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1

Orsi, Gisele de Oliveira [UNESP]. "Consulta de enfermagem como instrumento de avaliação do protocolo assistencial de gastrostomia endóscópica percutânea." Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/86303.

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Universidade Estadual Paulista (UNESP)
Avaliar a utilização do protocolo assistencial, utilizando a Sistematização da Assistência de Enfermagem (SAE), e a satisfação do cliente em relação às consultas de enfermagem nas gastrostomias endoscópicas percutâneas (GEP), de forma prospectiva. No período de novembro de 2009 a março de 2011, foram avaliadas todas as GEP, deforma prospectiva, utilizando a consulta de enfermagem como instrumento de avaliação de protocolo assistencial de satisfação do cliente, na Seção Técnica de Endoscopia do Hospital das Clínicas da Faculdade de Medicina de Botucatu – Unesp. As avaliações foram realizadas em 4 momentos: M1 a M4, sendo pós procedimento imediato, 1º, 30º e 90º dias após o procedimento, respectivamente, quando foram avaliados parâmetros da dor e características da região peri estomal, complicações precoces, tardias, menores e maiores. No período do estudo foram realizadas 38 GEP. A média de idade foi de 50,09 anos ± 20,12 anos, sendo 57,83 anos no sexo masculino e 61,14 anos no sexo feminino. Houve perda de seguimento por não comparecimento a consulta, no M3 de 5,2% e no M4 de 2,6% e por óbito no M3 de 10,52% e no M4 de 8,33%. Todos os pacientes contavam com a presença de cuidador. No M1, 28,9% não referiram dor, 63,16% referiram dor de fraca intensidade e 7,89% de moderada intensidade. No M2, 13,16% não referiram dor, 84,21% referiram dor de fraca intensidade e 2,63% de moderada intensidade. No M3, houve diminuição da queixa, sendo que 90,63% não referiram dor, 6,25% referiram dor de fraca intensidade e 3,13% de moderada intensidade. No M4, 93,10% não referiram dor e 6,90% referiram dor de fraca intensidade. Nenhum paciente queixou-se de dor intensa ou insuportável nos momentos de avaliação e 15,15% dos pacientes não apresentaram dor em nenhum momento. Entre as complicações...
Prospectively evaluate the use of an assistential care protocol for percutaneous endoscopic gastrostomy (PEG) using the systematization of nursing care and customer satisfaction regarding nursing consultations. A prospective study was conducted from November 2009 to March 2011 using nursing consultations to evaluate an assistential care protocol for PEG and customer satisfaction in all adults submitted to PEG in the Endoscopy Sector of the of Botucatu Medical School of São Paulo State University (UNESP).The parameters evaluated were pain and complications. Patient mean age was 50.1 ± 20.1 years-old (57.8 years-old for males and 61.1 years-old for females). Patient loss at follow-up occurred in 5,2% due to nonattendance at M3 (30 days postsurgery) and in 2,6% in M4 (90 days postsurgery) and to death in 10,5% at M3 and in 8,3% in M4, attributed to basic pathology and associated comorbidities. The parameters evaluated were pain and early,late, minor and major complications. In M1, 28,9% didn’t show pain, 63,16% refered weak pain and 7,89% had moderate pain. In M2, 13,16% didn’t present pain, 84,21% had weak pain, and 2,63% had moderate pain. In M3, 90,63% did not complain about pain, 6,25% had weak pain and 3,13% had moderate pain. In M4, 93,1% didn’t present pain and 6,9%had weak pain. None of the patients complained about severe pain in any moment, and 15,15% of the patients didn’t have pain at all. Hipoventilation was the main minor complication, in 15,79%, probably due to the patients main diagnosis. 7,89% presented aspirative pneumonia as an early major complication. In this study, all patients required the presence of a caregiver. The customer satisfaction questionnaire was validated by Cronbach's alpha, which showed coherence and consistency in its applicability, suggesting it can be used... (Complete abstract click electronic access below)
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2

Orsi, Gisele de Oliveira. "Consulta de enfermagem como instrumento de avaliação do protocolo assistencial de gastrostomia endóscópica percutânea /." Botucatu, 2012. http://hdl.handle.net/11449/86303.

