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6.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(3): 345-349, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-32386001

RESUMO

OBJECTIVE: To investigate the value and feasibility of early goal directed sedation (EGDS) in patients with acute brain injury. METHODS: A total of 110 patients with acute brain injury who were admitted to intensive care unit (ICU) of the Third Medical Center of the Chinese People's Liberation Army General Hospital from January 2015 to March 2019 were included and randomly divided into EGDS group and standard sedation group (STD) using the random number table. Patients in the EGDS group were sedated by continuous intravenous infusion of dexmedetomidine (initial dose of 0.2 µg×kg-1×min-1) for 72 consecutive hours. Patients in the STD group received intravenous bolus of propofol as appropriate clinically. Richmond agitation-sedation score (RASS) and electroencephalogram bispectral index (BIS) were used to continuously monitor the level of sedation. All patients were given sufentanil for analgesia. Routine treatments such as dehydration and reduction of intracranial pressure with mannitol, hemostasis or antiplatelet therapy were given according to the patients' condition. Vital signs, acute physiology and chronic health evaluation II (APACHE II) score, Glasgow coma scale (GCS) score, BIS value, artery blood gas analysis, duration of mechanical ventilation, analgesic dosage and adverse events were recorded in two groups before and 24, 48, and 72 hours after sedation. RESULTS: (1) Among the 110 patients, patients who received the second surgery due to cerebral hemorrhage, had worsening of cerebral hernia, withdrew during the course of the study, or whose family members abandoned treatment were excluded from the study. Finally, 105 patients were enrolled in the study, including 56 patients in the EGDS group and 49 in the STD group. There was no significant difference in gender, age, types of brain injury, baseline APACHE II or GCS score or rate of mechanical ventilation between the two groups. (2) Compared with before sedation, heart rate (HR) significantly decreased till 72 hours after sedation in both groups, and the decrease in the EGDS groups was more obvious as compared with the STD group (bpm: 70.49±7.53 vs. 79.83±9.48, P < 0.05). Besides HR, significant improvement was found in the APACHE II and GCS scores in the STD group at 72 hours of sedation as compared with before sedation, and no significant difference was found in other indicators. Compared with before sedation, arterial partial pressure of carbon dioxide (PaCO2) was significantly increased from the 24th hour of sedation, mean artery pressure (MAP) was decreased significantly and GCS score, BIS value were increased significantly from the 48th hour of sedation, till 72 hours, which were all improved significantly as compared with the STD group [72-hour PaCO2 (mmHg, 1 mmHg = 0.133 kPa): 40.30±5.98 vs. 31.57±8.20, 72-hour MAP (mmHg): 85.01±8.26 vs. 89.54±9.41, 72-hour GCS score: 8.62±3.34 vs. 7.89±2.74, 72-hour BIS: 60.87±24.79 vs. 56.68±33.43, all P < 0.05]. APACHE II score was significantly lower only at the 72nd hour of sedation as compared with before sedation in the EGDS group, and no significant difference was found as compared with the STD group (17.10±7.05 vs. 18.90±3.32, P > 0.05). Oxygenation index (PaO2/FiO2) was significantly increased only at the 24th hour of sedation in the EGDS group as compared with the STD group (mmHg: 261.05±118.45 vs. 226.45±96.54, P < 0.05). (3) The duration of mechanical ventilation was significantly shorter in the EGDS group than that in the STD group (hours: 20.56±9.03 vs. 27.75±11.23, P < 0.05), and the total administered dose of sufentanil was significantly lower in the EGDS group than that in the STD group (µg: 79.16±26.76 vs. 102.46±35.48, P < 0.05). (4) Compared with the STD group, the incidence of bradycardia in the EGDS group was increased significantly [10.71% (6/56) vs. 6.12% (3/49), P < 0.05], while the incidence of tachycardia was decreased significantly [14.29% (8/56) vs. 38.78% (19/49), P < 0.05], but no significant difference was found in the incidence of hypotension [5.36% (3/56) vs. 4.08% (2/49), P > 0.05]. The incidence of unexpected extubation in the STD group was 4.08% (2/49), which did not occurre in the EGDS group. CONCLUSIONS: EGDS can improve the GCS score and BIS value of patients with acute brain injury, suggesting that the EGDS is safe and feasible, which can help improve neurological function in patients with acute brain injury.


