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1.
Hum Vaccin Immunother ; 15(3): 549-559, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30689507

RESUMO

BACKGROUND: Two new formulations of an investigational 15-valent pneumococcal conjugate vaccine (PCV15-A and PCV15-B) were developed using 2 different protein-polysaccharide conjugation processes and evaluated in separate phase I/II studies (NCT02037984 [V114-004] and NCT02531373 [V114-005]) to assess optimal concentrations of pneumococcal polysaccharide (PnPs) and Aluminum Phosphate Adjuvant. METHODS: Various lots of PCV15-A and PCV15-B containing different concentrations of PnPs and/or adjuvant were compared to PCV13 in young adults and infants. Adults received single dose and infants received 4 doses at 2, 4, 6, and 12-15 months of age. Adverse events (AEs) were collected after each dose. Serotype-specific immunoglobulin G (IgG) concentrations and opsonophagocytic activity (OPA) were measured prior and 30 days postvaccination in adults, at 1 month postdose 3 (PD3), pre-dose4, and postdose 4 (PD4) in infants. RESULTS: Safety profiles were comparable across vaccination groups. At PD3, serotype-specific IgG GMCs were generally lower for either PCV15 formulation than PCV13 for most shared serotypes. PCV15 consistently elicited higher antibody responses to the 2 serotypes unique to the vaccine (22F and 33F) and serotype 3 for which PCV13 was shown to be ineffective. Except for serotypes 6A and 6B, no dose-response effect was observed with increasing concentrations of PnPs and/or adjuvant. CONCLUSION: PCV15 is safe and induces IgG and OPA responses to all 15 serotypes in the vaccine. No significant differences in antibody responses were observed with increases in PnPs and/or Aluminum Phosphate Adjuvant.


Assuntos
Anticorpos Antibacterianos/sangue , Imunogenicidade da Vacina , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/imunologia , Adolescente , Adulto , Relação Dose-Resposta Imunológica , Voluntários Saudáveis , Humanos , Imunoglobulina G/sangue , Lactente , Pessoa de Meia-Idade , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/química , Vacinas Conjugadas/administração & dosagem , Vacinas Conjugadas/química , Vacinas Conjugadas/imunologia , Adulto Jovem
2.
J R Army Med Corps ; 165(5): 338-341, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31129648

RESUMO

INTRODUCTION: The extent of the French forces' territory in the Sahel band generates long medical evacuations. In case of many victims, to respect the golden hour rule, first-line sorting is essential. Through simulation situations, the aim of our study was to assess whether the use of ultrasound was useful to military doctors. METHODS: In combat-like exercise conditions, we provided trainees with a pocket-size ultrasound. Every patient for whom the trainees chose to perform ultrasound in role 1 was included. An extended focused assessment with sonography for trauma (E-FAST) was performed with six basic sonographic views. We evaluated whether these reference views were obtained or not. Once obtained by the trainees, pathological views corresponding to the scenario were shown to assess whether the trainees modified their therapeutic management strategy and their priorities. RESULTS: 168 patients were treated by 15 different trainee doctors. Of these 168 patients, ultrasound (E-FAST or point-of-care ultrasound) was performed on 44 (26%) of them. In 51% (n=20/39) of the situations, the practitioners considered that the realisation of ultrasound had a significant impact in terms of therapeutic and evacuation priorities. More specifically, it changed therapeutic decisions in 67% of time (n=26/39) and evacuation priorities in 72% of time (n=28/39). CONCLUSION: This original work showed that ultrasound on the battlefield was possible and useful. To confirm these results, ultrasound needs to be democratised and assessed in a real operational environment.


