Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 724
Filtrar
1.
Cult. cuid ; 26(64): 1-10, 3º Cuatrimestre 2022.
Artigo em Espanhol | IBECS | ID: ibc-213759

RESUMO

Introduction: This paper states the need for comprehensive and humanized care in thecare of the oncological patient. Method: We present a theoretical reflection on relevant issues relatedto humanization: on the one hand, what it is and how interventions can be implemented from ahumanizing approach, and on the other hand, communication as a key tool in the professionalpatient relationship. From a practical perspective, we present our experience based on the development of the Humanization Plan we carried out at the Hospital Fundación General de la SantísimaTrinidad in Salamanca (Spain). Results: We present the humanization initiatives we developed inthe hospital grouped in three blocks; a) the hospital environment and the treatment room as a healthspace; b) the relationship with the team of professionals and communication with patients and theirfamilies; c) the management and occupation of time in the treatment room. Conclusions: The difficulty in establishing quality standards in humanization makes it difficult to determine the degreeof success of the interventions and to draw conclusions in this regard. In our case, the achievementsare endorsed mainly by the satisfaction and gratitude expressed by patients and companions. (AU)


Introducción: Este trabajo constata la necesidad de una atención integral y humanizadaen el cuidado del enfermo oncológico. Material y Método: En primer lugar, presentamos una reflexión teórica sobre cuestiones relevantes vinculadas con la humanización. Por una parte, qué es ycómo pueden implementarse intervenciones desde un enfoque humanizador, y por otra, la comunicación como herramienta clave de la relación profesional-paciente. En segundo lugar, desde unaperspectiva práctica, exponemos nuestra experiencia basada en el desarrollo del Plan de Humanización que llevamos a cabo en un hospital general en la ciudad de Salamanca (España). Resultados:Presentamos las iniciativas de humanización que desarrollamos en el hospital agrupadas en tres bloques; a) el entorno hospitalario y la sala de tratamientos como espacio de salud; b) la relación conel equipo de profesionales y la comunicación con los enfermos y sus familias; c) la gestión y ocupación del tiempo en la sala de tratamiento. Conclusiones: La dificultad a la hora de establecer estándares de calidad en humanización hace complicado determinar el grado de éxito de las intervenciones y establecer conclusiones al respecto. En nuestro caso los logros vienen avalados principalmentepor la satisfacción y gratitud que manifiestan pacientes y acompañantes. (AU)


Introdução: Este documento afirma a necessidade de cuidados abrangentes e humanizados no cuidado do paciente oncológico. Método: Apresentamos uma reflexão teórica sobre questõesrelevantes relacionadas com a humanização: por um lado, o que é e como as intervenções podemser implementadas a partir de uma abordagem humanizadora, e por outro lado, a comunicaçãocomo um instrumento chave na relação profissional-paciente. De uma perspectiva prática, apresentamos a nossa experiência baseada no desenvolvimento do Plano de Humanização que realizámosno Hospital Fundación General de la Santísima Trinidad em Salamanca (Espanha). Resultados:Apresentamos as iniciativas de humanização que desenvolvemos no hospital agrupadas em trêsblocos; a) o ambiente hospitalar e a sala de tratamento como espaço de saúde; b) a relação com aequipa de profissionais e a comunicação com os pacientes e as suas famílias; c) a gestão e ocupaçãodo tempo na sala de tratamento. Conclusões: A dificuldade em estabelecer padrões de qualidade nahumanização torna complicado determinar o grau de sucesso das intervenções e estabelecer conclusões a este respeito. No nosso caso, as realizações são endossadas principalmente pela satisfaçãoe gratidão expressas pelos doentes e companheiros. (AU)


Assuntos
Humanos , Humanização da Assistência , Psico-Oncologia , Conforto do Paciente , Qualidade de Vida , Saúde Holística , Espanha
2.
Enfoque Revista Científica de Enfermería ; 31(27): 24-38, jul.-dic.2022. ilus
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1380493

RESUMO

Los ensayos y escritos relacionados con el cuidado del paciente renal a través de los años se han enfocado a la calidad de vida, estilos de afrontamiento, satisfacción o percepciones que experimentan los pacientes durante su enfermedad. El presente articulo pretende reconocer que el cuidado de enfermería para con el paciente renal es un aspecto fundamental que proporciona al profesional la comprensión de la realidad del paciente y contribuye de manera positiva a comprender la realidad de enfermería como disciplina; enmarcadas en algunas posiciones que permiten garantizar su significado. Estas posiciones son la ética, la ontología y la epistemología. La ética se logra cuando el profesional de enfermería consigue proteger y respetar la dignidad humana del paciente renal que reciben atención de salud, la ontología se ocupa de reflexionar acerca de las concepciones de la realidad y sus relaciones centrando su finalidad en la búsqueda de la salud, del bienestar, la independencia y la trascendencia del paciente renal y la epistemología consiste en mostrar, de manera holística, la evolución del conocimiento de la enfermería para brindar un cuidado de excelencia al paciente renal.


