RESUMO
OBJECTIVE: Compare the mortality between critically ill patients who received urgent chemotherapy for a cancer-related life-threatening complication with matched patients (controls) who did not received it. DESIGN: Propensity score-matched retrospective study. SETTING: Adult intensive care unit in an oncological hospital. PARTICIPANTS: All adults with solid tumor or hematological malignancies who received at least 1 day of urgent intravenous chemotherapy for a cancer-related life-threatening complication. Using the propensity score method adjusted for 10 variables, patients who received urgent chemotherapy were matched to patients who did not. INTERVENTIONS: None. MAIN OUTCOMES MEASURES: Intensive care unit and hospital mortality. RESULTS: Forty-seven patients (57% with solid tumors and 43% with hematological malignancies) who received urgent chemotherapy were matched to 94 controls. At intensive care unit admission, patients were similar except that those who received urgent chemotherapy were less likely to have received chemotherapy previously (36% vs 85%; P < .01). The intensive care unit (48.9% vs 23.4%; P < .01) and hospital (76.6% vs 46.8%; P < .01) mortality of the patients who received urgent chemotherapy was higher than the controls. The subgroup analysis showed that the higher mortality was limited to patients with solid tumor. CONCLUSION: The use of urgent chemotherapy is associated with an increase in the intensive care unit and hospital mortality of unselected critically ill patients with solid tumors but not in patients with hematological malignancies.
Assuntos
Neoplasias Hematológicas/tratamento farmacológico , Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Cuidados para Prolongar a Vida/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Adulto , Antineoplásicos/administração & dosagem , Estudos de Casos e Controles , Resultados de Cuidados Críticos , Estado Terminal/mortalidade , Estado Terminal/terapia , Feminino , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/mortalidade , Humanos , Cuidados para Prolongar a Vida/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/mortalidade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: to describe the content construction and validation process of the Distance Education Basic Life Support Course. METHOD: methodological study, developed through literature review, outlined in the light of the Bloom's Taxonomy and Ausubel's Meaningful Learning Theory. For validation, the analysis was performed with judges, using a structured tool. RESULTS: the construction of the distance course was complex and challenging, since it was tried to develop it with logical-methodological coherence, considering the constructivist perspective, representing an advance in the process of dissemination of the Urgency and Emergency teaching culture. As for the content validation process, it was verified that of the 16 suggestions made by the judges, 14 were accepted and two rejected. CONCLUSION: the course had its contents validated by experts.
Assuntos
Currículo/normas , Educação a Distância/normas , Cuidados para Prolongar a Vida/normas , American Heart Association/organização & administração , Educação a Distância/métodos , Humanos , Cuidados para Prolongar a Vida/métodos , Avaliação das Necessidades , Validação de Programas de Computador , Estados UnidosRESUMO
ABSTRACT Objective: to describe the content construction and validation process of the Distance Education Basic Life Support Course. Method: methodological study, developed through literature review, outlined in the light of the Bloom's Taxonomy and Ausubel's Meaningful Learning Theory. For validation, the analysis was performed with judges, using a structured tool. Results: the construction of the distance course was complex and challenging, since it was tried to develop it with logical-methodological coherence, considering the constructivist perspective, representing an advance in the process of dissemination of the Urgency and Emergency teaching culture. As for the content validation process, it was verified that of the 16 suggestions made by the judges, 14 were accepted and two rejected. Conclusion: the course had its contents validated by experts.
RESUMEN Objetivo: describir el proceso de construcción y validación de contenido de un curso de Soporte Básico a la Vida en la modalidad de educación a distancia. Método: estudio metodológico, desarrollado mediante revisión de la literatura, delineado a la luz de la Taxonomía de Bloom y la Teoría del Aprendizaje Significativo de Ausubel. Para validación, fue realizado un análisis con jueces mediante la utilización de instrumento estructurado. Resultados: la construcción de un curso a distancia se mostró compleja y desafiante una vez que se intentó desarrollarlo con coherencia lógico-metodológica, considerando la perspectiva constructivista, representando un avance en el proceso de diseminación de la cultura de la enseñanza de urgencia y emergencia. En cuanto al proceso de validación de contenido, se verificó que de las 16 sugerencias realizadas por los jueces, 14 fueron acatadas y 2, rechazadas. Conclusión: el curso obtuvo su contenido validado por expertos.