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Orientador: Érika Veruska Paiva Ortolan
Banca: Walmar Kerche de Oliveira
Banca: Márcia Riromi Henna
Resumo: Avaliar a utilização do protocolo assistencial, utilizando a Sistematização da Assistência de Enfermagem (SAE), e a satisfação do cliente em relação às consultas de enfermagem nas gastrostomias endoscópicas percutâneas (GEP), de forma prospectiva. No período de novembro de 2009 a março de 2011, foram avaliadas todas as GEP, deforma prospectiva, utilizando a consulta de enfermagem como instrumento de avaliação de protocolo assistencial de satisfação do cliente, na Seção Técnica de Endoscopia do Hospital das Clínicas da Faculdade de Medicina de Botucatu - Unesp. As avaliações foram realizadas em 4 momentos: M1 a M4, sendo pós procedimento imediato, 1º, 30º e 90º dias após o procedimento, respectivamente, quando foram avaliados parâmetros da dor e características da região peri estomal, complicações precoces, tardias, menores e maiores. No período do estudo foram realizadas 38 GEP. A média de idade foi de 50,09 anos ± 20,12 anos, sendo 57,83 anos no sexo masculino e 61,14 anos no sexo feminino. Houve perda de seguimento por não comparecimento a consulta, no M3 de 5,2% e no M4 de 2,6% e por óbito no M3 de 10,52% e no M4 de 8,33%. Todos os pacientes contavam com a presença de cuidador. No M1, 28,9% não referiram dor, 63,16% referiram dor de fraca intensidade e 7,89% de moderada intensidade. No M2, 13,16% não referiram dor, 84,21% referiram dor de fraca intensidade e 2,63% de moderada intensidade. No M3, houve diminuição da queixa, sendo que 90,63% não referiram dor, 6,25% referiram dor de fraca intensidade e 3,13% de moderada intensidade. No M4, 93,10% não referiram dor e 6,90% referiram dor de fraca intensidade. Nenhum paciente queixou-se de dor intensa ou insuportável nos momentos de avaliação e 15,15% dos pacientes não apresentaram dor em nenhum momento. Entre as complicações... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Prospectively evaluate the use of an assistential care protocol for percutaneous endoscopic gastrostomy (PEG) using the systematization of nursing care and customer satisfaction regarding nursing consultations. A prospective study was conducted from November 2009 to March 2011 using nursing consultations to evaluate an assistential care protocol for PEG and customer satisfaction in all adults submitted to PEG in the Endoscopy Sector of the of Botucatu Medical School of São Paulo State University (UNESP).The parameters evaluated were pain and complications. Patient mean age was 50.1 ± 20.1 years-old (57.8 years-old for males and 61.1 years-old for females). Patient loss at follow-up occurred in 5,2% due to nonattendance at M3 (30 days postsurgery) and in 2,6% in M4 (90 days postsurgery) and to death in 10,5% at M3 and in 8,3% in M4, attributed to basic pathology and associated comorbidities. The parameters evaluated were pain and early,late, minor and major complications. In M1, 28,9% didn't show pain, 63,16% refered weak pain and 7,89% had moderate pain. In M2, 13,16% didn't present pain, 84,21% had weak pain, and 2,63% had moderate pain. In M3, 90,63% did not complain about pain, 6,25% had weak pain and 3,13% had moderate pain. In M4, 93,1% didn't present pain and 6,9%had weak pain. None of the patients complained about severe pain in any moment, and 15,15% of the patients didn't have pain at all. Hipoventilation was the main minor complication, in 15,79%, probably due to the patients main diagnosis. 7,89% presented aspirative pneumonia as an early major complication. In this study, all patients required the presence of a caregiver. The customer satisfaction questionnaire was validated by Cronbach's alpha, which showed coherence and consistency in its applicability, suggesting it can be used... (Complete abstract click electronic access below)
Mestre
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3

Nappi, José Humberto Giordano. "Modificação de dispositivo para gastrostomia endoscópica percutânea pela técnica de punção: utilização em pacientes com neoplasia maligna de cabeça e pescoço." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5154/tde-12032010-151918/.

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O câncer de cabeça e pescoço é a quinta neoplasia mais frequente nos países em desenvolvimento. A disfagia resultante da doença ou do tratamento pode levar à perda ponderal e à desnutrição. A nutrição enteral por sonda é o método de escolha para administração de terapia nutricional aos pacientes com trato gastrointestinal funcionante, incapazes de manter ingestão adequada por via oral. Sondas nasogástricas ou nasoenterais são empregadas para alimentação a curto prazo e sondas de gastrostomia ou jejunostomia, para períodos de tempo mais prolongados que 4 semanas. A gastrostomia endoscópica percutânea é o método mais utilizado, dada sua segurança e eficácia. A técnica de tração é a mais comumente empregada e consiste na introdução da sonda na câmara gástrica através da via orofaríngea e com auxílio do endoscópio. Em pacientes com câncer de cabeça e pescoço, esta técnica apresenta limitações decorrentes da estenose da via digestiva provocada por inflamação, irradiação prévia ou pelo próprio tumor que impede a passagem do aparelho ou da sonda. Nesta situação, reporta-se insucesso em cerca de 20% dos casos, além de complicações decorrentes da necessidade de dilatação da estenose, infecção do local da ostomia, obstrução aguda da via aérea e até implante do tumor no local da punção na parede abdominal. A gastrostomia endoscópica percutânea pela técnica de punção é a alternativa mais segura para esse grupo de pacientes, já que a sonda é colocada por via abdominal sob controle endoscópico. As desvantagens da técnica são o risco de deslocamento do estômago insuflado no momento da punção e a utilização de sonda de menor calibre. A introdução da gastropexia endoscópica permite a fixação do estômago à parede abdominal, evitando o deslocamento gástrico no momento da punção. Ainda assim, resta o problema do calibre da sonda. O objetivo deste estudo foi avaliar a modificação de dispositivo