Dissertations / Theses on the topic 'Burns Unit'

Made available in DSpace on 2014-06-11T19:28:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-20Bitstream added on 2014-06-13T20:57:52Z : No. of bitstreams: 1 sousa_al_me_botfm.pdf: 400232 bytes, checksum: 413adb726a7dddccb7a08b641c1afb97 (MD5)<br>O objetivo deste estudo foi compreender a experiência da equipe multiprofissional em uma unidade de queimados do interior paulista, visando ampliar o conhecimento sobre o tema apresentado, para subsidiar os profissionais que trabalham na referida unidade, melhorar a qualidade da assistência oferecida aos pacientes, bem como subsidiar e do ensino na área. Trata-se de um estudo descritivo, prospectivo e transversal, de abordagem qualitativa. Foram realizadas 27 entrevistas não diretivas e áudio gravadas, junto à equipe multiprofissional da unidade de tratamento de queimaduras (UTQ) do Hospital Estadual de Bauru, tendo como pergunta norteadora: Como tem sido a sua experiência trabalhando em uma unidade de queimados? A abordagem metodológica foi a de organização dos dados, baseada na Análise de Discurso do Sujeito Coletivo (DSC). Os dados obtidos geraram 21 ideias centrais no total, e destas, oito foram semelhantes para todos os entrevistados e 13 diferentes. Na análise dos discursos, pôde-se perceber a diversidade de sentimentos que afloram nos profissionais, desde a satisfação em trabalhar com esta clientela até sentimentos de pesar, incapacidade, fragilidade emocional, necessidade de suporte psicológico; bem como aspectos relacionados ao tratamento em si do queimado, como a importância do controle da dor. Compreendeu que a equipe de enfermagem é mais vulnerável à sobrecarga emocional gerada, quando comparada com as demais categorias profissionais. Outro aspecto a ser destacado é o controle da dor, principalmente na realização dos procedimentos inerentes ao tratamento. Diante disso, se destaca a importância de se oferecer aos membros da equipe multiprofissional o apoio necessário, para que o trabalho gere menos estresse e angústia e ressalta-se o uso correto do protocolo, que poderá contribuir para amenizar o sofrimento de ambos, equipe e pacientes, mas principalmente para estes últimos<br>The objective of this study was to understand the experience of the multidisciplinary team in a burns unit in the state of São Paulo, in order to increase the knowledge on the subject presented to support professionals working in the unit, improving the quality of care offered to patients as well as subsidize the education in the area. It is a descriptive, prospective cross-sectional, qualitative approach. 27 interviews were conducted with the non-directive taped together with the team of the multidisciplinary treatment unit burns (burn care unit), Bauru State Hospital, with the guiding question: How has been your experience working in a burn unit? The methodological approach was to organize the data based on analysis of the Collective Subject Discourse (CSD), 21 central ideas being generated in total and of these, eight were similar for all respondents and 13 different In a speech analysis it was possible to perceive the range of feelings that arose in professional satisfaction from working with these clients to feelings of grief, disability, emotional fragility, the need for psychological support, as well as aspects related to the treatment itself burned, the importance of pain control He realized that the nursing staff is more vulnerable to emotional overload generated when compared with the other professional categories. Another aspect to be highlighted is the control of pain, especially in procedures relating to treatment Therefore, we highlight the importance of providing members of the multidisciplinary team support needed to manage the job less stress and anxiety and it emphasizes the correct use of the protocol to help alleviate the suffering of both staff and patients but mainly for the latter

Orientador: Janete Pessuto Simonetti<br>Coorientador: Silvia Cristina Mangini<br>Banca: Magda Cristina Q. Dell Acqua<br>Banca: Lídia Aparecida Rossi<br>Resumo: O objetivo deste estudo foi compreender a experiência da equipe multiprofissional em uma unidade de queimados do interior paulista, visando ampliar o conhecimento sobre o tema apresentado, para subsidiar os profissionais que trabalham na referida unidade, melhorar a qualidade da assistência oferecida aos pacientes, bem como subsidiar e do ensino na área. Trata-se de um estudo descritivo, prospectivo e transversal, de abordagem qualitativa. Foram realizadas 27 entrevistas não diretivas e áudio gravadas, junto à equipe multiprofissional da unidade de tratamento de queimaduras (UTQ) do Hospital Estadual de Bauru, tendo como pergunta norteadora: Como tem sido a sua experiência trabalhando em uma unidade de queimados? A abordagem metodológica foi a de organização dos dados, baseada na Análise de Discurso do Sujeito Coletivo (DSC). Os dados obtidos geraram 21 ideias centrais no total, e destas, oito foram semelhantes para todos os entrevistados e 13 diferentes. Na análise dos discursos, pôde-se perceber a diversidade de sentimentos que afloram nos profissionais, desde a satisfação em trabalhar com esta clientela até sentimentos de pesar, incapacidade, fragilidade emocional, necessidade de suporte psicológico; bem como aspectos relacionados ao tratamento em si do queimado, como a importância do controle da dor. Compreendeu que a equipe de enfermagem é mais vulnerável à sobrecarga emocional gerada, quando comparada com as demais categorias profissionais. Outro aspecto a ser destacado é o controle da dor, principalmente na realização dos procedimentos inerentes ao tratamento. Diante disso, se destaca a importância de se oferecer aos membros da equipe multiprofissional o apoio necessário, para que o trabalho gere menos estresse e angústia e ressalta-se o uso correto do protocolo, que poderá contribuir para amenizar o sofrimento de ambos, equipe e pacientes, mas principalmente para estes últimos<br>Abstract: The objective of this study was to understand the experience of the multidisciplinary team in a burns unit in the state of São Paulo, in order to increase the knowledge on the subject presented to support professionals working in the unit, improving the quality of care offered to patients as well as subsidize the education in the area. It is a descriptive, prospective cross-sectional, qualitative approach. 27 interviews were conducted with the non-directive taped together with the team of the multidisciplinary treatment unit burns (burn care unit), Bauru State Hospital, with the guiding question: How has been your experience working in a burn unit? The methodological approach was to organize the data based on analysis of the Collective Subject Discourse (CSD), 21 central ideas being generated in total and of these, eight were similar for all respondents and 13 different In a speech analysis it was possible to perceive the range of feelings that arose in professional satisfaction from working with these clients to feelings of grief, disability, emotional fragility, the need for psychological support, as well as aspects related to the treatment itself burned, the importance of pain control He realized that the nursing staff is more vulnerable to emotional overload generated when compared with the other professional categories. Another aspect to be highlighted is the control of pain, especially in procedures relating to treatment Therefore, we highlight the importance of providing members of the multidisciplinary team support needed to manage the job less stress and anxiety and it emphasizes the correct use of the protocol to help alleviate the suffering of both staff and patients but mainly for the latter<br>Mestre

Rural to urban migration to major cities in South Africa continues to lead to the proliferation of informal settlements. There is little recent published data on the epidemiology of adult burns in the Western Cape, South Africa. The prediction of outcome in severe burns is important to aid in clinical decision making, improve scarce resource allocation and allow comparisons between different burn units. Age, burn size and the presence of inhalational injury have been determined to be the most important factors in predicting mortality. There is little published data on the outcome of severe burns in the Southern African region. A retrospective review of patients on the Burn Unit database was undertaken, looking at patients admitted to the Burn Unit between January 2003 and December 2008. This study discusses the characteristics and outcome of patients who were treated at the Tygerberg Burn unit. A total of 1908 patients were admitted to the burn unit during the 6 year period under review. Most fatal injuries occurred in the 20 to 40 year age group. Injuries due to shack fires and fuel stoves comprised 21% (399) of all admissions. Mortality due to these injuries comprised 28% (137) of total mortality. Gas stoves accounted for 24% with kerosene stoves accounting for 71% of injuries. The burn death rate in this study (25%) was found to have increased dramatically from the last audit done from 1986 to 1995 in which a burn death rate of 7.5% was observed. Reasons for this are explored. A stepwise logistic regression analysis was done on the derivation cohort where age, gender, TBSA% and presence of inhalational injury were identified as significant for predicting death. A mortality prediction model is presented which was internally validated on the validation cohort. An easy to use EXCEL calculator was created to estimate the probability of death. Shack fires and injuries due to fuel stoves are a common reason for admission to the burn unit and mostly involve young male individuals. Other research from the Southern African region does not mention shack fires as a separate entity making it difficult to obtain an accurate idea of the scale of the problem. Their injuries are severe with a high mortality. The use of kerosene stoves are a major contributing factor. Recommendations include enforceable legislation to promote safer stove design, research into safer bio fuels and materials for building shacks as well promoting fire safety among schoolchildren in the community. Further research is needed to determine the impact of HIV/AIDS on the outcome of acute burn injuries within the Southern African region. Further interventions are needed to tackle this serious public health issue. A mortality prediction model is proposed for use in the burn unit, but needs external validation before being adopted into clinical practice. Further research is needed to improve data capturing in the burn unit.

The consequences of sustaining a burn are potentially devastating to a person. Even a relatively smooth recovery from a burn injury can be traumatic to both the body and mind of the patient. Complications, such as infection, only serve to augment this traumatic period through prolonging recovery and worsening outcome. Notwithstanding the great advances in burn treatment made during the last half century, the presence of infection has remained a major influence in dictating the path of recovery for an individual. In fact, advances in resuscitation, surgery, and intensive care support have only served to emphasise the role played by infection. Patients with even severe burns are now surviving their initial injury and remaining in hospital for prolonged periods of rehabilitation. Coupled with a worldwide increase in multi-drug resistant bacteria, and an endemic overuse of increasingly complex regimens of antibacterials, the threat from nosocomial pathogens is greater than ever. As bacteria become increasingly resistant to antibiotics, novel bactericidal technologies must be explored. Furthermore, emphasis has shifted from treatment to prevention, specifically prevention of cross-contamination between patients. The High-Intensity Narrow-Spectrum light Environmental Decontamination System (HINS-light EDS) is one such weapon in the armamentarium against cross-infection. It works using a safe blue light to kill bacteria in the air and on surfaces around patients and staff. When considering the setting for the first clinical trials of the effectiveness of this light, no area was considered to be more appropriate than the burns unit, due to the high density and great significance of bacteria in this unique environment. This thesis has not just examined the HINS-light EDS. It has taken a holistic view through considering every step of the route by which one nosocomial strain of bacteria is passed from burns patient to burns patient: the cycle of cross-contamination. Every step in this cycle has been examined in order to determine when the HINS-light EDS could have its maximum efficiency. This has been coupled with extensive clinical studies of the HINS-light EDS in a variety of inpatient and outpatient scenarios in the burns unit, to determine the optimal utilisation of this technology and achieve maximum impact on bacterial populations in the environment.