RESUMO Objetivo: descrever o processo de construção e validação de conteúdo do curso de Suporte Básico de Vida na modalidade Educação a Distância. Método: estudo metodológico, desenvolvido mediante revisão da literatura, delineado à luz da Taxonomia de Bloom e Teoria da Aprendizagem Significativa de Ausubel. Para validação, foi realizada a análise com juízes, mediante utilização de instrumento estruturado. Resultados: a construção do curso a distância se mostrou complexa e desafiadora, uma vez que se procurou desenvolvê-lo com coerência lógico-metodológica, considerando a perspectiva construtivista, representando um avanço no processo de disseminação da cultura do ensino de Urgência e Emergência. Quanto ao processo de validação de conteúdo, verificou-se que das 16 sugestões realizadas pelos juízes, 14 foram acatadas e duas rejeitadas. Conclusão: o curso obteve o seu conteúdo validado por especialistas.
Assuntos
Humanos , Educação a Distância/normas , Currículo/normas , Cuidados para Prolongar a Vida/normas , Estados Unidos , Validação de Programas de Computador , Educação a Distância/métodos , Avaliação das Necessidades , American Heart Association/organização & administração , Cuidados para Prolongar a Vida/métodosRESUMO
OBJECTIVE: To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. METHODS: This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. RESULTS: A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. CONCLUSION: The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means.
Assuntos
Estado Terminal , Unidades de Terapia Intensiva , Cuidados para Prolongar a Vida/métodos , Cuidados Paliativos/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Tempo de Internação , Cuidados para Prolongar a Vida/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Respiração Artificial/estatística & dados numéricos , Ordens quanto à Conduta (Ética Médica) , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de TempoRESUMO
RESUMO Objetivo: Estimar a incidência de limitação de Suporte Avançado de Vida em pacientes graves internados em unidade de terapia intensiva com cuidados paliativos integrados. Métodos: Estudo de coorte retrospectivo, no qual foram incluídos os pacientes inseridos no programa de cuidados paliativos da unidade de terapia intensiva do Hospital Paulistano, maiores de 18 anos de idade, no período de 1º de maio de 2011 a 31 de janeiro de 2014. As limitações de Suporte Avançado de Vida analisadas foram: ordem para não ressuscitar, ventilação mecânica, hemodiálise e droga vasoativa. Para as variáveis quantitativas, foram calculadas medidas de tendência central. O teste qui quadrado foi utilizado para comparar características dos pacientes com ou sem limitação de Suporte Avançado de Vida e teste de Wilcoxon, para comparar o tempo de internação após Suporte Avançado de Vida. Para significância estatística, consideraram-se o intervalo de confiança e p ≤ 0,05. Resultados: Foram internados na unidade de terapia intensiva 3.487 pacientes, sendo 342 inseridos no programa de cuidados paliativos. Observou-se que, após entrada no programa de cuidados paliativos, demorou uma mediana de 2 (1 - 4) dias para o óbito na unidade de terapia intensiva e 4 (2 - 11) dias para óbito hospitalar. Boa parte das limitações de Suporte Avançado de Vida (42,7%) aconteceu no primeiro dia de internação. A ressuscitação cardiopulmonar (96,8%) e o suporte ventilatório (73,6%) foram as limitações mais adotadas. Conclusão: Foi relevante a contribuição dos cuidados paliativos integrados à unidade de terapia intensiva para a prática da ortotanásia, ou seja, o não prolongamento da vida de um paciente terminal por meios artificiais.