para gastrostomia endoscópica percutânea pela técnica de punção quanto à exequibilidade, segurança, eficácia do procedimento e mortalidade. Trinta pacientes com câncer de cabeça e pescoço (a idade média de 58 anos e 76,7% do sexo masculino) foram admitidos no estudo. O índice de Karnofsky médio foi de 67,7 e o risco anestésico, ASA 1 = 3,3%, ASA 2 = 50% e 46,6%, ASA 3. O método de traqueostomia havia sido realizado na metade dos pacientes, 18 (60%) tinham sido submetidos à quimioterapia e radioterapia associadas ou isoladamente. Os tumores da cavidade oral foram os mais frequentes, com 11 (36,7%) casos. Metade dos pacientes foi diagnosticada no estádio IV da doença, 7 (23,3%) no estádio III, 1 (3,3%) estádio II e 5 (16,7%) apresentavam recidiva. O tipo histológico mais comum foi o carcinoma escamocelular, em 27 (89,9%) casos. A presença de estenose foi encontrada em 23 (76,7%) pacientes, sendo 15 (50%) isoladas e em 8 (26,7%), associadas a trismo. Os pacientes foram submetidos à gastrostomia endoscópica percutânea pela técnica de punção com dispositivo modificado com fenda lateral e mandril com ponta cônica, associada à gastropexia e colocação de sonda balonada de 20 Fr. O procedimento foi realizado em regime ambulatorial em 26 (86,7%) pacientes, sempre sob sedação e anestesia local. A via mais frequente de acesso à câmara gástrica foi a oral em 26 (86,7%) pacientes e a nasal, nos demais. Não houve necessidade de dilatação da via aerodigestiva para passagem do endoscópio. O procedimento foi bem-sucedido em todos os enfermos e sem complicações perioperatórias. Os pacientes foram seguidos no pós-operatório imediato, com 72 horas, 10, 30 e 60 dias, para avaliação de dor, infecção do estoma, funcionalidade, problemas com a sonda e mortalidade. Não foram observados sinais de infecção do estoma por meio do escore combinado de infecção. No pós-operatório imediato, um (3,3%) paciente apresentou dor abdominal difusa, levando-o à laparotomia exploradora. Tratou-se de pneumoperitoneo maciço sem sinais de lesão de outras vísceras que o justificassem e foi considerada complicação maior precoce. A maioria dos pacientes apresentou dor leve e moderada no pós-operatório imediato e com 72 horas. Duas complicações menores (6,6%) foram observadas; dermatite química por extravasamento ao redor da sonda no 36º pós-operatório e perda inadvertida de sonda no 8º pós-operatório, sem sinais de complicação e que foi reposicionada sem necessidade de nova endoscopia. Em dois (6,6%) pacientes, houve rotura tardia do balão da sonda que foi substituída, sem exame endoscópico. A infusão da dieta foi considerada de fácil execução em todos os pacientes e não houve obstrução da sonda até 60 dias de avaliação. Não se observou mortalidade relacionada ao procedimento decorridos 30 dias da intervenção. Houve dois (6,6%) óbitos entre 30 e 60 dias, decorrentes da evolução da doença. Em conclusão, a modificação do dispositivo para gastrostomia endoscópica percutânea pela técnica punção é exequível, segura e eficiente em pacientes com neoplasia avançada e obstrutiva de cabeça e pescoço, sob regime ambulatorial e sedação, permitindo o uso de sonda mais calibrosa e sua troca sem necessidade de nova endoscopia, apresentando baixas taxas de complicações e sem mortalidade relacionada ao procedimento nesta série
Head and neck cancer is the fifth most frequent neoplasm in developing countries. Dysphagia resulting from head and neck cancer or its treatment may lead to weight loss and malnutrition. Enteral nutrition is the method of choice of therapy to patients with preserved gastrointestinal tract unable to maintain adequate oral ingestion. Nasogastric or nasoenteral tubes are employed for short-term feeding and gastrostomy or jejunostomy tubes for more than 4 weeks. Percutaneous endoscopic gastrostomy is the most used method due to its safety and efficacy. The pull technique is the most commonly used method consisting in the introduction of a tube into the inflated stomach through the oropharingeal route with endoscopic aid. In those patients, such technique presents limitations due to digestive tract stenosis caused by inflammation, irradiation, or the tumor itself preventing endoscope or tube passage. In this case, failure occurs in approximately 20% of cases. Complications caused by stenosis dilation, infection of the ostomy site, acute airway obstruction, and even implantation of tumor at the puncture site on the abdominal wall have also been reported. Percutaneous endoscopy gastrostomy through introducer technique is the safest alternative for this group of patients because the tube is placed through an abdominal access under endoscopic control. The disadvantages of this method are the risk of displacing the inflated stomach at the moment of puncture and the use of smaller caliber tubes. The advent of the endoscopic gastropexy enables the fixation of the stomach to the abdominal wall preventing gastric displacement at the moment of puncture. Even though, tube caliber problem remains. The aim of this study was to evaluate the modification of a percutaneous endoscopy gastrostomy device with introducer technique regarding procedure feasibility, complications, procedure safety efficacy, and mortality. Thirty patients (mean age: 58 years, 76.7%: male) were included in the study. Mean Karnofsky index was found to be 67.7% and anesthetic risk ASA 1 = 3.3%, ASA 2 = 46.6%, and ASA 3 = 46.6%. Half of the patients had already undergone tracheostomy and 18 (60%) had chemotherapy and radiotherapy associated or in monotherapy. Oral cavity tumors were the most frequent totaling 11 (36.7%) of cases. Half of the patients were diagnosed in the stage IV of the disease, 7 (23.3%) in stage III, 1 (3.3%) in stage II, and 5 (16.7%) had already recurrence. Squamous cell carcinoma was the most frequent histological type in 27 (89.9%) of cases. Stenosis was found in 23 (76.6%) of cases, of which 15 (50%) were found to be isolated and 8 (26.7%), associated to trismus. Patients underwent introducer technique percutaneous endoscopy gastrostomy using modified device, associated to gastropexy, and a 20-Fr balloon tube placement. The procedure