Assuntos
Avaliação Sonográfica Focada no Trauma , Medicina Militar/métodos , Modelos Teóricos , Conflitos Armados , Estudos de Viabilidade , Avaliação Sonográfica Focada no Trauma/métodos , Avaliação Sonográfica Focada no Trauma/estatística & dados numéricos , Humanos , Militares/educação , Tempo para o Tratamento , Transporte de Pacientes
4.
Soc Sci Med ; 37(3): 305-13, 1993 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8356480

RESUMO

Asthma is an invisible and unpredictable chronic illness characterized by recurrent episodes of airflow obstruction and airway inflammation. Until recently, psychological factors were thought to play a major role in this condition. The notion of an emotionally-based illness serves to discredit asthma as a 'real' illness among health professionals and patients alike, contributes to the sense of stigma that persons who have asthma experience, and impedes effective management. Findings from research with a sample of 95 adults with physician diagnosed and documented asthma indicate that persons who have asthma walk a tightrope between delaying formal medical intervention and seeking treatment too soon. Uncertainty about the quality and speed of care available in an emergency department shapes, in part, the nature of the lived experience of asthma and affects feelings of control over the illness. These concerns create a push-pull dynamic, as individuals struggle to make decisions about emergency department use that will provide relief, ensure autonomy, deter the experience of stigma, and diminish the threat of death.


Assuntos
Asma/psicologia , Serviço Hospitalar de Emergência , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Asma/terapia , Atitude Frente a Saúde , Doença Crônica/psicologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade
5.
Am J Crit Care ; 10(4): 216-29, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11432210

RESUMO

OBJECTIVE: To investigate the knowledge, beliefs, and ethical concerns of nurses caring for patients dying in intensive care units. METHODS: A survey was mailed to 3000 members of the American Association of Critical-Care Nurses. The survey contained various scenarios depicting end-of-life actions for patients: pain management, withholding or withdrawing life support, assisted suicide, and voluntary and nonvoluntary euthanasia. RESULTS: Most of the respondents (N = 906) correctly identified the distinctions among the end-of-life actions depicted in the scenarios. Almost all (99%-100%) agreed with the actions of pain management and withholding or withdrawing life support. A total of 83% disagreed with assisted suicide, 95% disagreed with voluntary euthanasia, and 89% to 98% disagreed with nonvoluntary euthanasia. Most (78%) thought that dying patients frequently (31%) or sometimes (47%) received inadequate pain medicine, and almost all agreed with the double-effect principle. Communication between nurses and physicians was generally effective, but unit-level conferences that focused on grief counseling and debriefing staff rarely (38%) or never (49%) occurred. Among the respondents, 37% had been asked to assist in hastening a patient's death. Although 59% reported that they seldom acted against their consciences in caring for dying patients, 34% indicated that they sometimes had acted against their conscience, and 6% had done so to a great extent. CONCLUSIONS: Intensive care unit nurses strongly support good pain management for dying patients and withholding or withdrawing life-sustaining therapies to allow unavoidable death. The vast majority oppose assisted suicide and euthanasia. Wider professional and public dialogue on end-of-life care in intensive care units is warranted.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Morte , Tomada de Decisões , Unidades de Terapia Intensiva/normas , Recursos Humanos de Enfermagem Hospitalar/psicologia , Assistência Terminal/normas , Adulto , Competência Clínica , Ética em Enfermagem , Eutanásia , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Cuidados Paliativos , Suicídio Assistido , Inquéritos e Questionários , Assistência Terminal/métodos , Estados Unidos
6.
Heart Lung ; 21(3): 265-72, 1992 May.
Artigo em Inglês | MEDLINE | ID: mdl-1592618

RESUMO

The purpose of this study was to explore patient perceptions of asthma severity and danger from asthma, correlate them with objective measures, and assess the impact of psychologic variables on the perception of severity. Recognition of patients at greatest risk for fatal attacks requires identifying those with severe asthma. In our study of 95 adults with asthma, we found that the subjective factors of perceived severity and perceived danger and the objective factors of medications, hospitalizations, history of intubation, and pulmonary function were important markers of asthma severity and risk. Our findings indicate that asthmatic adults make independent self-assessments that generally correlate with objective markers of increased risk of mortality and increased severity of the asthma. The perception of high severity was significantly correlated with depression, panic-fear, frequency of emergency department visits, and with an objective index of risk of death. The latter includes variables obtainable from history alone (number of medications to control symptoms, need for prednisone, prior intubation, and prior recent hospitalization) and is correlated with spirometric indexes of airflow obstruction, occurrence of nocturnal symptoms, and number of emergency department visits.