ABSTRACT Objective: To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. Methods: This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. Results: A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. Conclusion: The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Paliativos/organização & administração , Estado Terminal , Unidades de Terapia Intensiva , Cuidados para Prolongar a Vida/métodos , Respiração Artificial/estatística & dados numéricos , Fatores de Tempo , Estudos Retrospectivos , Estudos de Coortes , Ordens quanto à Conduta (Ética Médica) , Reanimação Cardiopulmonar/estatística & dados numéricos , Estatísticas não Paramétricas , Tempo de Internação , Cuidados para Prolongar a Vida/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To examine the effects of the Advanced Life Support in Obstetrics (ALSO) program on maternal outcomes in four low-income countries. METHODS: Data were obtained from single-center, longitudinal cohort studies in Colombia, Guatemala, and Honduras, and from an uncontrolled prospective trial in Tanzania. RESULTS: In Colombia, maternal morbidity and the number of near misses increased after ALSO training, but maternal mortality decreased. In Guatemala, sustained reductions in overall maternal mortality and mortality from postpartum hemorrhage (PPH) were recorded after ALSO implementation. In Honduras, there was a significant decrease in episiotomy rates, and increases in active management of the third stage of labor (AMTSL), vacuum-assisted delivery, and reported comfort managing obstetric emergencies. In Tanzania, the frequency of PPH and severe PPH decreased after training, while management improved. CONCLUSION: In low-income countries, ALSO training was associated with decreased in-hospital maternal mortality, episiotomy use, and PPH. AMTSL and vacuum-assisted vaginal delivery increased in frequency after ALSO training.
Assuntos
Países em Desenvolvimento , Cuidados para Prolongar a Vida/métodos , Obstetrícia/educação , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Adulto , Colômbia , Parto Obstétrico/tendências , Feminino , Guatemala , Honduras , Mortalidade Hospitalar/tendências , Humanos , Estudos Longitudinais , Mortalidade Materna/tendências , Near Miss/tendências , Hemorragia Pós-Parto/mortalidade , Gravidez , Estudos Prospectivos , TanzâniaRESUMO
Distocia de ombro é um evento imprevisível e profissionais habilitados para assistir ao parto devem estar capacitados para diagnosticar e instituir manobras efetivas para sua resolução. Tais manobras têm por objetivo aumentar a pelve funcional, reduzir o diâmetro biacromial e melhorar a relação feto-pélvica, facilitando o desprendimento do concepto dentro de sete minutos do diagnóstico, para prevenir complicações. Vários algoritmos têm sido propostos, com o desenvolvimento de mnemônicos para treinamento profissional, sendo o mais famoso o do Advanced Life Support in Obstetrics (ALSO), conhecido como HELPERR(em inglês) ou ALEERTA (em português). No entanto, estes são úteis quando a parturiente se encontra em decúbito dorsal. Propõe-se um novo protocolo, considerando os benefícios associados aos partos em posição não supina e a necessidade de iniciar a conduta das manobras menos para as mais invasivas. O mnemônico proposto é A SAIDA e consiste em: A = chamar ajuda, avisar parturiente, aumentar agachamento; S = pressãosuprapúbica; A = alterar posição para quatro apoios (manobra de Gaskin); I = manobras internas (Rubin II, Wood,parafuso invertido); D = desprender ombro posterior; A = avaliar manobras de resgate...
Shoulder dystocia is an unpredictable event and skilled birth attendants should be trained to diagnose and implement effective maneuvers to solve it. These maneuvers aim to increase the functional pelvis, to reduce biacromial diameter and to improve the relationship between the pelvis and the fetus, favoring the conceptus release within seven minutes of the diagnosis, in order to prevent complications.Several algorithms have been proposed including mnemonics for professional training, being the most famous the one developed by Advanced Life Support in Obstetrics (ALSO), known as HELPERR (in English) or ALEERTA(in Portuguese). However, these sequences of maneuvers are useful when the mother is in a supine position.A new protocol is proposed, considering the benefits of deliveries in non-supine positions, as well as the need for implementing less invasive maneuvers first. The proposed mnemonic is A SAÍDA and consists of A = ask for help, acquaint the mother, augment the squat; S = suprapubic pressure; A = alter the position to all fours (Gaskinmaneuver); I = internal maneuvers (Rubin II, Wood, inverted spin); D = deliver the posterior arm; A = assess theneed for rescue maneuvers...
