bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Recurrent Clostridium difficile Infections and Strategies to Decrease Readmissions in a Community Hospital
Authors: Majors Darrin , Ellis Patrick
Published: December 2015

Background

Currently there are no universally accepted approaches for the prevention of recurrent Clostridium difficile infections (CDI) following the initial infection. Several studies have identified common risk factors for the emergence of recurrent CDI. Identifying patients at high risk for recurrent CDI through the assessment of risk factors at initial diagnosis could enable health care providers to optimize available treatment options. A vancomycin hydrochloride–tapered regimen may be an effective treatment option for the prevention of recurrent CDI following the initial infection.

Methods

In this single-center, prospective study, we examined the efficacy of orally administered vancomycin-tapered regimens for the prevention of recurrent CDI in high-risk patients. High-risk patients were identified using patient risk factors found in a retrospective chart review. The primary objective was to decrease hospital readmissions for recurrent CDI. The secondary objective was to improve the discharge coordination-of-care process by providing a pharmacy benefits evaluation, which ensured vancomycin affordability and assistance in prescription attainment, and discharge counseling.

Results

Of the 83 patients enrolled in the study, 5 experienced recurrent CDI (6%). Memorial Health Care System's (Chattanooga, Tennessee) historical recurrent CDI rate was 8.2%. Thirty-one of the 83 patients received a vancomycin-tapered regimen following their initial infection (37%). A pharmacy benefits evaluation was performed on 35 of the 57 patients who were discharged home on vancomycin (61%).

Conclusions

Vancomycin-tapered regimens may provide a cost-effective method for the prevention of recurrent CDI following an initial infection in patients at high risk for recurrence.
Taking an Antibiotic Time-out: Utilization and Usability of a Self-Stewardship Time-out Program for Renewal of Vancomycin and Piperacillin-Tazobactam
Authors: Graber Christopher J. , Jones Makoto M. , Glassman Peter A. , Weir Charlene , Butler Jorie , Nechodom Kevin , Kay Chad L. , Furman Amy E. , Tran Thuong T. , Foltz Christopher , Pollack Lori A. , Samore Matthew H. , Goetz Matthew Bidwell
Published: December 2015

Background

Antibiotic time-outs can promote critical thinking and greater attention to reviewing indications for continuation.

Objective

We pilot tested an antibiotic time-out program at a tertiary care teaching hospital where vancomycin and piperacillin-tazobactam continuation past day 3 had previously required infectious diseases service approval.

Methods

The time-out program consisted of 3 components: (1) an electronic antimicrobial dashboard that aggregated infection-relevant clinical data; (2) a templated note in the electronic medical record that included a structured review of antibiotic indications and that provided automatic approval of continuation of therapy when indicated; and (3) an educational and social marketing campaign.

Results

In the first 6 months of program implementation, vancomycin was discontinued by day 5 in 93/145 (64%) courses where a time-out was performed on day 4 versus in 96/199 (48%) 1 year prior ( P = .04). Seven vancomycin continuations via template (5% of time-outs) were guideline-discordant by retrospective chart review versus none 1 year prior ( P = .002). Piperacillin-tazobactam was discontinued by day 5 in 70/105 (67%) courses versus 58/93 (62%) 1 year prior ( P = .55); 9 continuations (9% of time-outs) were guideline-discordant versus two 1 year prior ( P = .06). A usability survey completed by 32 physicians demonstrated modest satisfaction with the overall program, antimicrobial dashboard, and renewal templates.

Conclusions

By providing practitioners with clinical informatics support and guidance, the intervention increased provider confidence in making decisions to de-escalate antimicrobial therapy in ambiguous circumstances wherein they previously sought authorization for continuation from an antimicrobial steward.
Clofarabine and Cytarabine Regimen for Acute Myeloid Leukemia
Authors: Ho Kristin V. , Solimando Dominic A. , Waddell J. Aubrey
Published: December 2015

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases.
Sodium Thiosulfate: Calciphylaxis
Authors: Generali Joyce A. , Cada Dennis J.
Published: December 2015

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu .
National Survey regarding the Importance of Leadership in PGY1 Pharmacy Practice Residency Training
Authors: Cho Jonathan C. , Girnys Jonathan P.
Published: December 2015

Background

Leadership is considered a professional obligation for all pharmacists. It is important to integrate leadership training in residency programs to meet the leadership needs and requirements of the profession.

Objective

To evaluate the importance of leadership development during postgraduate year 1 (PGY1) pharmacy practice residency training as perceived by new practitioners.

Methods

A 15-question online survey was distributed to residency-trained new practitioners to assess (1) amount of time dedicated to leadership training during residency training, (2) different leadership tools utilized, (3) residents’ participation in various committees or councils, (4) perceived benefit of increased leadership training, (5) importance of having a mentor, (6) understanding of the residency organization's strategic objectives, (7) discussion of Pharmacy Practice Model Initiative (PPMI) during residency training, and (8) adequacy of leadership training in preparation to become a pharmacy practice leader.

Results

Although the majority of resident respondents had less than 20% of their residency devoted to leadership, nearly all survey participants acknowledged that leadership is an important component of PGY1 residency training. Residents agreed that their residency experience would have benefited from increased leadership opportunities. Most residents were knowledgeable about their organization's strategic objectives but did not have a full understanding of pharmacy initiatives such as the PPMI.

