bluuebunny/crossref_metadata_2025 huggingface dataset:
Carer-centred care: general practice support to family caregivers
Authors: Pyer Michelle , Campbell Jackie , Ward Alison
Published: October 2016

Rationale, aims and objectivesIn February 2009 the UK’s Department of Health invited bids for funding to host demonstrator sites in order to test new approaches to working with and for carers within the national Carers’ Strategy [1; 2]. This paper discusses some of the findings of the local level evaluation of one of the host sites, situated in Northamptonshire.  MethodsA mixed-method approach was used to gather data from a range of participant groups. This paper presents the findings of two of those methods; a postal survey of carers and an audit of support offered by general practices. ResultsThe findings of the evaluation show a considerable improvement in the extent to which carers’ roles were identified by their surgeries, however there is a need to ensure that this information is recorded and used in ways which benefit carers. Carers noted challenges in dealing with practice staff, particularly administrative staff who were not aware of their needs. Practices noted a range of services which were offered to carers, however carers were not always aware that these were available, suggesting that further publication of these opportunities is needed. ConclusionsThe paper argues the importance of the role undertaken by carers, and signals the range of ways in which General Practice can support or inhibit these activities.
Physician smoking cessation counseling and adherence to the Clinical Practice Guideline
Authors: Champassak Sofie , Catley Delwyn , Finocchario-Kessler Sarah , Farris Maghen , Ehtesham Maniza , Schoor Rachel , Goggin Kathy
Published: October 2016

Objective: The U.S. Public Health Service Clinical Practice Guideline recommends that physicians provide tobacco cessation interventions to their patients at every visit. While many studies have examined the extent to which physicians implement the guideline’s “5 A’s”, few studies have examined the extent to which physicians implement the guideline’s “5 R’s” which are to be used in a Motivational Interviewing (MI) consistent style with smokers not ready to quit. This study examined the extent to which physicians in usual practice and without specific training administered the 5 R’s including the use of an MI style.Methods: Thirty-eight physicians were audio recorded during their routine clinical practice conversations with smokers.Recordings were coded by independent raters on the implementation of each of the 5 A’s, 5 R’s and MI counseling style.Results: Results revealed that for patients not ready to quit smoking, physicians most frequently discussed the patient’s personal relevance for quitting and the risks of smoking. Roadblocks and rewards were discussed relatively infrequently. MI skill code analyses revealed that physicians, on average, had moderate scores for acceptance and autonomy support, a low to moderate score for collaboration and low scores for empathy and evocation.Conclusion: Results suggest that for the Clinical Guideline to be implemented appropriately physicians will need specialized training or will need to be able to refer patients to counselors with the necessary expertise of counseling efforts could increase providers’ willingness to implement guideline recommendations.
Examining preference of elderly for adding indication to the prescription label (Rx Label)
Authors: Sakharkar Prashant , Zargarzadeh Amir , Law Anandi
Published: October 2016

Rationale and aim To examine preference of the elderly for adding indication (medication use/purpose) to prescription label, reasons for their preference and its association with demographic characteristics. Methods A convenience sample of 143 patients of age 65 or older, who took at least one prescription medication every day were interviewed using a structured questionnaire. The data were analyzed for descriptive statistics, correlation for demographic characteristics with participant’s preference for adding indication to prescription label using the Chi-square and Fisher’s exact test. Regression analysis was conducted to predict participant’s preference.    Results Participants were ethnically diverse, majority being female (60.8%), with average age of 76.9 yrs. Twenty nine percent participants had more than high school education. About 91% participants preferred adding indications to their prescription label for the reasons: “managing medication by category” (29%), “distinguishing medications” (69%), and “reducing confusion” (29%). Adult daycare centers and community pharmacy participants with lower than high school education showed higher preference for adding indication for reducing confusion and distinguishing medication, respectively. Whereas, Hispanic/Latino participants of adult daycare centers preferred for the reason, distinguishing medications (p<0.05). Age, race/ethnicity and education were found to be good predictors of their preference. Conclusion The elderly showed higher preference for adding indication to the prescription label for improving their ability to distinguish medications and reduce confusion. Our results suggest a need for adopting recently released USP patient-centered prescription label standards, which also include adding indication to the Rx labels.
Report clinical sources of heterogeneity in meta-analysis: A commentary on Steurer et al (2014). “Are clinically heterogeneous studies synthesized in systematic reviews?
Authors: Buetow Stephen
Published: October 2016

Not required because the manuscript is an invited commentary.
The Impact of Patient Preference on Mental Health Treatment: A Methodological Critique and Suggestions for Future Research
Authors: Mott Juliette , Koucky Ellen , Teng Ellen
Published: October 2016