Assuntos
Humanos , Feminino , Gravidez , Competência Clínica , Distocia/terapia , Parto Obstétrico/métodos , Serviços Médicos de Emergência , Algoritmos , Protocolos Clínicos , Cuidados para Prolongar a Vida/métodos , Conhecimentos, Atitudes e Prática em Saúde , Parto Obstétrico/tendênciasRESUMO
OBJECTIVE: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death. STUDY DESIGN: Prospective cohort of 484 infants with 23(0/7) to 26(6/7) weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life. RESULT: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions. CONCLUSION: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day.
Assuntos
Mortalidade Infantil/tendências , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Neonatologia/normas , Obstetrícia/normas , Corticosteroides/uso terapêutico , Análise de Variância , Brasil , Reanimação Cardiopulmonar/normas , Reanimação Cardiopulmonar/tendências , Cesárea , Estudos de Coortes , Intervalos de Confiança , Parto Obstétrico/métodos , Feminino , Viabilidade Fetal , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Relações Interprofissionais , Cuidados para Prolongar a Vida/métodos , Modelos Logísticos , Masculino , Neonatologia/tendências , Obstetrícia/tendências , Razão de Chances , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Gravidez , Prognóstico , Estudos Prospectivos , Resultado do TratamentoRESUMO
PURPOSE: Death at the beginning of life is tragic but not uncommon in neonatal intensive care units. In Portugal, few studies have examined the circumstances surrounding the final moments of neonates. We evaluated the care given to neonates and their families in terminal situations and the changes that had occurred one decade later. DESIGN AND METHODS: We analyzed 256 charts in a retrospective chart review of neonatal deaths between two periods (1992-1995 and 2002-2005) in a level III neonatal intensive care unit. RESULTS: Our results show differences in the care of dying infants between the two periods. The analysis of the 2002-2005 cohort four years revealed more withholding and withdrawing of therapeutic activities and more effective pain and distress relief; however, on the final day of life, 95.7% of the infants received invasive ventilatory support, 76.3% received antibiotics, 58.1% received inotropics, and 25.8% received no opioid or sedative administration. The 2002-2005 cohort had more spiritual advisor solicitation, a higher number of relatives with permission to freely visit and more clinical meetings with neonatologists. Interventions by parents, healthcare providers and ethics committees during decision-making were not documented in any of the charts. Only eight written orders regarding therapeutic limitations and the adoption of palliative care were documented; seven (87.5%) were from the 2002-2005 cohort. Parental presence during death was more frequent in the latter four years (2002-2005 cohort), but only 21.5% of the parents wanted to be present at that moment. CONCLUSION: Despite an increase in the withholding and withdrawing of therapeutic activities and improvements in pain management and family support, many neonates still receive curative and aggressive practices at the end of life.
