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1.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1418907

ABSTRACT

Objetivo: identificar quais os posicionamentos e produtos auxiliares mais indicados para o recém-nascido hospitalizado em Unidade de Terapia Intensiva Neonatal. Método: caracteriza-se como básica, de caráter exploratório e quanto aos procedimentos técnicos é uma revisão sistemática da literatura. A busca teve como bases a Biblioteca Virtual em Saúde, Plataforma Capes e Unique, limitando as publicações realizadas entre 2011 e 2021. Obteve-se 85 resultados, sendo a análise e discussão dos dados realizada com 7 estudos. Resultados: verificou-se que existem diversos posicionamentos que podem ser utilizados nesses pacientes, como os decúbitos dorsal, ventral e lateral, sendo o ventral o mais indicado. Ademais, identificaram-se diversos produtos que podem ser utilizados para auxiliar no posicionamento dos recém-nascidos e que podem facilitar os cuidados de enfermagem. Considerações finais: observou-se que poucos estudos trouxeram um padrão e/ou um método de posicionamento vinculado com os produtos auxiliares.


Objective: to identify which are the most suitable positioning and auxiliary products for the newborn hospitalized in Neonatal Intensive Care Units. Method: this is characterized as basic, exploratory, and as to the technical procedures, it is a systematic literature review. The search was based on the Biblioteca Virtual em Saúde, Plataforma Capes and Unique, limiting publications between 2011 and 2021. A total of 85 results were obtained, and the analysis and discussion of the data was carried out with 7 studies. Results: it was found that there are several positions that can be used in these patients, such as dorsal, ventral, and lateral decubitus, with the ventral position being the most indicated. Furthermore, several products were identified that can be used to assist in positioning the newborns and that can facilitate nursing care. Final considerations: it was observed that few studies brought a standard and/or a positioning method linked to the auxiliary products.


Objetivo: identificar cuáles son los posicionamientos y productos auxiliares más adecuados para los recién nacidos hospitalizados en una Unidad de Cuidados Intensivos Neonatales. Método: se caracteriza como básico, de carácter exploratorio y en cuanto a los procedimientos técnicos es una revisión sistemática de la literatura. La búsqueda se basó en la Biblioteca Virtual em Saúde, Plataforma Capes y Unique, limitando las publicaciones entre 2011 y 2021. Se obtuvieron 85 resultados, siendo el análisis y la discusión de los datos realizados con 7 estudios. Resultados: Se ha comprobado que hay varias posiciones que pueden utilizarse en estos pacientes, como el decúbito dorsal, ventral y lateral, siendo la ventral la más adecuada. Además, se identificaron varios productos que pueden utilizarse para ayudar a colocar a los recién nacidos y que pueden facilitar los cuidados de enfermería. Consideraciones finales: se observó que pocos estudios trajeron un patrón y/o un método de posicionamiento vinculado a los productos auxiliares.


Subject(s)
Humans , Male , Female , Infant, Newborn , Intensive Care, Neonatal/methods , Equipment and Supplies, Hospital , Patient Positioning/methods , Infant, Newborn/growth & development , Intensive Care Units, Neonatal
2.
Article in Chinese | WPRIM | ID: wpr-1011043

ABSTRACT

Objective:To investigate the influence of Barbecure combined with Epley on residual dizziness of horizontal canal benign paroxysmal positional vertigo(HC-BPPV) by SRM-vertigo diagnosis system. Methods:A total of 406 patients diagnosed with HC-BPPV from Nov 2021 to Nov 2022 were enrolled by rapid axial roll test and Dix-Hallpike in the department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xi'an Jiaotong University. The patients were divided into two groups by hospital card numbers, in which the numbers that were odd were considered as group A, and the numbers that were even were considered as group B. The group A underwent two circles of Barbecure repositioning procedure by SRM-vertigo diagnosis system, while the group B underwent two circles Barbecure combined with Epley repositioning procedure by SRM-vertigo diagnosis system. The treatment was stopped on the next day when two groups of patients were cured, and those who were not cured will continue treatment with the same method. Results:The cure rate of group A was 83.41%, and the cure rate of group B was 80.51%, the difference between the two groups was not-statistically significant difference(P>0.05). The rate of residual dizziness of group A was 23.30%, the rate of residual dizziness of group B was 11.46%, the difference between the two groups was statistically significant(P<0.05). Conclusion:The Barbecure combined with Epley otoliths repositioning maneuver by SRM-vertigo diagnosis system can significantly reduce the rate of residual dizziness after the treatment of HC-BPPV, and improve the quality of life of patients.


Subject(s)
Humans , Benign Paroxysmal Positional Vertigo/therapy , Dizziness , Quality of Life , Patient Positioning/methods , Semicircular Canals
3.
Article in Chinese | WPRIM | ID: wpr-982730

ABSTRACT

Objective:To evaluate the influence of an additional roll test on the repositioning procedure by SRM-vertigo diagnosis system for horizontal canal benign paroxysmal positional vertigo(HC-BPPV). Methods:A total of 713 patients diagnosed with HC-BPPV in Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Xi'an Jiaotong University from Jan 2020 to Feb 2022 were enrolled. The patients were divided into two groups by hospital card numbers, in which the number is odd were considered as group A, and the number is even were considered as group B. The group A underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, while the group B first performed an additional roll test and then underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, to observe the cure rate and compare influence of HC-BPPV by an additional roll test. The quality of life and sleep of patients before and one-month after the treatment were assessed by the dizziness handicap inventory(DHI) and the pittsburgh sleep quality(PSQI). Results:The cure rate of group A was 63.21%, and the cure rate of group B was 87.68%,the difference between the two groups was statistically significant(P<0.05); The DHI score of patients after the repositioning was significantly lower than that before the repositioning(P<0.05). The PSQI score after the repositioning was significantly lower than that before the repositioning(P<0.05). The DHI and the PSQI scores after the repositioning were significantly lower than that before the repositioning, with a statistically significant difference (P< 0.05). The total score of DHI in group B after treatment was lower than that in group A, with a statistically significant difference(P<0.05). The total score of PSQI in group B after treatment was lower than that in group A, with non-statistically significant difference (P< 0.05). Conclusion:An additional roll test before the repositioning procedure by SRM-vertigo diagnosis system can significantly improve the cure rate of HC-BPPV, relieve anxiety, and improve the quality of life.


