.5%). The Charlson comorbidity index average was 0.6 (SD=1.4). Traffic accidents (57.5%) and blunt trauma (94.5%) prevailed in the sample. As regards the analysis of trauma severity, the average of Injury Severity Score was 19.3 (SD=9.1) and 27.1 (SD=9.9) for the New Injury Severity Score (NISS). The average number of injuries according to the Abbreviated Injury Scale (AIS) 3 was 3.1 (SD=1.8), and of the body region affected, 2.7 (SD=1.3). Head or neck had the most severe injuries (64.0%) and showed a higher frequency of injuries AIS 3 (65.5%). With respect to patient severity, the average death risk ranged from 21.1% to 25.6%, according to different indexes. Pulmonary (76.5%) and neurological (69.0%) insufficiency were predominant in the sample. The average NAS on ICU admission was 71.3% (SD=16.9), and 45.2% (SD=9.1) among survivors on the unit discharge. The mean ICU length of stay was 13.6 days (SD=14.6) and the mortality rate at the critical unit, 19.0%. A group of 136 patients submitted to similar procedures on ICU admission was identified. In this group, monitoring/titration and mobilization/positioning were regarded as the most complex activities, requiring longer than normal routine time of critical units. Gender, pulmonary insufficiency, number of body region injured and death risk by Simplified Acute Physiology Score (SAPS II) were factors associated with high nursing workload on ICU admission. The estimate model of nursing workload required by survivors on ICU discharge was expressed by the following formula: NAS discharge= 37.171 + 0.188 (death risk SAPS II) + 0.193 (NISS). The results obtained from this investigation provide information to the nursing teams offering assistance to trauma victims, during or post ICU discharge, with data which contributes to better care and quantitative staff planning, as well as task distribution, aiming for excellence in trauma patient assistance.

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Villela, Diana Lima. "Controle do odor de feridas neoplásicas malignas com metronidazol: revisão sistemática." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-12092014-153459/.

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Introdução: Feridas neoplásicas malignas (FNM) são resultantes da invasão direta do câncer na pele que, ao se exteriorizarem, adquirem características de ferida. Com incidência variando de 0,6 a 9,0%, são mais comuns nos cânceres de mama e cabeça e pescoço. Dentre os sinais e sintomas, destaca-se o odor que tem sido descrito como intolerável e nauseante, acarretando impacto negativo sobre o paciente, familiares e equipe de saúde. O odor em FNM ocorre em consequência da interação das microbiotas aeróbica e anaeróbica que colonizam e infectam as feridas. Objetivando reduzir a carga microbiana local e, assim, controlar o odor, tem-se descrito o uso de antissépticos e antibióticos tópicos, dentre os quais destaca-se o metronidazol. Objetivo: Identificar as evidências científicas sobre a utilização do metronidazol para controle do odor em FNM, por meio de revisão sistemática (RS) de ensaios clínicos controlados e não controlados. Método: A partir da questão norteadora do estudo: Qual a eficácia da terapia tópica de metronidazol para o controle do odor em feridas neoplásicas malignas?, realizou-se a busca dos artigos nas bases de dados BIREME, LILACS, COCHRANE, CINAHL e EMBASE, com auxílio da estratégia PICO, utilizando-se descritores indexados e não indexados. Os estudos foram selecionados por duas pesquisadoras de forma independente e os estudos incluídos na RS foram analisados segundo o enunciado CONSORT, grau de recomendação e nível de evidência. Para o estudo randomizado utilizou-se também a Escala de Jadad. Resultados: Recuperaram-se 384 artigos, sendo selecionados 14 para leitura na íntegra, sendo incluídos, ao final, apenas três estudos na RS. Destes, um estudo é randomizado (grau de evidência e recomendação = 2b, Jadad = 2) e dois não são controlados (grau de evidência 4 para ambos). Quanto ao método de avaliação e/ou classificação do odor, não se identificou um instrumento formal, sendo empregada apenas escala analógica de 0 a 10 ou presença/ausência de odor. O tempo necessário para o emprego da terapia tópica foi de 1 a 14 dias, com troca do curativo 1 ou 2 vezes ao dia; e a aplicação do metronidazol foi em gel de 0,75% a 0,8%. Os estudos não mencionaram ou descreveram reações adversas. Os estudos apresentam limitações e fragilidades metodológicas importantes, destacando-se as amostras reduzidas e a falta de descrição de aspectos como o cegamento e randomização no único estudo randomizado, além dos procedimentos empregados nos curativos, dentre outros. Conclusão: Apesar dos três estudos concluírem que o metronidazol tópico é eficaz no controle do odor em FNM, não há forte evidência científica para corroborar essa eficácia.
Introduction: Malignant wounds (MW) are the result of direct invasion of cancer in the skin that, when exteriorized, acquire characteristics of the wound. With an incidence ranging from 0.6 to 9.0%, are more common in breast and head and neck . Among the signs and symptoms, there is the odor that has been described as intolerable and sickening, causing negative impact on the patient, family and healthcare team. The MW odor occurs as a result of the interaction of aerobic and anaerobic bacteria that colonize and infect wounds. In order to reduce local microbial load and thus control the odor, there has been described the use of topical antiseptics and antibiotics, among which stands out metronidazole. Objective: To identify the scientific evidence on the use of metronidazole for odor control in MW, through systematic review (SR) of randomized controlled trials and uncontrolled. Method: From the main question of the study: \"What is the efficacy of topical metronidazole therapy for odor control in malignant neoplastic wounds,\" there was the search for articles in the databases MEDLINE, LILACS, Cochrane Library, CINAHL database and EMBASE, using the PICO strategy, using descriptors indexed and unindexed. Studies were selected by two researchers independently and studies included in the RS were analyzed according to the CONSORT statement, strength of recommendation and level of evidence. For the randomized study also used the Jadad Scale. Results: 384 articles were recovered, 14 were selected for full reading, being included in the end, only three studies in SR. Of these, a study is randomized (level of evidence and recommendation= 2b, Jadad= 2) and two are not controlled (evidence grade 4 for both). As to the method of assessment and / or classification of odor, did not identify a formal instrument, being used only analog scale of 0 to 10, or the presence / absence of odor. The time required for the use of topical therapy was 1 to 14 days, with change of the dressing 1 or 2 times a day, and the application of metronidazole was 0.75% gel 0.8%. Studies have not mentioned or described adverse reactions. The studies have important methodological limitations and weaknesses, highlighting the small sample size and lack of description of aspects such as blinding and randomization in the only randomized, besides the procedures used in dressings, among others. Conclusion: Although the three studies conclude that topical metronidazole is effective in controlling odor in MW, there is no strong scientific evidence to support its effectiveness

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Degani, Glaucia Costa. "Atendimento pré-hospitalar móvel avançado para idosos pós-trauma: evidências para a construção de um protocolo assistencial de enfermagem." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-29052018-153705/.