Objectives: Although mental health guidelines increasingly cite the importance of considering patient treatment preference, the substantial variability in study methodology complicates synthesis of empirical research in this area. The objective of this study was to critically review the methodological designs commonly used to assess the relationship between patient preference and mental health treatment outcome and to provide suggestions for future research.Methods: This study reviewed and critically evaluated the methods of studies published between 1993 and 2013 in PsychInfo and PubMed that assessed the effect of patient preference on mental health treatment outcome.Results: A total of 23 studies met inclusion criteria. Most studies (45%) evaluated preference as an added dimension of a randomized clinical trial or used a comprehensive cohort design (35%) wherein patients who refuse randomization can select a preferred treatment. Approximately half of the studies (45%) provided no detail about whether patients received any treatment information prior to preference assessment, and 36% of studies included no detail about how preference was assessed. Most studies focused on depression, indicating that the impact of patient preference remains underexamined in many mental health populations Conclusions: To date, preference effects have most often been evaluated with designs that are better suited to evaluate treatment effects than preference effects (i.e., randomized controlled trials, comprehensive cohort designs). The methodological limitations identified in the extant literature underscore the need for increased attention to key methodological issues, which can enhance the ability of future studies to meaningfully evaluate the impact of patient preference.
The roots of Compassion and Empathy: implementing the Francis report and the search for new models of health care.
Authors: Gray Alison , Cox John
Published: October 2016

Background: The Francis report into the catastrophic failures of care in a UK NHS hospital Trust identified lack of compassion as a major factor. Developing a ‘culture of compassion’ was emphasized in the Report, but the sources and meaning of compassion and empathy were not discussed further. In this paper we consider aspects of the scientific, theological and philosophical literature covering these key subjects. Findings and discussion: Compassion is an ancient concept found in all of the World’s major religions. Empathy is the intellectual recognition of someone suffering and the emotional response to this and compassion adds in the volition to act to relieve suffering. Karl Jaspers regarded empathic understanding as essential to psychology. Medicine is both an art and a science and as health practitioners we need to be able to view people from both interpersonal and objective perspectives. Exhausted, demoralized and threatened staff cannot sustain empathy and compassion and many UK NHS staff report such feelings. Unregulated empathy can also lead to clinician burnout and failure of compassion is indeed recognized as a symptom of burnout. Empathy shows a high heritability, it develops through the first five years, supported by responsive and consistent parenting. It is asserted that compassion needs to be deeply embedded in our characters, not least through spiritual practices such as meditation, reflection, modeling and direct teaching. In healthcare, compassion is sustained by individual supervision and group reflection.Conclusion: The need for compassion and empathy in healthcare has been highlighted repeatedly since at least 1927. Individuals need support and appropriate systems to enable compassionate care to be given. The NHS in England, UK is under severe strain and the current competitive business model has led to a culture of secrecy and ‘splitting’. In our opinion, the current system is not fit for purpose.
Healthcare personalism: a prolegomenon
Authors: Marcum James
Published: October 2016

Healthcare personalism is an approach to providing quality healthcare that focuses on personhood with respect to each member of the healthcare team and not to anyone team member, whether patient or healthcare provider. To that end, the philosophy of personalism provides a conceptual framework for developing a dynamic notion of healthcare. Specifically, the person is uniquely original, relationally intersubjective, and communicatively solidaritous. Moreover, healthcare personalism is non-foundational in the sense that no one approach to providing healthcare suffices for the clinical encounter. Rather, the encounter must be open to a range of possibilities for providing healthcare. In contrast to evidence-based medicine, healthcare personalism does not hold to single foundation, i.e. evidence, for practicing healthcare. Evidence is important but not foundational. And, in contrast to patient-entered medicine, it does not privy the patient to the personhood of other healthcare team members. The personhood of everyone involved in healthcare is required for meeting the goal of quality healthcare—the relief of human suffering.
Understanding relational aspects of shared decision-making in gynaecology: A qualitative analysis of patients’ and physicians’ perspectives as well as clinical consultations
Authors: Schwind Bettina , Gross Karin , Wehner Nina , Wegener Beate , Tschudin Sibil , Zemp Stutz Elizabeth
Published: October 2016

Rationale, aims and objectives: Following increased interest in the complexity of relational aspects of shared decision-making (SDM), this study traces the meanings and practices of the ways decisions are shared in clinical encounters within gynaecology. Methods: Guided by grounded theory, we analysed semi-structured interviews with 18 patients and 11 physicians as well as 33 observed consultations from 6 gynaecological outpatient care settings, selected by maximum variety sampling in the Basel area of Switzerland. Results: The results show how clinicians and patients co-produce different meanings and practices regarding decision-making across various care settings. Although female and male clinicians equally engaged in reciprocal bonds with patients in the decision-making process, the nature of these bonds differed and patients attributed gendered and different emotional meanings to decision-making. Shared decision-making was only advocated in female physician/female patient constellations, grounded in ‘being in reciprocal exchange’ due to sameness in gender and displayed as a means for creating closeness, empathy and support. In male physician/female patient constellations, the reciprocal bond was constructed upon unequal distribution of medical knowledge with patients favouring direct medical advice. However, whether patients felt supported in decision-making processes rather seemed to depend upon the continuity of clinical relationships than on the decision-making practices or care setting. Conclusion: By integrating different perspectives, insights into the complexity of relational aspects of SDM in gynaecology were obtained. Emotional meanings and practices of SDM differ according to gender constellations, care settings and continuity of clinical relationships.
Monitoring and improving the quality of person-centred care in health and social settings using Dementia Care Mapping (DCM): Staff experiences of implementation barriers and supports
Authors: Jones Stephanie , Hamilton Janine , Surr Claire
Published: October 2016