Subject(s)
Humans , Benign Paroxysmal Positional Vertigo/diagnosis , Quality of Life , Patient Positioning/methods , Dizziness , Semicircular Canals
4.
Rev. otorrinolaringol. cir. cabeza cuello ; 82(1): 50-59, mar. 2022. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1389830

ABSTRACT

Resumen Introducción: El vértigo posicional paroxístico benigno (VPPB) es la afección periférica más común en las enfermedades otoneurológicas. Con el reposicionamiento de partículas se busca eliminar el vértigo y sus síntomas asociados como lo son el mareo residual y la inestabilidad. Objetivo: Determinar si la maniobra de reposicionamiento de Epley (MRE) produce una modificación significativa del control postural (CP) en aquellos pacientes con VPPB de canal semicircular posterior (VPPB-CSC-P). Material y Método: Se realizó un estudio descriptivo prospectivo en una muestra de 21 pacientes con diagnóstico de VPPB-CSC-P. Comparamos el desplazamiento, la velocidad y el área del centro de presión (CoP) antes y después de la MRE. Resultados: La velocidad y el área de la CoP estudiada por posturografía computarizada muestra una disminución significativa en sus valores después de la MRE, mientras que el desplazamiento de la CoP se mantuvo sin cambios. Conclusión: La MRE ejecutada en pacientes con VPPB-CSC-P produce una modulación en el control de la CoP, demostrada por la disminución de la velocidad y el área de desplazamiento de la CoP. El éxito de la MRE produce modulación del CP.


Abstract Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral condition in otoneurologic diseases. With the repositioning of particles, the aim is to eliminate vertigo and its associated symptoms, such as residual dizziness and instability. Aim: To determine if the Epley repositioning maneuver (ERM) produces a significant modification of postural control (PC) in those patients with posterior semicircular canal BPPV (BPPV-CSC-P). Material and Method: A prospective descriptive study was carried out in a sample of 21 patients diagnosed with BPPV-CSC-P. We compared the displacement, velocity, and area of the center of pressure (CoP) before and after the Epley repositioning maneuver. Results: The velocity and the area of the CoP studied by computed posturography show a significant decrease in its values after the MRE, while the CoP shift remained unchanged. Conclusion: ERM performed in patients with BPPV-CSC-P produces an improvement in the control of the CoP, demonstrated by the decrease in the speed and the area of movement of the CoP. The success of the MRE produces modulation of the PC.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Semicircular Canals , Physical Therapy Modalities , Patient Positioning/methods , Benign Paroxysmal Positional Vertigo/therapy , Epidemiology, Descriptive , Prospective Studies
5.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 39: e2019399, 2021. tab, graf
Article in English, Portuguese | LILACS, SES-SP | ID: biblio-1143852

ABSTRACT

ABSTRACT Objective: To review the effects of the hammock positioning on clinical parameters of preterm newborn infants (PTNB) admitted to the Neonatal Intensive Care Unit (NICU). Data sources: This was a systematic review performed by searching the Pubmed, Lilacs, SciELO and PEDro databases. Intervention studies in English, Portuguese and Spanish that evaluated the effects of hammock positioning on clinical parameters of PTNB admitted to the NICU were selected. Three search strategies were used: 1) hammock positioning OR patient positioning AND intensive care units AND infant, newborn; 2) hammock positioning OR patient positioning AND intensive care units; 3) hammock positioning OR patient positioning AND intensive care units, neonatal. There was no restriction on the year of publication of the articles. Methodological quality was assessed by the PEDro scale. Data synthesis: Among 597 articles, only six were included and 139 neonates with gestational ages between 26 and 37 weeks and an average gestational weight <2240g were analyzed. Four studies included patients without any associated pathology and most of them placed the PTNB supine in hammock positioning. The duration of the intervention ranged from 15 to 180 minutes and most applied it at just one moment. There was an improvement in heart rate (HR), respiratory rate (RR) and pain (3/4 studies), as well as gains in peripheral oxygen saturation (SpO2) (2/4 studies). Only one study reported worsening of SpO2 with the intervention. The methodological quality of the studies was classified as low. Conclusions: Although this review suggests improvement with hammock positioning in HR, RR and pain in PTNB, the low methodological quality makes the results inconsistent.