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Os efeitos do trauma no organismo do idoso são sistêmicos e as complicações são comuns, o que pode resultar em aumento do tempo de hospitalização e maior número de mortes. Conhecer as características específicas deste evento para o idoso pode auxiliar os enfermeiros na tomada de decisões no atendimento pré-hospitalar móvel avançado. Os objetivos deste estudo foram analisar as evidências disponíveis na literatura científica acerca das intervenções de enfermagem no atendimento pré-hospitalar móvel para idosos pós-trauma e construir um protocolo assistencial de enfermagem para o atendimento pré-hospitalar móvel avançado de idosos pós-trauma. A pesquisa foi conduzida em duas fases: revisão integrativa e estudo metodológico e descritivo. A busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL e LILACS. A amostra da revisão integrativa foi composta por 26 estudos, agrupados em seis categorias temáticas, a saber: intervenções de enfermagem: circulação com controle da hemorragia (n=11); intervenções de enfermagem: disfunção, estado neurológico (n=7); intervenções de enfermagem: via aérea com proteção da coluna cervical (n=3); intervenções de enfermagem: avaliação secundária (n=3); intervenções de enfermagem: ventilação e respiração (n=1) e intervenções de enfermagem: exposição\\controle do ambiente (n=1). Em relação à construção do protocolo assistencial de enfermagem, as evidências encontradas na literatura e as recomendações de dois programas e duas diretrizes de atendimento ao trauma contribuíram para sua construção. O protocolo assistencial de enfermagem foi estruturado contendo título, objetivo, intervenções de enfermagem, atividades de enfermagem e suas respetivas justificativas, com ênfase na avaliação primária e secundária do atendimento ao trauma e reuniu de forma organizada as especificidades da senescência e senilidade. As evidências levantadas na literatura contribuíram para a elaboração do protocolo assistencial de enfermagem, que poderá subsidiar o atendimento imediato e avançado ao idoso pós-trauma
The effects of a trauma in the organism of elderly individuals are systemic and complications are common, which may result in longer hospitalizations and a greater number of deaths. Being aware of the specificities of this event among elderly individuals can aid the decision-making of nurses when providing advanced prehospital care in a mobile unit. This study\'s objective were to analyze evidence available in the scientific literature addressing nursing interventions provided to elderly individuals in prehospital care provided in mobile units after a trauma and develop a nursing protocol for elderly trauma patients specific for advanced prehospital care provided in mobile units. The study was conducted in two phases: integrative review and methodological and descriptive study. Primary studies were searched in the PubMed, CINAHL and LILACS databases. The sample for the integrative review was composed of 26 studies grouped into six thematic categories, namely: nursing interventions: circulation with hemorrhage control (n=11); nursing interventions: disorder, neurological status (n=7); nursing interventions: cervical spine protection in airway management (n=3); nursing interventions: secondary assessment (n=3); nursing interventions: ventilation and respiration (n=1); and nursing interventions: exposure/environment control (n=1). Evidence found in the literature and recommendations from two programs and two guidelines for essential trauma care contributed to the development of this nursing care protocol. The nursing care protocol was structured with a title, objective, nursing interventions, nursing activities, and respective justifications, with an emphasis on primary and secondary assessment of trauma care, and organized the specificities of senescence and senility. Evidence found in the literature contributed to develop a nursing care protocol that can support the immediate and advanced care provided to elderly patients after a trauma

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Reiniger, Lívia Ortiz. "Caracterização da gravidade das vítimas de acidente de transporte atendidos em uma unidade de Centro Cirúrgico." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-23122010-092931/.

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O trauma hoje é considerado a epidemia do século XXI, representando a principal causa de morte nas primeiras quatro décadas de vida. Na pesquisa atual, foram consideradas para análise as vítimas de traumas decorrentes de acidentes de transporte por considerar a relevância do tema no cenário da saúde nacional e internacional. Os objetivos foram: caracterizar a gravidade das vítimas de acidentes de transporte que foram atendidas em uma unidade de Centro Cirúrgico de um Hospital de referência no atendimento ao trauma no Município de São Paulo; caracterizar a amostra do estudo quanto aos dados sociodemográficos, tipo de colisão e atendimento pré-hospitalar; descrever a gravidade da lesão, segundo a região corpórea pelo score AIS e MAIS; descrever a gravidade global das vítimas, segundo o score ISS; caracterizar as condições clínicas das vítimas nos períodos pré, trans e pós-operatórios, verificar a relação existente entre os dados sociodemográficos, tipo de colisão, atendimento pré-hospitalar, os escores AIS, MAIS, ISS, as características clínicas e a ocorrência de óbito e sequela. Trata-se de uma pesquisa exploratória, descritiva, retrospectiva, de abordagem quantitativa, realizada por meio da análise retrospectiva dos prontuários de todos os pacientes vítimas de acidente de trânsito que foram admitidos no Centro Cirúrgico do ICHC-FMUSP no período de 1 de janeiro a 31 de dezembro de 2008. Concluiu-se estatisticamente que, os pacientes de maior gravidade cirúrgica, eram jovens, vítimas de acidente motociclístico ou pedestres, que chegaram à instituição, utilizando-se de dispositivos para a permeabilidade das vias aéreas (máscara de oxigênio ou cânula de intubação orotraqueal), com sinais vitais instáveis, que apresentavam lesões de abdome e conteúdo pélvico ou de extremidades e cintura pélvica, como fraturas, grandes hemorragias ou lesões abdominais. Eram também os que seriam submetidos em sua maioria, à cirurgia geral e cirurgia ortopédica, procedimentos de grande porte com grande probabilidade de gerarem algum tipo de sequela temporária ou permanente. Em razão dessa gravidade, há necessidade de infusão de volume seja hemoconcentrado, hemoderivado ou solução coloide, objetivando sempre a manutenção da homeostase, primordial para a manutenção da boa condição clínica desses pacientes. A pesquisa indicou que os pacientes que chegaram com maior gravidade à unidade de Centro Cirúrgico, têm maior risco de óbito ou sequela.
Trauma is now considered an epidemic of the century, representing the leading cause of death in the first four decades of life. In the current study, were considered for analysis the victims of injuries from traffic accidents by considering the relevance of the theme in the health service nationally and internationally. The aim of this study was to characterize the severity of traffic accident victims who were treated in Surgical Ward of a referral hospital in trauma care in São Paulo. The study sample was characterized by using demographic data; type of collision and use of pre-hospital service; severity of injury according to the body region using AIS and MAIS score; overall severity of the victims using ISS score; clinical condition of the victims before, during and after surgery; and the relationship between demographic data; type of collision and use of pre-hospital service; the AIS, MAIS and ISS score; the clinical features and occurrence of death and disability. This is an exploratory, descriptive, retrospective, quantitative approach study, carried out by retrospective chart review of all patients victims of traffic accidents who were admitted to the Surgical Ward of ICHC-FMUSP during the period January 1st to December 31th, 2008. It was concluded that statistically patients with more severe surgery were young, victims of motorcycle accidents or pedestrians, who came to the institution, using devices for airway permeability (oxygen mask or orotracheal tube) with unstable vital signs, patients with abdomen and pelvic contents lesions or extremities and pelvis lesions such as fractures, abdominal injuries or major bleeding. They were also to be submitted in most cases to general surgery and orthopedic surgery, major procedures most likely to generate some kind of temporary or permanent disability. Because of this seriousness, volume infusion were needed using blood product or colloid solutions aiming always to maintain homeostasis, essential for maintaining good clinical condition of these patients. The survey indicated that patients who arrived at the Surgical Ward with greater gravity have a higher risk of death or disability.

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Domingues, Cristiane de Alencar. "Trauma and injury severity score: análise de novos ajustes no índice." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-14102013-090011/.