The purpose of this historiographical nursing study was to explore Australian Burn Wound Care from a nursing perspective, at two periods of time. It was the intention of the author to explore practices at the inception of specialised burns units, from the 1950's, presenting an historical perspective, and at the present time, May 1995. Eleven burns units across Australia participated in the study. There were 22 participants in the research sample. Each burns unit identified the first Charge Nurse (n =11) and the current Clinical Nurse Specialist (n =11), to be involved in the data collection process. The conceptual framework for this study incorporates the Reflective Cycle (Gibbs, 1988) succinctly incorporating the 'who', 'where', 'why', 'when' and 'what' aspects of the historical method of inquiry. An interview guide, used in conjunction with three photographs depicting burn wounds, provided interview structure for the data collection. A variety of historical data were gathered and analysed. These included scientific medical and nursing texts, foundation minutes, reports and conference papers of Australian and New Zealand Bums Association, to gain perspective of Australian Bum Wound Care. However, the data collated from 1950 to 1996 uncovered no written material on bum wound care. The information available was obtained exclusively from the indepth interviews. The data collated for the current perspective included hospital/ burns unit protocols and indepth interviews with key nursing personnel. A field trip facilitated the data collection, enabling semi-structured, audiotaped interviews in person and the opportunity to visit hospital libraries. The findings of the study have been organised to show bum wound care practices endorsed by Australian burns units, at the inception of specialised facilities, and at the present time.

Sepsis and multi-organ failure are the most frequently reported causes of death in burn injuries. Their early identification allows therapies and resources to be targeted in a more effective and efficient way. Due to its frequent antibiotic drug resistance Acinetobacter baumannii (MRAB) is increasingly causing a problem in burns units. New strategies need to be found to combat infection and sepsis in the burn ICU. This study examines the potential of the Albumin Creatinine Ratio, a marker of systemic endothelial dysfunction in predicting outcomes, sepsis and multi-organ failure; the role of Acinetobacter in causing organ failure; and explores for the presence of the cathelicidin, LL-37 in the burn wound and examines it potential utility for treating infection and sepsis. It was found that ACR on admission and at 48 hours is predictive of patient outcomes and the development of sepsis, and may be of use predicting multi-organ failure. Multi-organ failure occurs more frequently in MRAB patients compared to those patients with drug sensitive Acinetobacter baumannii. The number of agency nursing staff and work intensity are possible contributing factors in MRAB acquisition. LL-37 has been found in both acute burn wounds as well as in the grafted healing burn wound and is active against drug resistant Acinetobacter baumannii. ACR can therefore identify those patients at risk of sepsis and may have a role in predicting multi-organ failure. MRAB acquisition in the burns intensive care unit is a significant cause for concern as patients are more likely to suffer from multi-organ failure as well as prolonging their hospital stay and resulting in poorer outcomes. LL-37 has many functions and importantly plays a role in the body’s innate immune system. In the era of increasing antibiotic resistance it may provide a novel therapeutic role in treating MRAB infection.

nÃo hÃ<br>The knowledge about the cultural and familiar view of accidents with burns in children allow to contribute the creation of strategies that value not only the cure of the sickness, yet conditions of prevention of new accidents with children, but also to promote conditions of dialogue between family and health professionals essential to humanization in Burn Specialized Centers. This study had as objective to understand as the beliefs, values and style of life of the families influence in the care of children victims of burns intern in a Burnt Treatment Center, in Fortaleza, CearÃ; and characterize families of burnt children intern from April to August of 2008. It is an ethnographic approach accomplish in a Hospital Institution of Urgency and Emergency, where there is a Burnt Treatment Center in the city of Fortaleza-Cearà from April to August of 2008, which has as key informers the families of burnt children. The whole collect and analysis process was based in ethnonursery proposed by Leininger (1991), to gather the data were made use of Observation-Participation-Reflection pattern (O.P.R.). In the data arrangement and analysis the Ethnonursery was the guide in the following stages: gathering information and documents; to cluster the storage data in the field day book; contextual or standard analysis and identification of main themes, discovery of research, theoretical formulations and warnings. From the ethnographic analysis sprout three cultural rules: 1) The child is very naughty, the families aim the curiosity of the children as the cause of the accident with burns, not knowing the stages of growing and development of the children, blame the infant for the burn. 2) She washed with water and brought to the hospital, the families think that to wash the burn with water is a way to render pleasant the pain of the burn and to forward the child to a hospital, to establish a way to offer a right care after the accident; 3) to watch more out for, it shows the significance to prevent other accidents with burns and to drive away children of the danger, as to take them away of the kitchen. It was perceived that mothers in spite of having their cultural knowledge, they learn a lot during the study, for as they have much uncertainty that day by day was enlightened and made them think about their behavior with their children. Therefore, we conclude that is essential the cultural approach of the professional to take care of children victims of burns and the Health Education must be available as strategies of welcome that consent the family and the child can feel safe<br>O conhecimento sobre a Ãtica cultural e familiar dos acidentes com queimaduras em crianÃas permite contribuir para a criaÃÃo de estratÃgias que valorizem nÃo apenas a cura da doenÃa, mas condiÃÃes de prevenÃÃo de novos acidentes com crianÃas, bem como promover o diÃlogo entre famÃlia e profissionais de saÃde essenciais para a humanizaÃÃo em Centros Especializados de Queimaduras. O presente estudo objetivou compreender como as crenÃas, valores e estilo de vida das famÃlias influenciam no cuidado de crianÃas vÃtimas de queimaduras internadas em um Centro de Tratamento de Queimados e caracterizar famÃlias de crianÃas queimadas internadas no perÃodo de abril a maio de 2008. à uma pesquisa etnogrÃfica realizada em uma InstituiÃÃo Hospitalar de UrgÃncia e EmergÃncia, na qual dispÃem de um Centro de Tratamento de Queimados em Fortaleza, CearÃ, no perÃodo de abril a agosto de 2008, que teve como informantes-chaves as famÃlias de crianÃas queimadas. Todo o processo de coleta e anÃlise foi embasado na Etnoenfermagem proposto por Leininger (1991), para a coleta de dados foi utilizado o modelo de ObservaÃÃo-participaÃÃo-reflexÃo (O.P.R.). Na ordenaÃÃo e anÃlise dos dados a Etnoenfermagem serviu como norteadora nas seguintes etapas: coleta de descritos e documentos; agrupar os dados armazenados no diÃrio de campo; anÃlise contextual ou padrÃo e identificaÃÃo de temas principais; descobertas de pesquisa; formulaÃÃes teÃricas e recomendaÃÃes. Das anÃlises etnogrÃficas surgiram trÃs domÃnios culturais: 1) A crianÃa à muito danada as famÃlias colocam a curiosidade das crianÃas como a causa do acidente com queimaduras, nÃo conhecendo as fases de crescimento e desenvolvimento dos filhos, culpam o infante pela queimadura; 2) Lavou com Ãgua e levou para o hospital as famÃlias consideram que lavar a queimadura m Ãgua à uma forma de amenizar a dor da queimadura e encaminhar o filho a uma instituiÃÃo hospitalar constitui uma forma de oferecer um cuidado correto apÃs o acidente; 3) Ter mais cuidado a importÃncia de prevenir outros acidentes com queimaduras e afastar as crianÃas dos fatores de risco, como: tirÃ-las da cozinha. Foi percebido que durante o estudo as mÃes, apesar de terem seus conhecimentos culturais, aprenderam muito, pois tinham muitas dÃvidas que gradativamente eram esclarecidas e faziam com que refletissem sobre seu comportamento com seus filhos. Portanto, considera-se imprescindÃvel a abordagem cultural do profissional para cuidar de crianÃas vÃtimas de queimaduras e que a EducaÃÃo em SaÃde deve ser utilizada como estratÃgia que permita que tanto a famÃlia, quanto a crianÃa possam se sentir segura

Introdução: A assistência hospitalar a pacientes portadores de queimaduras é altamente dispendiosa devido aos recursos humanos, materiais e estruturais necessários à sua viabilização. O conhecimento financeiro relativo a essa temática ainda é escasso, especialmente no que tange aos custos dos procedimentos executados por profissionais de enfermagem a pacientes, grandes queimados, em condições críticas. Objetivo: Identificar o custo direto médio (CDM) dos procedimentos realizados, com maior frequência, por profissionais de enfermagem, a pacientes grandes queimados internados em uma Unidade de Terapia Intensiva de Queimaduras (UTIQ). Método: Esta pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único, foi conduzida na UTIQ da Unidade de Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem na execução dos procedimentos, objeto de estudo, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais e soluções/medicamentos. Para a realização dos cálculos utilizou-se a moeda brasileira (R$). Resultados: A partir de 1354 observações, relativas a 12 procedimentos frequentemente realizados na UTIQ, obteve-se o CDM de R$ 1,88 (DP=1,04) para controle dos sinais vitais; R$ 28,78 (DP=69,74) para administração de medicamentos via intravenosa; R$ 16,97 (DP=7,92) para mensuração de diurese; R$ 2,68 (DP=1,20) para verificação de glicemia capilar; R$ 6,71(DP=2,20) para administração de medicamentos via sonda nasoenteral; R$ 50,07 (DP=11,89) para higiene íntima no leito; R$ 3,64 (DP=2,01) para auxílio alimentação; R$ 55,88 (DP=18,98) para banho no leito/arrumação da cama; R$ 287,11 (DP=372,87) para curativo; R$ 6,65 (DP=2,09) para higiene oral; R$ 3,13 (DP=1,08) para administração de medicamentos via oral e R$ 8,51 (DP=1,79) para administração de medicamentos via subcutânea. Conclusão: A apuração dos custos dos recursos consumidos nos procedimentos requeridos pelos pacientes, grandes queimados, em UTI, pode fundamentar as tomadas de decisão gerenciais subsidiando a sua eficiência alocativa, evitando a ocorrência de desperdícios e, quando possível, indicando estratégias de contenção/minimização de custos sem prejuízos à qualidade da assistência de enfermagem.<br>Introduction: Hospital care for critical burn patients is highly costly due to human, material and structural resources required for its viability. The financial knowledge concerning this subject is still scarce, especially in regard to the cost of procedures performed by nurses in critical burn patients. Objective: To identify the average direct cost (ADC) of the nursing procedures carried out with greater frequency for burn patients admitted into the burn intensive care unit (BICU). Methodology: This quantitative exploratory and descriptive single case study was conducted in BICU at the Burn Unit of the Hospital das Clinicas of the Faculty of Medicine, Universidade de Sao Paulo. The ADC was calculated by multiplying the time (chronometering) spent by nursing professionals in procedures, object of this study, by the unit cost of direct labor adding to the cost of materials and solutions/drugs. For the purposes of the calculation, the Brazilian currency (R$) was used. Results: Based on 1354 observations related to 12 procedures often performed in BICU, it was obtained the ADC of R$ 1.88 (SD=1.04) for \"control the vital signs\"; R$ 28.78 (SD=69.74) for \"administering medication intravenously\"; R$ 16.97 (SD=7.92) for \"measurement of diuresis\"; R$ 2.68 (SD=1.20) to \"check Capillary Blood Glucose\"; R$ 6.71 (SD=2.20) for \"drug administration via nasogastric tube\"; R$ 50.07 (SD=11.89) for \"patient intimate hygiene; R$ 3.64 (SD=2.01) for \"food aid\"; R$ 55.88 (SD=18.98) for \"bed bathing/make the bed\"; R$ 287.11 (SD=372.87) for \"dressing\"; R$ 6.65 (SD=2.09) for \"oral hygiene\"; R$ 3.13 (SD=1.08) for \"oral drug administration\" and R$ 8.51 (SD=1.79) for \"drug administration subcutaneously\". Conclusion: The calculation of the resource costs spent in the procedures required by critical burn patients, in ICU, justify the decision making of subsidizing its allocative efficiency, avoiding the occurrence of waste and, when possible, indicating control strategies/minimizing strategy costs without impairing the quality of nursing care