Conclusion

Feedback from residents indicates that an optimal dedication to leadership training would range between 20% and 30% of the residency year. Increased focus on PPMI, mentorship, and expanded use of leadership tools can serve as a way to help meet the future leadership needs of the pharmacy profession and help to better prepare residents to become pharmacy practice leaders.
US Food and Drug Administration Web Site: A Primer for Pharmacists
Authors: Leonard James , Baker Danial E.
Published: December 2015

The US Food and Drug Administration (FDA) Web site includes a vast amount of information, but it can be difficult to navigate. Despite frequently asked question (FAQ)–type pages within the Web site, it may not be easy for first-time users to find drug information. This article presents some examples of common questions, provides the locations of the answers on the FDA Web site, and gives a brief description of some of the many resources the FDA provides for health care professionals. Additionally, a newer project being undertaken by the FDA, Snapshot, is introduced.
Pharmacist Advancement of Transitions of Care to Home (PATCH) Service
Authors: Trang Joseph , Martinez Amanda , Aslam Sadaf , Duong Minh-Tri
Published: December 2015

Background

There is a paucity of literature on a well-defined role of a pharmacist in different aspects of transition of care service (TCS). Although health care institutions have specific details on the discharge process, there is a need for a sustainable TCS with a well-defined role of pharmacists.

Objective

To describe the impact of a pharmacist-led TCS on acute health care utilization, clinic quality indicators, and identification and resolution of medication-related problems (MRPs).

Methods

A pharmacist-managed TCS service, referred to as the Pharmacist Advancement of Transitions of Care to Home (PATCH) service, was established at an academic medical center, where high-risk patients received a postdischarge phone call from a pharmacist followed by a face-to-face meeting with the pharmacist and the patient's primary care provider (PCP). In a prospective transitions of care group ( n = 74), outcomes of patients such as acute health care utilization (an emergency department visit or an inpatient readmission, within 30 days post discharge), clinic quality indicators, and identification and resolution of MRPs were compared to a retrospective control group ( n = 87) who received the standard of care.

Results

Utilization of acute health care services was significantly lower in the prospective group compared to the retrospective control group (23% vs 41.4%; P = .013). A total of 49 MRPs were discovered in patients who received the TCS.

Conclusions

Pharmacists play an integral role in improving the transitions of care to reduce acute health care utilization. In addition, they may improve care transitions by optimizing clinic quality indicators and by identifying and resolving MRPs.
Torn designer jeans against fast fashion
Authors: Honigman Ana Finel
Published: December 2015

In this article, I argue that the qualities distinguishing luxury fashion from its ‘fast fashion’ imitators are conceptually akin to the subversive street-statements which inspire both catwalk designers and mass retailers. To demonstrate how designers’ catwalk creations and counterculture street-style share inherent conceptual qualities that are contrary to fast fashion, I illustrate my argument with the example of ripped denim and tears or holes in other fabrics. While scholars offer insight into the sociological, aesthetic and ideological importance of ripped denim, lesser attention has gone towards examining high-end designers’ artful tearing of opulent fabrics in their catwalk collections. This article discusses the origins of this style and examines the meaning of tears in five influential designers’ representative catwalk collections: Rei Kawakubo (for A/W Comme des Garçons, 1982), Marc Jacobs (for Perry Ellis, SS ‘92), Ann-Sofie Back (A/W ‘08), Rodarte (A/W ‘08) and Ashish (S/S ’14). By examining these collections, I analyse the ascent of the tear as a story of fashion functioning as art and social commentary. Although street-style and catwalk garments function as fodder for fast fashion trends, this article argues that individuals who wear their jeans to threads and designers who painstakingly craft handmade holes are aligned in making conceptual counterpoints to fast fashion. Contrary to fast fashion that relies on commercial considerations, it is only designer fashion that can participate in the critical discourse about fashion. It does so by reflecting subcultural anti-materialist viewpoints, or making anti-consumerist statements.
Exhibition Reviews
Authors: Tseëlon Efrat , Shorter Mark
Published: December 2015

Lyndal Walker, Silk Cut: The F Word, Ararat State Gallery, Ararat, Victoria, Australia, 21 August–12 October 2014; Benglis 73/74, TCB, Melbourne Australia, 1–18 October 2014; The Invitation, hangmenProjects, Stockholm, Sweden, 16–19 April 2015; Supermarket Independent Art Fair, hangmenProjects Stand, Stockholm, Sweden, 16–19 April 2015

David Bowie is, Australian Centre for the Moving Image, Melbourne, Australia, 16 July–1 November 2015
ASPECTOS COMPOSICIONAIS E NUTRICIONAIS DO LEITE DE JUMENTA: UMA REVISÃO
Authors: Rangel Adriano Henrique do Nascimento , Galvão Júnior José Geraldo Bezerra , Simplício Aurino Alves , Freire Rayssa Maria Bezerril , Novaes Luciano Patto
Published: December 2015

O objetivo deste trabalho foi buscar na literatura científica nacional e internacional informações relacionadas aos aspectos produtivos, características físico-químicas, microbiológicas e nutricionais do leite de jumenta. A pesquisa foi realizada entre os meses de janeiro e dezembro de 2014, na qual foram consultados artigos publicados entre os anos 1900 e 2014, por meio da base de dados Scielo Brasil, Web of Science, AGRIS, Google Acadêmico, FAOSTAT e EBSCO. O leite de jumenta apresenta relevante similaridade ao leite humano e seu consumo tem aumentado, associado a resultados de estudos que confirmam o seu uso como um alimento seguro e válido para maioria dos casos de intolerância alimentar múltipla. O leite de jumenta apresenta menor teor de gordura e, teores de lactose e pH semelhantes, se comparados ao leite humano. Possui maior percentual de ácidos graxos poli-insaturados em relação ao leite de ruminantes. Apresenta baixa contagem de células somáticas e baixa contagem bacteriana associadas à alta concentração de lisozima que possui características bactericidas, tornando-a um dos componentes do leite com propriedades biológicas úteis. Assim, a criação racional da espécie, com foco na produção e consumo de leite, representa uma alternativa promissora.
TECHNOLOGICAL AND FUNCTIONAL PROPERTIES OF LACTIC ACID BACTERIA: THE IMPORTANCE OF THESE MICROORGANISMS FOR FOOD
Authors: Motta Amanda De Souza , Gomes Melina Da Silva Mesquita
Published: December 2015