Abstract Over the years, essays and writings related to kidney patient care have focused on quality of life, coping styles, satisfaction, or perceptions experienced by patients during their illness. This article aims to recognize that nursing care for kidney patients is a fundamental aspect that provides the professional with an understanding of the patient's reality and contributes positively to understanding the reality of nursing as a discipline framed in some positions that guarantee their meaning. These positions are ethics, ontology, and epistemology. Ethics is achieved when the nursing professional manages to protect and respect the human dignity of kidney patients who receive health care. Ontology deals with reflecting on the conceptions of reality and their relationships, focusing its purpose on the search for health, well-being, independence, and transcendence of kidney patients. And epistemology consists of showing, in a holistic way, the evolution of nursing knowledge to provide excellent care to kidney patients.


Resumo: Ensaios e escritos relacionados com os cuidados aos pacientes renais ao longo dos anos têmse focado na qualidade de vida, estilos de enfrentamento, satisfação ou percepções que os pacientes experimentam durante a sua doença. Este artigo tem como objetivo reconhecer que o cuidado de enfermagem para o doente renal é um aspecto fundamental que proporciona ao profissional uma compreensão da realidade do doente e contribui positivamente para a compreensão da realidade da enfermagem como disciplina; emoldurado em algumas posições que permitem garantir seu significado. Estas posições são ética, ontologia e epistemología. A ética é alcançada quando o profissional de enfermagem consegue proteger e respeitar a dignidade humana do paciente renal que recebe cuidados de saúde, a ontologia se preocupa em refletir sobre as concepções da realidade e as suas relações centrando o seu propósito na procura de saúde, bem-estar, independência e transcendência do paciente renal e epistemologia consiste em mostrar, holisticamente, a evolução do conhecimento de enfermagem para prestar um excelente cuidado ao paciente renal.


Assuntos
Humanos , Masculino , Feminino , Idoso , Conhecimento , Ética , Nefropatias/enfermagem , Cuidados de Enfermagem , Qualidade de Vida , Diagnóstico de Enfermagem , Conforto do Paciente
3.
Arq. ciências saúde UNIPAR ; 26(3): 531-545, set-dez. 2022.
Artigo em Português | LILACS | ID: biblio-1399143

RESUMO

Objetivo: Conhecer as considerações éticas relacionadas às condutas terapêuticas das equipes de saúde frente aos pacientes terminais. Metodologia: Trata-se de um estudo exploratório de natureza qualitativa. Realizado no período de dezembro de 2020, através do acesso ao Banco de Teses e Dissertações da CAPES, considerando que este, coordena o Sistema de Pós-graduação brasileiro. Resultados: Foram identificadas seis classes semânticas, de modo que a mesma formulou a seguinte distribuição de contextos temáticos: Classe 1 Paciente terminal; Classe 2 Condutas médicas; Classe 3 Manejo terapêutico; Classe 4 Protocolos clínicos e aspectos metodológicos dos estudos; Classe 5 Dependências metodológicas e Classe 6 Suporte clínico na terminalidade Dependências metodológicas. Discussão: A morte e a vida tornam-se um impasse enfrentado pelos profissionais de saúde, pois existem fatores decisivos na vida de cada paciente em situação terminal com nenhuma esperança de cura, envolvendo assim questões éticas. Conclusão: Portanto, torna-se necessário que as instâncias de saúde assegurem protocolos, treinamentos e aporte psicológicos para esses profissionais que atuam diretamente com pacientes em situações terminais de vida, para que possa haver uma ressignificação do processo de cuidado com pacientes e segurança na tomada de decisões por parte dos profissionais de saúde, e assim possa preservar a ética.


Objective: To know the ethical considerations related to the therapeutic behavior of health teams towards terminal patients. Methodology: This is an exploratory study of a qualitative nature. Carried out in January 2020, through access to the CAPES Theses and Dissertations Bank, considering that it coordinates the Brazilian Postgraduate System. Results: Six semantic classes were identified, so that it formulated the following distribution of thematic contexts: Class 1 Terminal patient; Class 2 Medical conducts; Class 3 Therapeutic management; Class 4 Clinical protocols and methodological aspects of the studies; Class 5 Methodological dependencies and Class 6 Clinical support in terminality Methodological dependencies. Discusson: Death and life become an impasse faced by health professionals, as decisive there are factors in the life of each patient in a terminal situation with no hope of cure, thus involving ethical issues. Conclusion: Therefore, it is necessary that health institutions ensure protocols, training and psychological support for these professionals who work directly with patients in terminal situations, so that there can be a new meaning for the process of patient care and safety in decision-making by health professionals, and thus can preserve ethics.