Assuntos
Lesões Encefálicas/tratamento farmacológico , Dexmedetomidina/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Objetivos , Humanos , Unidades de Terapia Intensiva , Respiração Artificial
9.
BMC Infect Dis ; 20(1): 290, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32306918

RESUMO

In the context of global aging, HIV infection has become a new chronic disease and requires innovative models of care. Treating isolated comorbidities represents a useless and potentially harmful practice at advanced age. Therefore, a patient-centered approach, in which the interventions are focused on the biology and function of the individual, with understanding of the importance of securing social and home environment that provides psychosocial support, better suits unmet health needs. We present a paradigmatic case of healthy aging: the first reported HIV-infected patient who achieved 100th of life - the Lisbon patient. The construct of healthy aging, recently introduced by the World Health Organization, is the best example of this comprehensive model and could represent the fourth target of UNAIDS agenda of the end of AIDS.


Assuntos
Infecções por HIV/terapia , Envelhecimento Saudável/fisiologia , Longevidade/fisiologia , Idoso de 80 Anos ou mais , Objetivos , Infecções por HIV/fisiopatologia , Infecções por HIV/psicologia , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde para Idosos , Envelhecimento Saudável/psicologia , Humanos , Masculino , Assistência Centrada no Paciente
10.
PLoS One ; 15(4): e0230912, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282825

RESUMO

As educators strive to incorporate more active learning and inquiry-driven exercises into STEM curricula, Course-based Undergraduate Research Experiences (CUREs) are becoming more common in undergraduate laboratory courses. Here we detail a CURE developed in an upper-level undergraduate genetics course at Yeshiva University, centered on the Drosophila melanogaster ortholog of the human neurodegeneration locus PLA2G6/PARK14. Drosophila PLA2G6 mutants exhibit symptoms of neurodegeneration, such as attenuated lifespan and decreased climbing ability with age, which can be replicated by neuron-specific knockdown of PLA2G6. To ask whether the neurodegeneration phenotype could be caused by loss of PLA2G6 in specific neuronal subtypes, students used GAL4-UAS to perform RNAi knockdown of PLA2G6 in subsets of neurons in the Drosophila central nervous system and measured age-dependent climbing ability. We organized our learning objectives for the CURE into three broad goals of having students think, communicate, and perform like scientists. To assess how well students achieved these goals, we developed a detailed rubric to analyze written lab reports, administered pre- and post-course surveys, and solicited written feedback. We observed striking gains related to all three learning goals, and students reported a high degree of satisfaction. We also observed significantly improved understanding of the scientific method by students in the CURE as compared to the prior year's non-CURE genetics lab students. Thus, this CURE can serve as a template to successfully engage students in novel research, improve understanding of the scientific process, and expose students to the use of Drosophila as a model for human neurodegenerative disease.


Assuntos
Comunicação , Drosophila melanogaster , Doenças Neurodegenerativas , Ciência/educação , Estudantes/psicologia , Pensamento , Universidades , Animais , Modelos Animais de Doenças , Objetivos
11.
Am J Nurs ; 120(5): 11, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332342

RESUMO

What our profession needs to look like in the upcoming decade.


Assuntos
Saúde Global , Objetivos , Liderança , Papel do Profissional de Enfermagem , Âmbito da Prática , Humanos , Assistência Centrada no Paciente , Sexismo
12.
Zhonghua Yi Xue Za Zhi ; 100(14): 1087-1090, 2020 Apr 14.
Artigo em Chinês | MEDLINE | ID: mdl-32294873

RESUMO

Objective: To investigate the goal-oriented retroperitoneoscopic adrenalectomy and report the initial experiment. Methods: A total of 102 patients were selected to our clinic experiment, and performed retroperitoneoscopic adrenalectomy with the new method. including adrenal cortex adenoma 76 cases, phaochromocytoma 12 cases, adrenal cyst 6 cases, myelolipoma 4 cases, gangliocytoma 1 case and corticohyperplassia 3 cases. The mean diameter of the tumors was 2.8 cm (0.5-5.8 cm). The operative procedure was briefly described as such, with ultrasound guiding, a needle was punched percutaneously up to the adrenal mass or the renal upper pole from lateral to posterior axillary line just below the inferior border of the 12th rib. labeled the pathway of the needle with methylene blue. Along the way of the needle, a 12 mm port was introduced into the retroperitoneal space with closed method, and the laparoscope with a working tunnel was introduced to make a tunnel along the label up to the adrenal for finally removing it. Additional port should be used when it was needed in the procedure. Results: The procedures of all patients were successful, and 10 patients were performed with only one port, 81 patients with two ports, 11 patients with three ports. The operative duration was 49 (31-115) min, the average blood loss was 38 (0-260) ml. There was no transition to open surgery and no perioperative complications. The length of postoperative hospital stay was 4.1 d (2-7 d). 98 patients were available for follow-up of 16.5 months (1-38 months), no complication was found. Conclusions: The new method of retroperitoneoscopic adrenalectomy is feasible and safe for renal masses, and compared to the conventional method, it may be less trauma to the abdominal wall and retropertoneal tissue, and it was also better on cosmetics.