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Introdução: O Trauma and Injury Severity Score (TRISS) é considerado padrão ouro na análise de probabilidade de sobrevida do doente traumatizado, apesar de suas limitações. Vários têm sido os esforços na tentativa de torná-lo mais acurado, tendo em vista seu importante papel nos Programas de Melhoria de Qualidade em Trauma. Objetivos: Propor três novos ajustes à equação do TRISS e comparar suas performances com o TRISS e o TRISS-like originais e com esses índices e o NTRISS com coeficientes ajustados à população do estudo; identificar se a técnica de imputação múltipla aumenta a acurácia das equações derivadas de bancos de dados com perdas e comparar o desempenho dos novos modelos quando derivados e aplicados em diferentes grupos de vítimas traumatizadas. Método: Trata-se de um estudo multicêntrico, retrospectivo, com vítimas de trauma internadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FMUSP) e no Centro de Trauma da Universidade da Califórnia San Diego Medical Center (UCSD MC), no período de 1º de janeiro de 2006 a 31 de dezembro de 2010. As informações dos doentes foram agrupadas em Bancos de Dados Derivação e Teste, sendo o primeiro utilizado para derivar as equações e o segundo para validar as equações geradas. Os coeficientes dos modelos foram estabelecidos pela análise de regressão logística. A curva Receiver Operating Characteristics (ROC) foi utilizada para avaliar a performance dos modelos e o algoritmo de DeLonge et al. para comparar as áreas sob as curvas (AUC). Resultados: A casuística foi composta de 2.416 doentes do HC FMUSP (São Paulo, Brasil) e 8.172 participantes do UCSD MC (San Diego, EUA). Os novos modelos propostos foram o NTRISS-like, que incluiu as variáveis Melhor Resposta Motora (MRM), Pressão Artéria Sistólica (PAS), New Injury Severity Score (NISS) e idade; o TRISS SpO2, com as variáveis Escala de Coma de Glasgow, PAS, saturação periférica de oxigênio (SpO2), Injury Severity Score, além da idade e o NTRISSlike SpO2 (MRM + PAS + SpO2 + NISS + idade). Todas as equações tiveram coeficientes ajustados para trauma contuso e penetrante. A técnica de imputação múltipla aplicada à derivação das equações não melhorou a acurácia dos modelos. Os modelos TRISS original, TRISS, TRISS-like e NTRISS com coeficientes ajustados e as novas propostas não apresentaram diferença estatisticamente significativa em sua performance. As novas equações ajustadas aos dados de São Paulo e as geradas com informações de San Diego apresentaram diferentes AUC ao serem aplicadas nos dois grupos de doentes dessas localidades. A acurácia sempre foi maior quando as equações foram aplicadas na população de San Diego. Conclusões: Os novos modelos apresentaram boa acurácia (cerca de 89,5%) e desempenho similar a outros ajustes do índice TRISS anteriormente publicados; portanto, podem ser utilizados nas avaliações de qualidade da assistência ao traumatizado. Os ajustes dos índices de probabilidade de sobrevida à realidade local de sua aplicação não melhoraram seu desempenho, resultado que reforça a incerteza sobre a necessidade desses ajustes, conforme o local de aplicação do índice.
Introduction: Trauma and Injury Severity Score (TRISS) is considered the \"gold standard\" in the analysis of survival probability of trauma patients, despite its limitations. There have been several efforts to make it more accurate because of its important role in Trauma Quality Improvement Programmes. Objectives: To propose three new adjustments to the TRISS equation and compare their performances with the TRISS and TRISS-like originals and these indices and NTRISS with coefficients adjusted to the study population; identify if the multiple imputation technique increases the accuracy of the equations derived from databases with missing; and to compare the performance of the new models when derivatives and applied to different groups of trauma patients. Methods: This is a multicenter, retrospective study with trauma victims admitted to the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FMUSP) and the Trauma Center at the University of California San Diego Medical Center (UCSD MC) for the period between January 1st, 2006 and December 31st, 2010. The information of patients were grouped into two different databases: derivation and testing; the first one served to derive the equations and the second was used to validate the equations generated. The model coefficients were established by logistic regression analysis. Receiver Operating Characteristic curve (ROC) was used to evaluate the performance of the models and De Long et al. algorithm to compare the areas under the curves (AUC). Results: The casuistic consisted of 2,416 patients from HC FMUSP (São Paulo, Brazil) and 8,172 participants from UCSD MC (San Diego, USA). The new models proposed were NTRISS-like which included the variables Best Motor Response (BMR), Systolic Blood Pressure (SBP), New Injury Severity Score (NISS) and age; TRISS SpO2 that included the variables Glasgow Coma Scale, SBP, saturation of peripheral oxygen (SpO2), Injury Severity Score and age; and NTRISS-like SpO2 (BMR + SBP + SpO2 + NISS + age). All equations had adjusted coefficients for blunt and penetrating trauma. The multiple imputation technique applied in the derivation of the equations did not improve the accuracy of the models. The original TRISS, and TRISS, TRISS-like and NTRISS with adjusted coefficients and the new proposals showed no statistically significant difference in performance. The new equations fitted to the São Paulo data and generated with information from San Diego showed different AUC when applied in the two patient groups in these localities. The accuracy was always higher when the equations were applied to the population of San Diego. Conclusions: The new models demonstrated good accuracy (about 89.5%) and similar performance to other TRISS adjustments previously published, and may be used in assessments of quality of care for traumatized. The survival probability scores adjustments to the local reality of its application did not improve its performance, a result that reinforces the uncertainty about the need for such adjustments, as the application site index.

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Kallin, Kristina. "Falls in older people in geriatric care settings : predisposing and precipitating factors." Doctoral thesis, Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-307.

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Chibante, Carla Lube de Pinho. "Saberes e práticas de clientes no cuidado com feridas: implicações para a enfermagem." Universidade Federal Fluminense, 2014. https://app.uff.br/riuff/handle/1/880.

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Mestrado Acadêmico em Ciências do Cuidado em Saúde
Trata-se de um estudo qualitativo, descritivo do tipo etnográfico sobre os saberes e práticas de clientes no cuidado com feridas em um ambulatório de curativos no município de Niterói, Rio de Janeiro. Seus objetivos foram descrever os saberes e práticas dos clientes no cuidado com feridas, identificar as práticas utilizadas pelos clientes no cuidado com feridas e analisar os saberes e práticas dos clientes no cuidado de feridas e suas implicações para o cuidado de enfermagem. A coleta de dados foi desenvolvida no período de janeiro a maio de 2014, mediante as técnicas de observação simples, observação participante e entrevista semi-estruturada seguida de análise de conteúdo. Foram realizadas 20 entrevistas, das quais emergiram os temas: desafios no cuidado em saúde, a ferida, o cuidado, o poder do profissional, práticas populares e o entorno do cuidado. Posteriormente, realizou-se a categorização, resultando em duas categorias: Os desafios no cuidado em saúde e os saberes e práticas dos clientes com feridas. Quanto à caracterização dos participantes: a maioria é do sexo masculino (70%), sendo (50%) casados, (30%) aposentados, com média etária de 53,25 ± 10,17 anos. Com relação à escolaridade 30% possuem ensino fundamental completo e ensino médio completo, respectivamente; 55% dos participantes possuem filhos cuja média é de 2,54 filhos. Quanto a presença de comorbidades, 41,6% são hipertensos e 25% tem diabetes tipo 2. Nas falas dos participantes da pesquisa foram identificadas dificuldades no acesso aos serviços de saúde e financeiras, restrições de locomoção. Nas entrevistas, quando perguntados sobre a história da ferida, os clientes falam sobre o início da instalação da ferida, a sua evolução e a busca pelo cuidado. Observou-se a associação de práticas com uso do tratamento alopático e das práticas populares. As práticas identificadas nas falas dos clientes com feridas incluíram o uso do saião em forma de pasta para colocar sobre a ferida para drenagem da secreção, a casca de caju e a casca da aroeira em forma de chá para banhar a ferida e auxiliar na cicatrização. Além disso, a fé e os hábitos alimentares também foram citados como formas de ajudar na cicatrização das feridas. A maioria dos clientes relatou conhecer plantas e chás no cuidado com a ferida, porém mostram desconfiança quanto ao seu uso não legitimado pelo saber científico. A visão fragmentada do indivíduo e ausência da visão integral da pessoa, reforça a dependência do sujeito ao preconizado no modelo assistencial vigente focado no que é informado pelo profissional de saúde. Entretanto, é importante que o cliente participe do cuidado, optando e escolhendo o melhor para si, o que favorece sua autonomia e independência na implementação do cuidado, mediante uma relação dialógica que possibilita a troca de experiências e o compartilhamento dos saberes entre quem cuida e quem é cuidado. Nesse sentido, considerar o cliente como protagonista da sua história aponta como desafios trazer à tona o potencial de conhecimentos advindos das suas experiências em um dado contexto sociocultural como subjacentes aos seus saberes e práticas no cuidado de feridas e, portanto, bases para a prática do cuidado de enfermagem a esses clientes
Este es un estudio cualitativo, descriptivo de tipo etnográfico sobre los conocimientos y prácticas de los clientes en la atención con heridas en una curación clínica en la ciudad de Niterói, Río de Janeiro. Sus objetivos fueron describir los conocimientos y prácticas de los clientes en el cuidado de heridas, identificando las prácticas utilizadas por los clientes en el cuidado de heridas y analizar los conocimientos y prácticas de los clientes del cuidado de la herida y sus implicaciones para la atención de enfermería. Recolección de datos se llevó a cabo en el período enero-mayo 2014, a través de técnicas de observación simple, observación participante y entrevista semiestructurada seguida de análisis de contenido. Se realizaron 20 entrevistas, de los cuales surgieron los temas: desafíos en el cuidado de la salud, cuidado de la herida, poder profesional, prácticas populares y el ambiente de cuidado. Posteriormente, la categorización, resultando en dos categorías: los retos en salud y el conocimiento y las prácticas de los clientes con heridas. En cuanto a la caracterización de los participantes: la mayoría es hombre (70%) siendo (50%) son casados, (30%) de los jubilados, con edad promedio de ± 53.25 10,17 años. Con respecto a la educación el 30% tiene educación primaria completa y secundario completo educación, respectivamente; el 55% de los participantes tienen hijos cuyo promedio es de 2,54 niños. Como la presencia de comorbilidades, 41,6% son hipertensos y el 25% tiene diabetes tipo 2. En los discursos de los participantes de la encuesta fueron identificadas las dificultades en el acceso a servicios de salud y las limitaciones financieras de locomoción. En las entrevistas, cuando se le preguntó acerca de la historia de la herida, los clientes hablan sobre el principio de la instalación de la herida, su evolución y la búsqueda de atención. Se observó la Asociación de las prácticas con el tratamiento alopático uso y prácticas populares. Las prácticas identificadas en las líneas de los clientes con heridas incluidosen el uso de la tienda en forma de pasta para poner sobre la herida para el drenaje de la secreción, la cáscara de las castañas de cajú y la corteza de masilla en forma de té para bañar la herida y ayudar en la curación. Además, la fe y los hábitos alimentarios también se citaron como formas de ayudar en la curación de heridas. Mayoría de los clientes registrada con plantas e infusiones en el cuidado de la herida, pero no mostrar ninguna confianza en cuanto a su uso no legitimada por el conocimiento científico. La visión fragmentada de la persona y la ausencia de una visión integral de la persona, refuerza la dependencia del sujeto en el modelo asistencial actual abogó centrado en lo que se divulga por el profesional de la salud. Sin embargo, es importante que el servicio al cliente participar, elegir y elegir qué es lo mejor para ti, lo que favorece su autonomía e independencia en la implementación de la atención a través de una relación dialógica que permite el intercambio de experiencias y el intercambio de conocimientos entre a quién le importa y que es el cuidado. En este sentido, considerar al cliente como protagonista de su historia señala cómo sacar el potencial del conocimiento de sus experiencias en un contexto cultural determinado en cuanto a su conocimiento subyacente y la práctica en el cuidado de heridas, retos y por lo tanto, las bases para la práctica de la atención a los clientes de enfermería