RESUMO Objetivo: Revisar os efeitos da rede de posicionamento nos parâmetros clínicos de recém-nascidos pré-termo (RNPT) admitidos em Unidade de Terapia Intensiva Neonatal (UTIN). Fontes de dados: Trata-se de uma revisão sistemática realizada na PubMed, na Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), na Biblioteca Eletrônica Científica Online (SciELO) e na Base de Dados em Evidências em Fisioterapia (PEDro). Selecionaram-se estudos de intervenção, nos idiomas inglês, português e espanhol, que avaliaram os efeitos da rede de posicionamento sobre parâmetros clínicos de RNPT admitidos em UTIN. Foram utilizadas três estratégias de busca: hammock positioning OR patient positioning AND intensive care units AND infant, newborn; hammock positioning OR patient positioning AND intensive care units; e hammock positioning OR patient positioning AND intensive care units, neonatal. Não houve restrição quanto ao ano de publicação dos artigos. A qualidade metodológica foi avaliada pela escala PEDro. Síntese dos dados: De um total de 597 artigos, apenas seis foram incluídos. As amostras totalizaram 139 neonatos, com idade gestacional entre 26 e 37 semanas e média de peso gestacional <2.240 g. Quatro estudos incluíram pacientes sem nenhuma patologia associada, e a maior parte deles dispôs os RNPT em supino na rede de posicionamento. A duração da intervenção variou de 15 até 180 minutos, e a maioria aplicou essa intervenção em apenas um momento. Foi observada melhora na frequência cardíaca (FC), na frequência respiratória (FR) e na dor (3/4 estudos), além de ganhos na saturação periférica de oxigênio (SpO2) (2/4 estudos). Apenas um artigo relatou piora da SpO2 com a intervenção. A qualidade metodológica foi classificada como baixa. Conclusões: Embora a rede de posicionamento pareça causar melhora na FC, na FR e na dor em RNPT, a baixa qualidade metodológica torna inconsistentes os resultados.


Subject(s)
Humans , Infant, Newborn , Infant , Intensive Care Units, Neonatal , Patient Positioning/methods , Infant, Premature , Gestational Age , Evaluation Studies as Topic
7.
Rev. bras. ter. intensiva ; 32(1): 133-142, jan.-mar. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138473

ABSTRACT

RESUMO Esta revisão sistemática de estudos longitudinais objetivou avaliar o efeito da administração da dieta enteral em pacientes críticos adultos e pediátricos em posição prona no volume residual gástrico e em outros desfechos clínicos. A busca da literatura foi conduzida nas bases de dados PubMed®, Scopus e Embase, a partir de termos relacionados à população e à intervenção. Dois revisores independentes analisaram os títulos e resumos, e a coleta dos dados foi realizada a partir de uma ficha padronizada. Discrepâncias foram resolvidas por um terceiro revisor. A qualidade metodológica dos estudos foi avaliada considerando o potencial para erros sistemáticos e os dados analisados qualitativamente. Quatro estudos com pacientes adultos e um com pacientes pré-termos foram incluídos. O volume residual gástrico foi avaliado como principal desfecho: três não diferiram no volume residual gástrico entre as posições prona e supina (p > 0,05), enquanto um estudo demonstrou maior volume residual gástrico durante a administração da dieta em posição prona (27,6mL versus 10,6mL; p < 0,05), e outro apresentou maior volume residual gástrico na posição supina (redução do volume residual gástrico de 23,3% na posição supina versus 43,9% na posição prona; p < 0,01). Dois estudos avaliaram a frequência de vômitos, sendo maior na posição prona em um estudo (30 versus 26 episódios; p < 0,001) e sem diferença significativa em outro (p > 0,05). Incidência de pneumonia aspirativa e de óbito foram avaliadas por um estudo, não sendo observada diferença entre os grupos (p > 0,05). A literatura acerca da administração de dieta enteral em pacientes críticos em posição prona é escassa e de qualidade limitada, e os resultados sobre volume residual gástrico são contraditórios. Estudos observacionais com tamanho amostral apropriado deveriam ser conduzidos para fundamentar conclusões sobre o tema.


ABSTRACT This systematic review of longitudinal studies aimed to evaluate the effect of enteral feeding of critically ill adult and pediatric patients in the prone position on gastric residual volume and other clinical outcomes. A literature search was conducted in the databases PubMed, Scopus and Embase using terms related to population and intervention. Two independent reviewers analyzed the titles and abstracts, and data collection was performed using a standardized form. Discrepancies were resolved by a third reviewer. The methodological quality of the studies was evaluated considering the potential for systematic errors, and the data were qualitatively analyzed. Four studies with adult patients and one with preterm patients were included. The gastric residual volume was evaluated as the main outcome: three studies did not show differences in the gastric residual volume between the prone and supine positions (p > 0.05), while one study showed a higher gastric residual volume during enteral feeding in the prone position (27.6mL versus 10.6mL; p < 0.05), and another group observed a greater gastric residual volume in the supine position (reduction of the gastric residual volume by 23.3% in the supine position versus 43.9% in the prone position; p < 0.01). Two studies evaluated the frequency of vomiting; one study found that it was higher in the prone position (30 versus 26 episodes; p < 0.001), while the other study found no significant difference (p > 0.05). The incidence of aspiration pneumonia and death were evaluated in one study, with no difference between groups (p > 0.05). The literature on the administration of enteral feeding in the prone position in critically ill patients is sparse and of limited quality, and the results regarding gastric residual volume are contradictory. Observational studies with appropriate sample sizes should be conducted to support conclusions on the subject.