was performed in 26 (86.7%) outpatients under sedation and local anesthesia. The most frequent route to the inflated stomach was the oral route in 86.7% of patients and the nasal route in the others. There was no need for digestive dilation for passing the endoscope. The procedure was successful in all cases with no perioperative complications. Patients were followed up in the immediate postoperative period and at 72 hours, 10, 30 and 60 days for the assessment of pain, stoma infection, functionality, tube-related problems, and mortality. No signs of stoma infection were observed through the combined infection score. In the immediate postoperative period, one (3.3%) patient presented diffuse abdominal pain, leading to exploratory laparotomy that revealed massive pneumoperitoneum with no related signs of lesion to other organs and that was considered a major early complication. The majority of patients presented mild, moderate pain in the immediate postoperative period and at 72 hours. Two minor complications (6.6%) were observed: chemical dermatitis due to leakage around the tube on postoperative day 36 and inadvertent tube loss on postoperative day 8 with no signs of complication, so that the tube was repositioned without endoscopy. Two patients (6.6%) presented late rupture of tube balloon that was replaced without endoscopic examination. Dietary infusion was considered to be easily performed in all patients and no tube obstruction up to 60 assessment days was observed. Procedure-related deaths were not observed up to 30 days post intervention. There were two (6.6%) deaths between days 30 and 60 resulting from disease evolution. In conclusion, the application of the modified device for percutaneous endoscopy gastrostomy with introducer technique is feasible, safe, and efficient in outpatients with advanced, obstructive head and neck cancer under sedation, allowing the use of larger caliber, replaceable tube with low complication rates and no procedure-related mortality in this series
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4

Caselli, Thaisa Barboza 1990. "Parâmetros nutricionais e efeito da alimentação por gastrostomia em crianças e adolescentes com tetraparesia espástica." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310764.

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Orientadores: Maria Angela Bellomo Brandão, Elizete Aparecida Lomazi
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A tetraparesia espástica é um tipo de Encefalopatia crônica não progressiva ou não evolutiva (ECNE) que corresponde a uma condição neurológica associada a anormalidades motoras graves, ingestão alimentar deficiente, comprometimento da composição corporal e desnutrição frequente. A gastrostomia tem sido indicada para crianças com dificuldades em se alimentar decorrente da ECNE. O objetivo do trabalho foi avaliar o estado nutricional de crianças e adolescentes portadores de ECNE tetraespástica, por meio de curvas específicas e das dobras cutâneas, identificar a frequência das disfunções da motilidade digestiva e a comparar o estado nutricional daquelas alimentadas via gastrostomia (SGT) e via oral (VO). Também foi verificada a concordância entre curvas de crescimento utilizadas para população pediátrica no geral e as curvas específicas para pacientes com ECNE. Estudo transversal em que foram incluídos 54 pacientes. Foram obtidos os dados de: altura do joelho, estatura estimada, peso, dobras cutâneas e circunferências do braço. Os valores de dobras e circunferências foram comparados com a referência de Frisancho. As curvas de Brooks et al. foram utilizadas como padrão referencial e foram definidos como desnutridos aqueles que se encontravam abaixo do percentil 25 de peso para idade. A diferença dos parâmetros nutricionais entre o grupo SGT e grupo VO foi calculada por testes Qui-Quadrado e Exato de Fisher, enquanto que a relação entre curva de crescimento para crianças saudáveis (representada pelo Escore-Z calculado) e curva adotada como referencial foi verificada através do teste exato de Fisher. O nível de significância adotado foi de 5%. Dos 54 pacientes, 34 eram do sexo masculino e a média da idade foi de 10,2 anos. Vinte e cinco pacientes eram alimentados por SGT e 29 por VO. Observou-se que 70% (38/54) dos pacientes foram considerados eutróficos nos parâmetros de peso e Índice de Massa Corpórea (IMC) para idade, enquanto que 100% (54/54) estavam com estatura adequada para idade. A desnutrição em relação à dobra cutânea triciptal foi observada em 30% (26/54) enquanto que 52% (28/54) apresentaram depleção de massa magra através da circunferência braquial. Foi verificado que as disfunções da motilidade digestiva, como refluxo gastroesofágico, distúrbio de deglutição e constipação intestinal foram mais frequentes no grupo SGT, sendo possivelmente um dos fatores para indicação da cirurgia. O grupo VO apresentou mais indivíduos na faixa da desnutrição (24,14% ou 7/12), além de maior depleção de massa magra e adiposa quando comparado ao grupo SGT. Em relação às curvas, 14,3% dos pacientes que foram classificados como eutróficos no parâmetro peso para idade de acordo com a curva referencial, o Escore-Z os classificou como desnutridos e o mesmo ocorreu em 10% em relação ao IMC. A curva referencial classificou todos como tendo estatura adequada para idade, enquanto que o Escore-Z apontou baixa ou muito baixa estatura para idade. O estudo permitiu concluir que os parâmetros antropométricos indicam que os pacientes do grupo VO apresentam maior comprometimento do estado nutricional do que aqueles que se alimentam via SGT