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Ramos, Mily Constanza Moreno. "Instrumento Cartões de Qualidade da Dor (ICQD): adaptação cultural e evidências de validade em crianças colombianas com feridas." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/7/7141/tde-10052017-122945/.

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Introdução: A avaliação da dor, constitui uma intervenção de enfermagem fundamental para o estabelecimento do tratamento adequado da dor. Portanto, os profissionais de enfermagem devem considerar o uso de instrumentos de avaliação de dor apropriados para as crianças. Dentre os instrumentos de avaliação encontram-se os instrumentos multidimensionais, porém evidenciou-se escassez destes instrumentos em idioma espanhol para a avaliação da dor em crianças com feridas por profissionais de enfermagem Colombianos. Objetivo: Adaptar culturalmente e encontrar evidências de validade do Instrumento Cartões de qualidade da Dor (ICQD) em crianças com feridas para a língua espanhola da Colômbia. Método: Estudo metodológico e transversal, que foi desenvolvido em duas etapas. Etapa 1: adaptação cultural e validação de conteúdo que esteve composta por seis fases; tradução, síntese das traduções, retrotradução, avaliação da versão por um comitê de juízes, avaliação por crianças na escola e no hospital, e pré-teste da versão final; Etapa 2: evidências de validade baseadas no constructo e no critério externo do ICQD, com 90 crianças em idade escolar hospitalizadas portadoras de feridas. O estudo foi realizado em um hospital pediátrico da cidade de Bogotá Colômbia, com previa aprovação do Comitê de ética da EEUSP e do hospital pediátrico. Os dados foram processados através do software IBM-SPSS 19.0 com nível de significância de 5% (p<0.005). Resultados: Todos as fases pertencentes à etapa de adaptação cultural foram realizadas satisfatoriamente, obtendo uma versão do ICQD adaptado. Foram encontradas evidências fortes baseadas no conteúdo com um IVC total de 0,92; PABAK de 0,79 em representatividade; 0,69 em clareza e 0,74 em dimensão teórica mostrando concordância substancial segundo avaliação dos juízes. No pré-teste, o ICQD versão adaptada mostrou ser clara para mais de 70% de crianças escolares hospitalizadas portadoras de feridas. Na etapa de evidências no critério externo, as variáveis de diagnóstico médico, tipo de ferida, localização de ferida, infecção da ferida, mobilidade e intensidade de dor mostraram resultados significativos. Conclusões: O Instrumento Cartões de Qualidade da Dor (ICQD) versão espanhol, mostrou-se adaptado culturalmente em crianças escolares com feridas no contexto Colombiano apresentando evidências de validade baseadas no conteúdo e no critério externo.
Introduction: Pain assessment, is a fundamental nursing intervention to stablish an adequate pain management. Therefore, nursing professionals should consider the use of appropriate pain assessment tools for children. Among the assessment tools are multidimensional instruments, but it became clear the shortage of these instruments in Spanish for assessing pain in injured children by Colombian nursing professionals. Objective: To translate to the Colombian Spanish language and culturally adapt the Pain Quality Cards Instrument (PQCI) and find evidence of its validity for school age children with wounds. Method: methodological and transversal study, which was developed in two phases. phase 1: cultural adaptation, was composed of six stages translation, synthesis of translations, back translation, evaluation of the resulting version by a panel of judges, evaluation by children in school and in hospital, and pretesting of the final version; phase 2: evidence of validity based on the construct and external criterion PQCI, with a sample of 90 school age children hospitalized with wounds. The study was conducted in a pediatric hospital in Bogotá - Colombia, with anticipated approval of the Ethics Committee of EEUSP and a pediatric hospital. Data were processed through the IBM-SPSS 19.0 with a significance level of 5% (p <0.005). Results: All the stages of the cultural adaptation were performed satisfactorily, obtaining a version adapted PQCI. Strong evidence-based content was found with a total CVI of 0.92; PABAK 0.79 in representativeness; 0.69 in clarity and 0.74 in theoretical dimension shows a substantial agreement as assessed by judges. In the pre-test, the adapted PQCI version proved to be clear to over 70% of school age children hospitalized with wounds. In the phase of external criterion validity evidence the variables medical diagnosis, type of wound, wound location, wound infection, mobility and pain intensity showed significant results. Conclusions: Pain Quality Cards Instrument (PQCI) Spanish version proved to be culturally adapted in injured school age children in the Colombian context showing evidence of validity based on the content and external criterion.

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Nicolato, Fernanda Vieira. "Atenção Domiciliar: custos da família com o cuidado de idosos com feridas." Universidade Federal de Juiz de Fora (UFJF), 2017. https://repositorio.ufjf.br/jspui/handle/ufjf/5865.

