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1.
Medicine (Baltimore) ; 99(43): e22561, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120743

RESUMO

Although sedation for bronchoscopy improves patient comfort, there is a risk of oversedation in elderly patients. Only a few studies have evaluated the efficacy and safety of sedation for bronchoscopy in elderly patients.This study retrospectively analyzed records of 210 patients who underwent transbronchial brushing and/or biopsy under midazolam sedation at National Hospital Organization Omuta National Hospital between June 2017 and October 2019. Patients were administered 1 mg midazolam following 10 mL 4% lidocaine inhalation. When sedation was insufficient, 0.5 mg midazolam was administered additionally. Diagnostic yield, incidence of complications, amount of oxygen supplementation, decreases in percutaneous oxygen saturation (SpO2), changes in blood pressure, and degree of comfort were analyzed.Patients were divided into the elderly (n = 102) and non-elderly (n = 108) groups. No significant differences were observed in diagnostic yield and procedure time between the 2 groups, and no severe adverse events were noted in the elderly group. The degree of comfort during bronchoscopy was significantly higher in the elderly group. In patients administered < 2 mg midazolam, the amount of oxygen supplementation and decreases in SpO2 were significantly smaller in the elderly group compared to the non-elderly group.The risk of adverse events related to midazolam sedation in bronchoscopy does not increase with age, and sedation improves comfort during flexible bronchoscopy in elderly patients. Moreover, a total dose of midazolam <2 mg is safe for elderly patients undergoing bronchoscopy.


Assuntos
Broncoscopia , Sedação Consciente , Hipnóticos e Sedativos/uso terapêutico , Midazolam/uso terapêutico , Conforto do Paciente , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Oxigênio/sangue , Oxigenoterapia/estatística & dados numéricos , Estudos Retrospectivos
3.
Cuad Bioet ; 31(102): 203-222, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910672

RESUMO

The crisis in the health system caused by COVID-19 has left some important humanitarian deficits on how to care for the sick in their last days of life. The humanization of the dying process has been affected in three fundamental aspects, each of which constitutes a medical and ethical duty necessary. In this study, I analyze why dying accompanied, with the possibility of saying goodbye and receiving spiritual assistance, constitutes a specific triad of care and natural obligations that should not be overlooked - even in times of health crisis - if we do not want to see human dignity violated and violated some fundamental rights derived from it.


Assuntos
Atitude Frente a Morte , Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Espiritualidade , Assistência Terminal/ética , Desumanização , Emoções , Humanos , Relações Interpessoais , Obrigações Morais , Cuidados Paliativos , Conforto do Paciente , Isolamento de Pacientes/ética , Direitos do Paciente , Pessoalidade , Papel do Médico , Religião , Assistência Terminal/métodos , Assistência Terminal/psicologia , Visitas a Pacientes
4.
Acta Med Indones ; 52(2): 177-178, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32778633

RESUMO

Neurological complications from novel coronavirus is becoming more common. These patients usually have primary pulmonary problem of acute lung injury. Presentation in the form of encephalitis, meningitis, Guillain-Barre syndrome and seizures are noted. It is also noted that SARS-CoV-2 has predilection for brain stem leading to patient not feeling extensive pulmonary injury. Here we share another neurological presentation.


Assuntos
Infecções por Coronavirus , Hipóxia Encefálica , Pandemias , Pneumonia Viral , Acidente Vascular Cerebral , Tomografia Computadorizada por Raios X/métodos , Idoso , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipóxia Encefálica/diagnóstico por imagem , Hipóxia Encefálica/etiologia , Conforto do Paciente/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia
7.
Am Surg ; 86(8): 933-936, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32856933

RESUMO

BACKGROUND: Several studies have described the population of adult trauma patients who undergo withdrawal of life-sustaining treatments (WLST); however, no study has looked specifically at trauma patients who undergo WLST following surgery. METHODS: This was a retrospective chart review of all trauma patients who underwent surgery at our trauma center between January 1 and December 31, 2017. Demographics were collected along with injury patterns and advance directives. Charts of all patients who died or who were discharged to hospice were analyzed to determine whether WLST occurred. Statistics included Fisher's exact test and Mann-Whitney U test. RESULTS: Three thousand and twenty-five adult trauma patients received care and 1495 (49.4%) had operations. Thirty (2.0%) patients underwent WLST, 15 (50.0%) of whom died in the hospital and 15 (50.0%) of whom were discharged to hospice. Twenty-six (86.7%) patients had a palliative care consult and 12 (40.0%) had prior advance directives. The most common injuries were femur fractures and subdural hematomas. Adjusting for age, white race, and age-adjusted CCI, femur fracture patients had, on average, 8.8 more hours between presentation and surgery (95% CI 2.1-15.4, P = .01) and 39 fewer hours between surgery and WLST (95% CI -107-29, P = .26) than traumatic brain injury patients. DISCUSSION: The short time between surgery and WLST in this cohort of patients may demonstrate that surgery was not aligned with patients' goals of care. A patient-centered approach that includes surgeon-driven palliative care discussions may help avoid nonbeneficial surgery in the last few days of life.