Objetivo: Conocer las consideraciones éticas relacionadas con las conductas terapéuticas de los equipos de salud frente a los pacientes terminales. Metodología: Se trata de un estudio exploratorio de carácter cualitativo. Realizado en el período de diciembre de 2020, a través del acceso al Banco de Tesis y Disertaciones de la CAPES, considerando que este, coordina el Sistema de Pós-graduación brasileño. Resultados: Se identificaron seis clases semánticas, por lo que se formuló la siguiente distribución de contextos temáticos: Clase 1 Paciente terminal; Clase 2 Conductas médicas; Clase 3 Manejo terapéutico; Clase 4 Protocolos clínicos y aspectos metodológicos de los estudios; Clase 5 Dependencias metodológicas y Clase 6 Apoyo clínico en la terminalidad Dependencias metodológicas. Discusión: La muerte y la vida se convierten en un impasse al que se enfrentan los profesionales de la salud, porque hay factores decisivos en la vida de cada paciente en situación terminal sin esperanza de curación, lo que implica cuestiones éticas. Conclusión: Por lo tanto, se hace necesario que las instancias de salud garanticen protocolos, capacitación y apoyo psicológico para estos profesionales que trabajan directamente con los pacientes en situaciones de vida terminal, para que pueda haber una resignificación del proceso de atención al paciente y seguridad en la toma de decisiones por parte de los profesionales de la salud, y así poder preservar la ética.


Assuntos
Condutas Terapêuticas , Doente Terminal/psicologia , Ética , Cuidados Paliativos/ética , Equipe de Assistência ao Paciente/ética , Família/psicologia , Protocolos Clínicos , Morte , Tomada de Decisões/ética , Conforto do Paciente/ética , Assistência ao Paciente/ética
4.
Dermatol Surg ; 48(10): 1065-1070, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36129233

RESUMO

BACKGROUND: Maximizing patient comfort during hyaluronic acid gel injection is a common concern that is usually addressed by selecting fillers with lidocaine. OBJECTIVE: Two randomized, double-blinded, split-face trials aimed to demonstrate noninferiority of specific hyaluronic acid fillers incorporating mepivacaine (RHA-M) versus their lidocaine controls, at providing pain relief. METHODS: Thirty subjects per trial received injections of RHA R -M versus RHA R , and RHA4-M versus RHA4, respectively, in the perioral rhytids (PR) and nasolabial folds (NLF). Pain was assessed on a visual analog scale; aesthetic effectiveness was evaluated with validated scales, and safety was monitored based on common treatment responses (CTRs) and adverse events (AEs). RESULTS: RHA-M fillers proved as effective as their lidocaine counterparts at reducing pain (noninferior, p < .0002 and p < .0001). Bilateral wrinkle improvement was measured both in the PR (-1.5 ± 0.6 points on each side) and in the NLF (-1.8 ± 0.6 and -1.9 ± 0.5 points) trials at one month, with virtually identical responder rates (≥96.7%). Common treatment responses and AEs were similar between treated sides, and none was clinically significant. CONCLUSION: Resilient hyaluronic acid fillers with either mepivacaine or lidocaine are equally effective at reducing pain during treatment and equally performant and safe for correction of dynamic facial wrinkles and folds.


Assuntos
Técnicas Cosméticas , Preenchedores Dérmicos , Ácido Hialurônico , Anestésicos Locais , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Método Duplo-Cego , Humanos , Ácido Hialurônico/efeitos adversos , Lidocaína , Mepivacaína/efeitos adversos , Sulco Nasogeniano , Dor/prevenção & controle , Conforto do Paciente , Envelhecimento da Pele , Resultado do Tratamento
5.
Pain Res Manag ; 2022: 4206275, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36090766

RESUMO

Aim: Temporomandibular disorders (TMDs) are clinical situations that are characterized by pain, sound, and irregular movements of the temporomandibular joints. The most common method in the treatment of TMDs is arthrocentesis. This study aims to compare the effect of conventional extraoral auriculotemporal nerve block (ANB) and Gow-Gates (GG) mandibular anesthesia techniques on patient comfort in an arthrocentesis procedure. Materials and Methods: We performed this study on 40 patients who underwent TMJ arthrocentesis with ANB (n = 20) or GG (n = 20) mandibular anesthesia techniques at the Marmara University Faculty of Dentistry between 2016 and 2019. The predictor variable was the type of an anesthesia technique, and the outcome variables included were pain, maximum mouth opening (MMO), and protrusive movement (PM). They were compared at the preoperative period and 3rd and 6th month periods. Statistical analysis included means with standard deviations, a one-way ANOVA for continuous data, and the results were evaluated at the significance level of p < 0.05. Results: No statistically significant difference was observed between the VAS values, MMO, and PM averages of preoperative, 3rd and 6th months of ANB and GG (p=0.142, p=0.209, and p=0.148). Conclusion: Both anesthesia techniques have provided effective results in terms of pain and functional jaw movements in the postoperative period in arthrocentesis treatment.