Thesis (MPhil)--Stellenbosch University, 2012.<br>ENGLISH ABSTRACT: Rehabilitation therapists are at risk for burnout as a result of their emotionally challenging and stressful jobs. No South African studies could be found that focus on burnout in therapists who work in the field of rehabilitation. This study attempted to determine the prevalence of burnout amongst a select group of therapists in South Africa i.e. therapy staff employed by Life Rehabilitation. In addition, contributing factors to burnout in this environment, current management of the problem and suggestions for future management were explored. A descriptive design which used both quantitative and qualitative methods was utilised. Forty-nine therapists and seven managers participated in the study. No sampling was done. Quantitative data was collected through a demographic coding sheet and the Maslach Burnout Inventory (MBI). Data were statistically analysed and a p value of < 0.05 was deemed statistically significant. Interview schedules were used to guide the qualitative interviews on participants’ understanding of burnout, contributing factors, its impact on the therapists and company as well as management strategies. Qualitative data was analysed according to the inductive method. Regarding burnout prevalence in each of the subsections of the MBI, 57.14% of the therapy staff had high levels of Emotional Exhaustion (EE), 20.4% reported depersonalisation (DP) and 38.77% had low levels of Personal Accomplishment (PA). The variables associated with high burnout scores were: male gender (p=0.0238) (PA), absence of children (P=0.02994) (EE), (p=0.03895) (PA), ≤ four years tertiary education (p=0.03640) (PA), ≤ R15 000 income (p=0.02262) (PA), not working weekends (p=0.02882) (DP), none or poor coping skills (p=0.03180) (EE), high overwhelming work load (p=0.03972) (EE), (p=0.01227) (DP), overwhelming/too small patient load (p=0.02365) (EE), high administration load (p=0.00302) (PA), seldom achievable deadlines (p=0.03693) (DP), postponed contact with patients (p=0.02023) (DP), (p=0.01164) (PA) and a poor work environment (p=0.02162) (EE), (p=0.04034) (DP). The qualitative data identified the following factors as causes of burnout: relationship challenges, lack of planning and coping skills, personality type, disempowerment, the nature of rehabilitation work, private health care environment, ethical dilemmas, time pressures, lack of rewards, lack of space and resources, uncertainty/change, lack of support from management and high workload. The following burnout management strategies emerged from the qualitative data: psycho-social intervention, team building, decrease in workload/increase in staff, adjustment of administrative workload, acknowledgement of staff through salaries and other rewards, adjustment to leave package, improved orientation and induction of staff, “time-out” opportunities, development of staff and managers, improved treatment facilities, feedback from discharged patients as well as implementation of burnout monitoring systems and development of a burnout policy and burnout management system. Recommendations to Life Rehabilitation focus on practical strategies regarding the detection, prevention and management of burnout in therapists. The groundwork has been done through this research. Successful strategic implementation will depend on the leadership of the organisation and without these key players and all the other role players involved, commitment in terms of time, money and allocation of resources it will remain an academic exercise.<br>AFRIKAANSE OPSOMMING: Die gevaar bestaan dat gesondheidswerkers hulle kan “uitbrand” as gevolg van die emosioneel uitmergelende aspekte van hul werk en die kroniese inspanning waaraan hulle blootgestel word. Geen Suid-Afrikaanse studies kon gevind word wat op uitbranding van die terapeut of die terapeut-assistent in die rehabilitasieveld fokus nie. Hierdie studie het die oogmerk om die prevalensie van uitbranding onder ’n selektiewe groep terapeute, die terapeute in diens van Life Rehabilitasie in Suid Afrika, te bepaal. Ter aanvulling van die prevalensie van uitbranding, is die bydraende faktore van uitbranding in hierdie omgewing, die huidige bestuur van die probleem en voorstelle vir toekomstige bestuur ondersoek. ’n Beskrywende studie-ontwerp, wat sowel kwantitatiewe as kwalitatiewe metodes insluit, is vir data-insameling en -ontleding gebruik. ’n Steekproef is nie gebruik nie. Nege-en-veertig terapeute en sewe bestuurders het aan die studie deelgeneem. Die demografiese inligting is met behulp van ’n demografiese kodeblad ingesamel en maak deel uit van die kwantitatiewe data. ’n P waarde van < 0,05 is as statisties beduidend beskou. Daar is van die Maslach Uitbranding-Inventaris (Maslach Burnout Inventory) gebruik gemaak om die prevalensie van uitbranding te bepaal. Onderhoudskedules is gebruik tydens die kwalitatiewe onderhoude waartydens deelnemers se begrip van uitbranding, die bydraende faktore en die impak op die terapeute en maatskappy, asook die bestuurstrategieë te bepaal. Die kwalitatiewe data is volgens die induktiewe metode ontleed. Aangaande die dimensies van uitbranding, het die studie bevind dat 57,14% van die terapeute hoog getoets het vir emosionele uitputting (EU), 20.4% het in die hoë kategorie vir depersonalisasie (DP) geval en 38,77% het lae vlakke van persoonlike vervulling (PV) gehad. Die veranderlikes wat met hoë uitbranding-tellings verband gehou het, was manlike geslag (p=0.0238) (PV), gebrek aan kinders (p=0.02994) (EU), (p=0.03895) (PV), ≤ vier jaar tersiêre opleiding (p=0.03640) (PV), ≤ R15 000 inkomste (p=0.02262) (PV), geen werk oor naweke (p=0.02882) (DP), geen of min bybly-vermoëns (p=0.03180) (EU), hoë, oorweldigende werklas (p=0.03972) (EU), (p=0.01227) (DP), oorweldigende of ontoereikende pasiënt-belading (p=0.02365) (EU), hoë administratiewe werklas (p=0.00302) (PA), selde bereikbare spertye (p=0.03693) (DP), uitgestelde kontak met pasiënte (p=0.02023) (DP), (p=0.01164) (PV), ’n swak werksomgewing (p=0.02162) (EU), (p=0.04034) (DP). Die hoof-oorsake van uitbranding is faktore wat met individue, pasiënt/werk, bestuur en administrasie verband hou. Strategieë is geïdentifiseer wat gebruik kan word om uitbranding konstruktief in hierdie omgewing te bestuur en sluit psigiese-sosiale behandeling, spanverbeteringe, werk/pasiënt aanpassings, erkenning van personeel, verlofaanpassings, vakansietyd-geleenthede, personeelontwikkeling en bestuursverbetering, asook die implementering van moniteringsisteme en beleidsontwikkeling in. Aanbevelings vir Life Rehabilitation is onder meer praktiese strategieë vir die opsporing, voorkoming en bestuur van uitbranding onder terapeute. Die aanvoorwerk is deur hierdie navorsing gedoen. Suksesvolle implementering van die strategieë sal van die leierskap in die organisasie afhang. Sonder hierdie en ander sleutelfigure, hul toegewydheid ten opsigte van tyd, geld en toewysing van middele sal dit slage akademise waarde hê.

Submitted by NATÁLIA GROSSI VISONÁ null (natty_visona@hotmail.com) on 2018-04-04T01:15:21Z No. of bitstreams: 1 Dissetação Natália Grossi Visona Baruffi - repositorio.pdf: 882820 bytes, checksum: f8d4a34d565ca478f7d76d96ea3b1826 (MD5)<br>Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-04-06T12:01:58Z (GMT) No. of bitstreams: 1 baruffi_ngv_me_bot.pdf: 882820 bytes, checksum: f8d4a34d565ca478f7d76d96ea3b1826 (MD5)<br>Made available in DSpace on 2018-04-06T12:01:59Z (GMT). No. of bitstreams: 1 baruffi_ngv_me_bot.pdf: 882820 bytes, checksum: f8d4a34d565ca478f7d76d96ea3b1826 (MD5) Previous issue date: 2018-02-19<br>Estudo retrospectivo e documental cujo objetivo foi analisar a efetividade do protocolo bundles como ferramenta para prevenção de Infecções Relacionadas à Assistência a Saúde (IRAS) de indivíduos internados em Unidade de Terapia Intensiva de Queimaduras (UTIQ) de um hospital terciário do interior paulista. Inicialmente, efetuou-se o levantamento de dados dos prontuários de todos os indivíduos que apresentaram IRAS internados na UTIQ de janeiro de 2008 a dezembro de 2016 e coletadas informações referentes aos que apresentaram infecções abordadas no protocolo bundles, compreendidos como as pneumonias associadas à ventilação mecânica (PAV), Infecção de corrente sanguínea (ICS) por uso de cateter venoso central e infecção do trato urinário (ITU) por uso de sonda vesical de demora, dividida em dois momentos: M1 (2008 a 2010) e M2 (2011 a 2016) pré e pós implantação do protocolo respectivamente. Dos 612 indivíduos admitidos na UTIQ nos dois momentos, 58,4% são do sexo masculino, a média de idade da população do estudo foi de 44,1 ± 15,3 anos. Em relação à área queimada, a média calculada em porcentagem foi de 33 +/- 18,5%, e o grau de queimadura predominante foram os de 2º e 3º graus (61,1%), tendo o fogo como agente causal com maior ocorrência (76,5%). O microrganismo com maior percentual de notificações 91 (36,7%) foi o Acinetobacter baumanii, também relacionados com os casos de PAV e ICS, enquanto que a Candida albicans (8,5%) aparece como o microrganismo mais frequente nos casos de ITU, 267 indivíduos (43,6%) apresentaram IRAS, sendo 49 (55,8%) resultantes de infecções por dispositivos invasivos de longa permanência, 179 (29,2%) evoluíram a óbito, sendo 74 dos óbitos (41,3%) relacionados/causados por infecções. Comparando os dois momentos, não foi observada associação significativa entre os indivíduos que apresentaram infecção hospitalar, o número total de infecções por dispositivos invasivos e os óbitos relacionados/causados por infecções. A incidência de IRAS, não diminuiu após o uso do protocolo, entretanto ao analisar separadamente os tipos de infecção, evidenciou-se que o uso dos bundles mostrou-se efetivo para prevenção de PAV e ICS em queimados.<br>A retrospective and documentary study aimed at analyzing the effectiveness of the Bundles protocol as a tool for the prevention of Health Care Related Infections (IRAS) of individuals hospitalized in an Intensive Care Unit of Burns (UTIQ) of a tertiary hospital in the countryside of São Paulo State. Initially, data were collected from the medical records of all individuals who presented IRAS hospitalized at the ICUQ from January 2008 to December 2016 and it has been collected the information referring to those who presented Bundle-related infections, known as pneumonias associated with mechanical ventilation (PAV), bloodstream infection (ICS) by the use of the central venous catheter and urinary tract infection (UTI) by use of the bladder catheter, divided into two moments: M1 (2008 to 2010) and M2 (2011 to 2016), before and after the implantation of the protocol, respectively. From the 612 individuals admitted in the ICUQ at both moments, 58.4% were males, the mean age of the study population was 44.1 ± 15.3 years old. In relation to the burned area, the mean calculated in percentage was 33 +/- 18.5% and the predominant degree of burn was those of 2º and 3º degrees (61.1%), with fire being the causal agent with the highest occurrence (76.5%). The microorganism with the highest percentage of reports 91 (36,7%) was Acinetobacter baumanii, it also related to cases of PAV and ICS, while Candida albicans (8.5%) appears as the most frequent microorganism in cases of UTI. 267 individuals (43.6%) presented IRAS, of which 49 (55.8%) resulted from invasive device infections. Regarding deaths during the same period, 179 individuals (29.2%) of the total hospitalizations died, of which 74 death (41.3%), was related/caused by infections. Comparing the two moments, no significant association was observed among the individuals who presented hospital infection, the total number of infections by invasive devices and deaths related/caused by infections, that is, the incidence of IRAS, did not decrease after the use of the protocol, but when analyzing the types of infection separately, it was evidenced that the use of Bundles was effective for the prevention of PAV and ICS in burns.