Assuntos
Cuidados Paliativos/estatística & dados numéricos , Conforto do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios , Suspensão de Tratamento/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adulto , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Humanos , Masculino , Futilidade Médica , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Estudos Retrospectivos , Ferimentos e Lesões/mortalidade
9.
Lima; Perú. Ministerio de Salud; 20200600. 3 p.
Monografia em Espanhol | LILACS, MINSAPERÚ | ID: biblio-1100461

RESUMO

El documento contiene la incorporación de bienes al listado esencial para el manejo y tratamiento del COVID-19


Assuntos
Preparações Farmacêuticas , Infecções por Coronavirus , Insumos Farmacêuticos , Conforto do Paciente
10.
Gerokomos (Madr., Ed. impr.) ; 31(2): 71-75, jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193886

RESUMO

OBJETIVO: Describir la participación del familiar cuidador para el confort de las personas mayores de 65 años hospitalizadas, según la percepción de las enfermeras y los familiares cuidadores en un hospital público de Lambayeque, Perú. MÉTODOS: Investigación cualitativa exploratoria descriptiva; la muestra fue de 20 informantes previo consentimiento informado. Los datos fueron recolectados mediante la entrevista semiestructurada y procesados según análisis de contenido temático. RESULTADOS: Emergieron tres categorías: a) participación en los cuidados básicos: confort del cuerpo; b) estrategias para el descanso y sueño: confort del ambiente; c) afecto, ánimo y fe: contribución al confort emocional y espiritual. CONCLUSIONES: La permanencia hospitalaria genera incomodidades en las personas adultas mayores, pero el familiar cuidador participa activamente en la satisfacción de las necesidades básicas como la higiene, alimentación, tendido de cama, evitación del dolor y de los ruidos, iluminación adecuada, seguridad, afecto, esperanza y fe; cuidados orientados a proporcionarles un entorno tranquilo y agradable que les ayuda en el descanso y sueño, la adaptación, la recuperación y la calidad de vida. Es indispensable que el personal de enfermería capacite al familiar cuidador y lo prepare para colaborar en el cuidado tanto en la hospitalización como en el hogar


OBJECTIVE: To describe the participation of the family caregiver for the comfort of people over 65 hospitalized, according to the perception of nurses and family caregivers in a public hospital in Lambayeque, Peru. METHODS: Descriptive exploratory qualitative research, the sample was 20 informants with informed consent. The data was collected through the semi-structured interview and processed according to thematic content analysis. RESULTS: Three categories emerged: a) Participation in basic care: Body comfort; b) Strategies for rest and sleep: Comfort of the environment; c) Affection, encouragement and faith: Contribution to emotional and spiritual comfort. CONCLUSIONS: The hospital stay generates discomfort in older adults, but the family caregiver actively participates in the satisfaction of basic needs such as hygiene, food, laying of bed, avoidance of pain and noise, adequate lighting, safety, affection, hope and faith; care oriented to provide a peaceful and pleasant environment that helps them in rest and sleep, adaptation, recovery and quality of life. It is essential that the nursing staff trains the family caregiver and prepares them to collaborate in the care of both the hospitalization and the home


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Cuidadores/psicologia , Conforto do Paciente , Percepção , Esgotamento Psicológico/psicologia , Enfermagem Geriátrica/educação , Cuidadores/tendências , Saúde da Família , Pesquisa Qualitativa , Descanso/psicologia , Sono , Afeto , Qualidade de Vida/psicologia
11.
Gerokomos (Madr., Ed. impr.) ; 31(2): 81-85, jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193888

RESUMO

OBJETIVO: Conocer y analizar aquellas publicaciones que se orientan en explorar los significados que el adulto mayor atribuye al envejecimiento y su vejez. MÉTODO: La revisión fue realizada en bases de datos; las que se consultaron fueron APS physics, EBSCO, Elsevier, Scopus y Wiley. Se incluyeron investigaciones de tipo cualitativas y mixtas, publicadas en el periodo entre 2008 a 2018. RESULTADOS: Se encontraron un total de 265 artículos, llegando a una muestra final de 12; fueron evidentes las diversas temáticas que se exploraron, siendo los significados del bienestar de la vejez los más destacados. CONCLUSIÓN: Tener una mayor comprensión de la vejez en sus diversas facetas contribuye a la creación de mejores vínculos entre el profesional de enfermería y el adulto mayor, lo que facilita otorgar cuidados de enfermería que respondan a sus necesidades particulares