Bactérias produtoras de ácido láctico são um grupo de microrganismos com as características morfológicas de cocos ou bastonetes Gram-positivos, catalase negativos, não esporulantes, que produzem ácido láctico como o principal produto final durante a fermentação de hidratos de carbono. Quando aplicadas em alimentos, proporcionam efeitos benéficos para os consumidores através de suas propriedades funcionais e tecnológicas. Com isto o presente artigo de revisão objetiva explorar o potencial de aplicação de bactérias lácticas em alimentos. Os seguintes gêneros são considerados os principais produtores de ácido láctico: Aerococcus, Carnobacterium, Enterococcus, Lactobacillus, Lactococcus, Leuconostoc, Oenococcus, Pediococcus, Streptococcus, Tetragenococcus, Vagococcus e Weissella. Essas culturas têm sido usadas como culturas iniciadoras ou adjuntas para a fermentação de alimentos e bebidas, devido às suas contribuições para as características sensoriais destes produtos e pela estabilidade microbiológica conferida. As propriedades probióticas também foram investigadas. Estudos mais recentes de culturas autóctones têm recebido maior atenção, tendo em conta a procura de culturas isoladas de uma determinada matéria-prima e de uma determinada região. Estas culturas estão sendo estudadas por seu potencial funcional e tecnológico que pode ser aplicado no desenvolvimento de produtos com suas próprias características e denominação de origem. Essas propriedades serão discutidas na presente revisão a fim de destacar o desempenho dessas bactérias e a preocupação com o alto grau de controle sobre o processo de fermentação e padronização do produto final. O uso de culturas autóctones será considerado devido ao incremento de novos estudos de culturas de bactérias lácticas isoladas de leite, de carne e de produtos distintos.
Development and testing of a motorized cassava fufu pounding machine
Authors: Puoza Julius Caesar , Opoku Frimpong , Aboagye Bernard
Published: December 2015

A motorized cassava fufu pounding machine was developed and tested. The machine principal parts were hopper, throat, pounding compartment, discharge outlet, main frame, electric motor seat, auger, shaft and pulleys. Mild steel material and stainless steel sheet were used in the fabrication based on its availability, strength, appearance, cost, and corrosion resistance. The machine is powered by a 5hp electric motor; the dimension of the machine is 1010mm × 600mm × 930mm (length × breadth × height). Output capacity of 120kg/hr was obtained. The machine is affordable and easy to operate and manage. It is therefore recommended for the restaurants, chop bars and households to prepare a good and hygienic fufu thereby solving the problem of energy sapping and time wasting in manual fufu pounding.
Aksjologiczne założenia stosowania dyrektyw wykładni celowościowej
Authors: Smolak Marek
Published: December 2015

W artykule chciałbym wykazać, że dyrektywy preferencji wykładni prawa są konwencjonalnymi regułami konstytutywnymi. Nadto argumentuję, że w sytuacji wystąpienia konfliktu w stosowaniu dyrektyw preferencji (dyrektyw wykładni drugiego stopnia) podstawową rolę w rozwiązywaniu powyższego konfliktu odgrywają wartości prawa.
Normatywne uwarunkowania realizowania kompetencji prawodawczych przez organy jednostek samorządu terytorialnego
Authors: Jakimowicz Wojciech
Published: December 2015

W przedstawionym opracowaniu podjęto próbę analizy normatywnych determinant realizowania władztwa administracyjnego organów jednostek samorządu terytorialnego w ramach ich kompetencji prawodawczych. Przedstawiono wpływ normatywnej kategorii samodzielności jednostek samorządu terytorialnego na sposób realizowania kompetencji prawodawczych przez organy tych jednostek. Wśród normatywnych determinant realizowania kompetencji prawodawczych zwrócono uwagę na charakter norm kompetencyjnych i norm zadaniowych, a także wzajemne relacje między nimi. Zasygnalizowano problematykę metod wykładni tych norm. Dokonano także oceny wpływu norm, które determinują formalny aspekt korzystania z upoważnienia ustawowego, na sposób korzystania z kompetencji prawodawczych. Rozważania osadzono na tle poglądów prezentowanych w doktrynie prawa i zilustrowano aktualnymi przykładami analizowanymi w orzecznictwie.
Współdziałanie podmiotów władzy publicznej na rzecz rozwoju
Authors: Kokocińska Katarzyna
Published: December 2015

Artykuł obejmuje analizę prawnych instrumentów służących wzmocnieniu współpracy struktur rządowych i samorządowych, opartej na wzajemnie powiązanych działaniach podmiotów władzy wykonawczej. Wskazując nowe, prawne formy działania podmiotów władzy publicznej, występujące w sferze prowadzenia polityki rozwoju, szczególne znaczenie przypisać należy aktom polityki rozwoju ‒ strategiom rozwoju i programom, stanowiącym wynik prawnie uporządkowanego procesu ich przygotowania i przyjmowania przez współpracujące podmioty władzy wykonawczej. Swoisty układ stosunków w sferze prowadzenia polityki rozwoju doprowadził również do wykształcenia nowego typu zorganizowania współpracy w strukturach podmiotów władzy wykonawczej, określonego jako konsensualny mechanizm modelowania stosunków prawnych. Tworzą go nietypowe, dwustronne formy współdziałania podmiotów publicznych (kontrakt wojewódzki, kontrakt terytorialny i umowa partnerstwa), determinowane realizacją wspólnych celów publicznych. Te umowne formy współpracy służące wyznaczaniu relacji pomiędzy hierarchicznie niepodporządkowanymi podmiotami publicznymi władzy wykonawczej (wyznaczając wzajemne publicznoprawne relacje) mogą skutkować modyfikacją gwarantowanego ustawowo zakresu samodzielności podmiotów tych stosunków. Dlatego istota problematyki współadministrowania zasadza się na tym, że wyznaczanie wzajemnych relacji pomiędzy współdziałającymi podmiotami władzy publicznej determinować powinny ‒ obok uwarunkowań celowościowych, organizacyjnych i funkcjonalnych ‒ przede wszystkim założenia ustrojowe.
Możliwość przekazywania działań wykonawczych przez radę gminy
Authors: Ziemski Krystian
Published: December 2015