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O objeto desta pesquisa foi os custos para a família no cuidado de idosos com feridas em Atenção Domiciliar, com ênfase nas vivências dos cuidadores familiares, no âmbito da temática da produção do cuidado proposto pela Política de Atenção Domiciliar no Sistema Único de Saúde. Com o crescente processo de envelhecimento, há um aumento relativo das condições crônicas e as doenças cardiovasculares, respiratórias e metabólicas contribuem para o aparecimento de feridas. Além disso, o envelhecimento traz consigo algumas alterações, relacionados à pele e podem trazer como consequência o aparecimento de feridas. O idoso com feridas poderá reduzir significativamente a autonomia, capacidade funcional, além de aumentar o tempo de internação. A Atenção Domiciliar surge como alternativa preferível para dar continuidade aos serviços iniciados em outros pontos da Rede de Atenção à Saúde. No cuidado domiciliar, se dá a transferência dos custos para as famílias, com aumento nos custos diretos, água, luz e alimentação; além dos custos indiretos, que são provenientes da carga de cuidado; e dos intangíveis, referentes ao sofrimento, perda de bem-estar e ansiedade. Realizou-se uma pesquisa qualitativa, em duas etapas, com o método da Teoria Fundamentada nos Dados. A primeira foi realizada no Serviço de Atenção Domiciliar do município de Juiz de Fora. A segunda etapa ocorreu de maio de 2016 a agosto de 2017, incluindo dez participantes. Os dados foram coletados por meio de entrevista aberta, observação participante com registros em diário de campo, por meio de visita domiciliar. Seguiu-se o critério de amostragem e saturação teórica. Para organização, codificação e interpretação dos dados empíricos, utilizou-se o programa OpenLogos®. A análise dos dados ocorreu mediante três tipos de codificação: aberta, axial e seletiva. Emergiram dos dados as seguintes categorias: Compreendendo o cuidado domiciliar de um idoso com feridas pela família; Tendo o domicílio como local de cuidado; Percebendo os fatores que interferem nos custos do cuidado; Buscando estratégias para cuidar da ferida; Assumindo os diferentes custos com a ferida; e Vivenciando os custos do cuidado domiciliar de um idoso com ferida, sendo esta a última o fenômeno central da pesquisa. Os participantes vivenciam diferentes tipos de custos advindos com o processo de cuidar de um idoso com ferida no domicílio, pois, mesmo que haja contribuições de outros membros da família e o suporte do Serviço de Atenção Domiciliar, o cuidador assume o cuidado. Isso porque, na falta de material fornecido pelo serviço, ausência do suporte familiar, o cuidador responsável se vê frente à necessidade de prover o cuidado ou o idoso ficaria sem o tratamento. Desta forma, tem-se que a atuação do enfermeiro é determinante no processo de cuidado de um idoso com ferida em Atenção Domiciliar, ressaltando a importância de voltarem sua atenção aos familiares, para que minimize os custos provenientes deste cuidado.
The objective of this research was the costs to the family in the care of the elderly with wounds during home care with emphasis on the role assumed by family caregivers, within the scope of the care production proposed by the Home Care Policy in the Unified Health System. When Increasing aging process, there is a relative increase of the chronic conditions, being cardiovascular, respiratory and metabolic diseases that contribute to the appearance of wounds. In addition, aging brings with it some changes, related to the skin and, as a consequence, the appearance of wounds. The elderly with wounds can significantly reduce autonomy, functional capacity, and increase length of hospitalization. Home Care is a preferable alternative to provide continuity to the services started in other points of the Health Care Network. In home care, there is a transfer of costs to families, in which there is an increase in direct costs, water, electricity and food; Indirect costs, which come from the burden of care; And the intangibles, referring to suffering, loss of well-being and anxiety. A qualitative, two stages research was conducted using the Data Based Theory method. The first was performed at the Home Care Service of the city of Juiz de Fora. The second stage occurred from May 2016 to August 2017, including ten participants. The data were collected through a semi-structured interview, participant observation with records in the field diary, through a home visit. The second, by theoretical sampling, began with an eighth interview, consisting of three users. The criterion of sampling and theoretical saturation was followed. For the organization, codification and interpretation of the empirical data, the OpenLogos® program was used. Data analysis was performed using three types of coding: open, axial and selective. The following categories emerged from the data: Understanding the home care of an elderly person with wounds for the family; Having the domicile as place of care; Realizing the factors that interfere with the costs of wound care; Seeking strategies to take care of the wound; Assuming the different costs with the wound; And Experiencing the costs of the home care of a wounded elderly, this last one being the central phenomenon of the research. The participants experience different types of costs arising from the process of caring for an elderly person with a wound at home, because even if there are contributions from other family members and the support of the Home Care Service, the caregiver assumes the care. This is because, in the absence of material provided by the service, absence of family support, the caregiver responsible faces the need to provide care, or the elderly would be left without treatment. Thus, nurses' performance is determinant in the care process of a wounded elderly person in Home Care, emphasizing the importance of turning their attention to family members, in order to minimize the costs of this care.

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Castro, Maria Cristina Freitas de. "Subconjunto terminológico CIPE para pacientes em cuidados paliativos com feridas tumorais: estudo descritivo." Universidade Federal Fluminense, 2015. https://app.uff.br/riuff/handle/1/1719.

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Mestrado Profissional em Enfermagem Assistencial
O presente trabalho tem como objetivo o desenvolvimento e validação de subconjunto terminológico, utilizando a CIPE, para pacientes em cuidados paliativos, com feridas tumorais. No primeiro momento do estudo, foi realizada uma revisão integrativa da literatura em busca de evidências empíricas relacionadas às feridas tumorais e intervenções de enfermagem indicadas para o manejo dos sintomas. Para isso, foram empregados os descritores “ferimentos e lesões”, “cuidados paliativos”, “wounds and injuries” e “palliative care”, e as palavras-chaves “feridas neoplásicas”, “feridas tumorais”, “malignant wound”, “fungating wound” e “malignant fungating wound”. No segundo momento, a partir do cruzamento das evidências encontradas com os termos constantes na versão 2013 da CIPE® e tendo como base o Modelo de 7 Eixos, foram construídas 51 afirmativas de diagnósticos de enfermagem e 134 enunciados de intervenções de enfermagem. Após a construção das declarações de diagnósticos, estas foram distribuídas de acordo com as necessidades humanas básicas postuladas no referencial conceitual de Wanda Horta. No terceiro momento, o instrumento foi submetido à validação baseada na opinião de enfermeiros peritos e, no quarto momento, realizou-se a elaboração do catálogo, observando as etapas propostas pelo Guia para o Desenvolvimento de Catálogos CIPE®, do Conselho Internacional de Enfermeiros. Dos 51 diagnósticos apresentados, 43 (84,31%) alcançaram IC ≥ 0,8 e das 134 Intervenções de Enfermagem, 122 (91,04%) alcançaram IC ≥ 0,8, sendo, portanto, validadas. Considera-se que os objetivos do estudo foram alcançados, tendo como resultado a construção e validação do Subconjunto Terminológico CIPE para pacientes oncológicos, em cuidados paliativos, com feridas tumorais. Este instrumento servirá como um guia para os enfermeiros, propiciando um cuidado baseado em evidências, além do uso de uma linguagem unificada que facilite a documentação da prática de enfermagem. Espero que este trabalho possa gerar conhecimento, considerando a lacuna existente na literatura especializada de enfermagem e, assim, colaborar no fortalecimento da rede de cuidados ao paciente oncológico
The purpose of this study was to develop and validate an INCP terminological subset for patients with tumor wounds under palliative care. The first stage of the study consisted of an integrative literature review in search of empirical evidences related to tumor wounds and nursing interventions indicated for the handling of symptoms. The descriptors used were ‘wounds and injuries’ and ‘palliative care’; the key-words used were malignant wound, fungating wound, and malignant fungating wound. On the second stage, the correlation between the evidences found and the terms present in the 2013 Version of INCP®, based on the 7-Axes Model, led to the production of 51 nursing diagnoses and 134 nursing intervention statements. The diagnoses statements produced were distributed according to the basic human needs postulated in Wanda Horta’s theoretical references. On the third stage, the instrument was submitted to validation based on the opinion of specialized nurses; and on the fourth stage, a catalogue was generated following the steps proposed by the INCP® Guidelines for the Development of Catalogues, from the International Council of Nurses (ICN). Of the 51 diagnoses presented, 43 (84.31%) reached IC ≥ 0.8; and of the 134 nursing interventions, 122 (91.04%) reached IC ≥ 0.8, thus being validated. It has been considered that the purposes of this study have been achieved, resulting in the development and validation of an INCP® terminological subset for oncology patients under palliative care of tumor wounds. This instrument shall serve as a guide for nurses, providing evidence-based care, besides using a unified language that may facilitate the documentation of nursing practice. It is expected that this study may generate knowledge, considering the existing gap in the specialized nursing literature and therefore collaborate with the strengthening of the oncologic patient care network.

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Pereira, Talita de Azevedo Coelho Furquim. "Feridas complexas classificação de tecidos, segmentação e mensuração com o classificador Optimun-Path Forest /." Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/153761.