Abstract: Spastic Quadriplegic cerebral palsy is a sort of a non-progressive chronic encephalopathy, which is related to a neurological condition linked to serious motor abnormalities, deficient food intake, body composition compromising and frequent malnourishment. Gastrostomy is being indicated to children who have difficulties in feeding due to the non-progressive chronic encephalopathy. The aim was to evaluate nutritional status of children and teenagers carriers of non-progressive chronic encephalopathy with spastic quadriplegic cerebral palsy (through comparison with specifics curves and skinfolds), dysfunctions frequency of digestive motility and the nutritional status comparison of those who feed via gastrostomy and via oral. It was also verified the accordance between growth curves used to pediatric people in general, and specifics curves for patients with non-progressive chronic encephalopathy. Sectional study which were included 54 patients. The following data were obtained: knee height, estimated stature, weight, skin folds and arm circumference. Skin folds and circumferences values were compared to Frisancho¿s reference values. Brooks curves at al. were used as referential standards, and were defined as malnourished those who were below the 25th percentile to the age. Nutritional parameters¿ difference between the group feed via gastrostomy and via oral was measured by Chi-square test and Fisher exact test. Significance level adopted was 5%. From 54 patients, 34 were male and the average age was 10.2 years old. Twenty five patients were feed via gastrostomy and 29 via oral. It was observed that 70% (38/54) of all patients were considered as eutrophic as weight and body mass parameters for the age, while 100% (54/54) had the ideal stature for the age. Malnourishment related to triceps skinfold was observed in 30% (26/54), while 52% (28/54) presented lean mass depletion through arm circumference. Was also verified that digestive motility, such as gastroesophageal reflux, swallowing disorders and intestinal constipation were frequent in group feed via gastrostomy, and a probable factor for surgery indication. Via oral group presented more individuals in malnourishment range (24,24%, or 7/12), besides higher levels of lean mass depletion, and also of adipose mass when compared to in group feed via gastrostomy. In 14,3% of patients who were classified as eutrophic in weight/age parameters in according to referential curve, Z-Score classified them as malnourished and the same happened in 10% on their body mass index. The reference curve has classified all patients as suitable stature to their ages. This study allowed to conclude that anthropometric parameters indicates that patients from via oral group present a higher compromising of nutritional status than patients of gastrostomy group
Mestrado
Saude da Criança e do Adolescente
Mestra em Ciências
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Perissé, Vera Lúcia de Castro. "O enfermeiro no cuidar e ensinar à família do cliente com gastrostomia no cenário domiciliar." Universidade Federal Fluminense, 2007. https://app.uff.br/riuff/handle/1/1447.

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Clínica Vídeo-Endo
Mestrado Profissional em Enfermagem Assistencial
O cliente gastrostomizado requer o acompanhamento contínuo do enfermeiro estomaterapeuta, até que este e sua família readquiram a independência diante desta nova condição de vida. Este apoio inicia-se durante a hospitalização, a partir da instalação do cateter, estendendo-se para o dia-a-dia, no cenário domiciliar, quando este estoma assume o caráter permanente, havendo a necessidade de incentivo à família a participar no cuidado desse cliente, dando suporte às suas ações, ensinando-lhes os cuidados com o cateter, seu manuseio durante a administração da dieta, os cuidados em relação aos aspectos físicos e emocionais. Tais cuidados devem ser avaliados não só no sentido de prevenir complicações advindas do manuseio incorreto do cateter, mas também para garantir a reabilitação e a manutenção da saúde desse cliente no ambiente domiciliar, independente de sua condição sócio-econômica. Assim, o presente estudo teve por objetivos caracterizar o ambiente do cliente gastrostomizado e sua família, analisar as necessidades do familiar no cuidado do cliente gastrostomizado no cenário domiciliar e elaborar um programa de ensino ao familiar que cuida do cliente gastrostomizado no domicílio. Os sujeitos do estudo foram dez familiares que cuidavam de clientes gastrostomizados no domicílio. A coleta de informações foi desenvolvida através de visita domiciliar que possibilitou a aplicação das técnicas de observação participante, para caracterização do contexto domiciliar e entrevistas semi-estruturadas com os familiares desses clientes. Tais informações serviram de base para o documento que se encontra no final do estudo e que após testes e aprovação da equipe de médicos diretores da Clínica Vídeo-Endo, será enfim implantado
The client that suffered a gastrostomy needs the full attention of a stomach therapist nurse. This support starts with the probe installation and should be followed in homecare attention by motivating the family to take part of this process, giving them the necessary support, teaching how to manage the probe, how to handle it in the process of feeding the client and also the physical and emotional care required in order to prevent difficulties and contributing effectively to the health promotion, maintenance and rehabilitation of the client in home scene. The purpose of this work is to know the new possibilities of innovation in the nurse‟s practice and teaching with the family of the gastrostomized patient, identifying the needs of the family in this kind of care in home scene and elaborating a homecare program to the family of a gastrostostomized client. The subjects of this case study were ten members of the family who took care of gastrostomized patients in their homes. The information gathered was based on visitations to the homes, which enabled the use of techniques of participating observation, for the characterization of the home care context, as well as on semi structured interviews with family members of these patients. Such information is the basis of the document at the end of this study, which after trials and approval from the team of doctors - directors of the Clinic Video-Endo - will be then, implemented
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CALDAS, Ana Caroline Silva. "Tecnologia cuidativo-educacional para promoção da autonomia de famílias de crianças com gastrostomia." Universidade Federal do Maranhão, 2017. https://tedebc.ufma.br/jspui/handle/tede/tede/2028.