Artykuł dotyczy spornego w literaturze oraz orzecznictwie zakresu pojęcia „wymagająca załatwienia indywidualna sprawa z zakresu administracji publicznej”. Ustalenia w tym zakresie rzutują na zakres zastosowania art. 39 ust. 4 ustawy o samorządzie gminnym, który dotyczy możliwości przekazywania przez radę gminy kompetencji organu wykonawczego na organy wykonawcze jednostek pomocniczych gminy i inne podmioty.Według niektórych poglądów sprawa indywidualna z zakresu administracji publicznej utożsamiana musi być z zakresem pojęcia „decyzja administracyjna” w rozumieniu nadanym mu ustawą Kodeks postępowania administracyjnego. W artykule wykazano, że pogląd taki jest rezultatem utożsamiania pojęć „rozstrzyganie” z załatwianiem indywidualnych spraw publicznych. Tymczasem nie każda publiczna sprawa indywidualna wymaga rozstrzygania co do skutków prawnych danego stanu faktycznego. Znacząca część spraw indywidualnych załatwiana jest drogą dokonywania czynności faktycznych, niewymagających wydawania decyzji administracyjnej. W artykule zawarto także rozważania dotyczące tego, czy przekazanie kompetencji do załatwiania określonych spraw wymaga jednoczesnego wyraźnego umocowania do dokonywania działań o charakterze instrumentalnym w stosunku do wyraźnie przekazanych kompetencji, działań funkcjonalnie z nimi powiązanych, a także zasadności wyraźnego przekazywania oraz do podejmowania działań, do których zobowiązane są podmioty realizujące zadania o charakterze publicznym (np. kwestia wydawania zaświadczeń czy dokonywania działań uregulowanych ustawą o udostępniania informacji publicznych).
In search of the contemporary shape of self-government
Authors: Stępień Jerzy
Published: December 2015

The twenty-fifth anniversary of self-government in Poland is a good occasion to reflect on the road we have travelled so far. While we still remember well the intentions of the creators of the system (members of the First Senate) we can now compare them with the current state of affairsand the status quo of government in Poland today. Two concepts have always been there since the beginning. Whereas the original solutions were to be inscribed in the tradition of Polish self-government, everything was done from the very start to draw as much as possible from the achievements of legal political thinking, later manifested in the provisions of the European Charter on Local Self-Government – a document which is the quintessence of the Western model of a local authority. Self-government is an institution characteristic of Western civilisation, practically unknown elsewhere, and it extends the principles of representation onto the local space inhabited by its citizens. Examples offered in the article illustrate how the initially planned model of government in Poland, rooted in the city fathers model has, in the course of subsequent reforms, been losing its original Western clarity in favour of the previous host model of local authority that characterised the past system.
Discussion of “Effect of Overconsolidation on K in Centrifuge Models Using CPT and Tactile Pressure Sensor” by W. El-Sekelly, T. Abdoun, and R. Dobry. The Regular Article Was Published in Geotechnical Testing Journal, Vol. 38, No. 2, 2015. [DOI:10.1520/GTJ20140101]
Authors: Talesnick M. L.
Published: December 2015

This discussion dealt with two questions: (1) Is data from tactile sensing technologies reliable enough to consider basic conceptions of soil mechanics? and (2) Has the calibration of tactile sensing devices been rigorously approached, and is there sufficient basis to apply tactile sensing to particulate media with all the issues that it may involve, such as particle size, compliance, stiffness, stress history, and time dependence? On the face of things, it seems that the submission of El-Sekelly et al. has not included a rigorous approach.
Architects from Socialist Countries in Ghana (1957–67)
Authors: Stanek Łukasz
Published: December 2015

Architects from Socialist Countries in Ghana (1957–67): Modern Architecture and Mondialisation discusses the architectural production of the Ghana National Construction Corporation (GNCC), a state agency responsible for building and infrastructure programs during Ghana’s first decade of independence. Łukasz Stanek reviews the work of GNCC architects within the networks that intersected in 1960s Accra, including competing networks of global cooperation: U.S.-based economic institutions, the British Commonwealth, technical assistance from socialist countries, support programs from the United Nations, and collaboration within the Non-Aligned Movement. His analysis of labor conditions within the GNCC reveals a negotiation between Cold War antagonisms and a shared culture of modern architecture that was instrumental in the reorganization of the everyday within categories of postindependence modernization. Drawing on previously unexplored materials from archives in Ghana, Bulgaria, Croatia, Hungary, Poland, the United Kingdom, and the United States, the article reveals the role of architects from European socialist countries in the urbanization of West Africa and their contribution to modern architecture’s becoming a worldwide phenomenon.
Louis Kahn’s Silent Space of Critique in Tehran, 1973–74
Authors: Mohajeri Shima
Published: December 2015

Locating modernity’s unfinished project in the historical matrix of Iran, Louis Kahn’s Silent Space of Critique in Tehran, 1973–74 examines Louis Kahn’s master plan for a new civic center in Tehran. The 1970s witnessed a period of contention between political and cultural visions of modernity in Iran: as the shah’s state fabricated progress through a series of development plans, the queen’s reformist second court sponsored cultural and preservationist projects. This strife over modernity in Iran was reflected in Kahn’s design as form, space, and program. Shima Mohajeri shows that Kahn’s layout for a modern public space in Tehran concerned the development of an ethical attitude toward architectural modernity in a non-Western context as well as constituted a silent resistance to Iran’s sociopolitical reality and its spaces of representation.
Human Embryo Research
Authors:   Committee on Pediatric Research and Committee on Bioethics
Published: December 2015