INTRODUÇÃO: Sequelas de queimaduras na morfologia e mobilidade das estruturas motoras orais e nas funções orofaciais como mastigação, deglutição e fala não são incomuns em pacientes que sofreram queimaduras graves na região de cabeça e pescoço. O objetivo deste estudo foi analisar as características dos movimentos motores orais e da mímica facial em pacientes com queimaduras de cabeça e pescoço. MÉTODOS: Estudo transversal descritivo observacional, realizado com pacientes que sofreram queimaduras na cabeça e pescoço e que foram encaminhados para a Divisão de Funções da Face - Queimados de um hospital público brasileiro, entre janeiro de 2013 e dezembro de 2013, para avaliação e reabilitação. Somente pacientes com queimaduras de segundo grau (superficial e profunda) e queimaduras de terceiro grau em face e pescoço foram incluídos no estudo. Os pacientes foram submetidos à avaliação clínica, que incluiu: avaliação motora oral (postura, posição e mobilidade dos órgãos motoras orais e desempenho durante a mastigação e deglutição); avaliação da amplitude mandibular; avaliação da mímica facial. Para fins de caracterização, os pacientes foram divididos em dois grupos: G1 - pacientes com queimaduras de segundo grau superficial; G2 - pacientes com queimaduras de segundo grau profunda e terceiro grau. RESULTADOS: A amostra final do estudo foi composta por 40 pacientes: G1 com 19 indivíduos e G2 com 21 indivíduos. A análise estatística indicou que as contraturas e cicatrizes hipertróficas tem impacto negativo sobre o sistema miofuncional orofacial. A pontuação global obtida para avaliação clínica dos órgãos motores orofaciais indicou que tanto os pacientes de segundo grau como de terceiro grau apresentaram déficits relacionados à postura, posição e mobilidade dos órgãos motores orofaciais. Considerando a mímica facial, os grupos diferiram significativamente ao realizar movimentos faciais voluntários. Os pacientes também apresentaram limitação na medida de abertura oral máxima. Os déficits foram maiores para os indivíduos do G2 em todas as avaliações. CONCLUSÃO: Pacientes com queimaduras de cabeça e pescoço apresentam déficits significativos relacionados à postura, posição e mobilidade das estruturas miofuncionais orais, incluindo os movimentos da mímica facial. Estes pacientes devem ser considerados de risco para o desenvolvimento de futuras desordens temporomandibulares<br>INTRODUCTION: Burn sequelae on oral motor structures morphology, mobility and functions such as mastication, swallowing and speech are not uncommon in patients who suffered severe burns to the head and neck. The purpose of this study was to analyze the characteristics of the oral-motor movements and facial mimic in patients with head and neck burns. METHODS: An observational descriptive cross-sectional study was conducted with patients who suffered burns to the head and neck and who were referred to the Division of Orofacial Myology of a Brazilian public hospital, between January 2013 and December 2013, for assessment and rehabilitation. Only patients presenting second (i.e. superficial and deep) and third degree burns to areas of the face and neck were included in the study. Patients underwent clinical assessment that included: an oral motor evaluation (i.e. posture, position and mobility of the oral motor organs and performance during mastication and swallowing); assessment of the mandibular range of movement; assessment of the facial mimic. For characterization purposes, patients were divided into two groups: G1 - patients with superficial second degree burns; G2 - patients with deep second and third degree burns. RESULTS: Our final study sample was composed by 40 patients: G1 with 19 individuals and G2 with 21 individuals. Statistical analyzes indicated that contractures and hypertrophic scars have a negative impact on the oral myofunctional system. The overall scores obtained in the clinical assessment of the oral motor organs indicated that both second and third degree patients presented deficits related to posture, position and mobility of the oral motor organs. Considering facial mimic, groups differed significantly when performing voluntary facial movements. Patients also presented limited maximal incisor opening. Deficits were greater for individuals in G2 in all assessments. CONCLUSION: Patients with head and neck burns present significant deficits related to posture, position and mobility of the oral myofunctional structures, including facial movements. These patients should be considered at risk for developing future temporomandibular disorders

Thesis (MCur)--Stellenbosch University, 2012.<br>ENGLISH ABSTRACT: Burnout is one of the challenges that nurses are faced with in their stressful and rapidly changing work environment. The vulnerability of nurses to burnout remains a major concern which affects both the individual and institution. Knowledge about burnout and associated risk factors which influence the development of burnout is vital for early recognition and intervention. The research question which guided this study was: “What are the factors influencing the degree of burnout experienced by nurses working in neonatal intensive care units?” The objectives included determining which physical, psychological, social and occupational factors influenced the degree of burnout experienced by nurses. A descriptive, explorative research design with a quantitative approach was applied. The target population consisted of (n=105) permanent nursing staff members working in the neonatal units of two different hospitals. A convenience sampling method was used. Participants (n=102) who gave voluntary consent to participate was included in the study. Validity and reliability was supported through the use of a validated questionnaire, Maslach Burnout Inventory – General Survey including a section based on demographical information and a section based on physical, psychosocial, social and occupational factors. Validity of the questionnaire was supported by the use of a research methodologist, nurse expert and a statistician in the particular field. A pilot study was done to test the feasibility of the study and to test the questionnaire for any errors and ambiguities. Ethics approval was obtained from Stellenbosch University and permission from the Heads of the hospitals where the study was conducted. The data was analyzed with the assistance of a statistician and these are presented in histograms, tables and frequencies. The relationship between response variables and nominal input variables was analysed using analysis of variance (ANOVA). Various statistical tests were applied to determine statistical associations between variables such as the Spearman test, using a 95% confidence interval. Results have shown that participants experienced an average level of emotional exhaustion, a high level of professional efficacy and a low level of cynicism. Further analyses have shown that there is a statistical significant difference between emotional exhaustion and the rank of the participant (p=<0.01), highest qualification (p=0.05) and a high workload (p=0.01). Furthermore a statistical significant difference was found between professional efficacy and rank of participants (p=<0.01). In addition a statistical significant difference was found between cynicism and the number of years participants were in the profession (p=0.05). Multiple factors were determined in this study that influences the degree of burnout nurses experience. The majority of participants (n=56/55%) experienced decreased job satisfaction and accomplishment, (n=52/51%) of participants experienced that their workload is too much for them and (n=63/62%) participants received no recognition for their work. Recommendations are based on preventative measures, because preventing burnout is easier and more cost-effective than resolving burnout once it has occurred. In conclusion, the prevention strategies, early recognition of work stress and appropriate interventions are crucial in addressing the problem of burnout.<br>AFRIKAANSE OPSOMMING: Uitbranding is een van die uitdagings waarmee verpleegsters te kampe het in hulle stresvolle en vinnig veranderende werkomgewing. Die kwesbaarheid van verpleegsters vir uitbranding bly ’n kritieke bekommernis wat beide die individu en die inrigting affekteer. Kennis omtrent uitbranding en verwante risiko faktore wat die ontwikkeling van uitbranding beïnvloed, is deurslaggewend vir vroeë opsporing en intervensie. Die navorsingsvraag wat hierdie studie gelei het, is: “Wat is die faktore wat die mate van uitbranding beïnvloed wat deur verpleegsters ondervind word wat in neonatale intensiewe sorgeenhede werk?” Die doelwitte wat ingesluit is, is om te bepaal watter fisiese, sielkundige, maatskaplike en beroepsfaktore die mate van uitbranding wat deur verpleegsters ervaar word, beïnvloed. ’n Beskrywende, ondersoekende navorsingsontwerp met ’n kwantitatiewe benadering is toegepas. Die teikengroep het bestaan uit (n=105) permanente verpleegpersoneel wat in die neonatale eenhede van twee verskillende hospitale werk. ’n Gerieflikheidsteekproef metode is gebruik. Deelnemers (n=102) wat vrywillige toestemming gegee het om deel te neem, is ingesluit in die navorsingstudie. Geldigheid en betroubaarheid is ondersteun deur die gebruik van ’n geldige vraelys van “Maslach Burnout Inventory – General Survey”, asook ’n afdeling gebaseer op demografiese inligting en ’n afdeling gebaseer op fisiese, sielkundige, maatskaplike en beroepsfaktore. Geldigheid van die vraelys is ondersteun deur ’n navorsingsmetodoloog, ’n verpleegspesialis en ’n statistikus op die navorsingsgebied. ’n Loodsondersoek is gedoen om die haalbaarheid van die studie te toets en om die vraelys te toets vir enige foute en dubbelsinnighede. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch en goedkeuring van die Hoofde van die hospitale waar die studie uitgevoer is. Die data is geanaliseer met die hulp van ’n statistikus en is aangebied in histogramtafels en frekwensies. Die verwantskap tussen responsveranderlikes en nominale insetveranderlikes is geanaliseer deur gebruik te maak van die analise van variansie (ANOVA). Verskeie statistiese toetse is toegepas om statistiese assosiasies tussen veranderlikes te bepaal, soos deur van die Spearmantoets gebruik te maak, met ’n 95% betroubaarheidsinterval. Resultate het bewys dat deelnemers ’n gemiddelde vlak van emosionele uitputting, ’n hoë vlak van professionele effektiwiteit en ’n lae vlak van sinisme ervaar. Verdere analise het bewys dat daar ’n statistiese beduidende verskil tussen emosionele uitputting en die rang van die deelnemers (p=<0.01) is, hoogste kwalifikasie (p=0.05) en ’n hoë werklading (p=0.01). Verder is ’n statistiese beduidende verskil gevind tussen professionele effektiwiteit en rang van deelnemers (p=<0.01). Saam hiermee is ’n statistiese beduidende verskil gevind tussen siniesheid en die aantal jare wat deelnemers in die beroep is (p=0.05). Voorts, is veelvuldige faktore bepaal in hierdie studie wat die mate van uitbranding beïnvloed wat verpleegsters ervaar. Die meeste van die deelnemers (n=56/55%) het ’n afname in werksbevrediging en -verrigting ervaar, (n=52/51%) deelnemers het ervaar dat hul werklading te veel is vir hulle en (n=63/62%) deelnemers het geen erkenning vir hulle werk ontvang nie. Aanbevelings is gebaseer op voorkomende maatreëls, want om uitbranding te voorkom, is makliker en meer koste-effektief as om uitbranding te probeer oplos as dit alreeds begin het. Ten slotte, die voorkomende strategieë, vroeë identifisering van werkstres en geskikte intervensies is deurslaggewend om die probleem van uitbranding aan te spreek.