Assuntos
Anestesia por Condução , Transtornos da Articulação Temporomandibular , Artrocentese , Humanos , Nervo Mandibular/cirurgia , Dor , Conforto do Paciente , Transtornos da Articulação Temporomandibular/cirurgia
6.
Arch Dis Child ; 107(12): 1122-1127, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36162958

RESUMO

OBJECTIVE: To test the hypothesis that greater comfort is achieved using a nebuliser integrated into a high-flow nasal cannula (nebulisation system integrated in high-flow nasal cannula (NHF)) than using a jet nebuliser (JN), and to explore differences in analgesia requirement and the possibility of feeding during nebulisation. DESIGN: Randomised cross-over trial. SETTING: Paediatric intensive care unit. PATIENTS: Children aged <24 months diagnosed with bronchiolitis between November 2016 and May 2017. INTERVENTIONS: Nebulisations using NHF and JN. MAIN OUTCOME MEASURES: COMFORT-Behaviour Scale (CBS) and Numerical Rating Comfort Scale (NRSc) were used to measure comfort, and Numerical Rating Satisfaction Scale (NRSs) was used to assess satisfaction before, during and after nebulisation. Other variables included feeding, analgesia, need for being held and respiratory and heart rates. RESULTS: Thirty-three children with 233 nebulisations were included in the study. The median age was 3.0 (IQR 2-9) months. Comfort and satisfaction were greater with NHF than with JN. The median staff-recorded CBS, NRSc and NRSs scores for NHF versus JN were 13 (IQR 9-15) vs 17 (IQR 13-23), 8 (IQR 7-0) vs 7 (IQR 4-8), and 4 (IQR 3-4) vs 2 (IQR 2-3), respectively; and caregiver-recorded scores were 12 (IQR 10-15) vs 19 (IQR 13-24), 9 (IQR 7-10) vs 4 (IQR 1-6), and 4 (IQR 3-4) vs 2 (IQR 1-3), respectively (p<0.001). Children who received NHF had lower cardiac and respiratory rates, needed to be held less often during therapy and required less analgesia (p<0.001). CONCLUSION: Nebulisation through NHF appears to be a better alternative to JN in terms of comfort and satisfaction as well as making feeding possible during nebulisation.


Assuntos
Bronquiolite , Oxigenoterapia , Criança , Humanos , Pré-Escolar , Estudos Cross-Over , Conforto do Paciente , Bronquiolite/terapia , Cânula
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 1468-1471, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-36086391

RESUMO

With sound pressure levels reaching up to 130 dB, acoustic noise in Magnetic Resonance Imaging (MRI) is one of the main sources of patient discomfort in otherwise one of the safest medical imaging modalities. In this work, a noise prediction-based approach, termed predictive noise cancelling (PNC), is applied, for the first time, to suppress noise in MRI. In PN C the noise from the scanner gradient coils is predicted based on linear time-invariant models, which relate the individual gradient coil (X, Y and Z) input to the acoustic noise output. A model setup was constructed of a custom speaker box and MRI -compatible microphone to demonstrate live noise reduction. Additional tuning steps, including output channel equalization and clock mismatch correction, were performed to maximize noise reduction. A calibration sequence was designed to determine the model and tuning parameters. Analysis of actual scanner noise shows an upper limit of 21 dB noise reduction with the proposed linear model. For the components of a clinical example sequence, the setup demonstrated in-bore live noise reduction of up to 10 dB (7.01 ± 0.31 dB, 6.42 ± 2.04 dB and 9.28 ± 0.26 dB for X, Y and Z gradient coils respectively) in the presence of system imperfections. Clinical relevance - The results indicate promising noise attenuation without the need to modify scanner hardware or compromises in acquisition speed or quality. This has potential to substantially and cost effectively improve patient comfort in clinical MRI.


Assuntos
Acústica , Conforto do Paciente , Desenho de Equipamento , Humanos , Imageamento por Ressonância Magnética/métodos , Ruído/prevenção & controle
8.
Inf. psiquiátr ; (248): 17-26, jul.-sept. 2022. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-213418

RESUMO

El Daño Cerebral Adquirido (DCA) supone una situación de gran trascendencia personal, familiar y social. Sus secuelas implican dificultades en la integración normalizada del individuo, con respecto a su vida previa al daño y dificulta su participación en la sociedad, donde ha cambiado su rol. Las estrategias de atención al DCA varían atendiendo al momento y ámbito en que se sitúan. Durante la fase aguda, la subaguda y la atención crónica, las estrategias están muy ligadas a su etiología, pero una vez superadas estas fases, otras variables como el contexto psicosocial y laboral del afectado/a y su familia pasan a tomar relevancia. Se deben revisar las situaciones personales y familiares para atender a su grado de dependencia. Este análisis debe incluir instrumentos de evaluación que, desde una perspectiva integral, engloben todas las áreas de la vida que son importantes para las personas, y analice la calidad de vida de éstas. Es fundamental en este momento, construir conjuntamente con las personas con DCA, sus familias y los profesionales sociosanitarios, un nuevo proyecto de vida centrado en el bienestar emocional, físico y social, desde las diversas alternativas de recursos para los estadios crónicos con los que se cuenta actualmente en España (AU)