Subject(s)
Humans , Stomach/physiopathology , Prone Position , Critical Illness/therapy , Enteral Nutrition/methods , Patient Positioning/methods , Treatment Outcome
8.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(1): 19-27, mar. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1099198

ABSTRACT

INTRODUCCIÓN: El vértigo posicional paroxístico benigno (VPPB) es el vértigo periférico más frecuente. El tratamiento depende del compromiso de los canales semicirculares (CSC) y/o cúpulas, y consiste en maniobras de reposición de partículas. OBJETIVO: Evaluar los factores de riesgo asociados al VPPB en pacientes atendidos en el Servicio de Otorrinolaringología de la Red de Salud UC Christus. Evaluar la tasa de éxito de las maniobras de reposición. MATERIAL Y MÉTODO: Estudio retrospectivo. Se revisaron casos de VPPB con indicación de maniobras de reposición durante los años 2016-2017. Se obtuvo información demográfica, antecedentes médicos, la maniobra realizada y su éxito. Se evaluaron comorbilidades y temporada del año. RESULTADOS: Se incluyeron 195 consultas, realizándose 293 maniobras. La mayoría de los pacientes fueron mujeres (74%) con edad promedio de 63 años. Comorbilidades más frecuentes fueron hipertensión, dislipidemia y diabetes mellitus. El 20% presentó una hipofunción vestibular concomitante, 23% presentó antecedentes de VPPB y 8% compromiso bilateral. Canalolitiasis del CSC posterior fue predominante (90%). En el 77,3% se resuelve el caso con una maniobra. Los casos fueron más frecuentes en primavera y otoño. CONCLUSIONES: El VPPB fue más frecuente en mujeres, con una edad promedio de 63 años. La mayoría presentó canalolitiasis unilateral lográndose resolución con una maniobra de reposición.


INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. The treatment depends on the semicircular canal (SCC) and/or cupula involved and consists of particle repositioning maneuvers. AIM: Analyze risk factors associated with BPPV for patients seen at the otorhinolaryngology department of the UC Christus health center. Evaluate the success rate of the repositioning maneuvers. MATERIAL AND METHODS: Retrospective study. All cases of BPPV for which a repositioning maneuver was prescribed during the years 2016-2017 were reviewed. Data obtained includes demographics, medical history, maneuver performed, and its success rate. Comorbidities and seasonality were evaluated. RESULTS: 195 cases were included; with 293 maneuvers. The majority were women (74%), and the average age was 63 years. Common comorbidities were hypertension, dyslipidemia and diabetes mellitus. Concurrently, 20% had unilateral vestibular hypofunction, 23% had a history of BPPV, and 8% had bilateral involvement. Posterior SCC canalithiasis was most common (90%). In 77.3%, the case was resolved with one maneuver. Cases were most frequent in the spring and autumn season. CONCLUSION: BPPV was more common in women with an average age of 63 years. The majority of patients presented with unilateral canalithiasis obtaining a complete recovery with a single maneuver.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Physical Therapy Modalities , Patient Positioning/methods , Benign Paroxysmal Positional Vertigo/therapy , Benign Paroxysmal Positional Vertigo/epidemiology , Comorbidity , Semicircular Canals/physiopathology , Retrospective Studies , Risk Factors , Treatment Outcome , Benign Paroxysmal Positional Vertigo/rehabilitation
10.
Int. braz. j. urol ; 45(5): 956-964, Sept.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040071

ABSTRACT

ABSTRACT Purpose We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. Materials and Methods 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. Results The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). Conclusions Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.


Subject(s)
Humans , Male , Female , Adult , Kidney Calculi/surgery , Supine Position , Prone Position , Patient Positioning/methods , Nephrolithotomy, Percutaneous/methods , Fluoroscopy/methods , Kidney Calculi/pathology , Reproducibility of Results , Treatment Outcome , Matched-Pair Analysis , Statistics, Nonparametric , Operative Time , Kidney Pelvis/surgery , Middle Aged
11.
Rev. bras. ter. intensiva ; 31(3): 296-302, jul.-set. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1042576

ABSTRACT

RESUMO Objetivo: Avaliar as respostas fisiológicas e do sistema nervoso autônomo de recém-nascidos prematuros ao posicionamento do corpo e ruídos ambientais na unidade de terapia intensiva neonatal. Métodos: Este foi um estudo quasi-experimental. O sistema nervoso autônomo de recém-nascidos foi avaliado com base na variabilidade da frequência cardíaca quando os recém-nascidos foram expostos ao ruído ambiental e colocados em diferentes posições: supina sem suporte, supina com restrição manual e prona. Resultados: Cinquenta recém-nascidos prematuros foram avaliados (idade gestacional de 32,6 ± 2,3 semanas, peso de 1.816 ± 493g e nível Brazelton de sono/vigília de 3 a 4). Identificou-se correlação positiva entre o ruído ambiental e a atividade simpática (R = 0,27; p = 0,04). O ruído ambiental médio foi de 53 ± 14dB. A frequência cardíaca foi mais elevada na posição supina do que nas posições com restrição manual e prona (148,7 ± 21,6; 141,9 ± 16 e 144 ± 13, respectivamente; p = 0,001). A atividade simpática, representada por um índice de baixa frequência, foi mais elevada na posição supina (p < 0,05) do que nas demais posições, e a atividade parassimpática (alta frequência, raiz quadrada da média dos quadrados das diferenças entre os intervalos RR normais adjacentes e porcentagem dos intervalos R-R adjacentes com diferença de duração maior que 50ms) foi mais elevada na posição prona (p < 0,05) do que nas demais posições. A complexidade dos ajustes autonômicos (entropia aproximada e entropia da amostra) foi mais baixa na posição supina do que nas demais posições. Conclusão: A posição prona e a posição com restrição manual aumentaram tanto a atividade parassimpática quanto a complexidade dos ajustes autonômicos em comparação com a posição supina, mesmo na presença de ruído ambiental maior do que o nível recomendado, o que tende a aumentar a atividade simpática.