In 1996, a ban on the use of US Department of Health and Human Services funds for research on the creation of human embryos and research that involved the injury or destruction of human embryos was signed into law. This ban was partially reversed in 2000 when the National Institutes of Health announced it would fund selective research on human pluripotent stem cells. Given the potential benefits to society, research using human embryos is an issue that deserves additional consideration. The American Academy of Pediatrics believes that, under certain conditions, research using human embryos and pluripotent stem cells is of sufficient scientific importance that the National Institutes of Health should fund it and that federal oversight is morally preferable to the currently unregulated private sector approach.
Laparoscoppal végzett subtotalis gyomorresectio Roux-en-Y szerinti rekonstrukcióval, antralis gyomoradenocarcinoma miatt
Authors: Sztipits Tamás , Mészáros Péter , Dubóczki Zsolt , Tarpay Ádám , Mersich Tamás
Published: December 2015

Absztrakt

Esetismertetés: A 35 éves nőbetegnél epigastrialis panaszok
miatt végzett gastroscopia 2 cm-es antralis ulcust talált. Biopszia: közepesen
differenciált intestinalis típusú adenocarcinoma. Praeoperativ staging CT és
endoscopos UH: cT2cN0cM0. Műtét: Laparoscopos subtotalis
gyomorresectio + módosított D2 lymphadenectomia, Roux-en-Y szerinti
rekonstrukcióval. A duodenum és a gyomor mobilizálását LigaSure Dolphin (5 mm ×
37 cm Covidien) segítségével végeztük. A proxymalis és distalis resectióhoz
Endo-Gia Ultra Universal Stapler (Covidien) vágó-varró gépeket használtunk (60
mm-es AMT). Ezt követően módosított D2 lymphadenectomiát végeztünk a ligamentum
hepatoduodenale, a truncus coeliacus, valamint az arteria lienalis eredésének
környékéről. A side-to-side retrocolicus loop gastrojejunostomiát laparoscoposan
Endo-Gia Ultra Universal Stapler segítségével készítettük el a gyomor hátsó
falára. A felhozott jejunumkacsot Endo-Giával átvágtuk és lezártuk a gyomorcsonk
resectiós vonalával egy szintben, a gyomorcsonk nyílását ugyanezzel a
Gia-varrattal zártuk. Így a loop gastrojejunostoma Roux-en-Y anastomosissá
alakítható. Az ‘Y’ end-to-side jejunojejunostomiát a specimen eltávolítására
használt minilaparotomián kézi varrattal készítettük el. Műtéti
idő: 200 perc, vérveszteség: 100 ml. Eszközök:
Endo-Gia Ultra Universal Stapler vágó-varró gép + 6 darab 60 mm AMT‑tár + 1
darab 45 mm AMT-tár, LigaSure Dolphin 5 mm × 37 cm. A postoperativ szak
eseménytelenül telt, a kilencedik ápolás napon a beteget panaszmentesen
elbocsátottuk. Végleges szövettan: Invazív intestinalis típusú
adenocarcinoma, 2,7 cm átmérő, pT1bpN0, HER-2 2+. Megbeszélés:
A laparoscopos subtotalis gyomorresectio retrocolicus Roux-Y rekonstrukcióval
onkológiai kompromisszum nélkül, jó funkcionális eredménnyel végezhető a
gyomorrák korai stádiumaiban.
Annual variations of the presence of Nereididae (Annelida: Polychaeta) from intertidal rocky shores along the east coast of Algeria
Authors: Meghlaoui Zoubeida , Daas Tarek , Snani Meriem , Daas-Maamcha Ouided , Scaps Patrick
Published: December 2015

Four species of nereidid polychaetes, Peri­ner­eis cultrifera, P. macropus, Nereis falsa, and Platy­ner­eis dumerilii, were identified during three years in four intertidal rocky shore sites (El-Kala, Annaba, Skikda and Collo) along the east coast of Algeria during the years 2011–2013. Species’ distribution fluctuated according to sites and season. Perinereis cultrifera was observed during most of the year, except in summer. Perinereis macropus was observed at El-Kala, Skikda and Collo mainly in late winter and early spring. Nereis falsa was observed during most of the year in El-Kala and Annaba; this species was also observed in Skikda in 2011 but then disappeared in the last two years of this study. Finally, the presence of P. dumerilii was noticed only in El-Kala for a few months (mainly in March and April). Perinereis cultrifera, P. macropus and P. dumerilii reproduce after acquiring the epitokous form between April and May, when surface seawater temperature starts rising. The largest mature oocytes were about the same for P. cultrifera (279 µm) and P. macropus (278 µm), while this value was smaller for P. dumerilii (166 µm). In contrast to the other three species of nereidid polychaetes, N. falsa reproduces without epitokal modification between July and August when sea temperature was highest. The largest mature oocytes (168 µm) are about the same as P. dumerilii but is much small than those of P. cultrifera and P. macropus.
Belastungsbedingte, nichtinfektiöse unilaterale Buggelenksarthropathie der Brieftauben („Schieffliegersyndrom”)
Authors: Neumann-Aukthun M. , Kamphausen L. , Kirchhoff A.
Published: December 2015