A stroke is a situation of great personal, family, and social significance. The sequel cause problems to integrate the individual at his life before the stroke, and this is difficult to participate in society, where his role has changed. The strategies, in case of accident, are differents depending on time and ambit. The etiology is very important in the acute phase, post acuse phase and chronic phase, however, after chronic phase the etiology less important and the variables such as the psychosocial and work context of the affected person and his family are more important. Personal and family situations should be reviewed to pay attention to the degree of dependency. The analysis must include evaluation instruments that, from a integrative perspective, includes all areas of life important to people, and analyze their quality of life. At this time, it is essential to build a life proyect for people with stroke and their families, focused on emotional, physical and social aspects, using the resource and alternatives that are in Spain to people with a chronic stroke


Assuntos
Humanos , Conforto do Paciente/métodos , Dano Encefálico Crônico/psicologia , Qualidade de Vida
9.
J Plast Reconstr Aesthet Surg ; 75(9): 3473-3484, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35961926

RESUMO

BACKGROUND: Although local anesthetics have been extensively studied, limited evidence is available regarding the optimal solution for maximizing patient comfort in minor oculoplastic procedures. OBJECTIVES: To determine the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries to maximize patient comfort. METHODS: This systematic review with network meta-analysis of prospective studies was conducted to understand the efficacy of different local anesthetics in combination to maximize patient comfort. The study was designed according to the Cochrane Handbook for Systematic Reviews of Interventions. The population comprised patients receiving local infiltration anesthesia in minor oculoplastic surgeries. Various anesthetics with adjuvants were compared with respect to injection pain, operative bleeding, and complications. Random-effects model was performed. The primary outcome of injection pain was measured using the visual analog scale (VAS) or a preference question (which intervention was the least painful). Other outcomes were operative bleeding and complications, which were evaluated with a similar preference question. RESULTS: Eleven randomized controlled trials (RCTs) of 521 patients (917 eyes) were included. The network meta-analysis revealed that "bicarbonate-buffered lidocaine with epinephrine" led to a significant decrease in injection pain (preference question) compared to "prilocaine with felypressin" and "lidocaine with epinephrine," whereas no significant differences were detected in the analysis of injection pain measured using the VAS. CONCLUSIONS: "Bicarbonate-buffered lidocaine with epinephrine" may be the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries due to reduced injection pain, operative bleeding, and postoperative swelling. However, this should be interpreted cautiously as the confidence in the evidence was very low. THE CLINICAL TRIAL REGISTRATION NUMBER: CRD42021260332 (PROSPERO).


Assuntos
Anestésicos Locais , Felipressina , Anestesia Local/métodos , Bicarbonatos , Método Duplo-Cego , Epinefrina , Humanos , Lidocaína , Metanálise em Rede , Dor , Conforto do Paciente , Prilocaína , Revisões Sistemáticas como Assunto
10.
Clin Imaging ; 90: 50-58, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35917662

RESUMO

OBJECTIVE: To investigate aspects of image quality, feasibility and patient comfort in dedicated spiral breast computed tomography (B-CT) in a large patient cohort. METHODS: This retrospective study was approved by the institutional review board. 2418 B-CT scans from 1222 women examined between 04/16/2019 and 04/13/2022 were analyzed. Patients evaluated their comfort during the examination, radiographers carrying out the scans evaluated the patient's mobility and usability of the B-CT device, whereas radiologists assessed lesion contrast, detectability of calcifications, breast coverage and overall image quality. For semi-quantitative assessment, a Likert-Scale was used and statistical significance and correlations were calculated using ANOVAs and Spearman tests. RESULTS: Comfort, mobility and usability of the B-CT were rated each with either "no" or "negligible" complaints in >99%. Image quality was rated with "no" or "negligible complaints" in 96.7%. Lesion contrast and detectability of calcifications were rated either "optimal" or "good" in 92.6% and 98.4%. "Complete" and "almost complete" breast coverage were reported in 41.9%, while the pectoral muscle was found not to be covered in 56.0%. Major parts of the breast were not covered in 2.1%. Some variables were significantly correlated, such as age with comfort (ρ = -0.168, p < .001) and mobility (ρ = -0.172, p < .001) as well as patient weight with lesion contrast (ρ = 0.172, p < .001) and breast coverage (ρ = -0.109, p < .001). CONCLUSIONS: B-CT provides high image quality and contrast of soft tissue lesions as well as calcifications, while covering the pre-pectoral areas of the breast remains challenging. B-CT is easy to operate for the radiographer and comfortable for the majority of women.