ABSTRACT Objective: Evaluate the physiological and autonomic nervous system responses of premature newborns to body position and noise in the neonatal intensive care unit. Methods: A quasi-experimental study. The autonomic nervous system of newborns was evaluated based on heart rate variability when the newborns were exposed to environmental noise and placed in different positions: supine without support, supine with manual restraint and prone. Results: Fifty premature newborns were evaluated (gestational age: 32.6 ± 2.3 weeks; weight: 1816 ± 493g; and Brazelton sleep/awake level: 3 to 4). A positive correlation was found between environmental noise and sympathetic activity (R = 0.27, p = 0.04). The mean environmental noise was 53 ± 14dB. The heart rate was higher in the supine position than in the manual restraint and prone positions (148.7 ± 21.6, 141.9 ± 16 and 144 ± 13, respectively) (p = 0.001). Sympathetic activity, represented by a low frequency index, was higher in the supine position (p < 0.05) than in the other positions, and parasympathetic activity (high frequency, root mean square of the sum of differences between normal adjacent mean R-R interval and percentage of adjacent iRR that differed by more than 50ms) was higher in the prone position (p < 0.05) than in the other positions. The complexity of the autonomic adjustments (approximate entropy and sample entropy) was lower in the supine position than in the other positions. Conclusion: The prone position and manual restraint position increased both parasympathetic activity and the complexity of autonomic adjustments in comparison to the supine position, even in the presence of higher environmental noise than the recommended level, which tends to increase sympathetic activity.


Subject(s)
Humans , Male , Female , Infant, Newborn , Autonomic Nervous System/physiology , Infant, Premature/physiology , Intensive Care Units, Neonatal , Prone Position/physiology , Patient Positioning/methods , Heart Rate/physiology , Noise , Prospective Studies
12.
Arq. neuropsiquiatr ; 77(8): 568-573, Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019471

ABSTRACT

ABSTRACT Motor impairments in stroke survivors are prevalent and contribute to dependence in daily activities, pain and overall disability, which can further upper-limb disability. Treatment with botulinum toxin A (BoNT-A) is indicated for focal spasticity and requires knowledge of biomechanics and anatomy to best select muscles to be injected in the limb. Objective: We aimed to describe the frequency of posture patterns in a Brazilian sample of stroke survivors and correlate them with recommendations of muscle selection for treatment with BoNT-A. Methods: Fifty stroke patients with spastic upper limbs scheduled for neuromuscular block were photographed and physically examined, to be classified by three independent evaluators according to Hefter's classification. Muscles that were injected with BoNT-A by their routine doctors were retrieved from medical charts. Results: Pattern III and IV were the most common (64.7%, 21.6%). We further subclassified pattern III according to the rotation of the shoulder, which effectively interfered in muscle choice. The muscles most frequently treated were shoulder adductors and internal rotators, elbow flexors and extensors, in forearm, the pronator teres and finger and wrist flexors, and, in the hand the adductor pollicis. Conclusion: Frequencies of upper-limb postures differed from previous reports. Other clinical features, besides spasticity, interfered with muscle choice for BoNT-A injection, which only partially followed the recommendations in the literature.


RESUMO As deficiências motoras que ocorrem nos indivíduos com doença cerebrovascular (DCV) são prevalentes e contribuem para dependência, dor e incapacidade, o que pode atrasar a reabilitação do membro superior e sua funcionalidade. O tratamento com toxina botulínica do tipo A (BoNT-A) é indicado para a espasticidade focal e requer conhecimento da biomecánica e anatomia para melhor selecionar os músculos a serem injetados. Objetivo: Descrever a frequência de padrões posturais numa amostra de brasileiros com sequelas de DCV e correlacioná-los com as recomendações de seleção de músculos. Métodos: Cinquenta pacientes com comprometimento do membro superior devido a DCV do ambulatório de bloqueios neuromusculares foram fotografados e examinados para categorização de acordo com a Classificação de Hefter. Os músculos tratados pelos seus médicos de rotina foram obtidos a partir dos prontuários. Resultados: Os padrões III e IV de Hefter foram mais comuns (64,7%; 21,6%). Nós propusemos a subclassificação do padrão III de acordo com a rotação do ombro, pois isso interferiu na escolha dos músculos tratados. Os músculos tratados com maior frequência foram os adutores e rotadores internos do ombro; flexores e extensores do cotovelo; no antebraço, o pronador redondo, flexores dos dedos e do carpo e na mão, o adutor do polegar. Conclusão: As frequências das posições do membro superior diferiram de relatos prévios. Além da espasticidade, outros fatores interferiram na escolha dos músculos tratados, que seguiram parcialmente as recomendações da literatura.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Botulinum Toxins/administration & dosage , Upper Extremity , Patient Positioning/methods , Acetylcholine Release Inhibitors/administration & dosage , Stroke Rehabilitation/methods , Muscle Spasticity/drug therapy , Treatment Outcome , Stroke/complications , Injections, Intramuscular , Muscle Spasticity/etiology
13.
J. vasc. bras ; 18: e20180117, 2019. ilus
Article in English | LILACS | ID: biblio-1002492

ABSTRACT

Acute compartment syndrome of the lower extremities after urological surgery in the lithotomy position is a rare but potentially devastating clinical and medicolegal problem. We report the case of a 67-year-old male who underwent laparoscopic prostatectomy surgery to treat cancer, spending 180 minutes in surgery. Postoperatively, the patient developed acute compartment syndrome of both legs, needing emergency bilateral four-compartment fasciotomies, with repeated returns to the operating room for second-look procedures. The patient also exhibited delayed wound closure. He regained full function within 6 months, returning to unimpaired baseline activity levels. This report aims to highlight the importance of preoperative awareness of this severe complication which, in conjunction with early recognition and immediate surgical management, may mitigate long-term adverse sequelae and improve postoperative outcomes