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Introdução: As feridas complexas apresentam difícil resolução e associam-se a perda cutânea extensa, infecções importantes, comprometimento da viabilidade dos tecidos e/ou associação com doenças sistêmicas que prejudicam os processos normais de cicatrização, cursam com elevada morbimortalidade e têm sido apontadas como grave problema de saúde pública. Na prática clínica, é importante avaliar as feridas e documentar a avaliação. O registro incompleto sobre o paciente e o tratamento em uso é apontado como um desafio no acompanhamento das feridas e também prejudica ações de gestão, pesquisa e educação. A incorporação de fotografias de feridas à pratica profissional, mostra-se como uma estratégia para auxiliar profissionais na observação, evolução e registro claro e preciso. O Optimum-Path Forest (OPF) é um framework para o desenvolvimento de técnicas de reconhecimento de padrões baseado em partições de caminhos ótimos e particularmente eficiente para a classificação de imagens. O classificador OPF gera resultados a partir do cruzamento das classes e características selecionadas. Objetivo: Descrever as etapas do desenvolvimento de um aplicativo para dispositivos móveis capaz de segmentar e classificar tecidos de feridas complexas baseado no Optimum-Path Forest (OPF) supervisionado. Método: Foi aplicada uma nova metodologia inteligente para análise e classificação de imagens de feridas complexas por meio de técnicas de processamento digital de imagens e aprendizado de máquina com o classificador de padrões Optimum-Path Forest (OPF) supervisionado. Criou-se o banco de imagens de 27 feridas complexas, que foram rotuladas por quatro especialistas conforme a classificação dos tecidos em quatro classes: granulação (vermelho), tecido fibrinóide (amarelo), necrose (preto) e hematoma (roxo), gerando 108 imagens rotuladas. Acrescentou-se duas classes: branco (o que está na foto, exceto o leito da ferida) e dúvida (divergência na classificação pelos profissionais). O classificador OPF foi treinado a partir dessas 108 imagens. Aplicou-se o OPF às imagens de feridas e verificou-se a acurácia. Em seguida, iniciou-se a construção do aplicativo. Resultados e Discussão: O presente estudo desenvolveu um esquema de classificação de tecido de feridas assistido por computador para avaliação e gerenciamento de feridas complexas, a partir de fotos de feridas da câmera digital de um smartphone. A aplicação do OPF a feridas complexas trouxe como resultado uma acurácia de 77,52% ± 6,14. Com esta ferramenta, foi desenvolvido como produto desta pesquisa um aplicativo para segmentação, classificação de tecidos e mensuração de feridas complexas. O aplicativo gera um relatório no formato Portable Document Format (PDF) que pode ser enviado por e-mail, impresso ou anexado a prontuário eletrônico compatível. Conclusão: Foi construído um banco com 27 imagens de feridas complexas, que quatro profissionais rotularam para treinamento do classificador OPF, aplicou-se o OPF às imagens de feridas complexas, avaliou-se a acurácia deste processo e desenvolveu-se um aplicativo para dispositivos móveis com as funções de segmentação da ferida, classificação de tecidos e mensuração da ferida. Os resultados mostraram que o valor da acurácia obtido na análise computacional teve valor significativo, equiparando-se a avaliação de especialistas em feridas. Comparando com estudos similares, a análise computacional de feridas mostrou-se com menor variabilidade em relação a avaliação de profissionais, sugerindo que a incorporação desta tecnologia na prática clínica favoreça o cuidado em saúde do paciente com feridas complexas, além de fornecer dados para a gestão, ensino e pesquisa.
Introduction: Complex wounds are difficult to resolve and are associated with extensive cutaneous loss, major infections, compromised tissue viability and / or are related to systemic diseases that impair normal healing processes, have high morbidity and mortality and have been identified as severe public health problem. In clinical practice, it is important to evaluate the wounds and document the evaluation. The incomplete record on the patient and the treatment in use is pointed out as a challenge in the follow up of the wounds and also impairs management, research and education actions. The incorporation of wounds’ photos in the professional practice, stands out as a strategy to assist professionals in the observation, evolution and clear and precise recording. Optimum-Path Forest (OPF) is a framework for the development of pattern recognition techniques based on optimal path partitions and is particularly efficient for image classification. The OPF classifier generates results from the intersection of the selected classes and characteristics. Objective: Describe the steps in developing a mobile application capable of segmenting and sorting complex wound tissue based on the supervised Optimum-Path Forest (OPF). Method: A new intelligent methodology was applied for the analysis and classification of complex wound images using digital image processing and machine learning techniques with the supervised Optimum-Path Forest (OPF) standards classifier. The image bank of 27 complex wounds was created, which were labeled by four specialists according to the classification of the tissues into four classes: granulation (red), fibrinoid (yellow) tissue, necrosis (black) and hematoma (purple), generating 108 images. Two classes were added: white (what is in the photo, except the wound bed) and doubt (divergence in classification by professionals). The OPF classifier was trained from these 108 images. The OPF was applied to the wound images and the accuracy was verified. Then, the application developing process was started. Results and Discussion: The present study developed a computer-aided wound tissue classification scheme for evaluation and management of complex wounds from photos of a smartphone. The OPF application to complex wounds resulted in an accuracy of 77.52 ± 6.14. With this 4 tool, it was developed the product of this research: an application for segmentation, tissue classification and measurement of complex wounds. The application generates a Portable Document Format (PDF) report that can be emailed, printed or attached to a compatible electronic medical record. Conclusion: A bank was made with 27 images of complex wounds, which four professionals labeled for training the OPF classifier, applied the OPF to complex wound images, assessed the accuracy of this process and developed a mobile application with the functions of wound segmentation, tissue classification and wound measurement. The results showed that the value of the accuracy obtained in the computational analysis had a significant value, being equal to the evaluation of specialists in wounds. Comparing to similar studies, the computational analysis of wounds showed less variability than professionals´ evaluation, suggesting that the incorporation of this technology in clinical practice favors the health care of patients with complex wounds, besides providing data for the management, teaching and research.

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Foster, Michele. "A window of opportunity : referral from acute care to rehabilitation following traumatic brain injury /." [St. Lucia, Qld.], 2001. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16181.pdf.

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Schneider, Jillian Claire Zillmer Eric Moelter Stephen T. "Emotional sequelae of sports-related injuries : concussive and orthopedic injuries /." Philadelphia, Pa. : Drexel University, 2006. http://hdl.handle.net/1860/1115.

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Murnyack, Roberta Michelle. "Development of a three-dimensional finite element model of lateral controlled cortical impact injury in the rat with geometry from magnetic resonance imaging." Thesis, Georgia Institute of Technology, 2001. http://hdl.handle.net/1853/17058.

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Lin, Htein. "Causes and prevalence of traumatic injuries to the permanent incisors of school children aged 10-14 years in Maseru, Lesotho." Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&amp.

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The aim of this study was to investigate the prevalence, etiology and types of injuries to permanent incisors among schoolchildren aged 10-14 years from Maseru, Lesotho. Upper and lower permanent incisors were examined for dental injuries.

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33

Margand, Paul Marcus Buchanan. "Ultrastructural changes in electrically damaged x-enopus laevis sciatic nerve." Scholarly Commons, 1991. https://scholarlycommons.pacific.edu/uop_etds/2217.

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Electrical injury is known to alter the normal physiological function of nerves. In most cases, the change in function is only minor, but in severe instances the physiological function may be lost entirely. The changes in function involve the ability of the nerve to transmit an impulse, which is a function of the nerve's ability to create and maintain an electrical gradient across its membrane. When the nerve is exposed to an electrical current, the ability to maintain an electrical gradient across the membrane is reduced or lost. This change may be transient or permanent. The changes in the gradient hinder the nerve from propagating the impulse, which is the means of information transfer to and from the CNS (central nervous system). Due to the manner in which human victims are typically exposed to an electric shock, the peripheral axons usually display the greatest change in physiological function.

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Ackermann, Tessa Ruth. "Minor "dings" - major effects? a study into the cognitive effects of mild head injuries in high school rugby." Thesis, Rhodes University, 2000. http://hdl.handle.net/10962/d1002429.

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The present study is part of a larger and ongoing research initiative investigating the cumulative cognitive effects of mild head injury in rugby union and focused specifically on high school rugby players. A comprehensive battery of neuropsychological tests was administered to top team high school rugby players (n = 47), and a non-contact sport control group of top team high school hockey players (n = 34). Direct comparisons of group mean scores and standard deviations across each neuropsychological test were carried out for the Total Rugby group versus the Total Hockey group as well as for the subgroups Rugby Forwards versus Rugby Backs. A correlational analysis was conducted to ascertain whether a relationship exists between the number of mild head injuries reported by the players and their cognitive test performance. Results of the group comparisons of means and variability on WMS Paired Associate Learning Hard Pairs - Delayed Recall provides tentative indications of the initial stages of diffuse damage associated with mild head injury in the rugby group and provides some evidence for impairment of verbal learning and memory in the Rugby Forwards group. The correlational analysis revealed no significant relationship between number of reported mild head injuries and cognitive performance. The findings and possible latent effects of the multiple mild head injuries reported by the rugby players are discussed in terms of brain reserve capacity theory and suggestions for future research are provided.

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Scholtz, Hendrik Johannes. "Fatal penetrating injuries of the chest." Master's thesis, University of Cape Town, 1996. http://hdl.handle.net/11427/26781.