Assuntos
Calcinose , Mamografia , Mama/diagnóstico por imagem , Feminino , Humanos , Mamografia/métodos , Conforto do Paciente , Estudos Retrospectivos , Tomografia Computadorizada Espiral/métodos
11.
J Orthop Surg Res ; 17(1): 381, 2022 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-35962409

RESUMO

BACKGROUND: Insufficient pain control after lower limb arthroplasty results in delayed recovery and increased risk for pain chronicization. The ideal kind of analgesia is still discussed controversially. We conducted a retrospective analysis of single-center routine data from a German university hospital, including patients receiving either total hip (THA) or knee arthroplasty (TKA). METHODS: All patients received general anesthesia. Patients undergoing THA received either continuous epidural ropivacaine infusion (0.133%, Epi) or patient-controlled analgesia (PCA) with the Wurzburg Pain Drip (tramadol, metamizole and droperidol, WPD) or with piritramide (Pir). After TKA, patients received either continuous femoral nerve block (ropivacaine 0.2%, PNB) or Pir. RESULTS: The analyzed cohort comprised 769 cases. Use of WPD after THA (n = 333) resulted in significantly reduced Numeric Rating Scale (NRS) values at rest, compared to Epi (n = 48) and Pir (n = 72) (.75 [IQR 1.14] vs. 1.17 [1.5], p = .02 vs. 1.47 [1.33], p < .0001) as well as maximum NRS scores (2.4 [1.7] vs. 3.29 [1.94], p < .001 vs. 3.32 [1.76], p < .0001). Positive feedback during follow-up visits was significantly increased in patients with a WPD PCA (p < .0001), while negative feedback (senso-motoric weakness/technical problems/nausea/dizziness/constipation) was particularly increased in Epi patients and lowest in those with WPD (p < .0001). After TKA, Pir (n = 131) resulted in significantly reduced NRS values at rest, compared to PNB (n = 185) (1.4 [1.4] vs. 1.6 [1.68], p = .02). Positive feedback was increased in patients with a Pir PCA in comparison with PNB (p = .04), while negative feedback was increased in PNB patients (p = .04). Overall, WPD presented with the lowest rate of any complications (8.7%), followed by Pir (20.2%), PNB (27.6%) and Epi (31.3%) (p < .001). CONCLUSIONS: In the assessed population, the use of a WPD PCA after THA offered better pain control and patient comfort in comparison with continuous epidural or piritramide-based analgesia. After TKA, the use of a Pir PCA provided superior analgesia and a lower complication rate compared to continuous PNB.


Assuntos
Artroplastia do Joelho , Bloqueio Nervoso , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/métodos , Anestésicos Locais , Artroplastia do Joelho/efeitos adversos , Nervo Femoral , Humanos , Extremidade Inferior , Bloqueio Nervoso/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Conforto do Paciente , Nervos Periféricos , Pirinitramida , Estudos Retrospectivos , Ropivacaina
13.
Tomography ; 8(3): 1401-1412, 2022 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-35645399

RESUMO

BACKGROUND: The purpose of the present study is to evaluate the patient comfort during CT examinations with a modern CT scanner (Photon-Counting CT (PCCT)) and to compare the perceived patient comfort with a standard CT scanner. METHODS: A total of 157 patients participated in this study and completed a questionnaire on their subjective perceptions after their CT examination. The following aspects of comfort were rated on a 5-point Likert scale: (1) claustrophobia in general and during the examination, (2) the effort to lie down and to get up from the CT table, (3) the speed and comfort of the CT table, (4) the difficulty of holding the breath during the CT scan, and (5) the communication during the examination. RESULTS: Patients rated the modern CT scanner significantly better in terms of speed and comfort of the CT table and in terms of difficulty of holding their breath during the CT scan. The answers regarding the other aspects of comfort did not reveal significant differences. When asked for a comparison, patients who did perceive a difference between both scanners rated the modern CT scanner as more comfortable in all aspects of comfort. CONCLUSIONS: The survey did not reveal any major deficits in terms of comfort on the standard CT scanner. However, patients perceived the structural changes positively and appreciated the comfort of a modern CT scanner.