Background: Dementia Care Mapping (DCM) is a person-centred care quality monitoring and improvement tool used for nearly 20 years in formal dementia care settings and there are thousands of people trained in its use internationally. However, little is known about if and how DCM is used in practice or regarding application of inter-rater reliability checks to ensure data quality. Aims and Objectives: This study aimed to explore the application of DCM in practice in the UK. Methods: A mixed methods design including an on-line survey and in-depth, semi-structured interviews was employed. Results: There were 98 survey respondents, representing 71 health and social care, University/research and training/consultancy organisations. Twenty-one people participated in the semi-structured interviews. Fifty-nine percent of survey respondents had used DCM since completing training. Those working in clinical roles and in health and social care provider organisations were least likely to have used DCM. A range of barriers and supports to use of DCM in practice after training were reported, including lack of management support and time. The majority of those who had used DCM also conducted inter-rater reliability checks at least once per year or more frequently. Of the 20% who did not the main barriers to this were absence of someone to conduct the checks with and lack of time and resources. Discussion and Conclusions: The study has shown that it is possible to apply an evidence-based quality monitoring and improvement tool such as DCM to support implementation of person-centred care in practice, despite widespread limitations on time and resources as well as to identify a range of setting conditions that can help or hinder implementation.
Setting Limits: How person-centered healthcare can assist clinicians in the allocation of scarce resources
Authors: Tonelli Mark
Published: October 2016

Within person-centered healthcare, clinicians often occupy the center of a clinical decision along with the patient. As such, person-centered healthcare must value the clinician as person. Clinicians bring a duty of stewardship, professional values and clinical expertise to medical decisions, aiming to help the patient achieve a medical benefit and to avoid causing undue burden or risk of harm. The clinician is the best position to determine the range of interventions that are medically appropriate in an individual case. At times, patients or their surrogates may request or demand interventions that are not medically appropriate, as they have no meaningful chance of achieving a medical benefit or are likely to cause harm. Respecting clinicians as persons means that they cannot be obligated to provide medically inappropriate interventions, even when requested by patients.
When researchers stumble, clinicians fall and patients suffer
Authors: Granan Lars-Petter
Published: October 2016

No abstract
Generalizations of the normal basis theorem
Authors: Björkholdt Elise , Lundström Patrik
Published: October 2016

We give several generalizations of the normal basis and primitive element theorems for a finite Galois field extension, with an infinite base field. These generalizations are obtained by considering polynomial expressions of conjugates of a fixed element.
One dimension higher of the word problem
Authors: Çevik A. Sinan
Published: October 2016

Just as a group presentation ${\mathcal P}$ can be regarded as a $2$-complex with a single $0$-cell, so we can consider a $3$-complex with a single $0$-cell, known as a $3$-presentaton. In this paper, by using a geometric way, called spherical pictures, we show that there exist a finite $3$-presentation which has unsolvable generalised identity problem which can be thought as one-dimension higher of the word problem.
On a family of (1,7)-polarised abelian surfaces
Authors: Marini Alfio
Published: October 2016

We study the geometry of the moduli space of $(1,7)$-polarised abelian surfaces with canonical level structure in detail. In particular we describe the locus where the syzygies of the embedded Heisenberg-invariant abelian surface degenerate, and relate this to the other known descriptions of the moduli space in question.
Anomalous enhancement of Seebeck coefficients of the graphene/hexagonal boron nitride composites
Authors: Nakamura Jun , Akaishi Akira
Published: October 2016

Thermoelectric devices convert heat energy to electric power. The dimensionless thermoelectric figure of merit, ZT, is used as a standard criterion for efficiency of thermoelectric conversion. This criterion requires a high Seebeck coefficient, a high electric conductivity, and a low thermal conductivity. In this regard, PbTe, BiTe, and their alloys consisting of relatively heavier elements have been found to show higher values of ZT. In this paper, we focus on the potential of graphene-based composites as thermoelectric materials. Graphene was considered to be a disadvantageous material because of its extremely high thermal conductance and relatively low Seebeck coefficient. However, it has been reported recently that a structural modulation is an effective way of raising the thermoelectric ability of graphene. We introduce the recent progress in the design of graphene-based materials for thermoelectric devices. In particular, we provide a focused investigation of our recent progress regarding the thermopower enhancement in nanoarchitectonics, superlattices, and composites consisting of graphene and hexagonal BN nanoribbons. It has been shown that low-dimensional modulations are effective ways of obtaining a high thermoelectric performance of graphene-based materials.
Enhanced diffraction of MeV γ-rays by mosaic crystals
Authors: Matsuba Shunya , Hayakawa Takehito , Shizuma Toshiyuki , Nishimori Nobuyuki , Nagai Ryoji , Sawamura Masaru , Angell Christopher T. , Fujiwara Mamoru , Hajima Ryoichi
Published: October 2016

The diffraction of γ-rays by mosaic Si crystals with thicknesses of 20, 40, and 80 mm and by a 2-mm-thick perfect Si crystal in a transmission Laue geometry was measured using a high-flux 60Co source with an intensity of 2.2 TBq. The measured diffraction intensities at 1.17 and 1.33 MeV using 40- and 80-mm-thick mosaic crystals were enhanced by a factor of approximately 8.6 compared with those of the perfect Si crystal. The integrated reflectivity is well described in statistical dynamical theory by taking into account γ-ray absorption inside the crystals.
Ontogenetic foraging activity and feeding selectivity of the Brazilian endemic parrotfishScarus zelindae
Authors: Pereira Pedro H.C. , Santos Marcus , Lippi Daniel L. , Silva Pedro
Published: October 2016