Assuntos
Asma/psicologia , Adulto , Asma/fisiopatologia , Asma/terapia , Atitude Frente a Saúde , Depressão , Feminino , Humanos , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autoavaliação (Psicologia) , Índice de Gravidade de Doença , Espirometria
7.
J Reprod Med ; 28(10): 677-80, 1983 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-6361250

RESUMO

Systemic lupus erythematosus with renal involvement is associated with excessive pregnancy wastage as well as substantial maternal risk. The same may be said of borderline renal function after renal transplantation. We treated a patient who had both problems and who carried a pregnancy to term successfully.


Assuntos
Falência Renal Crônica/fisiopatologia , Transplante de Rim , Lúpus Eritematoso Sistêmico/fisiopatologia , Complicações na Gravidez/fisiopatologia , Adulto , Feminino , Humanos , Recém-Nascido , Falência Renal Crônica/terapia , Lúpus Eritematoso Sistêmico/terapia , Gravidez , Complicações na Gravidez/terapia
8.
West J Nurs Res ; 22(7): 812-25, 2000 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11077549

RESUMO

Research on immigrant health emphasizes that the elderly are more vulnerable than other age groups in many immigrant populations. This study describes the meanings of health, illness, and disease for Iranian elderly immigrants in Sweden and their relationships with life disruptions. Analysis of interviews using an interpretive-phenomenological method illustrates that the participants, experience health as continuity and balance in life. Any disruption of this balance creates a sense of illness that is only partially related to the emergence of disease. Participants did not view health and disease as polarized. Rather, disease is just one component among many that may disrupt the experience of health. Health is perceived as a sense of well-being, can be achieved in spite of disease, and can be disrupted even in the absence of disease. This description of the meaning of health, disease, and illness contrasts with the Western biomedical perspective and is similar in its holism to various non-Western medical systems and complementary approaches. This knowledge can foster more culturally sensitive care.


Assuntos
Atitude Frente a Saúde/etnologia , Saúde Holística , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Irã (Geográfico)/etnologia , Masculino , Pessoa de Meia-Idade , Suécia
9.
ANS Adv Nurs Sci ; 8(1): 1-14, 1985 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-3933410

RESUMO

A Heideggerian phenomenological approach to explanation, prediction, and understanding in the study of health, illness, and disease is presented. The extremes of objectification and subjectivism as barriers to understanding illness and suffering are explored. It is argued that meaning terms are essential when studying practical activity and relational issues, and that a privileged position is not gained by developing structural analyses or power terms that get behind or beyond meaning. Hermeneutics, or interpretive methodology, is a holistic strategy because it seeks to study the person in the situation rather than isolating person variables and situation variables and then trying to put them back together. Paradigm cases, exemplars, and thematic analysis are described as interpretive and presentational strategies.


Assuntos
Teoria de Enfermagem , Qualidade de Vida , Comportamento , Saúde Holística , Humanos , Filosofia em Enfermagem , Projetos de Pesquisa
10.
ANS Adv Nurs Sci ; 14(2): 1-21, 1991 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-1759806

RESUMO

Two major types of narrative--constitutive or sustaining narratives and narratives of learning--are presented to illustrate the functions of narrative in everyday ethical expertise and socially embedded caring practices. Four narrative themes illustrate constitutive and sustaining narratives: healing and transcendence, the heroic saving of a life, fostering care and correction, and stories of being present. Five themes illustrate narratives of learning: the skill of involvement, being open to experience, disillusionment, facing death and suffering, and liberation. Quandary- and rights-based procedural ethics address ethical problems and breakdown and overlook everyday ethical comportment. Public storytelling is recommended as a way to explore notions of the good and ethical concerns.