Assuntos
Tomada de Decisões/fisiologia , Unidades de Terapia Intensiva Neonatal/normas , Cuidados para Prolongar a Vida/métodos , Manejo da Dor/métodos , Assistência Terminal/métodos , Suspensão de Tratamento/normas , Humanos , Recém-Nascido , Cuidados para Prolongar a Vida/estatística & dados numéricos , Manejo da Dor/estatística & dados numéricos , Pais , Portugal , Estudos Retrospectivos , Fatores de Tempo , Visitas a Pacientes/estatística & dados numéricosRESUMO
PURPOSE: Death at the beginning of life is tragic but not uncommon in neonatal intensive care units. In Portugal, few studies have examined the circumstances surrounding the final moments of neonates. We evaluated the care given to neonates and their families in terminal situations and the changes that had occurred one decade later. DESIGN AND METHODS: We analyzed 256 charts in a retrospective chart review of neonatal deaths between two periods (1992-1995 and 2002-2005) in a level III neonatal intensive care unit. RESULTS: Our results show differences in the care of dying infants between the two periods. The analysis of the 2002-2005 cohort four years revealed more withholding and withdrawing of therapeutic activities and more effective pain and distress relief; however, on the final day of life, 95.7 percent of the infants received invasive ventilatory support, 76.3 percent received antibiotics, 58.1 percent received inotropics, and 25.8 percent received no opioid or sedative administration. The 2002-2005 cohort had more spiritual advisor solicitation, a higher number of relatives with permission to freely visit and more clinical meetings with neonatologists. Interventions by parents, healthcare providers and ethics committees during decision-making were not documented in any of the charts. Only eight written orders regarding therapeutic limitations and the adoption of palliative care were documented; seven (87.5 percent) were from the 2002-2005 cohort. Parental presence during death was more frequent in the latter four years (2002-2005 cohort), but only 21.5 percent of the parents wanted to be present at that moment. CONCLUSION: Despite an increase in the withholding and withdrawing of therapeutic activities and improvements in pain management and family support, many neonates still receive curative and aggressive practices at the end of life.
Assuntos
Humanos , Recém-Nascido , Tomada de Decisões/fisiologia , Unidades de Terapia Intensiva Neonatal/normas , Cuidados para Prolongar a Vida/métodos , Manejo da Dor/métodos , Assistência Terminal/métodos , Suspensão de Tratamento/normas , Cuidados para Prolongar a Vida/estatística & dados numéricos , Pais , Portugal , Manejo da Dor/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Visitas a Pacientes/estatística & dados numéricosRESUMO
OBJECTIVE: To evaluate the modes of death and treatment offered in the last 24 h of life to patients dying in 10 Brazilian intensive care units (ICUs) over a period of 2 years. DESIGN AND SETTING: Cross-sectional, multicentre, retrospective study based on medical chart review. The medical records of all patients that died in seven paediatric and three adult ICUs belonging to university and tertiary hospitals over a period of 2 years were included. Deaths in the first 24 h of admission to the ICU and brain death were excluded. INTERVENTION: Two intensive care fellows of each ICU were trained in fulfilling a standard protocol (kappa=0.9) to record demographic data and all medical management provided in the last 48 h of life. The Student t test, Mann-Whitney U test, chi(2) test and RR were used for data comparison. MEASUREMENTS AND MAIN RESULTS: 1053 medical charts were included (59.4% adult patients). Life support limitation was more frequent in the adult group (86% vs 43.5%; p<0.001). A 'do not resuscitate' order was the most common life support limitation in both groups (75% and 66%), whereas withholding/withdrawing were more frequent in the paediatric group (33.9% vs 24.9%; p=0.02). The life support limitation was rarely reported in the medical chart in both groups (52.6% and 33.7%) with scarce family involvement in the decision making process (23.0% vs 8.7%; p<0.001). CONCLUSION: Life support limitation decision making in Brazilian ICUs is predominantly centred on the medical perspective with scarce participation of the family, and consequently several non-coherent medical interventions are observed in patients with life support limitation.