Parrotfish are fundamental species in controlling algal phase-shifts and ensuring the resilience of coral reefs. Nevertheless, little is known on their ecological role in the south-western Atlantic Ocean. The present study analysed the ontogenetic foraging activity and feeding selectivity of the Brazilian endemic parrotfishScarus zelindaeusing behavioural observation and benthic composition analyses. We found a significant negative relationship between fish size and feeding rates forS. zelindaeindividuals. Thus, terminal phase individuals forage with lower feeding rates compared to juveniles and initial phase individuals. The highest relative foraging frequency ofS. zelindaewas on epilithic algae matrix (EAM) with similar values for juveniles (86.6%), initial phase (88.1%) and terminal phase (88.6%) individuals. The second preferred benthos for juveniles was sponge (11.6%) compared with initial (4.5%) and terminal life phases (1.3%). Different life phases ofS. zelindaeforaged on different benthos according to their availability. Based on Ivlev’s electivity index, juveniles selected EAM and sponge, while initial phase and terminal phase individuals only selected EAM. Our findings demonstrate that the foraging frequency of the endemic parrotfishS. zelindaeis reduced according to body size and that there is a slight ontogenetic change in feeding selectivity. Therefore, ecological knowledge of ontogenetic variations on resource use is critical for the remaining parrotfish populations which have been dramatically reduced in the Southwestern Atlantic Ocean.
Case Report: Repetitive Surgical Resections for Intestinal Intussusception due to Multiple Ileal Lipomatosis
Authors: Oya Shuichiro , Yamagata Yukinori , Yagi Kouichi , Kiyokawa Takashi , Aikou Susumu , Nishida Masato , Shintani Yukako , Mori Kazuhiko , Yamashita Hiroharu , Nomura Sachiyo , Fukayama Masashi , Seto Yasuyuki
Published: October 2016

Adult intestinal intussusception is a rare disease known to be associated with intestinal tumors. We describe a case requiring partial ileal resection in 2 occasions due to intussusception from multiple lipomatosis. A 45-year-old Japanese man was referred to our hospital for detailed examination after positive fecal blood test results and intermittent abdominal pain. He was diagnosed with intussusception of the ileum due to multiple lipomatosis and underwent partial ileal resection. Three years after the first surgery, he again experienced intermittent abdominal pain and nausea, and was referred to our department. Contrast-enhanced computed tomography at this time also showed intussusception near the ileocecal valve, with several fat-density tumors. He underwent partial ileal resection as an emergency surgery, with the histologic diagnosis confirming ileal multiple lipomatosis. Repeated surgical resections are sometimes required for patients with intestinal intussusception due to lipomatosis, since lipomas not causing symptoms are often left untouched after minimal resection. Close follow-up such as contrast-enhanced CT and small-bowel endoscopy after surgery should be performed regularly so that the patients can avoid emergency surgeries because of the insufficient preoperative examinations.
Cuidados paliativos e bioética: estudo com enfermeiros assistenciais Palliative care and bioethics: study with assistance nurses
Authors: Andrade Cristiani Garrido de , Andrade Maria Ione de , Brito Fabiana Medeiros de , Costa Isabelle Cristinne Pinto , Costa Solange Fátima Geraldo da , Santos Kamyla Félix Oliveira dos
Published: October 2016

Objetivo: Objetivou-se investigar as observâncias éticas utilizadas pelos enfermeiros ao assistirem o paciente sem possibilidades de cura. Métodos: Pesquisa exploratória, de natureza qualitativa, realizada com 28 enfermeiros de um hospital público, localizado na cidade de João Pessoa – PB. Os dados foram coletados por meio de questionário, de agosto a outubro de 2012 e submetidos à técnica de análise de conteúdo. Resultados: As categorias identificadas foram: Cuidados Paliativos: princípios da Bioética ao paciente sem possibilidades de cura e Privacidade e sigilo profissional no âmbito dos cuidados paliativos. Tais categorias indicaram que os profissionais passam a valorizar os princípios da Bioética, assim como a privacidade e o sigilo profissional, utilizando-os como estratégia para auxiliar o cuidar ao paciente sem possibilidades de cura. Conclusão: Espera-se que este estudo subsidie novas investigações, pois ainda são incipientes as pesquisas que abordam a bioética na assistência ao paciente sob cuidados paliativos.
Referência e contrarreferência no cotidiano da atenção à saúde de Divinópolis-MG, Brasil: o suporte às decisões da atenção primária Reference and counter-reference in everyday health care in Minas Gerais, Brazil: the support to decisions of primary care
Authors: Melo Duane Ferreira de Melo Ferreira , Criscuolo Maria Beatriz Rodrigues Criscuolo Rodrigues , Viegas Selma Maria Fonseca
Published: October 2016