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The making of gastrostomy leads many families to experience conflicting moments characterized by uncertainty, stress and disagreements between parents. In addition to the feelings of anguish and fear unveiled by caregivers, families are required to have innumerable knowledge and practices that are unusual for the daily care of children. Families need to receive professional support and have the social support network to deal with adversities that permeate family life. This research seeks to develop educational-care technology to support the care of the gastrostomy child based on the Model of Interpersonal Relations of Peplau and conception of Autonomy of Paulo Freire. Qualitative descriptive research utilized the Sensitive Creative Method (MSC) and Body Knowledge dynamics. Participants were 10 families living the gastrostomy preparation process, from the preoperative to the home care. For data collection, we used semi-structured interview recorded in audio, systematic observation and field notes. The data were coded / recoded and the situations-problems revealed were substrate for construction of the educational-care technology. The situation-problems encountered were: lack of knowledge of the families about the hospitalization process of the child, difficulty in the families' perception on gastrostomy, disruption of the parents' ideal of a perfect child, insufficient health education to attend to the demands of family care for the children with gastrostomy, resignation to the new family situation, having a child dependent on technologies, loss of the physiological feeding route. It is concluded that families with knowledge about gastrostomy will be empowered with their rights and thus may transform their reality. The technology can help families better understand what a gastrostomy is and how to handle it so that the care safely provided to the child helps in adapting to the situation of chronicity experienced.
A confecção da gastrostomia em crianças leva muitas famílias a vivenciar momentos conflituosos caracterizados por incertezas, estresse e desavenças. Além dos sentimentos de angústia e medo desvelados pelos cuidadores, é exigido das famílias inúmeros saberes e práticas incomuns para o cuidado cotidiano das crianças. As famílias precisam receber suporte profissional e dispor da rede de apoio social para enfretamento das adversidades que permeiam a vida familiar. Nesta investigação procura-se desenvolver tecnologia cuidativo-educacional para apoiar o cuidado à criança gastrostomizada a partir do Modelo das Relações Interpessoais de Peplau e Concepção da Autonomia de Paulo Freire. A pesquisa descritiva qualitativa utilizou o Método Criativo Sensível com a dinâmica Corpo Saber. Foram sujeitos de participação 10 famílias que vivenciavam o processo de confecção da gastrostomia, desde o pré-operatório até o cuidado domiciliar. Para coleta de dados utilizou-se entrevista semiestruturada gravada em áudio, observação sistemática e anotações de campo. Os dados foram codificados/recodificados e as situações-problemas reveladas constituíram substrato para construção da tecnologia cuidativoeducacional. As situações-problemas estabelecidas foram: desconhecimento das famílias sobre o processo de hospitalização da criança, dificuldade na percepção das famílias sobre a gastrostomia, desestruturação do imaginário dos pais sobre a criança perfeita, educação em saúde insuficiente para atender demandas de cuidado das famílias às crianças com gastrostomia, resignação diante da nova situação familiar, ter um filho dependente de tecnologias, perda da via de alimentação fisiológica. Conclui-se que as famílias com o conhecimento sobre gastrostomia serão empoderadas dos seus direitos e assim poderão transformar sua realidade. A tecnologia poderá ajudar famílias a conhecer melhor o que é uma gastrostomia e como manuseá-la para que o cuidado fornecido com segurança à criança auxilie na adaptação à situação de cronicidade vivenciada.
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Grenå, Madeleine, and Beata Gill. "Gastrostomi : Granulombehandling vid gastrostomi hos barn och ungdomar." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-165806.