Assuntos
Unidades de Terapia Intensiva , Cuidados para Prolongar a Vida/métodos , Assistência Terminal/métodos , Adulto , Idoso , Brasil , Criança , Pré-Escolar , Estudos Transversais , Tomada de Decisões , Feminino , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação , Cuidados para Prolongar a Vida/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Suspensão de Tratamento/estatística & dados numéricosRESUMO
La patología comparada resurge como el punto de encuentro entre el patrón de estudio morfológico humano y el animal. Su aplicación desde sus inicios se apoyó en los biomodelos animales, muchos de los cuales se lograron por manipulación genética. Estos métodos de estudio fueron generados a partir del comportamiento de la enfermedad en el humano. La ingeniería genética se refiere a tecnología desarrollada por el manejo del ADN recombinante, definida por ser una secuencia nueva de ADN creada en los laboratorios por la unión de porciones de ADN con orígenes diferentes. A un organismo cuyo material genético ha sido modificado artificialmente mediante la supresión de expresiones génicas o la incorporación de fracciones o secuencias de ADN ajeno a su especie, se le llama organismo genéticamente modificado (OGM); organismo modificado genéticamente (OMG) o simplemente transgénico (antes, transgenético). La ingeniería genética se define como el conjunto de técnicas y métodos que se utilizan para construir moléculas de ADN recombinante y luego introducirlas en moléculas receptoras. En Venezuela existe una prohibición para la manipulación en animales. Se aplican la Ley de Biodiversidad, el Convenio de Diversidad biológica y el Protocolo Internacional de Biodiversidad. Con la investigación animal, los científicos han descubierto las maneras de salvar y prolongar la vida humana. Vacunaciones tales como la poliomielitis trasplantes de órganos perfeccionados así como el desarrollo de técnicas quirúrgicas y de traumatología reconstructivas. De manera activa se ha generado un debate por el uso de animales en la investigación y en los ensayos biotecnológica. Se plantea la bioética en la aplicación de los biomodelos animales. Es importante el conocimiento de estos métodos de investigación genética en animales de investigación, más aún en instituciones generadoras de productos biológicos. En poco tiempo se ha generado un fenómeno transgénico de la...
Assuntos
Humanos , Animais , DNA Recombinante/genética , Anatomia Comparada/métodos , Animais Geneticamente Modificados/anatomia & histologia , Animais Geneticamente Modificados/genética , Cuidados para Prolongar a Vida/métodosRESUMO
The occurence of brain death in pregnancy represents a catastrophic entity although infrequent. The aims of continue medical management are focused in a double purpose: to preserve intrauterine product's life and fetal maturation until delivery and to consider the mother as a potential organ donor. Ethical considerations together with gestational age, fetal well being and relatives' wishes are cardinal for continuing medical support. Modern critical care units allow us to obtain favourable results, supported in scientifical reports that describe successful outcomes. Nutritional aspects plays a cardinal role in the medical management, allowing to preserve the mother's organs' viability and also to preserve fetal intrauterine growth and development.
Assuntos
Morte Encefálica , Lesões Encefálicas/terapia , Nutrição Enteral , Cuidados para Prolongar a Vida/métodos , Nutrição Parenteral , Complicações na Gravidez/terapia , Descolamento Prematuro da Placenta , Adulto , Lesões Encefálicas/etiologia , Evolução Fatal , Feminino , Morte Fetal , Desenvolvimento Fetal , Monitorização Fetal , Humanos , Doadores Vivos , Masculino , México , Necessidades Nutricionais , Gravidez , Complicações na Gravidez/etiologia , Tentativa de Suicídio , Coleta de Tecidos e Órgãos , Ferimentos por Arma de Fogo/complicaçõesRESUMO
Há evidências de que o estilo de vida sedentário afeta 40 a 80% da população brasileira. Gênero, idade, condição de saúde, nível sócio-econômico e escolaridade estão associados aos maiores índices de inatividade física. Parte desse resultado pode ser creditada a barreiras individuais e ambientais que dificultam a prática de atividade física (AF). Devido às características, as Unidades Básicas de Saúde (UBS) são locais privilegiados para promoção da saúde mediante AF, uma vez que minimizam parte das barreiras presentes em grupos populacionais sujeitos à inatividade física. O objetivo deste estudo é compartilhar evidências acumuladas ao longo de 6 anos de existência de um programa de AF desenvolvido em UBS no município de Rio Claro-SP. Os resultados do programa se mostraram efetivos em melhorar o desempenho de alguns componentes da aptidão funcional, metabolismo de lipídios e glicose, estados de ânimo e qualidade de vida relacionada à saúde dos participantes. Tendo em vista os resultados apresentados e a presença de UBS na grande maioria dos municípios brasileiros, acreditamos que a implantação de um programa desta natureza seja uma iniciativa viável tanto do ponto de vista social quanto de promoção da saúde.