Objetivo: Compreender, na percepção dos profissionais e gestores da Atenção Primária à Saúde (APS), o sistema de referência e contrarreferência na atenção à saúde e o suporte às decisões dos profissionais da APS.Métodos: Estudo qualitativo, delineado pelo Estudo de Casos Múltiplos Holísticos, fundamentado na Sociologia Compreensiva do Cotidiano com 41 participantes.  Resultados: O suporte às decisões dos profissionais da APS ao encaminhar os usuários é dependente do fluxo e da regulação das demandas referenciadas; do tempo de espera do usuário para o atendimento; pode ser prejudicado pelos encaminhamentos desnecessários e ilegíveis e pela visão dos profissionais sobre o sistema.Conclusão: A Saúde é um processo social, de construção coletiva, e que precisa vencer o paradigma assistencialista e curativista, o consumo excessivo de consultas com elevado índice de encaminhamentos.
Diagnósticos e intervenções de enfermagem para a pessoa com insuficiência cardíaca descompensada Nursing diagnoses and interventions for people with decompensated heart failure
Authors: Sousa Mailson Marques de , Araújo Angela Amorim de , Freire Maria Eliane Moreira , Oliveira Jacira dos Santos , Oliveira Simone Helena dos Santos
Published: October 2016

Objetivo: identificar os diagnósticos e intervenções de enfermagem a pessoa com insuficiência cardíaca descompensada. Método: estudo descritivo, observacional e transversal do tipo relato de caso clínico. O lócus foi à unidade de terapia intensiva de um hospital terciário de ensino. Utilizou-se a nomenclatura Diagnósticos e Intervenções de Enfermagemdesenvolvida e validada para o referido hospital, conforme termos da Classificação Internacional para a Prática de Enfermagem (CIPE®). Resultados: foram estabelecidos diagnósticos de enfermagem a partir dos sinais e sintomas clínicos durante a admissão do paciente com insuficiência cardíaca descompensada. Os termos identificados mais comuns à doença foram: dispneia, edema, fadiga, débito cardíaco diminuído e arritmia. Conclusão: os diagnósticos/intervenções de enfermagem contribuem para a atuação do enfermeiro na tomada de decisão e manejo do paciente com insuficiência cardíaca descompensada, possibilitando realizar uma sistematização da assistência de enfermagem eficaz e resolutiva.
Facilidades e dificuldades das enfermeiras gerentes na implementação da gerência do cuidado no ambiente hospitalar Facilities managers and difficulties of nurses in the implementation of environmental management of care hospital
Authors: Fernandes Marcelo Costa , Silva Francisca Maria Pereira da , Costa Stéphany Pereira da , Andrade Mayara Evangelista de
Published: October 2016

Objetivo: Analisar as facilidades e dificuldades das enfermeiras gerentes na implementação da gerência do cuidado no ambiente hospitalar. Métodos: Trata-se de um estudo descritivo, com abordagem qualitativa realizado no período de outubro a novembro de 2012, em um hospital público de nível terciário da cidade de Fortaleza-CE. A coleta de dados foi feita através de entrevista semiestruturada, a técnica utilizada para a interpretação dos dados foi à análise de conteúdo. Resultados: Foram encontrados como fatores facilitadores no desenvolvimento da gerência do cuidado o apoio da líder do setor de enfermagem do hospital e a relação dialética entre os membros da equipe. Como fatores impeditivos observaram-se a estrutura física do hospital e a falta de pessoal.  Conclusão: O estudo busca sensibilizar a discussão sobre a gerência do cuidado, pois a articulação entre as atividades gerenciais e de cuidado, é importante para inovação e renovação do processo de trabalho do enfermeiro.
Qualidade da atenção à saúde de portadores de HIV: opinião de profissionais de saúde Quality of health care for HIV patients: health professionals’ view
Authors: Silva Richardson Augusto Rosendo da , Silva Ilisdayne Thallita Soares da , Costa Danyella Augusto Rosendo da Silva , Holanda Jose Rebberty Rodrigo , Dantas Sueleide Cristina , Torres Gilson de Vasconcelos
Published: October 2016

Objetivo: Avaliar a qualidade da assistência prestada a portadores de HIV/Aids, no centro de referência de tratamento da Aids em Natal/RN, na perspectiva de profissionais de saúde. Métodos: Pesquisa avaliativa e quantitativa realizada em um hospital público de Natal/RN em agosto de 2010 a julho de 2011 por meio de entrevista estruturada com os profissionais que atendem os portadores de HIV. Resultados: A avaliação do serviço foi considerada satisfatória por 58,8% dos entrevistados, destacando-se em oito indicadores: apoio oferecido pelo serviço; conveniência dos horários de atendimento; acolhimento; orientações recebidas sobre o tratamento; pontualidade dos profissionais; disponibilidade de antirretrovirais e exames laboratoriais; relacionamento profissional/usuário; acesso ao serviço. Conclusão: Não houve diferença significativa quanto à satisfação em relação aos indicadores: Pontualidade dos profissionais, Conveniência dos horários e Disponibilidade de Exames laboratoriais.Descritores: HIV, Síndrome de imunodeficiência adquirida, Avaliação de serviços de saúde, Satisfação do paciente, Qualidade da assistência à saúde.
Riscos de acidentes com materiais perfurocortantes no setor de urgência de um hospital público Risks of accidents with needlestick materials at the urgency sector of a public hospital
Authors: Silva Francisca Francineide Andrade da , Farias Hercilla Nara Confessor Ferreira de , Costa Romanniny Hévillyn Silva , Souza Nilba Lima de , Carvalho Jovanka Bitencourt Leite de , Silva Richardson Augusto Rosendo da
Published: October 2016