A síndrome compartimental aguda dos membros inferiores após cirurgia urológica na posição de litotomia é um problema clínico e médico-legal raro, mas potencialmente devastador. Reportamos o caso de um homem de 67 anos submetido a uma prostatectomia laparoscópica por câncer. A cirurgia durou 180 min. No pós-operatório, o paciente desenvolveu síndrome compartimental aguda de ambos os membros inferiores, necessitando de fasciotomias de urgência, com retornos repetidos à sala de cirurgia para procedimentos adicionais. O paciente também apresentou fechamento tardio da ferida. Ele recuperou a função completa dentro de 6 meses e retornou a um nível de atividade basal irrestrito. Este artigo tem a importância de ressaltar a consciência pré-operatória desta grave complicação que, em conjunto com o reconhecimento precoce e o tratamento cirúrgico imediato, pode mitigar sequelas adversas em longo prazo e melhorar os resultados pós-operatórios


Subject(s)
Humans , Male , Aged , Postoperative Complications/diagnosis , Urologic Surgical Procedures/adverse effects , Urologic Surgical Procedures/methods , Compartment Syndromes , Lower Extremity , Prostatectomy/methods , Prostatic Neoplasms , Blood Pressure , Risk Factors , Laparoscopy/methods , Fascia , Patient Positioning/methods , Fasciotomy/methods
14.
Int. braz. j. urol ; 44(5): 965-971, Sept.-Oct. 2018. tab
Article in English | LILACS | ID: biblio-975638

ABSTRACT

ABSTRACT Purpose: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones. Material and Methods: From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy's Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan. Results: We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases. Conclusion: Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.


Subject(s)
Humans , Male , Female , Nephrostomy, Percutaneous/methods , Kidney Calculi/surgery , Supine Position , Prone Position , Patient Positioning/methods , Nephrostomy, Percutaneous/adverse effects , Tomography, X-Ray Computed , Prospective Studies , Retrospective Studies , Treatment Outcome , Patient Positioning/adverse effects , Middle Aged
15.
Arq. neuropsiquiatr ; 76(8): 563-565, Aug. 2018. graf
Article in English | LILACS | ID: biblio-950572

ABSTRACT

ABSTRACT The main objective of this manuscript is to describe some personal and professional aspects of two outstanding researchers and pioneers in neuro-otology. Among other achievements, Margaret Ruth Dix, and Charles Skinner Hallpike, designed the most-used provocative test for positional nystagmus for the diagnosis of lithiasis in the vestibular posterior semicircular canal.


RESUMO O principal objetivo desse manuscrito diz respeito a alguns aspectos pessoais e profissionais de dois excelentes pesquisadores e pioneiros da neuro-otologia. Entre outras descrições, Margaret Ruth Dix e Charles Skinner Hallpike descreveram o teste provocativo mais utilizado de nistagmo posicional para o diagnóstico de litíase no canal semicircular posterior do sistema vestibular.


Subject(s)
History, 20th Century , Neurotology/history , Vestibular Diseases/diagnosis , Vestibular Diseases/history , Vestibular Diseases/therapy , Lithiasis/diagnosis , Lithiasis/history , Patient Positioning/history , Patient Positioning/methods , London
16.
Arq. neuropsiquiatr ; 76(8): 534-538, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-950583

ABSTRACT

ABSTRACT Objective: To describe an unusual patient reaction to maneuvers used in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) that we termed the "Tumarkin-like phenomenon". Methods: At a private practice, 221 outpatients were diagnosed and treated for PC-BPPV. The treatment consisted of performing the Epley or Semont maneuvers. At the end of these maneuvers, when assuming the sitting position, the patients' reactions were recorded. Results: Thirty-three patients showed a Tumarkin-like phenomenon described by a self-reported sensation of suddenly being thrown to the ground. In the follow-up, this group of patients remained without PC-BPPV symptoms up to at least 72 hours after the maneuvers. Conclusion: The occurrence of a Tumarkin-like phenomenon at the end of Epley and Semont maneuvers for PC-BPPV may be linked with treatment success.


RESUMO Objetivo: Descrever uma reação incomum dos pacientes às manobras utilizadas no tratamento da vertigem posicional paroxística benigna do canal posterior (VPPB-CP), a qual denominamos de fenômeno Tumarkin-like. Métodos: Em uma clínica privada, 221 pacientes ambulatoriais foram diagnosticados e tratados para VPPB-CP. O tratamento consistiu em realizar as manobras de Epley ou de Semont. Ao término da manobra, ao serem colocados na posição sentado, as reações dos pacientes foram filmadas. Resultados: Trinta e três pacientes apresentaram o fenômeno de Tumarkin-like, descrito como uma sensação súbita de ser jogado no chão. O acompanhamento mostrou que todos eles permaneceram sem sintomas de VPPB até pelo menos 72 horas após as manobras. Conclusão: A ocorrência do fenômeno Tumarkin-like no final das manobras de Epley e Semont para VPPB-CP pode estar associado ao sucesso terapêutico.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Patient Positioning/methods , Benign Paroxysmal Positional Vertigo/physiopathology , Benign Paroxysmal Positional Vertigo/therapy , Sensation/physiology , Time Factors , Semicircular Canals/physiopathology , Physical Therapy Modalities , Treatment Outcome , Self Report , Sitting Position
17.
Rev. bras. ginecol. obstet ; 40(7): 379-383, July 2018. tab
Article in English | LILACS | ID: biblio-959016