Assuntos
Análise Ética , Ética em Enfermagem , Aprendizagem , Enfermeiras e Enfermeiros/psicologia , Papel (figurativo) , Assertividade , Atitude do Pessoal de Saúde , Atitude Frente a Morte , Casuísmo , Competência Clínica , Sinais (Psicologia) , Desenvolvimento Humano , Humanos , Desenvolvimento Moral , Relações Enfermeiro-Paciente , Pesquisa Metodológica em Enfermagem , Relações Profissional-Família , Identificação Social
11.
ANS Adv Nurs Sci ; 14(3): 13-28, 1992 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-1550330

RESUMO

The purpose of this study was to further explicate the Dreyfus Model of Skill Acquisition in the practice of critical care nursing. For this analysis data were used from a sample of 105 nurses practicing in the adult, pediatric, and newborn intensive care units of eight hospitals in three metropolitan areas. The data were composed of group interviews in which nurses gave narrative accounts of exemplars from their practice and close observations and intensive personal history interviews of a subsample of nurses. Two interrelated aspects were found to distinguish four levels of practice, from advanced beginner through expert. First, practitioners at different levels of skill literally live in different clinical worlds, noticing and responding to different directives for action. Second, a sense of agency is determined by one's clinical world and shows up as an expression of responsibility for what happens with the patient.


Assuntos
Competência Clínica , Cuidados Críticos , Aprendizagem , Modelos Psicológicos , Recursos Humanos de Enfermagem Hospitalar/educação , Sinais (Psicologia) , Família/psicologia , Saúde Holística , Humanos , Relações Interprofissionais , Pesquisa Metodológica em Enfermagem , Processo de Enfermagem , Registros de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/psicologia , Recursos Humanos de Enfermagem Hospitalar/normas , Autoimagem , Semântica
12.
Int J Nurs Stud ; 33(6): 669-74, 1996 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8970864

RESUMO

Articulating the knowledge, skill and ethos embedded in practice is the explicit goal of From Novice to Expert, in order to inform our science by raising new issues and questions. The work is not inherently conservative, since it does not assume a monolithic position in opposition to all other perspectives. It does not call for traditionalism, i.e. using tradition as the only source of authority and power. Instead, it attempts to articulate the best in our current practice while raising questions about the silences and hidden assumptions in the Cartesian tradition, a tradition which holds that there are, in principle, no limits to formalism, that skill is just a mechanistic following of formal propositions held as representations in the mind, that contrasts necessarily form oppositions and contradictions rather than discovery and dialogue, and that all perspectives are best understood from an objectivist point of view. Such a hegemonic epistemological stance may indeed be the most conservative position of all. If we continue to force our ways of knowing into one hegemonic mold for the sake of 'winning' in a power discourse, we may have 'lost' before we have begun, because our agenda will continue to be described and evaluated in terms of what it is not rather than in terms of what it is (Benner, 1994b).


Assuntos
Competência Clínica , Modelos de Enfermagem , Enfermagem/normas , Humanos , Modelos Teóricos , Pesquisa em Enfermagem/métodos , Filosofia , Ciência
13.
J Transcult Nurs ; 12(1): 15-24, 2001 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11988980

RESUMO

This study develops a sociocultural health and illness model for Iranian late-in-life immigrants in Sweden by analyzing ways in which they perceive, experience, and explain their health situations. Fifteen Iranian immigrants, ages 55 to 80, were interviewed; data were analyzed using the interpretive-phenomenology method. The interviews revealed the following concepts: Reflections on the meaning of health were interpreted as cultural understanding of health. Reflections expressing knowledge about preventing illness and maintaining health were interpreted as proposed strategies and beliefs. Reflections expressing how to prevent illness and maintain health were interpreted as practical strategies, which were based on understanding of cultures and were contingent on immigration. Health care providers might use the resulting model to assist patients and families in appropriating cures and symptom management to support patients' sense of well-being.