Objetivo: Conhecer os fatores de risco relacionados aos acidentes com material perfurocortante presente no trabalho dos técnicos de enfermagem do setor de atendimento de urgência de um hospital público. Método:Trata-se de um estudo descritivo, de abordagem qualitativa realizado com 14 profissionais. Os dados foram obtidos por meio de entrevistas semi-estruturadas, no período de julho a setembro de 2010 e analisados seguindo a análise temática categorial. Resultados: As categorias emergidas dos discursos dos entrevistados foram: situações de urgências e emergências, adesão aos Equipamentos de Proteção Individual, Descuido e armazenamento inadequado do material perfurocortante. Conclusão: Observou-se que as condições de trabalho no setor de urgência necessitam ser revistas, a fim de oferecer um ambiente adequado para minimizar os riscos ocupacionais durante o desenvolvimento dos procedimentos de enfermagem. Descritores: Saúde do trabalhador, riscos ocupacionais, fatores de risco.
Acesso e vínculo ao tratamento de tuberculose na atenção primária em saúde Acess and link to treatment of tuberculosis in primary health care
Authors: Neves Rubia Rodrigues , Ferro Priscila dos Santos , Nogueira Laura Maria Vidal , Rodrigues Ivaneide Leal Ataíde
Published: October 2016

Objetivo: Avaliar o acesso aos serviços de atenção primária à saúde para o controle da tuberculose, identificando as facilidades e dificuldades, além de analisar a forma como os doentes são acolhidos pela equipe multidisciplinar. Método: Estudo operacional realizado em cinco Unidades Básicas de Saúde do município de Belém. Constituíram a amostra 34 doentes com tuberculose. Estudo aprovado pelo Comitê de Ética em Pesquisa, sob Parecer nº 206.875.Resultados: Constatou-se como facilidades para o acesso ao tratamento a proximidade da Unidade Básica de Saúde à residência dos doentes, o pouco tempo de espera para a consulta e o vínculo com a equipe de saúde. Como dificuldade identificou-se a não realização de visitas domiciliares. Conclusão: O fortalecimento do vínculo, a garantia de acesso e o acolhimento pela equipe de saúde são fatores que podem contribuir para o sucesso do tratamento. Descritores: tuberculose; acesso aos serviços de saúde; atenção primária em saúde.
Cuidados com a pele do recém-nascido internado em unidade de terapia intensiva neonatal: revisão integrativa Skin care to newborns admitted in neonatal intensive care unit: integrative review
Authors: Schaefer Mariga Tania Inez , Naidon Angela Maria , Neves Tatsch Eliane
Published: October 2016

Objetivo: Descrever a natureza e tendência na produção científica de enfermagem sobre a temática de cuidados com a pele do recém-nascido (RN). Método: Realizou-se uma pesquisa bibliográfica, do tipo exploratório descritiva com abordagem qualitativa. Nas bases de dados Lilacs, Bdenf e Pubmed, com seleção de 11 artigos. Resultados: Mediante a leitura dos estudos, foram analisadas seis publicações nacionais e cinco publicações internacionais. Sendo sete estudos de abordagem qualitativa e quatro estudos de abordagem quantitativa. Este estudo possibilitou conhecer cuidados e formas de acompanhamento na avaliação da pele do neonato. Conclusão: evidenciaram-se poucos estudos sobre a temática de cuidados com a pele do recém-nascido, sendo necessários estudos que colaborem para a elaboração e revisão de protocolos de assistência direcionados a prevenção de agravos ao recém-nascido.
Análise dos acidentes de trabalho na equipe de enfermagem: uma revisão integrativa Analysis of the accidents at work in the nursing staff: an integrative review
Authors: Da Silva Patrick Leonardo Nogueira , Carvalho Larissa Mendes , De Mendonça José Márcio Girardi , Gonçalves Renata Patrícia Fonseca , Souto Simone Guimarães Teixeira , Torres Marcelo Rocha
Published: October 2016

Objetivo: Analisar os acidentes de trabalho na equipe de enfermagem. Método: Revisão integrativa na qual a amostra de artigos captados estava disponível em periódicos nacionais e internacionais e se encontravam nas bases do SCIELO e LILACS, durante os anos de 2007-2011. Resultados: Encontrou-se 212 publicações, sendo que 18 foram selecionados após aplicação dos critérios de inclusão. Encontrou-se um maior número de publicações na SCIELO (61%) e houve igualdade no número de publicações nos anos de 2007-2009 e 2011 (22,2%). Após a análise, percebeu-se que a equipe de enfermagem é bastante atingida pelos acidentes de trabalho, e que os materiais perfurocortantes são os principais vilões nesse sentido, e o material biológico se faz bastante presente. Conclusão: Conclui-se que não somente os trabalhadores devem ter a ciência dos cuidados em seu local de trabalho, mas também as instituições de saúde em cumprir suas obrigações visando à proteção do trabalhador.
Cateter central de inserção periférica em neonato: revisão integrativa da literatura Central catheter of peripherally insertion in neonates: integrative literature review
Authors: Rangel Regiane Josy Mediote , Castro Denise Silveira de , Primo Candida Caniçali , Zandonade Eliana , Christoffel Marialda Moreira , Amorim Maria Helena Costa
Published: October 2016