Assuntos
Conforto do Paciente , Tomografia Computadorizada por Raios X , Humanos , Tomógrafos Computadorizados
14.
COPD ; 19(1): 274-281, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35642841

RESUMO

Background: Hypoxemia is currently treated in hospital wards with oxygen, released continuously by "conventional" flow meters. A new type of hybrid flow meter allows to switch between on-demand and continuous mode. The aim of this observational study was to assess whether this new device reduces oxygen expenditure, is well accepted in a hospital setting and improves patient comfort during oxygen therapy. Methods: Oxygen was administered in hypoxemic patients with conventional or hybrid flow meters to maintain an oxygen saturation of ≥ 92% over a 12-week period. Every two weeks conventional and hybrid flow meters were switched. The overall oxygen delivery to the ward was continuously measured with a data logging device installed in the main oxygen pipeline and corrected for multiple confounding factors. Humidity measurements, for which a sensor placed in front of one of the nostrils, and patient questionnaires, were used to assess patient comfort during continuous and on-demand flow. Results: Overall oxygen delivery decreased by 39% when switching from continuous flow to on-demand therapy after correction for confounding factors. Continuous flows significantly decreased relative humidity more than equivalent on-demand settings and the latter tended to increase comfort. Conclusions: Hybrid flow meters cause a significant reduction in oxygen delivery in a hospital ward, which may lead to financial savings. Using the on-demand technology also lowers the dryness of the upper airways (and may increase patient comfort), while maintaining an adequate oxygenation.


Assuntos
Oxigênio , Doença Pulmonar Obstrutiva Crônica , Hospitais , Humanos , Oxigenoterapia , Conforto do Paciente
15.
Comput Math Methods Med ; 2022: 1056910, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35756427

RESUMO

This aim of this research was to explore the evaluation and prediction value of diffusion-weighted imaging (DWI) under artificial intelligence algorithm in the vomiting management and chemotherapy of early lung cancer under comfort care. 118 patients with lung cancer were included as the research objects. They were randomly divided into the control group (routine care) and the experiment group (comfort care) with 59 cases in each. The DWI under the weighted nuclear norm minimization (WNNM) noise reduction algorithm was used for examinations. The noise reduction effect of the algorithm under different Gaussian noises, as well as the sensitivity, specificity, and area under the curve (AUC) of the apparent diffusion coefficient (ADC) maps under different b values, was compared and analyzed. The indicators of vomiting, psychological state, quality of life, serum tumor marker levels, and nursing satisfaction were also compared between the two groups of patients after chemotherapy. Compared to the photon mapping (PM) algorithm and the total variation (TV) norm minimization algorithm, the WNNM algorithm had the most ideal noise reduction effect with clearer images, which was conducive to identification. When the b value was 800 s/mm2, the ADC chart had the best sensitivity, specificity, and AUC values of 0.95, 0.89, and 0.87, respectively. After chemotherapy, 45.76% of patients in the experiment group had vomiting in degree 0 and 40.68% had that in degree I, which suggested that the incidence of vomiting was significantly lower than that in the control group (P < 0.05). All of the psychological state, quality of life, serum tumor marker levels, and nursing satisfaction of patients in the experiment group were significantly better than those in the control group (P < 0.05). It showed that comfort care could alleviate the vomiting response effectively of patients with lung cancer after chemotherapy and had significant effects in improving the quality of life, the psychological state, and curative effect of patients. WNNM algorithm had the better noise reduction effect in DWI image processing. This work provided a certain reference for the nursing intervention plan after chemotherapy of early lung cancer.


Assuntos
Inteligência Artificial , Neoplasias Pulmonares , Algoritmos , Biomarcadores Tumorais , Imagem de Difusão por Ressonância Magnética/métodos , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Conforto do Paciente , Qualidade de Vida , Vômito/etiologia
16.
BMC Palliat Care ; 21(1): 76, 2022 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-35578219

RESUMO

BACKGROUND: To support family caregivers of people with dementia in end-of-life decision making, a family booklet on comfort care has been adapted and adopted by several European jurisdictions since the original publication in Canada in 2005. METHODS: We analyzed and compared the adaptations to the family booklets used in Canada, the Czech Republic, Italy, the Netherlands, the UK and Ireland that were made up to 2021. Qualitative content analysis was used to create a typology of changes to the original booklet. Interviews with the teams that adapted the booklets contributed to methodological triangulation. Further, using an established framework, we assessed whether the contents of the booklets addressed all domains relevant to optimal palliative dementia care. RESULTS: The booklets differed in the types of treatment addressed, in particular tube feeding, euthanasia, and spiritual care. There was also variability in the extent to which medical details were provided, an emphasis on previously expressed wishes in medical decision making, addressing of treatment dilemmas at the end of life, the tone of the messages (indirect or explicit) and the discussion of prognosis (as more or less positive), and the involvement of various healthcare professionals and family caregivers in care. All booklets addressed all domains of palliative dementia care. CONCLUSIONS: We identified core elements in providing information on end-of-life care to family caregivers of people with dementia as related to optimal palliative care in dementia. Additionally, local adaptations and updates are required to account for socio-cultural, clinical, and legal differences which may also change over time. These results may inform development of educational and advance care planning materials for different contexts.