There are evidences that sedentary life style affects 40-80% of the Brazilian population. Gender, age, health condition, social-economic level and schooling are linked to the highest physical inactivity contents. Part of this result may be due to individual and environmental barriers which make the practice of physical activities (PA) difficult. Due to their characteristics, the Basic Health Units (BHU) are privileged places for health promotion through PA, once they minimize part of the existent barriers in groups of population subject to physical inactivity. The objective of this study is to share evidence accumulated along 6 years of existence of a PA program accomplished in a BHU in Rio Claro County - SP. The results of this program have shown effective in improving the performance of some components of functional aptitude, the metabolism of lipids and glucose, states of mood and life quality related to the health of the participants. Considering such results and the presence of BHU in most of te Brazilian Counties, we believe that the setting up of a program like this can be a viable initiative from both the social point of view and of health promotion.
Assuntos
Humanos , Feminino , Idoso , Antropometria/métodos , Exercícios Respiratórios , LDL-Colesterol , Cuidados para Prolongar a Vida/métodos , Frequência Cardíaca/fisiologia , Índice Glicêmico , Lipídeos/análise , Obesidade/prevenção & controle , Serviços de Saúde para Idosos/estatística & dados numéricos , Atividade Motora , Aptidão FísicaRESUMO
Los constantes cambios socioculturales que pueden observarse actualmente en países de América Latina como Chile, catalogados cómo en vías de desarrollo, traen consigo un incremento de trastornos como la diabetes, hipertensión arterial, dislipidemias, stress, obesidad, etc., y por ende mayor prevalencia de enfermedades cardiovasculares, lo que las coloca hoy en día en el primer lugar como causa general de morbilidad y mortalidad en la población. Constituido así en un problema de salud pública es imprescindible tomar medidas enérgicas para su enfrentamiento. Se ha demostrado en países desarrollados que una mayor cantidad de gente capacitada en maniobras de resucitación básica, trae consigo una disminución importante de la morbimortalidad producto de paro cardiorrespiratorio (PCR). En este sentido, es preciso e imprescindible fomentar y difundir los diversos programas educativos que pueden ser aplicados en diversos grupos blanco de nuestra población, de manera de preparar a las personas que pudieran verse enfrentadas a una situación de este tipo en distintos escenarios.
The constant social and cultural changes currently observed in Latin American countries like Chile, are associated with increases in pathological conditions like diabetes, arterial hypertension, dyslipidemia, stress, obesity, etc. As a consequence, a higher prevalence of cardiovascular diseases is observed, positioning them as the first general cause of morbidity and mortality. As a major public health issue, it is essential to implement measures to confront them. It has been demonstrated in developed countries that the more people is trained in basic resuscitation maneuvers, the bigger is the decrease in morbidity and mortality due to cardiogenic cardiorespiratory failure. Then, it appears of great importance to stimulate and diffuse diverse educative programs that may be applied to many target groups of our population, in order to prepare people to confront this kind of situations in different scenarios.
Assuntos
Humanos , Cuidados para Prolongar a Vida/métodos , Educação em Saúde/métodos , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/métodos , Medicina de Emergência/educaçãoRESUMO
The advanced life support in obstetrics (ALSO) course is designed to help maternity care providers prepare for obstetrical emergencies. A team of 12 US physicians and a medical interpreter recently taught the ALSO course in Ecuador, with the goal of addressing Ecuador's high maternal and infant mortality rates. To have a greater impact, a teach-the-teacher model was used so that Ecuadorian physicians can now hold their own ALSO courses. In the process of implementing the courses, valuable lessons were learned which can be applied to future ALSO courses in developing countries and in the United States.