OBJETIVO: Avaliar as evidências publicadas acerca das práticas no uso do Cateter Venoso Central de Inserção periférica (PICC) em Recém-Nascido.MÉTODO: Revisão integrativa que pesquisou as bases de dados LILACS, MEDLINE e COCHRANE nos anos de 2008 a 2012.RESULTADOS: Selecionaram-se 41 artigos, os quais foram classificados, em nível de evidência, dois (4,9%) nível 1, quatro (9,8%) nível 2, treze (31,7%) nível 3, quatorze (34,2%) nível 4, sete (17%) nível 5, e um (2,4%) nível 6. Foram agrupados em categorias: complicações gerais, infecção de corrente sanguínea relacionada ao cateter, descrição da utilização e práticas de inserção e manutenção.CONCLUSÃO: As evidências encontradas ressaltaram a importância da educação permanente para inserção, manutenção e aplicação de novas tecnologias para minimizar os efeitos indesejados do uso do PICC. Observou-se escassez de produção nacional de estudos que retratem fortes níveis de evidências. DESCRITORES: Cateterismo venoso central. Recém-nascido. Unidades de Terapia Intensiva Neonatal. Enfermagem Neonatal.
A diagnostic study on heavy rainfall induced by Typhoon Utor (2013) in South China: 1. Rainfall asymmetry at landfall
Authors: Meng Weiguang , Wang Yuqing
Published: October 2016

After striking the Philippines on 11 August 2013, Typhoon Utor made its second landfall over southern South China on 14 August and brought heavy rainfall, causing widespread damages after its landfall. The heavy rainfall associated with Utor includes three main episodes: rainfall at landfall, postlandfall rainfall in the inner core region, and postlandfall rainfall induced by the intensification of southwesterly monsoon flow. In part 1 the rainfall at landfall is analyzed and diagnosed using the surface mesonet observations and the high‐resolution European Centre for Medium‐Range Weather Forecasting Interim reanalysis (ERA‐Interim) data. Results show that when Utor approached and made landfall over the southern coast of South China, it was embedded in a deep‐layer (200–850 hPa) easterly northeasterly vertical wind shear (VWS) environment with heavy rainfall mostly occurring downshear left in its southwestern quadrant. Under a favorable environment with moderate convective available potential energy and moderate low‐level VWS, a surface cold pool was found in the west‐southwestern quadrants of Utor triggered by the middle‐lower tropospheric dry air intrusion from inland to the north. Both frontogenesis and quasi‐balanced, ageostrophic Q‐vector diagnostics demonstrate that the quasi‐balanced forcing near the surface cold cool contributed to the enhancement of convection in the west‐southwestern quadrants of Utor. It is concluded that the environmental VWS and the consequent surface cold pool dynamics play an important role in rainfall asymmetry in Utor when it made landfall over the southern coast of South China.
Climatic drivers for multidecadal shifts in solute transport and methane production zones within a large peat basin
Authors: Glaser Paul H. , Siegel Donald I. , Chanton Jeffrey P. , Reeve Andrew S. , Rosenberry Donald O. , Corbett J. Elizabeth , Dasgupta Soumitri , Levy Zeno
Published: October 2016

Northern peatlands are an important source for greenhouse gases, but their capacity to produce methane remains uncertain under changing climatic conditions. We therefore analyzed a 43 year time series of the pore‐water chemistry to determine if long‐term shifts in precipitation altered the vertical transport of solutes within a large peat basin in northern Minnesota. These data suggest that rates of methane production can be finely tuned to multidecadal shifts in precipitation that drive the vertical penetration of labile carbon substrates within the Glacial Lake Agassiz Peatlands. Tritium and cation profiles demonstrate that only the upper meter of these peat deposits was flushed by downwardly moving recharge from 1965 to 1983 during a Transitional Dry‐to‐Moist Period. However, a shift to a moister climate after 1984 drove surface waters much deeper, largely flushing the pore waters of all bogs and fens to depths of 2 m. Labile carbon compounds were transported downward from the rhizosphere to the basal peat at this time producing a substantial enrichment of methane in Δ14C with respect to the solid‐phase peat from 1991 to 2008. These data indicate that labile carbon substrates can fuel deep production zones of methanogenesis that more than doubled in thickness across this large peat basin after 1984. Moreover, the entire peat profile apparently has the capacity to produce methane from labile carbon substrates depending on climate‐driven modes of solute transport. Future changes in precipitation may therefore play a central role in determining the source strength of peatlands in the global methane cycle.
Time scales of foam stability in shallow conduits: Insights from analogue experiments
Authors: Spina L. , Scheu B. , Cimarelli C. , Arciniega‐Ceballos A. , Dingwell D.B.
Published: October 2016