Made available in DSpace on 2015-12-10T14:22:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-25. Added 1 bitstream(s) on 2015-12-10T14:28:47Z : No. of bitstreams: 1 000850026.pdf: 1654101 bytes, checksum: 049ca9ff4188a7cab18e355aabfaa3f2 (MD5)<br>É complexo assistir as pessoas em Unidade de Terapia Intensiva Especializada em Queimados, pois a falta de proteção do maior órgão do corpo, a pele, assim como as lesões inalatórias podem apresentar alterações hemodinâmicas e condições de vulnerabilidade para infecção. O objetivo do estudo é avaliar a carga de trabalho de enfermagem, segundo o Nursing Activities Score (NAS), em uma Unidade de Terapia Intensiva destinada ao tratamento de pacientes com queimaduras; correlacionar a carga de trabalho aos aspectos sociodemográficos, clínicos, gravidade (SAPS 3), superfície corporal queimada (SCQ%), grau de queimadura e desfecho e construir um tutorial para instruir e uniformizar a aplicação do instrumento. Trata-se de estudo exploratório e descritivo, prospectivo, de delineamento quantitativo, realizado na UTI de queimados de um Hospital Estadual de grande porte, localizado no interior de São Paulo. A Unidade é composta por 4 leitos. A população constou de pacientes atendidos na unidade no período de janeiro a junho de 2014. A amostra foi de 33 pacientes, com 447 medições. Obteve-se a aprovação do Comitê de Ética sob o nº CAAE 26679314.2.0000.5411. A carga de trabalho foi avaliada por meio do NAS, prospectivamente, referindo-se às últimas 24 horas. Utilizou-se a Correlação de Pearson, o teste Anova e de Tukey, todos com nível de significância de 5% (p≤0,05). Do total de 33 pacientes prevaleceu o gênero masculino com 61%, brancos 67%, com união consensual estável 54%, primeiro grau completo 71%, grande queimado 55%, com acidentes por álcool e fogo 30%, depressivos 53%, submetidos à intubação e sedados 45%, em uso de medicação vasoativa 45% e com lesão inalatória associada 55%. O mês de maior ocorrência das internações foi fevereiro, com 27%. Em relação ao desfecho, 61% receberam alta para enfermaria. A média NAS foi de 81,94% para os pacientes sobreviventes e 86,16 % para os que foram a...<br>It is complex to watch people in the Intensive Care Unit Specialized in Burnt, because the lack of the body's largest organ protection, the skin, as well as inhalation injuries may present hemodynamic changes and conditions of vulnerability to infection. The objective of the study is to evaluate the nursing workload, according to the Nursing Activities Score (NAS) in a Intensive Care Unit for the treatment of burned patients; correlate the workload to sociodemographic aspects, clinicals, severity (SAPS 3), burned surface area (BSA%), degree of burn and outcomes and build a Tutorial to instruct and standardize the instrument application. It is an exploratory and descriptive, prospective, quantitative design study, performed in the burn ICU of a large State Hospital, located in e interior city of São Paulo. The unit consists of 4 beds. The population consisted of patients attending the unit from January to June 2014. The sample consisted of 33 patients, with 447 measurements. We obtained the approval of the Ethics Committee under the number CAAE 26679314.2.0000.5411. The workload was assessed by the NAS, prospectively, referring to the last 24 hours. Pearson correlation was used, ANOVA and Tukey tests, all of them with a significance level of 5% (p=0.05). From the total of 33 patients prevailed males with 61%, white 67%, with a stable relationship 54%, 71% with complete primary education, major burn 55%, with accident caused by alcohol and fire 30%, 53% depressed, submitted to intubation and sedated 45% by use of vasoactive medications associated with 45% and 55% with associated inhalation injury. The month of highest incidence of hospitalizations was February with 27%. Regarding the outcome, 61% were discharged to infirmary. The average NAS was 81.94% for the patients who survived and 86.16% for those who died. The hours of nursing in 24 hours was 19.6%. When comparing the nursing hours according to the NAS and COFEN resolution on the ...

Orientador: Magda Cristina Queiroz Dell'Acqua<br>Banca: Valéria de Castilho Palhares<br>Banca: Neuza Aparecida de Souza Basso<br>Resumo: É complexo assistir as pessoas em Unidade de Terapia Intensiva Especializada em Queimados, pois a falta de proteção do maior órgão do corpo, a pele, assim como as lesões inalatórias podem apresentar alterações hemodinâmicas e condições de vulnerabilidade para infecção. O objetivo do estudo é avaliar a carga de trabalho de enfermagem, segundo o Nursing Activities Score (NAS), em uma Unidade de Terapia Intensiva destinada ao tratamento de pacientes com queimaduras; correlacionar a carga de trabalho aos aspectos sociodemográficos, clínicos, gravidade (SAPS 3), superfície corporal queimada (SCQ%), grau de queimadura e desfecho e construir um tutorial para instruir e uniformizar a aplicação do instrumento. Trata-se de estudo exploratório e descritivo, prospectivo, de delineamento quantitativo, realizado na UTI de queimados de um Hospital Estadual de grande porte, localizado no interior de São Paulo. A Unidade é composta por 4 leitos. A população constou de pacientes atendidos na unidade no período de janeiro a junho de 2014. A amostra foi de 33 pacientes, com 447 medições. Obteve-se a aprovação do Comitê de Ética sob o nº CAAE 26679314.2.0000.5411. A carga de trabalho foi avaliada por meio do NAS, prospectivamente, referindo-se às últimas 24 horas. Utilizou-se a Correlação de Pearson, o teste Anova e de Tukey, todos com nível de significância de 5% (p≤0,05). Do total de 33 pacientes prevaleceu o gênero masculino com 61%, brancos 67%, com união consensual estável 54%, primeiro grau completo 71%, grande queimado 55%, com acidentes por álcool e fogo 30%, depressivos 53%, submetidos à intubação e sedados 45%, em uso de medicação vasoativa 45% e com lesão inalatória associada 55%. O mês de maior ocorrência das internações foi fevereiro, com 27%. Em relação ao desfecho, 61% receberam alta para enfermaria. A média NAS foi de 81,94% para os pacientes sobreviventes e 86,16 % para os que foram a...<br>Abstract: It is complex to watch people in the Intensive Care Unit Specialized in Burnt, because the lack of the body's largest organ protection, the skin, as well as inhalation injuries may present hemodynamic changes and conditions of vulnerability to infection. The objective of the study is to evaluate the nursing workload, according to the Nursing Activities Score (NAS) in a Intensive Care Unit for the treatment of burned patients; correlate the workload to sociodemographic aspects, clinicals, severity (SAPS 3), burned surface area (BSA%), degree of burn and outcomes and build a Tutorial to instruct and standardize the instrument application. It is an exploratory and descriptive, prospective, quantitative design study, performed in the burn ICU of a large State Hospital, located in e interior city of São Paulo. The unit consists of 4 beds. The population consisted of patients attending the unit from January to June 2014. The sample consisted of 33 patients, with 447 measurements. We obtained the approval of the Ethics Committee under the number CAAE 26679314.2.0000.5411. The workload was assessed by the NAS, prospectively, referring to the last 24 hours. Pearson correlation was used, ANOVA and Tukey tests, all of them with a significance level of 5% (p=0.05). From the total of 33 patients prevailed males with 61%, white 67%, with a stable relationship 54%, 71% with complete primary education, major burn 55%, with accident caused by alcohol and fire 30%, 53% depressed, submitted to intubation and sedated 45% by use of vasoactive medications associated with 45% and 55% with associated inhalation injury. The month of highest incidence of hospitalizations was February with 27%. Regarding the outcome, 61% were discharged to infirmary. The average NAS was 81.94% for the patients who survived and 86.16% for those who died. The hours of nursing in 24 hours was 19.6%. When comparing the nursing hours according to the NAS and COFEN resolution on the ...<br>Mestre

Introdução: Em pacientes críticos, como os grandes queimados, todos os parâmetros farmacocinéticos (absorção, distribuição, metabolismo e excreção) de muitas classes de drogas, incluindo antimicrobianos, estão alterados. Devido à forte associação entre a terapia antimicrobiana adequada em pacientes com queimaduras e mortalidade, intervenções como o monitoramento terapêutico de drogas podem ser uteis para otimizar a concentração sérica desses agentes em diferentes estágios do estado hiperdinâmico. Portanto, é possível melhorar desfecho clínico e sobrevivência além de reduzir o desenvolvimento de resistência. O objetivo deste estudo foi analisar o impacto em mortalidade de uma estratégia de ajuste de dose de acordo com o monitoramento terapêutico e modelagem farmacocinética/farmacodinâmica em pacientes de uma Unidade de Terapia Intensiva (UTI) para Queimados. Métodos: Um estudo comparativo, retrospectivo, foi conduzido entre pacientes admitidos com pneumonia, infecção em queimadura, infecção de corrente sanguínea e/ou infecção do trato urinário associados à assistência à saúde em uma UTI para Queimados do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Estes pacientes foram divididos em dois grupos: aqueles admitidos de maio de 2005 a outubro de 2008 que receberam antibioticoterapia em regime de dose convencional proposto pelo Grupo de Controle de Infecção Hospitalar do HC-FMUSP e aqueles admitidos de novembro de 2008 a junho de 2011 que receberam terapia antimicrobiana com dose ajustada de acordo com o monitoramento plasmático e modelagem farmacocinética. Características gerais dos dois grupos foram analisadas e desfechos clínicos (melhora dos sinais e sintomas da infecção), mortalidade em 14 dias e mortalidade hospitalar foram comparados. Resultados: 63 pacientes admitidos na UTI de Queimados apresentaram os critérios de inclusão para o grupo de tratamento convencional e 77 para o grupo de tratamento monitorado. Comparando dois grupos homogêneos em suas características gerais, houve diferenças quanto ao número de desbridamentos realizados e história de alcoolismo e uso de drogas ilícitas, mais frequentes no grupo de tratamento monitorado. Melhora clínica ocorreu em 56% dos pacientes sob regime monitorado e a mortalidade hospitalar foi similar entre os grupos. Pertencer a um dos grupos de tratamento não afetou o prognóstico. Na análise multivariada final, variáveis significativamente associadas com mortalidade hospitalar foram superfície corporal queimada maior que 30%, idade mais avançada e sexo masculino. Conclusão: Nosso estudo demonstrou que a estratégia de monitoramento terapêutico de antimicrobianos não alterou prognóstico de pacientes queimados. Acreditamos que são necessários mais estudos para embasar esta estratégia<br>Introduction: In critical patients, such as burn patients, pharmacokinetic parameters (absorption, distribution, metabolism and excretion) of many classes of drugs, including antibiotics, are altered. The aim of this study was to compare two groups of burned patients under treatment for healthcare associated infections with and without therapeutic drug monitoring (TDM) based on PK/PD modeling. Methods: A comparative study was conducted with patients with healthcare-associated pneumonia, burn infection, bloodstream infection and urinary tract infection in the Burn Intensive Care Unit (ICU) of a tertiary-care hospital. These patients were divided into two groups: 1) those admitted from May 2005 to October 2008 who received conventional antimicrobial dose regimen; and 2) those admitted from November 2008 to June, 2011 who received antibiotics with doses adjusted according to plasma monitoring and pharmacokinetics modeling. General characteristics of the groups were analyzed and clinical outcomes, 14-day and in-hospital mortality. Results: 63 patients formed the conventional treatment group and 77 the monitored treatment group. The groups were very homogeneous. Improvement occurred in 56% of the patients under monitored treatment and the in-hospital mortality was similar between groups. In the final multivariate models, variables significantly associated with in-hospital mortality were total burn surface area (TBSA) > 30%, older age and male sex. Treatment group did not affect the prognosis. Conclusions: TDM for antimicrobial treatment did not alter the prognosis of burn patients. More trials are needed to support the use of TDM to optimize treatment in burn patients