OBJECTIVE: To know and analyze those publications that focus on exploring the meanings that older adults attribute to aging. METHOD: the revision was made in different Databases; those consulted were APS physics, EBSCO, Elsevier, Scopus and Wiley. Qualitative and mixed researches were included, published in the period that corresponded between 2008 to 2018.RESULTS: A total of 265 articles were found, reaching a final sample of 12, the various themes that were explored were evident, with the meanings of the well-being of old age being the most prominent. CONCLUSION: Have a greater understanding of old age in its various facets contributes to the creation of better relationships between the nurse and the elderly, facilitating to grant nursing care that responds to their particular needs


Assuntos
Humanos , Envelhecimento , Saúde do Idoso , Emoções/fisiologia , Conforto do Paciente/métodos , Relações Enfermeiro-Paciente , Cuidados de Enfermagem , Promoção da Saúde , Serviços de Saúde para Idosos , Pesquisa Qualitativa
15.
Med. intensiva (Madr., Ed. impr.) ; 44(4): 239-247, mayo 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-190576

RESUMO

La sedación es necesaria en el tratamiento de los pacientes críticos, tanto para aliviar el sufrimiento como para curar a los pacientes con enfermedades que precisan el ingreso en unidades de cuidados intensivos. Esta sedación debe ser la adecuada a las necesidades del paciente en cada momento de su evolución clínica, ni por debajo (infrasedación) ni por encima (sobresedación). Una sedación adecuada influye en la comodidad, la seguridad, la supervivencia, la calidad de vida posterior, la rotación de camas de las unidades de críticos y los costes. La infrasedación se detecta y corrige rápidamente. Sin embargo, la sobresedación es silente y difícil de prevenir sin unas pautas de actuación, una concienciación colectiva y un trabajo en equipo. El proyecto «Sobresedación Zero» del Grupo de Trabajo de Sedación, Analgesia y Delirium de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias pretende ser una herramienta docente, práctica y de concienciación colectiva de comodidad, seguridad y gestión para maximizar el resultado clínico y minimizar los efectos perjudiciales de la sedación excesiva. Se basa en un paquete de medidas que se incluye monitorizar el dolor, la analgesia, la agitación, la sedación, el delirium y el bloqueo neuromuscular, mantener a los pacientes sin dolor, realizar una sedación dinámica según objetivos clínicos, consensuar el protocolo multidisciplinar a seguir y evitar la sedación profunda no indicada clínicamente


Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated


Assuntos
Humanos , Sedação Profunda , Gestão da Segurança/normas , Analgesia/normas , Segurança do Paciente , Unidades de Terapia Intensiva , Gestão da Segurança/métodos , Conforto do Paciente , Número de Leitos em Hospital , Projetos , Cuidados Críticos
18.
J Clin Nurs ; 29(13-14): 2441-2454, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32242994

RESUMO

AIMS AND OBJECTIVES: To explore in depth discomfort in intensive care as experienced by patients and attended to by critical care nurses. BACKGROUND: Discomfort in illness is complex and persistent, and its alleviation is a challenge for nurses working in intensive care units (ICU). In previous studies, we showed that ICU patients described little actual pain but suffer from much discomfort. Critical care nurses had a systematic approach to the treatment of pain, but were more haphazard in dealing with other types of discomfort. DESIGN: Secondary qualitative analysis of data from two previous exploratory studies. METHODS: Content analysis was used on existing data from 28 interviews with ICU patients, and 16 field notes and interviews with critical care nurses. Kolcaba's Comfort Theory was applied for further analysis. The COREQ checklist was used. RESULTS: Three themes, "Being deprived of a functioning body", "Being deprived of a functioning mind" and "Being deprived of integrity" characterised the discomfort experienced by ICU patients. The nurses appeared to attend to all areas of discomfort expressed by patients. In need of, and providing acknowledgment and alleviation became a common overarching theme. We identified a comfort gap caused by the discrepancy between the patients' needs and the nurses' achievements in fulfilling these needs. CONCLUSIONS: A gap exists between ICU patients' comfort needs and nurses' achievements in fulfilling these, indicating that discomfort currently is an inevitable part of the critical illness trajectory. Increased knowledge about how the brain is affected in ICU patients and more systematic approaches to assessing comfort needs and enhancing comfort may support nurses in fulfilling patient needs and possibly diminish the existing comfort gap. RELEVANCE FOR CLINICAL PRACTICE: An increased understanding of the complex experience of discomfort in ICU patients may bring about more systematic approaches to enhance comfort and direct for education and further research.


Assuntos
Enfermagem de Cuidados Críticos/normas , Unidades de Terapia Intensiva/normas , Avaliação em Enfermagem/normas , Conforto do Paciente/métodos , Adulto , Atitude do Pessoal de Saúde , Estado Terminal/enfermagem , Estado Terminal/psicologia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
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