Volcanic systems can exhibit periodical trends in degassing activity, characterized by a wide range of time scales. Understanding the dynamics that control such periodic behavior can provide a picture of the processes occurring in the feeding system. Toward this end, we analyzed the periodicity of outgassing in a series of decompression experiments performed on analogue material (argon‐saturated silicone oil plus glass beads/fibers) scaled to serve as models of basaltic magma. To define the effects of liquid viscosity and crystal content on the time scale of outgassing, we investigated both: (1) pure liquid systems, at differing viscosities (100 and 1000 Pa s), and (2) particle‐bearing suspensions (diluted and semidiluted). The results indicate that under dynamic conditions (e.g., decompressive bubble growth and fluid ascent within the conduit), the periodicity of foam disruption may be up to several orders of magnitude less than estimates based on the analysis of static conditions. This difference in foam disruption time scale is inferred to result from the contribution of bubble shear and bubble growth to inter‐bubble film thinning. The presence of particles in the semidiluted regime is further linked to shorter bubble bursting times, likely resulting from contributions of the presence of a solid network and coalescence processes to the relative increase in bubble breakup rates. Finally, it is argued that these experiments represent a good analogue of gas‐piston activity (i.e., the periodical rise‐and‐fall of a basaltic lava lake surface), implying a dominant role for shallow foam accumulation as a source process for these phenomena.
Hydrothermal fluid venting in the offshore sector of Campi Flegrei caldera: A geochemical, geophysical, and volcanological study
Authors: Di Napoli R. , Aiuppa A. , Sulli A. , Caliro S. , Chiodini G. , Acocella V. , Ciraolo G. , Di Vito M.A. , Interbartolo F. , Nasello C. , Valenza M.
Published: October 2016

The ongoing unrest at the Campi Flegrei caldera (CFc) in southern Italy is prompting exploration of its poorly studied offshore sector. We report on a multidisciplinary investigation of the Secca delle Fumose (SdF), a submarine relief known since antiquity as the largest degassing structure of the offshore sector of CFc. We combined high‐resolution morphobathymetric and seismostratigraphic data with onshore geological information to propose that the present‐day SdF morphology and structure developed during the initial stages of the last CFc eruption at Monte Nuovo in AD 1538. We suggest that the SdF relief stands on the eastern uplifted border of a N‐S‐trending graben‐like structure formed during the shallow emplacement of the Monte Nuovo feeding dike. We also infer that the high‐angle bordering faults that generated the SdF relief now preferentially allow the ascent of hot brines (with an equilibrium temperature of 179°C), thereby sustaining hydrothermal degassing on the seafloor. Systematic vertical seawater profiling shows that hydrothermal seafloor venting generates a sizeable CO2, pH, and temperature anomaly in the overlying seawater column. Data for the seawater vertical profile can be used to estimate the CO2 and energy (heat) outputs from the SdF area at ∼50 tons/d (∼0.53 kg/s) and ∼80 MW, respectively. In view of the cause‐effect relationship with the Monte Nuovo eruption, and the substantial gas and energy outputs, we consider that the SdF hydrothermal system needs to be included in monitoring programs of the ongoing CFc unrest.
Volcano dome dynamics at Mount St. Helens: Deformation and intermittent subsidence monitored by seismicity and camera imagery pixel offsets
Authors: Salzer Jacqueline T. , Thelen Weston A. , James Mike R. , Walter Thomas R. , Moran Seth , Denlinger Roger
Published: October 2016

The surface deformation field measured at volcanic domes provides insights into the effects of magmatic processes, gravity‐ and gas‐driven processes, and the development and distribution of internal dome structures. Here we study short‐term dome deformation associated with earthquakes at Mount St. Helens, recorded by a permanent optical camera and seismic monitoring network. We use Digital Image Correlation (DIC) to compute the displacement field between successive images and compare the results to the occurrence and characteristics of seismic events during a 6 week period of dome growth in 2006. The results reveal that dome growth at Mount St. Helens was repeatedly interrupted by short‐term meter‐scale downward displacements at the dome surface, which were associated in time with low‐frequency, large‐magnitude seismic events followed by a tremor‐like signal. The tremor was only recorded by the seismic stations closest to the dome. We find a correlation between the magnitudes of the camera‐derived displacements and the spectral amplitudes of the associated tremor. We use the DIC results from two cameras and a high‐resolution topographic model to derive full 3‐D displacement maps, which reveals internal dome structures and the effect of the seismic activity on daily surface velocities. We postulate that the tremor is recording the gravity‐driven response of the upper dome due to mechanical collapse or depressurization and fault‐controlled slumping. Our results highlight the different scales and structural expressions during growth and disintegration of lava domes and the relationships between seismic and deformation signals.
Polycrystal anelasticity at near‐solidus temperatures
Authors: Yamauchi Hatsuki , Takei Yasuko
Published: October 2016

Elasticity, anelasticity, and viscosity of polycrystalline aggregates were measured at the near‐solidus temperatures ranging from below to above the solidus temperature (Tm). The result shows that the mechanical effects of the partial melting are twofold; changes just below the solidus temperature in the absence of melt and changes at the solidus temperature due to the onset of partial melting. As homologous temperature (T/Tm) increases from about 0.92 to 1, high‐frequency part of the attenuation spectrum significantly grows. Viscosity of the grain boundary diffusion creep is also reduced in this temperature range. These changes are caused by a solid‐state mechanism and have a large amplitude even for the samples which can generate very small amounts of melt at the solidus temperature. At the onset of melting, further increases in the elastic, anelastic, and viscous compliances occur. These changes are caused by the direct effects of the melt phase and are very small for the samples with very small melt fractions. Mechanical properties of a partially molten aggregate are determined by these twofold changes, and when melt fraction is small, the former changes are dominant. We performed a parameterization of the present experimental results and applied the obtained empirical formula to the seismic tomographic data in the upper mantle. The present model explains well the steep reduction of the seismic shear wave velocity in the oceanic lithosphere just below the solidus temperature.