La micro-cogénération, production simultanée d’électricité et de chaleur à échelle domestique, se développe actuellement en Europe du fait notamment de son intérêt en termes d’économie d’énergie primaire. L’utilisation d’un combustible biomasse dans un système de micro-cogénération contribue à augmenter la part d’énergie renouvelable dans le mix énergétique. L’objet de ce travail est le développement d’un banc d’essai d’une unité de micro-cogénération biomasse composée d’une chaudière à pellets, d’un moteur à air chaud de type Ericsson (décomposé en une partie compression et une partie détente) et d’un échangeur gaz brûlés-air pressurisé inséré dans la chaudière. Des modèles de chacun de ces composants ont été établis pour caractériser leur fonctionnement sur la plage de réglage des paramètres influents et pour dimensionner l’unité prototype. Deux modèles du moteur Ericsson, en régime permanent et en régime dynamique, ont été mis en place. Ils ont montré l’influence prépondérante sur les performances du moteur des conditions de température et pression de l’air en entrée de détente et des réglages des instants de fermeture des soupapes. L’effet de la prise en compte des pertes dynamiques (pertes de charge, pertes thermiques à la paroi du cylindre, frottements mécaniques) sur l’estimation des performances du moteur a été étudié. Deux modélisations de l’échangeur ont permis de caractériser les transferts thermiques qui le traversent, incluant le rayonnement et l’encrassement par des particules de suie du côté des gaz brûlés. Le banc d’essai de l’unité de micro-cogénération mis en place<br>Nowadays, the micro combined heat and electrical power (micro-CHP) systems are developing in Europe, in particular because of their interest in terms of primary energy savings. The use of biomass fuel in micro-CHP systems enhances the share of renewable energy in the energy mix. The objective of this work is to develop a test bench for a biomass-fuelled micro-CHP unit composed of a pellet boiler, an Ericsson type hot air engine (decomposed into a compression and an expansion part) and a burned gas-pressurized air heat exchanger inserted in the boiler. Models of every component have been established to characterize their working conditions depending on influent parameter settings and to size the micro-CHP unit. Two models of Ericsson engine, with established and dynamic regimes, were implemented. The preponderant influence of the temperature and pressure conditions at the inlet of the expansion cylinder and of the timing of valve closing on the engine performances are shown. The dynamic model shows the effect of considering the dynamic losses (pressure loss, heat transfer at the cylinder wall, mechanical friction) on the estimation of engine performances. Two models of the heat exchanger allow the characterization of the heat transfers crossing it, taking into account the radiation and the fouling by soot particles on the side of combustion gases. Experimental measurements obtained from the test bench of the micro-CHP unit set up were used in the developed models

Les industries lithiques qui ont pennis la caractérisation du Gravettien présentent des traits culturels partagés qui étayent une vision paneuropéenne de cette civilisation. Pourtant, certaines séries échappent à cette règle. Comment les interpréter ? A partir de l' exemple du Gravettien à burins du Raysse, ce travail propose une nouvelle réflexion. Le premier chapitre est consacré à la caractérisation technologique de la série de la Picardie (37). Le second chapitre élargit la réflexion avec l'analyse de la couche V de la Grotte du Renne (89). Le troisième chapitre est un inventaire des gisements à burins du Raysse qui vise à détenniner quels sites peuvent participer aux discussions. Le dernier chapitre pennet une comparaison diachronique des données des chapitres antérieurs avec les résultats de l' analyse des séries de Brassempouy (40) et du Cirque de la Patrie (77). Les différences évoquées conduisent à proposer l'existence d'un épisode paléohistorique particulier.

Introdução: Pacientes com grande superfície corpórea queimada (SCQ) são graves e precisam de suporte em unidade de terapia intensiva (UTI). Estudos que caracterizem esses pacientes queimados durante sua internação em UTI são escassos na literatura. Objetivo: Caracterizar do ponto de vista epidemiológico e de desfechos clínicos os pacientes que foram admitidos em uma UTI de queimados, definindo os fatores associados à mortalidade e morbidade. Métodos: A partir de um banco de dados colhido prospectivamente, foram coletadas as informações de pacientes maiores de 16 anos com história de internação por queimaduras e admitidos na UTI durante o período de 60 meses. Foram coletados dados epidemiológicos e clínicos relativos ao suporte de terapia intensiva nos primeiros sete dias de internação na UTI, no décimo quarto, vigésimo primeiro e vigésimo oitavo dia de internação de UTI se o paciente ainda permanecesse internado na unidade. Resultados: Foram incluídos 163 pacientes. A mortalidade hospitalar foi de 42%. A mediana do tempo de internação hospitalar foi de 29 [11, 50] dias, aidade mediana foi de 34[25,47] anos, a SCQ foi de 29 [18,43]% e o SAPS3 foi de 41 [34, 54]. Aárea queimada letal associada à mortalidade de 50% dos pacientes foi de 36,5%. O valor do escore SOFA total nos não sobreviventes foi maior em todos os momentos analisados em comparação com os sobreviventes. A mediana do valor máximo do escore SOFA total apareceu de maneira precoce, sendo no segundo dia de internação para os sobreviventes e quarto dia para os não sobreviventes. O valor da área sob a curva ROC do escore SOFA total foi de 0,887 e para os componentes respiratório, cardiovascular, renal hematológico, hepático e neurológico foram respectivamente 0,814, 0,811, 0,738, 0,738, 0,526 e 0,569. Houve uma associação significativa entre a mortalidade hospitalar e o escore SAPS3 [OR (IC 95%) = 1,114 (1,062-1,168)], SCQ [OR (IC 95%) = 1,043 (1,010-1,076)], tentativas de suicídio [OR (95% CI) = 8,166 (2,284-28,907)], e balanço hídrico cumulativo por litro na primeira semana [OR (IC 95%) = 1,090 (1,030-1,154)]. Lesão inalatória esteve presente em 45% dos pacientes e não foi associada à mortalidade hospitalar. Conclusões: Os fatores associados independentemente à mortalidade de pacientes queimados críticos são a SCQ extensa, tentativa de suicídio e SAPS 3. Balanço hídrico acumulado mais elevado nos primeiros sete dias após a admissão na UTI também foi associado independentemente à mortalidade hospitalar. A implementação da gestão judiciosa de fluidos após a fase de ressuscitação aguda pode melhorar os desfechos neste cenário. As disfunções orgânicas se apresentam precocemente nos pacientes queimados e as disfunções respiratória, cardiovascular, renal e hematológica se associam à maior mortalidade nesta população. Assim, esforços devem ser direcionados para detecção e intervenção precoce das disfunções orgânicas<br>Introduction: Patients with large total burn surface area (TBSA) are critically ill and need support in the intensive care unit (ICU). However, the characteristics of burn patients who require ICU admission are scarce in the literature. Objective: To characterize the patients from an epidemiological point of view and clinical outcomes who were admitted to a burn ICU, defining the factors associated with mortality and morbidity. Methods: From a database collected prospectively, informations from patients older than 16 years with hospital admissions for burns and admitted to the ICU during a period of 60 months were collected. We collected epidemiological and clinical data regarding the Intensive care support in the first seven days in the ICU, the fourteenth, twentyfirst and twenty-eighth day of ICU hospitalization if the patient still remained hospitalized in the unit. Results: One-hundred sixty-three patients were included. The hospital mortality was 42%. The median hospital stay was 29 [11, 50] days, the age was 34 [25.47] years, the TBSA was 29 [18.43]% and the SAPS 3 was 41 [34, 54]. Lethal burn area at which fifty percent of patients died (LA50%) was 36.5%. The value of total SOFA score was higher in nonsurvivors at all timepoints analyzed compared with survivors. The median maximum value of the total SOFA score came at an early stage and on the second day of hospitalization for survivors and fourth day for non-survivors. The area under the ROC curve of the total SOFA score was 0.887 and the respiratory components, cardiovascular, renal, hematologic, hepatic and neurological were respectively 0.814, 0.811, 0.738, 0.738, 0.526 and 0.569. We found a significant association between hospital mortality and SAPS3 [OR(95%CI) = 1.114(1.062-1.168)], TBSA [OR(95%CI) = 1.043(1.010-1.076)], suicide attempts [OR(95%CI) = 8.126(2.284-28.907)], and cumulative fluid balance per liter within the first week [OR(95%CI) = 1.090(1.030-1.154)]. Inhalation injury was present in 45% of patients, and it was not significantly associated with hospital mortality. Conclusions: The factors independently associated with mortality during admission were increased TBSA, suicide attempt and higher SAPS 3. A higher accumulative fluid balance within the first seven days after ICU admission was also independently associated with hospital mortality. The implementation of judicious fluid management after an acute resuscitation phase may help to improve outcomes in this scenario. The organ dysfunction is present early in burn patients. Respiratory, cardiovascular, renal and hematological dysfunctions are associated with a higher mortality in this population. Thus, efforts should be targeted for early detection and intervention in organ dysfunction

O processo de reparação tecidual evolui tardiamente com alteração das propriedades físicas da pele, cuja gravidade varia, entre outros fatores, em função da profundidade original da lesão. Clinicamente a pele é seca, descamativa, discrômica e com diminuição da elasticidade, especialmente em cicatrizes hipertróficas. As características do tegumento pós-queimadura podem ser melhoradas com agentes de uso tópico normalmente utilizados em patologias como acne e fotoenvelhecimento. Foram avaliados 77 pacientes portadores de seqüela de queimadura peri-oral, entre seis e 46 anos de idade. O tipo de tegumento foi classificado como restaurado, quando epitelizado espontaneamente, ou enxertado. O tratamento tópico consistiu de tretinoína (0,01-0,05%) e ácido glicólico (5-7%) durante três meses. Duas distâncias foram medidas com paquímetro digital em abertura bucal máxima, a inter-dentária (D) e a inter-labial (L). Houve aumento significativo (p£0,01) de D e L nos grupos tratados quando comparados aos respectivos controles, tanto nos pacientes com tegumento restaurado como nos enxertados. O aumento de L foi significativamente maior que D. Sugerimos a utilização da medida inter-labial como parâmetro complementar à medida inter-incisal como método de avaliação indireta da elasticidade cutânea no tegumento pós-queimadura.<br>Tissue repair processes evolve with alterations of the cutaneous physical properties, which are proportional, among other factors, to the original depth of the lesion. At examination, the skin is dry, dyschromic and less elastic, specially in hypertrophic scars. Post-burn skin characteristics can be improved by topical agents regularly used in pathologies like acne or photodamage. We evaluated 77 patients who had peri-oral burn sequela. The ages ranged from six to 46 years old. The tegument was classified as restored, when spontaneously healed, or skin grafted. The topical treatment consisted of tretinoin (0,01-0,05%) and glycolic acid (5-7%) for three months. Inter-incisal (D) and inter-labial (L) distances were measured at maximal mouth opening with a digital pachymeter. Both inter-incisal and inter-labial distances increased significantly in the groups treated when compared to respective controls (p£0,01). This fact was similar in both types of tegument. Inter-labial distance (L) increased significantly more than D. We suggest its use as a complementary measure to inter-incisal distance for indirect evaluation of skin elasticity in the post-burn tegument.