Assuntos
Neoplasias das Glândulas Suprarrenais , Adrenalectomia , Neoplasias das Glândulas Suprarrenais/cirurgia , Objetivos , Humanos , Laparoscopia , Espaço Retroperitoneal
13.
Science ; 368(6488): 307-311, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-32299952

RESUMO

The worldwide decline of coral reefs necessitates targeting management solutions that can sustain reefs and the livelihoods of the people who depend on them. However, little is known about the context in which different reef management tools can help to achieve multiple social and ecological goals. Because of nonlinearities in the likelihood of achieving combined fisheries, ecological function, and biodiversity goals along a gradient of human pressure, relatively small changes in the context in which management is implemented could have substantial impacts on whether these goals are likely to be met. Critically, management can provide substantial conservation benefits to most reefs for fisheries and ecological function, but not biodiversity goals, given their degraded state and the levels of human pressure they face.


Assuntos
Biodiversidade , Conservação dos Recursos Naturais , Recifes de Corais , Pesqueiros , Animais , Peixes , Objetivos , Atividades Humanas , Humanos
16.
N Z Med J ; 133(1512): 76-84, 2020 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-32242181

RESUMO

Since the 1970s, neoliberalism has been the dominant economic and political philosophy among global institutions and some Western governments. Its three main strategies are: privatisation and competitive markets; reduced public expenditure on social services and infrastructure; and deregulation to enhance economic activity and ensure freedom of 'choice'. Generally, these measures have negatively affected the health and wellbeing of communities. In New Zealand, privatisation and competition led to income inequality and an unequal distribution of the 'determinants of health', a burden borne disproportionately by children, the poor, and by Maori and Pacific people. Limiting health expenditure led to inequalities in access to services with restructuring in the 1990s, subverting the service culture of the health system. Failure to regulate for the protection of citizens has undermined health and safety systems, the security of work and collective approaches to health improvement. There has been some retreat from neoliberalism in New Zealand, but we can do more to focus on 'upstream' health initiatives, to recognise that social investment, including adequate funding of services, returns benefits far in excess of any costs, and to make sure that social and cultural equity goals are achieved.


Assuntos
Assistência à Saúde , Política , Seguridade Social , Competição Econômica , Objetivos , Equidade em Saúde , Gastos em Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Nova Zelândia , Privatização , Responsabilidade Social
17.
N Engl J Med ; 382(16): 1575-1576, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32294366
18.
19.
J Rehabil Med ; 52(4): jrm00054, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32286676

RESUMO

OBJECTIVE: To investigate the association of goal attainment scaling outcomes with change in the Func-tional Independence Measure, and the association between the perceived importance, difficulty and degree of achievement of individual goals in general inpatient rehabilitation. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 208 participants admitted to inpatient rehabilitation in a metropolitan tertiary referral hospital in Melbourne, Australia. METHODS: Participants determined the nature of the goals and their importance, and therapists determined the difficulty of the goals. The associations were investigated using median regression and random effect ordinal regression. RESULTS: An increase of each point in the goal attainment scaling score was associated with an adjusted median increase of 0.34 points (95% confidence interval (CI): 0.18-0.5, p < 0.001) in Functional Independence Measure change. More important goals of similar difficulty (very important vs a little important: adjusted common odds ratio (cOR) = 1.97, 95% CI: 1.01-3.83, p = 0.045) and less difficult goals of similar importance (moderately difficult vs a little difficult cOR = 0.59, 95% CI: 0.04-0.87, p = 0.007; very difficult vs a little difficult cOR = 0.59, 95% CI 0.37-0.94, p = 0.027) were better achieved. CONCLUSION: Rehabilitation progress measured using the goal attainment scaling method is associated with changes in functional outcomes. For goals with similar difficulty, those with higher importance were better achieved, while for goals with similar importance, less difficult goals were better achieved.


Assuntos
Dependência Psicológica , Objetivos , Pacientes Internados/psicologia , Participação do Paciente/psicologia , Logro , Adulto , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Análise de Regressão , Centros de Reabilitação , Resultado do Tratamento
20.
J Nurs Adm ; 50(4): 183-184, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32195909

RESUMO

A successful nursing strategic plan establishes a roadmap for the future. It gives nurses a direction to follow and can refresh and reenergize an organization. A robust strategic plan is a critical component to ensure excellent patient care and the best possible outcomes. In this month's Magnet Perspectives, we unpack the essential elements that make a strategic plan effective, how to create and implement a plan that will work for you, and how to engage nurses at all levels in the process. We explore how strategic planning is used to guide the work of Magnet-recognized organizations and support nurses with the tools and resources they need to contribute fully to the care team.


Assuntos
Objetivos , Enfermeiras Administradoras/organização & administração , Planejamento Estratégico , Humanos , Objetivos Organizacionais
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