Assuntos
Atitude Frente a Saúde/etnologia , Emigração e Imigração , Nível de Saúde , Modelos Psicológicos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Irã (Geográfico)/etnologia , Masculino , Pessoa de Meia-Idade , Suécia
14.
Ned Tijdschr Geneeskd ; 145(10): 487-90, 2001 Mar 10.
Artigo em Holandês | MEDLINE | ID: mdl-11268913

RESUMO

A 55-year-old woman presented with complaints of recurrent dyspnoea one year after pneumonectomy carried out as treatment for a tumour of the left lung. During several months her symptoms progressed and eventually mechanical ventilation became necessary. On admission a patent foramen ovale was found with transoesophageal ultrasound but this was judged not to be the cause of her symptoms. The pulmonary angiogram showed a intracardiac shunt with no intrapulmonary shunts. After repeated transoesophageal ultrasound a second defect was found of a sinus venosus type. This large defect was proven to be clinically significant during catherisation of the heart, when occlusion with a balloon was performed. After surgical repair of these defects with an artificial patch, the patient recovered well. Since then she has been without complaints.


Assuntos
Dispneia/etiologia , Comunicação Interatrial/complicações , Pneumonectomia/efeitos adversos , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Feminino , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/terapia , Humanos , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
15.
Pflege ; 10(2): 67-71, 1997 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-9216361

RESUMO

This (shortened) interview from 1995 contains Patricia Benner's thoughts on the relationship between nursing practice, language and nursing science. Benner alludes to the philosophical and theoretical sources of her work and uses a narrative in order to show her method of interpretation.


Assuntos
Idioma , Teoria de Enfermagem , Filosofia em Enfermagem , Neoplasias Encefálicas/enfermagem , Criança , Humanos , Intuição , Masculino , Neuroblastoma/enfermagem , Ciência , Assistência Terminal
16.
Ann Fr Anesth Reanim ; 31(5): 416-20, 2012 May.
Artigo em Francês | MEDLINE | ID: mdl-22464161

RESUMO

OBJECTIVE: To assess the feasibility and actual performance of ultrasound control in verification of the correct positioning of a nasogastric tube in pre-hospital settings. STUDY TYPE: Prospective, observational, single-centre study. PATIENTS AND METHODS: Correct positioning of nasogastric tubes in patients intubated in a pre-hospital setting was verified by ultrasound and routinely compared with the results of two pre-hospital tests, namely a test involving insufflation of air through a syringe coupled with epigastric auscultation and a test involving aspiration of gastric fluid with a syringe. Routine x-ray control was carried out and compared with the pre-hospital results. RESULTS: Ninety-six patients were included. Mean age was 52 years (median: 53.5 years, SD: 23 years). In 83% of the patients (n=80), the nasogastric tube was located by ultrasound immediately during the insertion procedure. The mean times to ultrasound confirmation of correct positioning of the nasogastric tube were 7s (median: 2s; SD: 16s) and 19s for the syringe tests (median 19s, SD: 5s). Eight ultrasound control tests were negative. Location coupled with insufflation of air through a syringe allowed detection of the nasogastric tube in the stomach but without providing confirmation of the actual gastric position. The pre-hospital ultrasound results were confirmed by subsequent radiological controls at the hospital. CONCLUSION: The ultrasound test performed in our study to verify correct positioning of a nasogastric tube is feasible in a pre-hospital setting. This technique is rapid and non-irradiating and is more sensitive and specific than the syringe tests commonly used in pre-hospital settings, and it may be performed in place of the latter tests.


Assuntos
Serviços Médicos de Emergência/métodos , Intubação Gastrointestinal/métodos , Ultrassonografia/métodos , Adulto , Idoso , Auscultação , Feminino , Humanos , Insuflação , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Aspiração Respiratória , Estômago/diagnóstico por imagem , Seringas , Resultado do Tratamento
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