Gegenstand: Nach Mittel- und Langstreckenflügen sowie nach den ersten Trainingseinheiten des Jahres wird bei Brieftauben eine einseitige Schädigung im Schultergelenk beobachtet. Ziel der Arbeit war, die Pathogenese sowie die Ätiologie der Schädigung zu diskutieren. Material und Methoden: Von 35 „schieffliegenden” Tauben wurden aus schließlich die verdächtigen Schultergelenke mikrobiologisch und histopathologisch untersucht. Weiterhin erfolgte bei 12 betroffenen Tauben eine pathologisch-anatomische und histopathologische Untersuchung beider Schultergelenke. Ergebnisse: Gelenkkapsel, Gelenkknorpel, Sehnen und Knochenstrukturen zeigten pathologische Veränderungen. Schlussfolgerung: Allem Anschein nach handelt sich um eine belastungsbedingte mechanische Schädigung des Schultergelenks. Die verschiedenen Gelenkstrukturen werden durch die physikalischen/ mechanischen Einflüsse bei längerem Flug überfordert.
Ernährungsberatung in der Kleintierpraxis – ein Arbeitsfeld für spezialisierte Tierärzte
Authors: Bergler R. , Wechsung S. , Hoff T. , Dobenecker B. , Kienzle E.
Published: December 2015

Gegenstand und Ziel: Es wurde geprüft, wodurch die Etablierung der Ernährungsberatung in der Kleintierpraxis erschwert wird. Ferner werden Unterschiede im Problemlöseverhalten von Tierärzten bei der Ernährungsberatung dargestellt. Material und Methoden: Repräsentative Online-Befragung von 214 Tierärzten (weiblich/männlich) mittels eines standardisierten Fragebogens, Faktorenanalyse zur Typisierung der Tierärzte anhand einer Clusteranalyse. Ergebnisse: Mehr als 90% der Tierärzte waren der Ansicht, dass Fragen der Tierbesitzer zur Fütterung von Haustieren zugenommen haben, 41% der Tierärzte schätzten den Anteil ernährungsbedingter Krankheiten auf 20–30%. Gleichzeitig stimmten 70% der Aussage zu, dass die Ernährungsberatung im Praxisalltag vernachlässigt wird. Nach Angabe der Tierärzte setzen nur knapp 30% der Besitzer Ernährungsempfehlungen um. Mehr als 80% der Tierärzte nahmen an, dass Tierbesitzer falsche Angaben zur Fütterung der Tiere machen. In anderen sensiblen Punkten wie z. B. der häuslichen Situation wurden unrichtige Angaben dagegen auf unter 60% eingeschätzt. Etwa die Hälfte der Tierärzte fühlte sich bei der Ernährungsberatung nicht kompetent. Weniger als 50% liquidierten für diese Leistung. Eine Fortbildung zur Tierernährung besuchten nur 18% der Tierärzte. Die Clusteranalyse identifizierte fünf typische Verhaltensstrategien im Umgang mit der Ernährung, wobei vier davon auf einem eher geringen Stellenwert der Ernährung basierten. Einige der an Ernährungsfragen wenig interessierten Tierärzte überweisen an spezialisierte Kollegen (7,2%), andere wenden sich ratsuchend an die Futtermittelindustrie (28,2%), wieder andere behelfen sich mit kurzen kostenlosen Fütterungstipps (23,4%) und ein kleiner Teil verdrängt die Tierernährung weitgehend (13,4%). Es gibt aber auch eine Gruppe an der Tierernährung besonders interessierter Tierärzte (27,8%). Diese Gruppe war sich der Defizite bei den fachlichen und kommunikativen Kompetenzen am stärksten bewusst. Schlussfolgerung und praktische Relevanz: Für eine fundierte Ernährungsberatung in der Kleintierpraxis sind ein hoher Spezialisierungsgrad sowie praktikable Lösungen für die Anamneseerhebung und die Liquidierung notwendig.
Facial diplegia: etiology, clinical manifestations, and diagnostic evaluation
Authors: Varol Sefer , Ozdemir Hasan Huseyin , Akil Esref , Arslan Demet , Aluclu M. Ufuk , Demir Caner F. , Yucel Yavuz
Published: December 2015

ABSTRACT Objective Facial diplegia (FD) is a rare neurological manifestation with diverse causes. This article aims to systematically evaluate the etiology, diagnostic evaluation and treatment of FD. Method The study was performed retrospectively and included 17 patients with a diagnosis of FD. Results Patients were diagnosed with Guillain-Barré syndrome (GBS) (11), Bickerstaff’s brainstem encephalitis (1), neurosarcoidosis (1), non-Hodgkin’s Lymphoma (1), tuberculous meningitis (1) herpes simplex reactivation (1) and idiopathic (1). In addition, two patients had developed FD during pregnancy. Conclusion Facial diplegia is an ominous symptom with widely varying causes that requires careful investigation.
Da frustração ao enfrentamento do cuidado para a morte por técnicos de enfermagem
Authors: Beraldo Lívia Maria , Almeida Débora Vieira de , Bocchi Silvia Cristina Mangini
Published: December 2015

RESUMO Objetivo: compreender a experiência de técnicos de enfermagem com o cuidado para a morte de pacientes terminais em UTI e configurar um modelo teórico. Método: estudo qualitativo, com saturação teórica mediante a análise da 10ª entrevista não diretiva, tendo como referenciais a Teoria Fundamentada nos Dados, o Interacionismo Simbólico e a Bioética. Resultados: a categoria central - da frustração ao enfrentamento do cuidado digno de enfermagem para a finitude: a aceitação da morte como componente terapêutico e interveniente - emergiu da comparação dos subprocessos: não se sentindo preparado para o cuidado para a morte, aceitando a morte como um fenômeno terapêutico, desenvolvendo estratégias de enfrentamento. Conclusão: segundo o Interacionismo Simbólico, a frustração do profissional iniciante em cuidar da pessoa para a morte está relacionada à sua interação e interpretação da situação, por sentir-se preparado somente para assistir a pessoa para a vida.
Temporalidade da mulher após cirurgia cardíaca: contribuições para o cuidado de enfermagem
Authors: Amorim Thais Vasconselos , Salimena Anna Maria de Oliveira , Souza Ívis Emília de Oliveira , Melo Maria Carmen Simões Cardoso de , Silva Lúcia de Fátima da , Cadete Matilde Meire Miranda
Published: December 2015