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In the Republic of South Africa, an autopsy is required in all cases of unnatural death, or in cases where the cause of death is unknown in terms of the Inquest Act of 1959. These are performed at the Salt River Medicolegal Laboratory by Forensic Pathologists and Registrars of the Department of Forensic Medicine and Toxicology of the University of Cape Town. The Salt River Medicolegal Laboratory serves the greater Cape Town area with a population of approximately 2,5 million, including the magisterial districts of Cape Town, Wynberg, Mitchell's Plain and Simonstown. Cape Town has one of the world's highest homicide rates and in 1986 the incidence was 56, 91 100000 population per annum. In contrast, Singapore has a homicide rate of only 2, 5/100 000, while the United States has an overall homicide rate of 7,7/ 100 000 population. In order to document the true impact of penetrating chest injuries, and to place mortality data in perspective, a retrospective descriptive study of all cases with fatal penetrating chest injuries admitted to the Salt River Medicolegal Laboratory in Cape Town during 1990 was undertaken. In 1990, a total of 5 758 cases was admitted to the Salt River Medicolegal Laboratory of which 1834 cases (39%) were the result of homicide. Of the homicide cases, 408 (22%) were the result of firearm injuries. A total of 2044 (35, 5%) cases admitted was deemed to have died of natural causes. This study identified a total of 841 cases of fatal penetrating injuries of the chest admitted during 1990, which constituted 22,6% of all non-natural cases admitted.

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Ottosson, Carin. "Somato-psycho-social aspects of recovery after traffic injuries /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-721-9/.

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Hudson, Diana Stark. "Immersion- and recreationalboating related injuries in Alaska /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-454-6/.

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Springer, H. Keo. "The development and validation of an in vitro model of traumatic brain injury." Thesis, Georgia Institute of Technology, 1998. http://hdl.handle.net/1853/17859.

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Ou, Jingxing. "Chronic wound state associated with cytoskeletal defects and exacerbated by oxidative stress in Pax6+/- aniridia-related keratopathy." Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2008. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=25200.

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40

Cogger, Naomi. "Epidemiology of musculoskeletal injuries in two- and three-year-old Australian Thoroughbred racehorses." University of Sydney, 2006. http://hdl.handle.net/2123/1611.

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Doctor of Philosophy
The aim of this research was to describe the epidemiology of musculoskeletal (MS) injuries in two- and three-year-old Thoroughbred racehorses. A 27 month longitudinal study commencing in May 2000 was conducted. The study convenience sampled 14 trainers with facilities at metropolitan and provincial racetracks in New South Wales, Australia. In the 2000/01 and 2001/02 racing season, 323 and 128 two-year-olds, respectively, were enrolled in the study. The 451 Thoroughbred horses contributed, 1, 272 preparations and 78, 154 training days to the study. Of the 323 horses enrolled in the 2000/01 racing season, 219 contributed three-year-old data to the study. During the study period 8%, of training days had missing training data and 3% of the 1, 986 starts in the races or barrier trials were incorrectly recorded. The rate of incorrect entries varied with both study month and trainer. Similarly, the rate of training days with missing data varied between trainers and with study month. Four hundred and twenty-eight MS injuries were recorded in association with 395 preparations in 248 two- and three-year-old Thoroughbred racehorses. The IR for all categories of MS injuries, except for tendon and ligament injuries, were higher in twoyear- olds than three-year-olds, although the differences were only significant for shin soreness. Seventy-eight percent of horses enrolled in the study started, in a barrier trial or race, within one year on entering the study. After accounting for other confounders, horses that had sustained a MS injury were 0.50 times less likely to start, in a race or trial, race than those that did not sustain an injury. Seventy percent of horses returned to training after their first MS injury, and the cumulative percentage of these horses that had recovered within six months of the initial MS injury was 55%. After adjusting for clustering at the level of the trainer, the analysis showed that horses that exercised at a gallop pace ≥ 890 m/minute (but had not started in a race) prior to the onset of MS injury, were 2.14 times more likely to recover than horses whose maximum speed, prior to the onset of the first MS injury, was less than 890 m/minute. Similarly, horses that had started in a race or barrier trial were 4.01 times more likely to recover than horses whose maximum speed was less than 890 m/minute. 8 Training days were grouped into units referred to as preparations. A preparation began on the day that the horse was enrolled in the study, or when a horse returned to training after an absence of more than seven days from the stable. The preparation continued until the horse was lost to follow-up or left the stable for a period of more than seven consecutive days. Univariable and multivariable analytical methods were used to examine the association between a range of independent variables and four preparationlevel measures of performance: (i) the duration of preparations, (ii) length of time from the beginning of the preparation until the first start in a race or barrier trial, (iii) length of time from the first start until the end of the preparation and (iv) rate of starts in races or barrier trials. After adjusting for confounders, younger horses tended to have shorter preparations, took longer to start in a race or barrier trial, had a shorter interval from the first start to the end of the preparation and fewer starts per 100 training days. MS injury was not conditionally associated with any of the outcomes considered in this chapter. Multivariate statistical models were used to explore risk factors for MS injuries. The results suggest that MS injuries involving structures in the lower forelimb (carpus to fetlock inclusive) could be reduced by limiting exposure to high-speed exercise. This supports the proposition that training injuries are caused by the accumulation of micro damage. The results suggest there are a number of other factors that vary at the trainer level that may be risk factors for injuries, in particular joint injuries. These include unmeasured variables such as the rate of increase in distance galloped at high-speed, conformation of the horse, skill of the riders and farrier and veterinary involvement.

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41

Dakin, Stephanie Georgina. "The role of prostaglandins in equine tendinopathy." Thesis, Royal Veterinary College (University of London), 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.572458.

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42

Strout, Teresa J. "Malingering of mild closed head injury sequelae with the neuropsychological symptom inventory : a study of the effect of prior knowledge." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1063204.

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Clinical neuropsychologists who assess patients following mild closed head injury (CHI) are often asked to offer an opinion whether there is evidence of malingering. Factors that impact the ability of a person to intentionally portray impairment are quite important since mis-diagnosis of malingering can result in delayed treatment. In this study knowledge of the sequelae of mild CHI was provided to normal college students in an effort to change reporting of symptoms and influence the type of malingering strategy used when completing the Neuropsychological Symptom Inventory (NSI). Subjects were randomly assigned to either a prior knowledge malingering group (PK;N=57), no prior knowledge malingering group (NPK;N=58), or control group (CON;N=61). The results showed that PK subjects endorsed more general and attention/concentration symptoms than NPK or CON subjects. The results also showed PK subjects were as likely to be detected by the NSI lie scale as NPK subjects. Thus, the NSI lie scale demonstrated sensitivity to malingering despite subjects having brief instruction about mild CHI. Also, having prior knowledge did not result in significantly different strategies when completing the NSI. Instead, both malingering groups reportedly used exaggeration and attempted to be consistent as frequent strategies.
Department of Educational Psychology

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43

Granger, Nicolas. "Effects of intraspinal transplantation of mucosal olfactory ensheathing cells in chronic spinal cord injury in domestic dogs." Thesis, University of Cambridge, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.608161.

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44

Willemse, Hermanus Barend. "A strategy to facilitate renewed resilience to re-establish meaning for persons with spinal cord injuries." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1008119.

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Census estimates in 2010 indicated that 6,3 percent South Africans aged 5 years and older are currently classified as disabled in five of the nine provinces in the country. The national figure for 2005 was 5 percent, with the figure for females (6,5 percent) slightly higher than that for males (6,1percent). Spinal cord injured persons and their significant others experience a range of emotions which affect their relationships with themselves, others and their environment. To deal with the life-changing consequences of the injury and regain control, these persons not only require a variety of coping strategies but rediscovery of resilience is inevitable if the experience of personal purpose and meaningful existence is ever to be regained. In the Nelson Mandela Bay Municipal area, Port Elizabeth, South Africa – the geographical area in which this research study was undertaken - persons with spinal cord injuries have many challenges to face due to the shortcomings the existing resource for health care delivery in the post-discharge phase. The research objectives identified for the study were, firstly, to explore and describe the lived experiences of persons with spinal cord injuries; secondly, to explore and describe the lived experiences of the significant others of persons with spinal cord injuries; and thirdly, to develop a strategy to guide the professional nurse and the health care team in facilitating the health care of persons with spinal cord injuries. The study was a qualitative, exploratory, descriptive, and contextual method of inquiry. The data obtained was used to formulate the strategy with its three sub-strategies to guide professional nurses and the health care team to facilitate renewed resilience and the re-establishment of meaning for persons with spinal cord injuries. Although the experiences of the significant others were explored in order to thicken the description of the experiences of persons with spinal cord injuries, the strategy developed was limited to the persons with spinal cord injuries. Although it is well documented that there are significant physical needs, the themes that emerged from the current research mostly related to psychological and social aspects. In acknowledging the human being as unitary multi-dimensional being, the researcher in his discussions and quest to address the issue of renewed resilience in spinal cord injured persons towards finding purpose and re-establishing meaning in their lives, focused on their psychological, spiritual and social health. The outcome of the study is a strategy constructed to facilitate renewed resilience, and three sub-strategies ‘addressing experienced emotions’, ‘facilitating meaningful relationships’ and ‘facilitating effective coping’. The strategy has as purpose the empowering of spinal injured persons in their efforts to re-establish meaning by serving as a tool to guide professional nurses and members of the health care team in their facilitating of renewed resilience in persons with spinal cord injury. It is envisaged that the co-ordination of the strategy will take place from the health care delivery facility nearest to the spinal cord injured individual concerned. In order for persons with spinal cord injuries to become accountable members of society, all levels and aspects of care aimed at physical, psychological, spiritual and social well-being need to be holistically addressed. The front-line role of the professional nurse is vital as the professional nurse acts as the co-ordinator for the health care team in ensuring that persons with spinal cord injuries receive quality and holistic care in order to deal meaningfully with the life-altering consequences of a spinal cord injury. Through this study, valuable insight was gained with regard to experiences of both persons with spinal cord injuries and that of their significant others. Recommendations were made for nursing practice, nursing education and nursing research.