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Syfte. Syftet med detta arbete var att undersöka förekomsten och behandling av granulom vid gastrostomier hos barn och ungdomar under 18 år i Sverige. Syftet var även att undersöka sjuksköterskors kunskaper om granulombehandling hos barn och ungdomar under 18 år med gastrostomi i Sverige. Metod. Den forskningsdesign som valdes var av kvantitativ metod genom enkätundersökning. Enkäterna skickades ut till sjuksköterskor som arbetar i Sverige och finns med i något av följande nätverk: Nätverket för habiliteringssjuksköterskor, Nätverket för habiliteringssjuksköterskor inom nutrition och/eller Nätverket för nutritionssjuksköterskor. Resultat. Det upplevdes att granulombesvären var varierande och berodde på barnets övriga hälsa. 52% uppskattade att barnen utvecklade granulom inom två månader efter inläggning av gastrostomin. 34% av deltagarna uppskattade att ca 25% av barn och ungdomar med gastrostomier utvecklar granulom. 46% använde en kombination av lapis och kortisonsalva som behandlingsmetod vid granulom. Slutsats. De behandlingar som idag används för granulom är lapis och kortisonsalva, dessa används av många i kombination med varandra och verkar ha ett gott resultat. Sjuksköterskors kunskap inom området är brett och många har en gemensam åsikt om att granulombildning ofta har ett samband med patientens övriga hälsa.
Aim. The aim of the study was to investigate the occurrence and treatment of granulomas in children and adolescents under the age of 18 with gastrostomy in Sweden. The aim was also to investigate nurses knowledge of granulomatreatment in children and adolescents under the age of 18 with gastrostomy in Sweden. Methods. The design was of quantitative method by questionnaire. A questionnaire was sent to nurses who work in Sweden and are included in one of the following networks: Network for rehabilitation nurses, Network for rehabilitation nurses in nutrition and / or Network for nutrition nurses. Results. The severity of granuloma varied, depending on the child's general health. 52% estimated that the children developed granulomas within two months after insertion of the gastrostomy. 34% of respondents estimated that about 25% of children and adolescents with gastrostomier develop granulomas.46% used a combination of lapis and cortisone ointment as a treatment for granuloma. Conclusion.The treatments currently used for granulomas is lapis and cortisone ointment, these are used by many in combination with each other and seem to have a good result. Nurses' knowledge in the field is extensive and many have a common view that granuloma formation is often linked to the patients general health.
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Martins, Ana Cristina Ferreira [UNESP]. "Perfil de pacientes portadores de gastrostomia e o papel dos cuidadores no domicílio." Universidade Estadual Paulista (UNESP), 2013. http://hdl.handle.net/11449/108609.

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Pacientes com desnutrição e paralisia cerebral atendidos no ambulatório AIPEG (Ambulatório Interdisciplinar para Paciente Infantil Portador de Encefalopatia e Gastrostomia) do HEB (Hospital Estadual Bauru), necessitam de gastrostomia para auxiliar na alimentação pela disfagia e são acompanhados por uma equipe multiprofissional e interdisciplinar. Neste estudo quantitativo, transversal, descritivo e exploratório, verificou-se o perfil dos cuidadores e pacientes deste ambulatório e descreveu-se as dificuldades encontradas por esses familiares/cuidadores em domicílio. Após aprovação do comitê de ética em pesquisa e a assinatura do termo de consentimento livre e esclarecido os familiares/cuidadores dos pacientes do AIPEG (Ambulatório Interdisciplinar para Paciente Infantil Portador de Encefalopatia e Gastrostomia) foram abordados com um questionário e responderam questões abertas e fechadas. Utilizou-se também, como fonte de dados, a análise dos prontuários dos pacientes. Os dados foram coletados no período de janeiro a junho de 2012. A amostra foi composta de 50 pacientes e seus respectivos familiares/cuidadores, sendo 60,00% dos pacientes eram do sexo feminino, 70,00% etnia branca e com média de idade de 11,43 anos. O diagnóstico médico de todos os pacientes (100,00%) era de paralisia cerebral e 91,17% apresentava desnutrição. A maioria dos pacientes, em 92,00%, realizou gastrostomia cirúrgica. Com relação aos cuidadores, 98,00% eram do sexo feminino, com média de idade em 40,82 anos de idade, 70,00% de etnia branca, 86,00% dos familiares/cuidadores são as próprias mães dos pacientes e a renda com média de 2,32 salários mínimos. Quanto às dificuldades mais relatadas, pelos familiares/cuidadores, verificou-se o relato da saída da sonda de ostomia com prevalência de 84,00% e 68,00% dos familiares/cuidadores relatou a ocorrência de lesão na pele. A gastrostomia é um procedimento ...