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2015.<br>This study was intended to investigate the lived experiences of nurses caring for patients with burn injuries. A qualitative, phenomenological descriptive design based on Husserl`s (1962) philosophy, was used to achieve the study`s objectives. Registered nurse participants (n=13) were recruited from the adult and children`s burns units of a public sector academic hospital in Johannesburg. Data was collected using in-depth interviews with the participants, which provided them with an opportunity to express their experiences and opinions regarding caring for patients with burn injuries. The collected data was analysed using a descriptive methodology utilising Colaizzi`s (1978) data analysis approach. There was a general expression amongst the participants that caring for patients with burn injuries induced both physical and emotional discomfort, however good patient outcome was a source of gratification. The source of stress included labour intensity, unsightly nature of wounds and limitations in the provision for burns care with emphasis on shortage of nursing staff and lack of organisational support. There were apparently strong expressions that on-job training without recognisable certification made the nurses and others doubt their capabilities in burns nursing practice. The desire was for speciality training relating to burns care, with accompanying recognisable certification. Despite the prevailing challenges, the participants exhibited caring behaviour characterised by commitment to duty, passion for the job and compassion for the patients, which all enhanced professional boundaries and accountability. The findings of the study further reflected that the participants acknowledged management and other sources of vi external support. However, there was evidence that participants engaged in establishing their own mechanisms of coping with the prevailing challenges related to their job through self-motivation, resilience, team work and team support. It was apparent the participants demonstrated self-determination, perseverance and suppressed their stressful feelings to continue with the nature of their work. The findings of this study suggest that a supportive work environment coupled with competency and empowerment among the nurses are critical for the wellbeing of the patients and nursing staff in passing swiftly through the burns caring process. As the field of burns care is just developing, especially in the Low and Middle Income Settings, a lot of research is needed to determine the clinical, educational and management gaps in burns care with focus on nursing perspectives. Replica studies can therefore be conducted in other burns care settings to compliment the findings of the current study.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2017<br>Background: Burns are a significant cause of paediatric injuries, particularly in low and middle-income countries, where more than 90% of burn-related paediatric deaths occur. Physiotherapy is an essential, sometimes painful, component of burn rehabilitation therapy. The popularity of the video game use in burns rehabilitation has grown because, in addition to facilitating range of motion (ROM) in an effort to prevent joint contracture formation, the virtual imaging characteristics of these games provides additional benefit of distraction from pain. Video games provide a more efficient, effective and enjoyable method training, and are a helpful adjunct to rehabilitation. Aim: To investigate the effect of using the Xbox Kinect™ on discharge outcomes and early activity levels of children in the Paediatric Burns Unit (PBU) at Chris Hani Baragwanath Academic Hospital (CHBAH) Methods: This non-equivalent post-test only control group design study took place over a period of time until the total number of children required was achieved for each group. The control group was the first group of children recruited to the study and received standard physiotherapy treatment and rehabilitation. The experimental group was the second group of children recruited to the study who received standard physiotherapy treatment and rehabilitation as well as the Xbox Kinect™. Comparisons were made only after the intervention and analysed. Outcome measures for each participant were ROM, Activities Scale for Kids© participation (ASK©p) and a modified Wong-Baker FACES® enjoyment rating scale. On discharge from the unit, ROM assessments and the modified Wong-Baker FACES® enjoyment rating scale were administered. On follow-up one week post discharge, ROM re-assessments were done and the ASK©p was administered. A questionnaire regarding the use of the Xbox Kinect™ was completed by health professionals working within the PBU. Results: Seventy children were recruited into the study of which the data for 66 were analysed. Thirty five children were part of the control group and 31 were part of the Xbox intervention group. No significant difference was found between groups regarding demographic characteristics, the median age was seven years old and 55% of the participants were male. There was one mortality and five children in total were lost to follow up. The majority burns were as a result of hot water attributing to more than 50% of admissions, followed by flame burns (30%) and electrical burns (12%). This study population showed an overall total burn surface area (TBSA) of nine percent which were superficial partial in depth; this is seen as a minor burn injury. Forty percent were seen to have moderate-severe injury and three children were considered to have severe major burns > 30 % TBSA. We observed a greater proportion of injury involving the lower limbs (23.10%) and upper limbs (21.10%), followed by injury involving the trunk (11.40%), buttocks and genitalia (7.50%) and the head and neck regions (6.80%). There was no difference in length of stay (LoS) or the chance of Intensive Care Unit (ICU) stay between the two groups. In the intervention group 75% of the children received 2 or more Xbox Kinect™ sessions. The Xbox Kinect™ was shown to be significant in achieving higher active range of movement (AROM) at discharge (p< 0.01) and at follow up (p< 0.01), and highlights the advantages it has in providing a more amusing and comfortable option as part of the burns rehabilitation process. By allowing the children to be more engaged in the Xbox Kinect™ experience and games, they were distracted and thus experienced less pain. In this study we found that TBSA% was a predictor of ASK©p scores (p= 0.03), thus the higher the burn percentage the lower the ASK©p scores. We also found that age (p= 0.05) and AROM (p= 0.04) were associated with ASK©p scores, thus the younger the child or a child with reduced AROM would have lower ASK©p scores. Fun and enjoyment (p<0.01) was found to be significant in this study, thus highlighting the fun and enjoyment factor the Xbox Kinect™ offers as part of therapy and as an adjunct to burns rehabilitation. Thirty one questionnaires regarding the value and use of the Xbox Kinect™ were completed by health professionals working within the PBU. Many highlighted the value of fun, enjoyment and distraction the Xbox Kinect™ offered as part of the rehabilitation, as well as assisting in achieving more AROM but also indicated that the Xbox Kinect™ sessions still needed to be supervised and guided. Conclusion: This study was the first study done in South Africa involving video game technology during physiotherapy within the paediatric burns population. The use of the Xbox Kinect™ as seen in this study has proven to be beneficial and a useful adjunct to burns rehabilitation within in the paediatric burns population. This distraction and decline in pain assists in reducing the fear associated with movement these burns children experience and assist in improvements related to activity and ultimately age-appropriate play and activities of daily living (ADLs).<br>MT2017

People with diabetes are at a greater risk of burn injuries than those without diabetes. This stems from the epidemiological profiles of the conditions and the effects of morbidities associated with diabetes. Both conditions share some similarities in terms of metabolic alterations and suboptimal immune functions which may result in poor outcomes for patients. For that reason, it is reasonable to deduce that patients with diabetes are a challenging group to manage in burns units. However, this deduction should be taken cautiously because of lack of supporting evidence. Accordingly and after consulting with clinical experts, the research in this portfolio investigated the association between diabetes and burn injuries. In particular, two different aspects of this association were investigated in two individual quantitative and descriptive inquiries. The first was a case note review of patients hospitalised with a principal diagnosis of a foot burn injury in a large tertiary hospital in South Australia from 1999 to 2004. The second study investigated management of diabetes in burns units treating adults. This study is an e-mail survey of clinical leaders of burns units in Australia, New Zealand, Hong Kong and the United Kingdom. The clinical leaders were approached indirectly through key liaison persons in each identified unit. In the first study, outcomes for twelve subjects with and fifty-two without diabetes were described using descriptive and non-parametric statistics. In the second study, descriptive frequencies and content analysis were adopted to analyse twenty-nine responses from seventeen out of thirty burns units which participated in the study. Supporting findings in the literature, the first study showed that burn injuries among subjects with diabetes were mainly resulted from household devices. There were no statistically significant differences between subjects with and without diabetes in terms of size and depth of burn injuries and treatment received. In spite of this, there was a statistically significant association between diabetes and the experience of local post-burn complications and longer duration of hospitalisation. The second study indicated that more than twenty-five percent of the respondents believed that multidisciplinary centres should only occasionally be involved in the process of care. Participants reported that the individual profile of each patient plays a major role in determining the management of diabetes. Additionally, it was found that the insulin sliding scale was commonly used in the management of diabetes in burns units. The association between diabetes and a burn injury is a serious issue in terms of health and cost. This association need be addressed firstly and most importantly at the prevention level; secondly through proper management of both diabetes and burns.<br>http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1285462<br>Thesis (D.Nurs.)--Population Health and Clinical Practice, 2007.

People with diabetes are at a greater risk of burn injuries than those without diabetes. This stems from the epidemiological profiles of the conditions and the effects of morbidities associated with diabetes. Both conditions share some similarities in terms of metabolic alterations and suboptimal immune functions which may result in poor outcomes for patients. For that reason, it is reasonable to deduce that patients with diabetes are a challenging group to manage in burns units. However, this deduction should be taken cautiously because of lack of supporting evidence. Accordingly and after consulting with clinical experts, the research in this portfolio investigated the association between diabetes and burn injuries. In particular, two different aspects of this association were investigated in two individual quantitative and descriptive inquiries. The first was a case note review of patients hospitalised with a principal diagnosis of a foot burn injury in a large tertiary hospital in South Australia from 1999 to 2004. The second study investigated management of diabetes in burns units treating adults. This study is an e-mail survey of clinical leaders of burns units in Australia, New Zealand, Hong Kong and the United Kingdom. The clinical leaders were approached indirectly through key liaison persons in each identified unit. In the first study, outcomes for twelve subjects with and fifty-two without diabetes were described using descriptive and non-parametric statistics. In the second study, descriptive frequencies and content analysis were adopted to analyse twenty-nine responses from seventeen out of thirty burns units which participated in the study. Supporting findings in the literature, the first study showed that burn injuries among subjects with diabetes were mainly resulted from household devices. There were no statistically significant differences between subjects with and without diabetes in terms of size and depth of burn injuries and treatment received. In spite of this, there was a statistically significant association between diabetes and the experience of local post-burn complications and longer duration of hospitalisation. The second study indicated that more than twenty-five percent of the respondents believed that multidisciplinary centres should only occasionally be involved in the process of care. Participants reported that the individual profile of each patient plays a major role in determining the management of diabetes. Additionally, it was found that the insulin sliding scale was commonly used in the management of diabetes in burns units. The association between diabetes and a burn injury is a serious issue in terms of health and cost. This association need be addressed firstly and most importantly at the prevention level; secondly through proper management of both diabetes and burns.<br>Thesis (D.Nurs.)--Population Health and Clinical Practice, 2007.