ABSTRACT

Abstract Objective Perineal trauma is a negative outcome during labor, and until now it is unclear if the maternal position during the second stage of labormay influence the risk of acquiring severe perineal trauma. We have aimed to determine the prevalence of perineal trauma and its risk factors in a low-risk maternity with a high incidence of upright position during the second stage of labor. Methods A retrospective cohort study of 264 singleton pregnancies during labor was performed at a low-risk pregnancymaternity during a 6-month period. Perineal trauma was classified according to the Royal College of Obstetricians and Gynecologists (RCOG), and perineal integrity was divided into three categories: no tears; first/ second-degree tears + episiotomy; and third and fourth-degree tears. A multinomial analysis was performed to search for associated factors of perineal trauma. Results From a total of 264 women, there were 2 cases (0.75%) of severe perineal trauma, which occurred in nulliparous women younger than 25 years old. Approximately 46% (121) of the women had no tears, and 7.95% (21) performed mediolateral episiotomies. Perineal trauma was not associated with maternal position (p = 0.285), health professional (obstetricians or midwives; p = 0.231), newborns with 4 kilos or more (p = 0.672), and labor analgesia (p = 0.319). The multinomial analysis showed that white and nulliparous presented, respectively, 3.90 and 2.90 times more risk of presenting perineal tears. Conclusion The incidence of severe perineal trauma was low. The prevalence of upright position during the second stage of labor was 42%. White and nulliparous women were more prone to develop perineal tears.


Resumo Objetivo O trauma perineal é um desfecho negativo durante o parto, e é incerto, até omomento, se a posiçãomaternal durante o período expulsivo pode influenciar o risco de evoluir com trauma perineal severo. Nós objetivamos determinar a prevalência de trauma perineal e seus fatores de risco em uma maternidade de baixo risco com alta prevalência de posição vertical durante o período expulsivo. Métodos Um estudo de coorte retrospectivo de 264 gestações únicas durante o trabalho de parto foi realizado durante 6 meses consecutivos. O trauma perineal foi classificado de acordo com o Royal College of Obstetricianns and Gynecologists (RCOG). A integridade perineal foi dividida em três categorias: períneo íntegro; trauma perineal leve (primeiro e segundo graus + episiotomia); e trauma perineal severo (terceiro e quarto graus). Uma análise multinomial foi realizada para buscar variáveis associadas ao trauma perineal. Resultados De um total de 264 mulheres, houve 2 casos (0,75%)de trauma perineal severo m nulíparas com menos de 25 anos. Aproximadamente 46% (121) das mulheres não tiveram trauma perineal e 7,95% (21) realizaram episiotomias mediolaterais. Não houve correlação do trauma perineal com a posição de parto (p = 0,285), tipo de profissional que realizou o parto (p = 0,231), recém-nascidos com 4.000 gramas ou mais (p = 0,672), e presença de analgesia de parto (p = 0,319). Uma análise multinomial evidenciou que mulheres brancas e nulíparas apresentaram, respectivamente, um risco 3,90 e 2,90 vezes maior de apresentar trauma perineal. Conclusão A incidência de trauma perineal severo foi baixa. A prevalência de parto vertical durante o período expulsivo foi de 42%. Mulheres brancas e nulíparas foram mais suscetíveis a apresentar trauma perineal.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Perineum/injuries , Labor Stage, Second , Lacerations/etiology , Patient Positioning/methods , Patient Positioning/statistics & numerical data , Obstetric Labor Complications/etiology , Prevalence , Retrospective Studies , Risk Factors , Cohort Studies , Risk Assessment , Lacerations/epidemiology , Obstetric Labor Complications/epidemiology
18.
Rev. bras. cir. plást ; 33(2): 181-186, abr.-jun. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-909403

ABSTRACT

Introdução: Desde a década de 1980, com Illouz, a lipoaspiração ganhou popularidade e representa hoje um dos procedimentos mais realizados no mundo. Algumas de suas complicações são graves e potencialmente letais. Não existe, contudo, uma uniformidade em sua prática ou no seu ensino. A avaliação das técnicas empregadas por cirurgiões plásticos pode ser o início de uma padronização. Métodos: Foi aplicado um questionário sobre lipoaspiração no 52º Congresso Brasileiro de Cirurgia Plástica para cirurgiões plásticos de diferentes faixas etárias e regiões do Brasil, presentes no evento. Resultados: Foram contabilizados 243 questionários preenchidos (n = 243). O número médio de incisões foi de 9 (2 - 16). Duzentos e quarenta e um cirurgiões (99%) realizam incisões na linha mediana/ paramediana anteriormente e 236 (97%) incisam na linha mediana/paramediana na região posterior. Aproximadamente metade dos questionados utilizam a anestesia geral. Duzentos e nove cirurgiões (86%) posicionam o paciente em decúbito ventral durante o procedimento. A lipoaspiração superficial é realizada por 146 (60%) entrevistados, sendo que 22 (9%) fazem a aspiração apenas desta camada adiposa. Oitenta e cinco (35%) participantes relatam controlar a pressão do aparelho durante o procedimento. Conclusão: A lipoaspiração realizada no Brasil apresenta grande variação técnica. Essa constatação nos faz refletir sobre a necessidade de uma uniformização de sua prática e ensino a fim de aumentar o controle e a segurança do procedimento.