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45

Tse, Yuen-kwan. "Impact of traumatic events on patients with physical injuries." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B29759304.

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46

林玊玲 and Yuk-ling Lam. "Patterns of musculoskeletal injuries in collegiate dancers." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31257264.

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47

Aniruth, Sunildutt. "Maxillofacial fractures in children attending the Red Cross War Memorial Children's Hospital." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&amp.

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The literature shows that maxillofacial fractures in children are uncommon. Although the Department of Oral and Maxillofacial Surgery of the Faculty of Dentistry, of the University of the Western Cape, has been providing a service to the Red Cross Children&rsquo
s Hospital (RXH) for the past twenty years, no study had been undertaken to determine the age, gender, number of patients per year, aetiology, patterns, and management of maxillofacial fractures at this institution. A retrospective records based study was undertaken to determine these features. This study accessed the records of patients seen at the trauma unit at RXH, from 1994 to 2003 inclusive, and referred for maxillofacial attention.

One-hundred-and-five patient records were obtained and analyzed using the SPSS statistic package. One-hundred-and-twenty-seven fractures were recorded in one hundred and five patients. The age of the patients ranged from one to thirteen. Sixty-five male and forty female patients were seen. Dentoalveolar fractures were the most common fracture seen in both the midface and mandible. Midface fractures were more common than mandibular fractures. Falls, followed by motor vehicle accidents, were the most common cause of facial fractures. Most fractures were successfully managed by closed procedures. At this institution, nasal and frontal fractures have surprisingly little or no input from the Department of Oral and Maxillofacial Surgery.

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48

Scarvell, Jennifer. "Kinematics and degenerative change in ligament-injured knees." University of Sydney, 2004. http://hdl.handle.net/2123/4139.

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Doctor of Philosophy
The aim of the work presented in this thesis was to examine the associations between the kinematics of the knee characterised by the tibiofemoral contact pattern, and degenerative change, in the context of anterior cruciate ligament (ACL) injury. While the natural history of degenerative change following knee injury is well understood, the role of kinematics in these changes is unclear. Kinematics of the knee has been described in a variety of ways, most commonly by describing motion according to the six degrees of freedom of the knee. The advantage of mapping the tibiofemoral contact pattern is that it describes events at the articular surface, important to degenerative change. It was hypothesised that the tibiofemoral contact pattern would be affected by injury to the knee. A model of ACL injury was chosen because the kinematics of the knee have been shown to be affected by ACL injury, and because the majority of chronic ACL-deficient knees develop osteoarthritis, the associations between kinematics and degenerative change could be explored. A technique of tibiofemoral contact pattern mapping was established using MRI, as a quantifiable measure of knee kinematics. The tibiofemoral contact pattern was recorded from 0º to 90º knee flexion while subjects performed a leg-press against a 150N load, using sagittal magnetic resonance imaging (MRI) scans. The technique was tested and found to be reliable, allowing a description of the tibiofemoral contact pattern in 12 healthy subjects. The tibiofemoral contact patterns of knee pathology were then examined in a series of studies of subjects at a variety of stages of chronicity of ligament injury and osteoarthritis. Twenty subjects with recent ACL injury, 23 subjects with chronic ACL deficiency of at least 10 years standing, and 14 subjects with established osteoarthritis of the knee were recruited. The 20 subjects with recent ACL injury were examined again at 12 weeks and 2 years following knee reconstruction. The tibiofemoral contact patterns were examined for each group of subjects and the associations between changes in the contact patterns and evidence of joint damage explored. Evidence of joint damage and severity of osteoarthritis were recorded from xrays, diagnostic MRI, operation reports and bone densitometry at the tibial and femoral condyles of the knee. Each of the three groups with knee pathology exhibited different characteristics in the tibiofemoral contact pattern, and these differences were associated with severity of joint damage and osteoarthritis. The recently ACL-injured knees demonstrated a tibiofemoral contact pattern that was posterior on the tibial plateau, particularly in the lateral compartment. Those with chronic ACL deficiency demonstrated differences in the contact pattern in the medial compartment, associated with severity of damage to the knee joint. Osteoarthritic knees showed reduced femoral roll back and longitudinal rotation that normally occur during knee flexion. Two years following knee reconstruction there was no difference between the contact pattern of the reconstructed and healthy contralateral knees. This technique of tibiofemoral contact pattern mapping is sensitive to the abnormal characteristics of kinematics in ligament injury and osteoarthritis. This is the first time the tibiofemoral contact characteristics of chronic ACL-deficient and osteoarthritis knees have been described and links examined between tibiofemoral contact patterns and degenerative change.

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Steele, Brian E. "Gender differences in the cutting maneuver in intercollegiate basketball." Virtual Press, 1999. http://liblink.bsu.edu/uhtbin/catkey/1125154.

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Female intercollegiate basketball players experience a three times greater rate of ACL injuries than their male counterparts. This investigation hypothesized that women and men perform the cutting maneuver differently with respect to ground reaction forces and knee range of motion.The subjects performed a ninety degree cut on a force platform while being video taped. The male subjects exhibited a 23.1 percent greater (p=.0167) knee flexion angle than did the female subjects. The female subjects exhibited a 25.5 percent greater (p=.0022) braking force than did the male subjects. The impact maximum was not statistically significant (p=.3290).The performance characteristics exhibited by the female subjects in this study would suggest that the cutting maneuver is more dangerous for female basketball player. Female athletes should be taught correct performance of the cutting maneuver. I addition to technique, strength training should be encouraged to develop a stronger secondary stabilization mechanism for the knee.
School of Physical Education

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50

Beilinsohn, Taryn. "Cumulative mild head injury in rugby: a comparison of cognitive deficit and postconcussive symptomatology between schoolboy rugby players and non-contact sport controls." Thesis, Rhodes University, 2001. http://hdl.handle.net/10962/d1002440.

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This study investigates the cumulative effects of concussive and subconcussive mild head injury on the cognitive functioning of schoolboy rugby players. A comprehensive battery of neuropsychological tests and a self-report postconcussive questionnaire were administered to top level schoolboy rugby players (n=47), and a non-contact sport control group of top level schoolboy hockey players (n=34). Group comparisons of the percentage of individuals with cognitive deficit were carried out between i) the schoolboy rugby and the schoolboy hockey players, ii) the rugby forward and the rugby backline players; iii) the rugby forward and the schoolboy hockey players and, iv) the rugby backline and the schoolboy hockey players. Results on the neuropsychological test battery did not provide any substantial evidence of a higher level of neuropsychological impairment in the rugby players relative to the control group, or in the rugby forward players relative to the rugby backline players. Results obtained on the postconcussive symptom questionnaire provided tentative indications that the rugby players do report a greater frequency of postconcussive symptomatology. The symptoms most frequently reported were being easily angered, memory problems, clumsy speech and sleep difficulties. It was hypothesized that the absence of cognitive impairment in the schoolboy rugby players compared with that noted for professional players was due to their younger age, relatively high IQ and education level and a less intensive level of physical participation in the sport, and hence less accumulated exposure to the game, thereby decreasing their exposure to mild head injuries. From a theoretical perspective, these pre-existing conditions were considered to act as protective factors against reductions in brain reserve capacity and concomitant susceptibility to the onset of neuropsychological dysfunction.

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Dissertations / Theses on the topic 'Wounds and injuries – Nursing'

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