With the decrease in burn mortality following improved burn care facilities and methods, burn survivors are often left with residual physical and psychosocial consequences that they have to cope with requiring adaptation and modification of lifestyle. Burn survivors habitually receive excellent treatment for their wounds while in hospital but may experience challenges due to disruption of care and rehabilitation after discharge. This aim of the study was to explore and describe the lived experiences of burn survivors’ adaptation post hospital discharge. A qualitative, hermeneutic, phenomenological design using an interpretive framework was used. A purposeful sampling was used in the selection of nine participants who were above 18 years and had been admitted to the Limpopo Burn Unit while still undergoing reviews at the Plastic and Reconstructive Surgery Clinic. Data were collected through face-to-face interviews using unstructured open-ended questions. Data were analysed using the Colaizzi’s strategy. Three main themes emerged from the data, along with sub-themes. (a)The burn survival experience involved the person in totality with reference to their internal and external environment. (b)The process of recovery was lengthy and started in hospital and continued post discharge at home. (c) Reclaiming their life and finding new meaning was a process of adaptation. The core of the participants’ needs included the need for the care and rehabilitation of the whole person in terms of their physical and psychosocial aspects, the importance of the survivor’s involvement in his/her care, and the rehabilitation. Health care personnel and family support during this difficult time should be available in order to enable the survivors to cope and adapt effectively and reclaim their lives.<br>Health Studies<br>M.A. (Nursing Science)

碩士<br>逢甲大學<br>建築及都市計畫研究所<br>88<br>Abstract Owing to the fact that studies with regard to hospital constructionin Taiwan are considerably short of at present. In most cases, data from advanced countries, for instance, European countries. USA. Japan etc. are followed and adopted; therefore study data with a motherland character and evaluation made after using are considerably lacking of;In addition, due to hospital construction being involved with social welfare, public life. and popular custom, consequently to set up a hospital construction scheme system with a motherland character is pressingly required. In view of this fact, this study will focus on the burn intensive care unit of hospitals on hand to do evaluation and study,to examine the efficacy of burn intensive care unit of each hospital with respect to construction and management practice, to get using experience of burn intensive care units transferred to hospital scheme and decision making unit to enrich the basic knowledge of construction and management of each hospital intensive care unit, furthermore, it can be taken as referential data by other hospitals for scheming a burn intensive care unit so as to get the quality of national medical care relatively uplifted as expected. Scope of this study takes hospitals furnished with burn intensive care unit in North Taiwan. Central Taiwan and South Taiwan as major object. Hospitals with relation to Children Burn Intensive Care Foundation are taken as referential objects (part of military hospitals and hospitals unfurnished with burn intensive care unit are deducted),so totally twenty three (23) hospitals play the part of objects to be investigated. Contents of the investigation take burn intensive care unit management、space usage、 intenal path line and plane scheme as the main parts.Working method of this study takes literature review、current condition survey and questionaire application as three study methods. Basing on the results obtained from the aforesaid study methods to work out a synthetic evaluation so as to establish a scheme principle for the integrated function of burn intensive care unit. Scheming Principle for the Integrated Function of Burn Intensive Care Unit Is Suggested ly this Study as Below: 1. In respect of space allocation, burn treatment district and nontreatment district should be learlydistinguished so as to get the chance of patients being infected in the district reduced. 2. Regarding path line disposition, a fluent working space should be maintained and indistinguishable path lines should be avoided. 3. With regard to supply district and storage space allocation, path line for medical supplies transporting and storage space should be simply and perspicuously marked so as to increase physicians'' and nurses'' convenience. Path line should be separated from treatment distreict so that chance of patients cross infection in the district can be reduced. 4. As to dirt disposal, path line should be clearly separated from treatment district so as to reduce the chance of patients being infected in the district. 5. Concerning plane scheme practice, it must be matched with the integrated design、 management scales internal space requirements、pathline arrangement so as to seek for the most appropriate plane type and a well planned design. The purpose of managing a burn intensive care unit and the demand for construction schemelie in no other than satisfying the requirements of medical care operating space. The more important target is to satisfy the basic requisitions of human being： Safety、convenience、 fluency are the most important matter. Key Words： Burn Intensive Care Unit、Management、Construction、 Pathline

Background: Burned patients are a special fragile population in which infections are a leading cause of dead and morbidity. Fungal infections have become increasingly prevalent in Intensive Care Units (ICU) and burn ICUs. Management of fungal colonization and infection still constitutes a challenge for clinicians.Aim: characterize the population of burn patients with fungal infections admitted in our Burn ICU.Methods: a retrospective cross-sectional study of all patients admitted to a Burn ICU between 2013 and 2015. 172 patients were included and characterized regarding age, gender, date of admission and exit, type of burn, type of exit, TBSA and presence of inhalation injury. Presence of fungal infection, causative pathogen and site of sampling were also registered. Statistical analysis centered around the presence of fungal infection was performed using IBM SPSS Statistics.Results: 172 patients were included, 38 (22,1%) had a fungal infection and from this 8 (21,1%) died. Patients with fungal infection stayed more days than those without infection. However, this tendency didn't reach statistical significance when patients that died on ICU where excluded. No relations were found when comparing fungal infection with TBSA, burn aetiology, inhalation injury or mortality.Conclusion: fungal infection are a major cause of morbidity and mortality despite of TBSA, burn type or presence of inhalation injury. Efforts should be made to improve management of fungal infections, especially on burn patients and other critically ill groups.

Background: Burned patients are a special fragile population in which infections are a leading cause of dead and morbidity. Fungal infections have become increasingly prevalent in Intensive Care Units (ICU) and burn ICUs. Management of fungal colonization and infection still constitutes a challenge for clinicians.Aim: characterize the population of burn patients with fungal infections admitted in our Burn ICU.Methods: a retrospective cross-sectional study of all patients admitted to a Burn ICU between 2013 and 2015. 172 patients were included and characterized regarding age, gender, date of admission and exit, type of burn, type of exit, TBSA and presence of inhalation injury. Presence of fungal infection, causative pathogen and site of sampling were also registered. Statistical analysis centered around the presence of fungal infection was performed using IBM SPSS Statistics.Results: 172 patients were included, 38 (22,1%) had a fungal infection and from this 8 (21,1%) died. Patients with fungal infection stayed more days than those without infection. However, this tendency didn't reach statistical significance when patients that died on ICU where excluded. No relations were found when comparing fungal infection with TBSA, burn aetiology, inhalation injury or mortality.Conclusion: fungal infection are a major cause of morbidity and mortality despite of TBSA, burn type or presence of inhalation injury. Efforts should be made to improve management of fungal infections, especially on burn patients and other critically ill groups.

ABSTRACT Comparing Early Enteral Nutrition AmONG Medical, Burn, Surgical/Trauma, and Neurocritical Intensive Care Units and its Effect on Length of Stay By Kelsey Spinks Background: Current research supports that early enteral nutrition (EEN), or enteral nutrition delivered within 48 hours of admission, may reduce infection, incidence of pneumonia, mortality, and time that critical care patients spend on the ventilator. EEN may also decrease intensive care unit (ICU) length of stay. With one day in the ICU costing an estimated $14,462, length of stay becomes a financial concern for hospitals that care for uninsured or underinsured patients. Most studies that examine the effect of EEN on length of stay lump all critical care patients into one group or will only examine one ICU population at a time. Objective: To examine the effect of EEN on length of stay for critical care patients in four adult intensive care units to include: burn, neurocritical, medical, and surgical/trauma ICUs in a large urban teaching hospital. Methods: A retrospective chart review was conducted for patients admitted between September 2012 and February 2014 in each of the four adult ICUs. Statistical analyses for nonparametric data were conducted using SPSS 21. Sample Description: The median age of the 89 patients was 55 years. The median BMI was 28. There were 61 males and 28 females. In the surgical/trauma ICU, the median age was 48 years, BMI was 25, and there were 15 males and 8 females. In the medical ICU, the median age was 57 years, BMI was 32, and there were 17 males and 6 females. In the burn ICU, the median age was 40 years, BMI was 28, and there were 14 males and 5 females. In the neurocritical ICU, the median age was 62 years, BMI was 27, and there were 15 males and 9 females. Results: There was a significant but weak positive correlation between the time to initiation of enteral nutrition (EN) and ICU length of stay in the surgical ICU (p=0.04), medical ICU (p=0.03) and neurocritical ICU (p=0.04). A significant difference (p=0.03) was found in ICU length of stay between the medical ICU patients who were fed early (within 48 hours of admission) versus those who were fed late (after 48 hours of admission). Patients fed late had a longer ICU length of stay than those who were fed early. There was a significantly earlier time in the initiation of EN (p<0.001) between the units who have an RD rounding daily (burn and neurocritical) and the units that did not (surgical and medical). Conclusions: EEN is significantly associated with shorter ICU lengths of stay in surgical, medical, and neurocritical populations. Even if EEN does not decrease length of stay in a particular population, it could still be beneficial for other patient outcomes, like reduced mortality, lower incidence of pneumonia, and shorter time spent on the ventilator. The ICU dietitian plays an important role in advocating for EEN in those patients who are medically ready for it. In terms of best practice, critical care RDs have a valuable opportunity to establish their niche as the nutrition expert on the interdisciplinary care team by incorporating medical rounds in to their daily practice.

Burnout is reflected in pathological emotional depletion and maladaptive detachment that is a secondary result of exposure prolonged occupational stress. It is comprised of three dimensions, namely, emotional exhaustion, depersonalization and reduced personal accomplishment. It is becoming increasingly recognized as one of the most serious occupational hazards for nurses who work in critical care units. The objectives of this study are to assess the prevalence of burnout among a sample of nurses who worked in the critical care units in a particular hospital in Kenya, to analyze factors that contributed to the development of burnout and to identify measures for the mitigation of burnout. For this study, the researcher utilized a mixed methods research design in two phases. Phase one assessed the prevalence of burnout in nurses working in the critical care units by making use of the Maslach Burnout Inventory – Human Services Survey. Focus groups discussions were then held in Phase two to investigate the factors that the nurses perceived as the main causes of burnout and to solicit their ideas about it could be mitigated. Convenience sampling and purposive sampling were used in the two phases of the study respectively.<br>Health Studies<br>M.A. (Health Studies)