RESUMO Objetivo: desvelar o movimento existencial da mulher após a intervenção cirúrgica cardíaca. Método: pesquisa qualitativa de abordagem fenomenológica. Teve como cenário uma instituição hospitalar em Minas Gerais, na qual dez mulheres foram entrevistadas entre dezembro de 2011 e janeiro de 2012. Resultados: após a alta hospitalar, as mulheres vivenciam comprometimentos físicos, sociais e emocionais, desejando a volta do tempo anterior ao diagnóstico, uma vez que ainda se sentem cardiopatas. Essa compreensão vaga e mediana emerge de três unidades de significação, as quais, na perspectiva da hermenêutica heideggeriana, permitiram desvelar o fenômeno da cirurgia cardíaca como um agora que limita o dia a dia das mulheres. Conclusão: o enfermeiro, na disposição de ser-com-o-ser-aí-mulher-após-a-cirurgia-cardíaca, deve promover a saúde, considerando as facetas existenciais que se mostram nos momentos de cuidado. Nessa oportunidade de encontros singulares e plenos de subjetividade se revelam as bases para a integralidade da assistência.
Familiares cuidadores articulando rede social de criança com necessidades especiais de saúde
Authors: Cabral Ivone Evangelista , Moraes Juliana Rezende Montenegro Medeiros de
Published: December 2015

RESUMO A rede de atenção à criança com necessidades especiais de saúde é restrita e pouco abordada no Brasil. Objetivos: caracterizar a rede social de criança com essa condição de saúde e analisar o papel da família na sua constituição. Método: abordagem qualitativa desenvolvida com cinco dinâmicas Mapa Falante do método criativo sensível, com cinco grupos familiares (12 participantes), realizadas em seus domicílios. Resultados: a análise crítica do discurso de cuidadores (avós, irmãos e vizinhos) apontou a mãe como a principal articuladora da rede social cujos pontos eram unidos pelo hospital, Programa Médico de Família, reabilitação, domicílio, escola etc. O cuidado familial adquire maior visibilidade no domicílio e na comunidade. Conclusão: na ausência de políticas articuladoras dos cuidados em saúde na comunidade, os familiares conformam uma rede social de malha densa e fluida.
Mastite lactacional grave: particularidades da internação à alta
Authors: Viduedo Alecssandra de Fátima Silva , Leite Juliana Rocha de Carvalho , Monteiro Juliana Cristina dos Santos , Reis Márcia Cristina Guerreiro dos , Gomes-Sponholz Flávia Azevedo
Published: December 2015

RESUMO Objetivo: identificar as características de mulheres que sofreram mastite lactacional grave. Método: estudo descritivo, retrospectivo e documental, com abordagem quantitativa. Os dados foram coletados de registros da assistência nos prontuários de 114 mulheres internadas no período de janeiro de 2009 a dezembro de 2013. Análise mediante estatística descritiva. Resultados: constatou-se maior porcentagem de mastite lactacional grave em mulheres jovens, primíparas, com ensino médio completo, que não tinham companheiro e não trabalhavam fora do lar; 96,5% das mulheres tiveram alguma intercorrência mamária antes da internação e permaneceram internadas em média 4,4 dias; na alta hospitalar 23,7% das mulheres desmamaram. Conclusão: este estudo mostrou que a mastite lactacional grave pode causar grandes danos à mulher e ao bebê.
Resíduos de serviços de saúde em serviço de atendimento pré-hospitalar móvel
Authors: Mendes Adriana Aparecida , Veiga Tatiane Bonametti , Ribeiro Tânia Márcia Lopes , André Silvia Carla da Silva , Macedo Juice Ishie , Penatti Juliana Trebi , Takayanagui Angela Maria Magosso
Published: December 2015

RESUMO Objetivo: identificar o tipo de manejo de Resíduos de Serviços de Saúde (RSS) de um serviço de Atendimento Pré-Hospitalar Móvel (APHM) do interior paulista, além de caracterizar e quantificar esses resíduos. Método: estudo de campo de caráter exploratório e descritivo, com coleta de dados baseada em metodologia proposta pela Organização Pan-Americana da Saúde (OPAS) realizada em oito dias consecutivos para identificar a produção e as características dos resíduos gerados. Resultados: verificou-se que o manejo dos RSS no serviço de APHM ainda não está adequado às exigências da RDC 306/04, o que pode comprometer a segurança ocupacional dos trabalhadores, dos pacientes, comunidade e ambiente. Conclusão: recomendase atenção dos gestores de saúde para essa problemática. A ausência de estudos em serviço de APHM remete também à necessidade da continuidade de novas pesquisas relacionadas ao manejo de resíduos gerados.
Cultura de segurança do paciente em unidade de Transplante de Medula Óssea
Authors: Fermo Vivian Costa , Radünz Vera , Rosa Luciana Martins da , Marinho Monique Mendes
Published: December 2015

RESUMO Objetivo: avaliar a cultura de segurança do paciente sob a ótica dos profissionais da área de saúde da unidade de Transplante de Medula Óssea do Centro de Pesquisas Oncológicas, hospital de referência no tratamento do câncer em Santa Catarina, Brasil. Método: pesquisa de abordagem quantitativa, do tipo survey transversal, desenvolvida a partir do Questionário de Atitudes de Segurança, entre agosto e setembro de 2013. Foram incluídos 33 inquéritos de profissionais. Para análise dos dados utilizou-se a estatística descritiva e inferencial. Resultados: entre as dimensões analisadas, somente a "satisfação no trabalho" alcançou a média de escore acima de 75, avaliada como positiva para a cultura de segurança do paciente. Conclusão: as dimensões da cultura de segurança presentes no inquérito necessitam ser valorizadas por profissionais e gestores para o alcance de um cuidado seguro ao paciente.
Validação de protocolo de posicionamento de recém-nascido em Unidade de Terapia Intensiva
Authors: Toso Beatriz Rosana Gonçalves de Oliveira , Viera Cláudia Silveira , Valter Jéssica Martins , Delatore Silvana , Barreto Grasiely Mazoti Scalabrin
Published: December 2015