Assuntos
Demência , Assistência Terminal , Cuidadores , Morte , Demência/terapia , Família , Humanos , Cuidados Paliativos/métodos , Folhetos , Conforto do Paciente
17.
J Am Med Dir Assoc ; 23(9): 1492-1498, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35609637

RESUMO

OBJECTIVES: Comfort care for a dying patient increases the quality of the end of life. End-of-life situations are frequently managed in acute geriatric units (AGUs), and transition to comfort care only is often necessary. However, the frequency of transition to comfort care and the latter's putative link with the end-of-life trajectory (sudden death, cancer, organ failure, and frailty with or without dementia) have not previously been studied in acute geriatric units. We sought to (1) describe end-of-life trajectories and the transition to comfort care only, and (2) analyse the relationship between the two, prior to death in an AGU. DESIGN: A secondary analysis of a subgroup of the DAMAGE cohort (a prospective multicentre cohort of 3509 patients aged 75 years and over and admitted consecutively to an AGU). SETTING/PARTICIPANTS: DAMAGE patients who died in an AGU after a stay of at least 48 hours. METHODS: Data on the end-of-life trajectory and the transition to comfort care only were extracted from medical records. RESULTS: Of the 177 included patients, 123 (69.5%) transitioned to comfort care only in the AGU. A frailty trajectory (in patients living with dementia or not) accounted for nearly 70% of deaths. Paradoxically, only frailty among people living without dementia was not significantly associated with a more frequent transition to comfort care [odds ratio (95% confidence interval): 1.44 (0.44-4.76), relative to a patient dying suddenly]. CONCLUSIONS AND IMPLICATIONS: Transition to comfort care only is frequent in AGUs and is linked to the end-of-life trajectory (except for frail patients living without dementia). The frailty trajectory is one of the most frequent, and, therefore, physicians must be aware of the need to improve practice in this context.


Assuntos
Fragilidade , Assistência Terminal , Idoso , Morte , Humanos , Conforto do Paciente , Estudos Prospectivos
19.
J Int Bioethique Ethique Sci ; Vol. 32(4): 103-115, 2022 Mar 09.
Artigo em Francês | MEDLINE | ID: mdl-35485041

RESUMO

In the context of end of life, palliative care offers support for the patient and his family, from a global perspective. This means paying attention to pain and difficult symptoms, but also to psychological, social and spiritual issues. Some situations confront healthcare teams with the difficulty of providing support to the end of life, not only in terms of relieving pain and suffering, but also when communication is impaired or even impossible. This is particularly the case with sedative practices. These situations involve providing comprehensive support by different evaluations of the patient’s pain and discomfort. This is therefore carried out by hetero-evaluation, by following observational pain assessment scales. Monitoring devices, such as ANI, usually used in anesthesia services, are experimented, for clinical purposes but also for research. In this article, we propose to analyze a clinical situation in which the use of ANI raised a whole series of questions about the use of the technical approach in palliative medicine and its integration into a care team. We will question some issues, in context, on the use of techniques and technologies in palliative medicine.


Assuntos
Medicina Paliativa , Conforto do Paciente , Morte , Humanos , Hipnóticos e Sedativos , Dor
20.
Prosthet Orthot Int ; 46(2): 95-107, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35412519

RESUMO

INTRODUCTION: Fit and alignment are observable objectives of the prosthesis rendering process for individuals with lower limb amputation. Nevertheless, there is a dearth of validated measures to directly assess the quality of this clinical procedure. OBJECTIVES: The objectives of this scoping review are to evaluate existing measurement parameters and clinical outcomes used in investigations of transtibial socket fit or prosthetic alignment and to identify gaps in the literature regarding tools for evaluation of prosthetic fitting. STUDY DESIGN: Scoping literature review. METHODS: A comprehensive search was conducted in the following databases: MEDLINE (through PubMed), Embase (through Elsevier), Scopus (through Elsevier), and Engineering Village (through Elsevier), resulting in 6107 studies to be screened. RESULTS: Sixty-three studies were included in the review. When measuring fit, studies most frequently reported on patient-reported comfort (n = 22) and socket size compared with the residual limb volume (n = 9). Alignment was most frequently measured by the prosthetists' judgment and/or use of an alignment jig (n = 34). The measurement parameters used to determine alignment or fit varied greatly among the included studies. CONCLUSION: This review demonstrated that most measures of socket fit rely on a patient's self-report and may vary with biopsychosocial factors unrelated to the socket fitting process. Meanwhile, alignment is determined mostly by the prosthetist's judgment, paired with objective measurements, such as alignment jigs and gait analysis. Efforts to standardize and validate measures of these parameters of prosthetic fitting are vital to improving clinical practice and reporting outcomes.


Assuntos
Membros Artificiais , Cotos de Amputação , Análise da Marcha , Humanos , Conforto do Paciente , Desenho de Prótese , Ajuste de Prótese/métodos , Tíbia/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...