Introduction: Since the 1980s, with Illouz, liposuction has gained popularity and represents one of the most commonly performed procedures in the world today. Some of the complications are serious and potentially lethal. Nevertheless, uniformity in its practice or the manner in which it is taught does not exist. Evaluating techniques employed by plastic surgeons may be the start toward standardization. Methods: A questionnaire on liposuction was given to plastic surgeons of different age groups and from regions of Brazil who were present at the 52nd Brazilian Conference for Plastic Surgery. Results: Two hundred forty-three questionnaires were filled out (n = 243). The average number of incisions was 9 (2­16). Two hundred fortyone surgeons (99%) made incisions along the anterior median/ paramedian line, and 236 (97%) made incisions on the posterior median/paramedian line. Approximately half of those surveyed utilized general anesthesia. Two hundred nine surgeons (86%) placed the patient in the prone position during the procedure. One hundred forty-six (60%) interviewees performed superficial liposuction, with 22 (9%) performing liposuction only on this adipose layer. Eighty-five (35%) participants reported controlling the apparatus's pressure during the procedure. Conclusion: Liposuction procedures performed in Brazil have significant technical variations. This finding encourages us to reflect on the need to standardize liposuction practice and the manner in which it is taught so as to increase control over the procedure and its safety.


Subject(s)
Humans , History, 21st Century , Patients , Reference Standards , Surgical Procedures, Operative , Back , Lipectomy , Surveys and Questionnaires , Patient Selection , Subcutaneous Fat, Abdominal , Patient Positioning , Surgeons , Anesthesia , Surgical Procedures, Operative/standards , Surgical Procedures, Operative/statistics & numerical data , Back/surgery , Lipectomy/methods , Lipectomy/statistics & numerical data , Surveys and Questionnaires/statistics & numerical data , Subcutaneous Fat, Abdominal/abnormalities , Subcutaneous Fat, Abdominal/surgery , Patient Positioning/methods , Patient Positioning/statistics & numerical data , Surgeons/standards , Surgeons/ethics , Anesthesia/methods , Anesthesia/statistics & numerical data
19.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 10(1): 106-112, jan.-mar. 2018. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-908438

ABSTRACT

Objective: to analyze the arguments contained in electronic reports on the network about the use of the hammock with premature infants in NICU environment. Method: A qualitative, exploratory document study. Six electronic news were analyzed searching for information that it could describe the technique and the results about using the hammock. Results: The main benefits highlighted were weight gain, better motor and sensory development and stress reduction. The more frequently arguments based on concrete evidence were linguistic competence and authority. Conclusion: The reports reveal a favorable view of hammock usage, and pointed benefits in accordance to previous studies, however there is a need to develop studies to evidence this practice.


Objetivo: analisar os argumentos contidos nas notícias veiculadas na mídia eletrônica sobre o uso da rede em prematuros no ambiente da UTI Neonatal. Método: Estudo qualitativo, exploratório, do tipo documental. Foram analisadas seis notícias eletrônicas, buscando informações que descrevessem a técnica e os resultados do uso da rede e o tipo de argumentação utilizado. Resultados: Ganho de peso, melhor desenvolvimento motor e sensorial, redução do estresse foram os principais benefícios apontados. Argumentos mais frequentes foram de competência linguística, de autoridade, baseado em provas concretas. Conclusão: As notícias mostram uma visão favorável sobre o uso da rede, e os benefícios apontados encontram ressonância nos estudos já realizados, entretanto há necessidade de realizar estudos que gerem evidências para esta prática.


Objetivo: analizar los argumentos en los informes en los medios electrónicos a respecto del uso de la red en los bebés prematuros en el ambiente de la UCIN. Método: Estudio cualitativo, exploratorio documental. Seis notas electrónicas fueran analizadas en busca de informaciones para describir la técnica y los resultados del uso de la red y el tipo de argumento que fue utilizado. Resultados: Aumento de peso, un mejor desarrollo motor y sensorial, reducción del estrés son los principales beneficios evidenciados. Los argumentos eran con frecuencia la competencia lingüística, la autoridad, basado en pruebas concretas. Conclusión: Los informes muestran una opinión favorable del uso de la red, y los beneficios apuntados resuenan en estudios previos, sin embargo hay una necesidad de estudios para generar evidencia de esta práctica.


Subject(s)
Humans , Infant, Newborn , Health Communication , Infant, Premature , Information Dissemination , Intensive Care Units, Neonatal/trends , Neonatal Nursing , Patient Positioning/methods , Mass Media , Social Media , Brazil
20.
Rev. Hosp. Ital. B. Aires (2004) ; 38(1): 40-46, mar. 2018. ilus.
Article in Spanish | LILACS | ID: biblio-1046234

ABSTRACT

Las úlceras por presión han constituido un problema para la salud en general a través del tiempo. La realidad es que son una preocupación para el cuidado de la salud y todos los profesionales son responsables de su prevención y tratamiento. Se requieren múltiples estrategias de intervención para evitar el daño de la piel; una de ellas, el manejo de las cargas sobre los tejidos blandos. La correcta elección de las superficies de apoyo, la adecuada redistribución de la presión especialmente en las prominencias óseas y un progresivo programa de movilización constituyen las bases para evitar la producción de las úlceras por presión. (AU)


Pressure ulcers (PU) have been as a health problem throughout time. The reality is that PU are a global health care concern and all the professionals need to be responsible for the prevention and treatment of them. Multiple intervention strategies are needed to avoid the skin breakdown. Managing loads on the skin and associated soft tissue is one of these strategies. Properly chosen support surfaces, adequate periodic pressure redistribution, protection of specially vulnerable bony prominences and a progressive program of joint mobilization are the basis to avoid PU production. (AU)


Subject(s)
Humans , Soft Tissue Injuries/therapy , Critical Care/trends , Pressure Ulcer/prevention & control , Moving and Lifting Patients/methods , Patient Positioning/methods , Pressure Ulcer/complications , Pressure Ulcer/etiology , Pressure Ulcer/therapy , Pressure Ulcer/epidemiology , Moving and Lifting Patients/trends , Patient Positioning/trends
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