RESUMO Objetivo: verificar as indicações de posicionamento dos recém-nascidos (RN) e construir um protocolo de procedimento operacional padrão (POP) para posicionamento de RN em Unidade de Terapia Intensiva Neonatal (UTIN). Método: para validação do POP utilizou-se a técnica Delphi, em que enfermeiros especialistas na área avaliaram o procedimento proposto. Resultados: apresentam-se os resultados dessa validação na forma de protocolo, para contribuir com a discussão sobre o posicionamento do RN na UTIN e padronização da assistência de enfermagem relacionada ao posicionamento. Foram avaliados dez indicadores, em sete dos quais houve concordância de 100,0% e, em três, de 80%, acima dos 60% preconizados pela técnica de validação. Conclusão: dada a importância do posicionamento dos recém-nascidos internados em Unidades de Terapia Intensiva Neonatal para seu desenvolvimento neuromuscular, o estudo contribui para adoção de uma prática baseada em evidência para a enfermagem.
Baixo peso ao nascer em município da região sudeste do Brasil
Authors: Mendes Carolina Queiroz de Souza , Cacella Bruna Cristina de Almeida , Mandetta Myriam Aparecida , Balieiro Maria Magda Ferreira Gomes
Published: December 2015

RESUMO Objetivo: identificar a prevalência de baixo peso ao nascer no município de São Paulo. Método: estudo epidemiológico do tipo transversal, a partir de dados do Sistema de Informações sobre Nascidos, referentes aos nascimentos ocorridos no município de São Paulo, nos anos entre 2007 - 2013. As variáveis maternas, gestacionais, do parto e neonatais foram analisadas descritivamente e por associação. Resultados: do total de nascidos vivos (1.342.655), 9,65% apresentaram baixo peso (média de 3234,55 gramas no grupo a termo e 2312,17 no grupo pré-termo) e média de idade materna de 27,53 anos. Os fatores de riscos identificados incluem idade materna, ausência de companheiro, baixo nível de escolaridade materno, raça não branca; gestação pré-termo, gemelaridade, baixo número de consultas no pré-natal e parto cesáreo. Conclusão: o conhecimento destas evidências favorece o planejamento da assistência com a definição de estratégias para sua redução e consequentemente melhoria na atenção à saúde materno infantil.
Biologia reprodutiva de Cordiera macrophylla (K. Schum.) Kuntze (Rubiaceae), espécie dioica da região sudoeste do Estado de Mato Grosso, Brasil
Authors: Cobra Simone Santos de Oliveira , Nascimento Franciele do , Antoniazzi Sabrina Aparecida , Krause Willian , Silva Celice Alexandre
Published: December 2015

RESUMO O gênero Cordiera (Rubiaceae) possui aproximadamente 25 espécies e ampla distribuição no Brasil. Seus representantes são árvores ou arbustos dioicos, com flores funcionalmente unissexuadas. Este estudo foi realizado em dois fragmentos de Floresta Estacional Semidecidual, no município de Tangará da Serra, MT. Foram investigadas a fenologia reprodutiva, a razão sexual, a morfologia e a biologia floral, o sistema e o sucesso reprodutivo. Cordiera macrophylla floresceu de julho a setembro, durante a estação seca, com pico sincrônico entre flores pistiladas e estaminadas. Flores estaminadas florescem antecipadamente e por um período mais prolongado que as pistiladas. A antese das flores pistiladas apresentou maior longevidade. A razão sexual foi de 1:1. Flores estaminadas são dispostas em inflorescências umbeliformes e as pistiladas são unifloras, ambas semelhantes morfologicamente. Os frutos são bagas verrucosas, polispérmicas. A taxa de formação de frutos por polinização natural foi de 95%, evidenciando a dependência dos polinizadores para a manutenção da espécie. O sucesso reprodutivo também foi alto, confirmando que a associação entre morfologia e biologia floral favoreceu a espécie nas áreas estudadas.
Interação entre volume de vaso e competição com plantas daninhas sobre o crescimento da soja
Authors: Almeida Mirielle Oliveira , Matos Christiano da Conceição de , Silva Daniel Valadão , Braga Renan Rodrigues , Ferreira Evander Alves , Santos José Barbosa dos
Published: December 2015

RESUMO A avaliação dos efeitos da competição das plantas daninhas sobre o crescimento da soja é efetuada por meio de ensaios em ambientes protegidos. Esses ensaios, geralmente, são feitos em recipientes (vasos) em que se testam os efeitos desejados em diferentes épocas de coleta. O tamanho (volume) dos vasos a ser escolhido depende do tipo de estudo, da espécie-teste e das variáveis que serão estudadas. Por esta razão, objetivou-se com este trabalho avaliar o efeito do tamanho de vasos na habilidade competitiva da soja com as plantas daninhas Urochloa brizantha e Bidens pilosa. O experimento foi conduzido em casa de vegetação e o delineamento foi em blocos ao acaso, em esquema fatorial 3 × 5, com quatro repetições. Os fatores considerados no experimento foram três sistemas de competição (soja cultivada isoladamente, soja + U. brizantha e soja + B. pilosa) e cinco volumes dos recipientes (2, 4, 7, 10 e 16 dm3). O crescimento das plantas de soja foi afetado tanto pelo volume dos vasos quanto pela competição com U. brizantha e B. pilosa, sendo que U. brizantha foi mais competitiva com a soja. Vasos com maiores volumes aumentam os efeitos da competição sobre o crescimento da soja.