Patients with malnutrition and cerebral palsy attended in the ambulatory AIPEG (Interdisciplinary Ambulatory for Child Patient with encephalopathy and gastrostomy) of BSH (Bauru State Hospital), need of gastrostomy for help feeding by dysphagia and are accompanied by a multidisciplinary team and interdisciplinary. In this quantitative, transversal, descriptive and exploratory study, it was verified a profile of caregivers and patients in this ambulatory and described the difficulties found by these families / caregivers at home. After approval of the research ethics committee and signing the free and informed consent families/carers of patients AIPEG (Interdisciplinary Ambulatory for Child Patient with encephalopathy and gastrostomy) were approached with a questionnaire and answered open and closed questions. We used also, as a source of data, analysis of the patients' records. Data were collected from January to June 2012. The sample was composed of 50 patients and their family/caregivers, 60,00% of patients were female, 70,00% Caucasian, with a mean age of 11.43 years. The medical diagnostic of all patients (100,00%) was cerebral palsy and 91,17% presented malnutrition. Most patients, 92,00% made surgical gastrostomy. With respect to caregivers 98,00% were female, with mean age of 40.82 years old, 70,00% were Caucasian, 86,00% of families / caregivers are mothers themselves and the patients income with mean of 2.32 minimum salaries. About the difficulties most reported, by family / caregivers, there was the account of output of the tube ostomy with prevalence of 84,00% and 68,00% of family / caregivers told the occurrence of skin lesion. A gastrostomy is a procedure that assists in the patient's condition, helping the family care in homes, which has a preference for silicone tube at skin level (button). Becomes evident that although the service offers an appropriate structure, with a multidisciplinary team and ...
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Martins, Ana Cristina Ferreira. "Perfil de pacientes portadores de gastrostomia e o papel dos cuidadores no domicílio /." Botucatu, 2013. http://hdl.handle.net/11449/108609.

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Orientador: Magda Cristina Queiroz Dell'Acqua
Coorientador: Silvia Justina Papini
Banca: Cleide Carolina da Silva Demoro Mondini
Banca: Janete Pessuto
Resumo: Pacientes com desnutrição e paralisia cerebral atendidos no ambulatório AIPEG (Ambulatório Interdisciplinar para Paciente Infantil Portador de Encefalopatia e Gastrostomia) do HEB (Hospital Estadual Bauru), necessitam de gastrostomia para auxiliar na alimentação pela disfagia e são acompanhados por uma equipe multiprofissional e interdisciplinar. Neste estudo quantitativo, transversal, descritivo e exploratório, verificou-se o perfil dos cuidadores e pacientes deste ambulatório e descreveu-se as dificuldades encontradas por esses familiares/cuidadores em domicílio. Após aprovação do comitê de ética em pesquisa e a assinatura do termo de consentimento livre e esclarecido os familiares/cuidadores dos pacientes do AIPEG (Ambulatório Interdisciplinar para Paciente Infantil Portador de Encefalopatia e Gastrostomia) foram abordados com um questionário e responderam questões abertas e fechadas. Utilizou-se também, como fonte de dados, a análise dos prontuários dos pacientes. Os dados foram coletados no período de janeiro a junho de 2012. A amostra foi composta de 50 pacientes e seus respectivos familiares/cuidadores, sendo 60,00% dos pacientes eram do sexo feminino, 70,00% etnia branca e com média de idade de 11,43 anos. O diagnóstico médico de todos os pacientes (100,00%) era de paralisia cerebral e 91,17% apresentava desnutrição. A maioria dos pacientes, em 92,00%, realizou gastrostomia cirúrgica. Com relação aos cuidadores, 98,00% eram do sexo feminino, com média de idade em 40,82 anos de idade, 70,00% de etnia branca, 86,00% dos familiares/cuidadores são as próprias mães dos pacientes e a renda com média de 2,32 salários mínimos. Quanto às dificuldades mais relatadas, pelos familiares/cuidadores, verificou-se o relato da saída da sonda de ostomia com prevalência de 84,00% e 68,00% dos familiares/cuidadores relatou a ocorrência de lesão na pele. A gastrostomia é um procedimento ...
Abstract: Patients with malnutrition and cerebral palsy attended in the ambulatory AIPEG (Interdisciplinary Ambulatory for Child Patient with encephalopathy and gastrostomy) of BSH (Bauru State Hospital), need of gastrostomy for help feeding by dysphagia and are accompanied by a multidisciplinary team and interdisciplinary. In this quantitative, transversal, descriptive and exploratory study, it was verified a profile of caregivers and patients in this ambulatory and described the difficulties found by these families / caregivers at home. After approval of the research ethics committee and signing the free and informed consent families/carers of patients AIPEG (Interdisciplinary Ambulatory for Child Patient with encephalopathy and gastrostomy) were approached with a questionnaire and answered open and closed questions. We used also, as a source of data, analysis of the patients' records. Data were collected from January to June 2012. The sample was composed of 50 patients and their family/caregivers, 60,00% of patients were female, 70,00% Caucasian, with a mean age of 11.43 years. The medical diagnostic of all patients (100,00%) was cerebral palsy and 91,17% presented malnutrition. Most patients, 92,00% made surgical gastrostomy. With respect to caregivers 98,00% were female, with mean age of 40.82 years old, 70,00% were Caucasian, 86,00% of families / caregivers are mothers themselves and the patients income with mean of 2.32 minimum salaries. About the difficulties most reported, by family / caregivers, there was the account of output of the tube ostomy with prevalence of 84,00% and 68,00% of family / caregivers told the occurrence of skin lesion. A gastrostomy is a procedure that assists in the patient's condition, helping the family care in homes, which has a preference for silicone tube at skin level (button). Becomes evident that although the service offers an appropriate structure, with a multidisciplinary team and ...
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Bonin, Eduardo Aimoré. "Novo dispositivo magnético para a realização de gastrostomia pericutânea : estudo controlado em modelo suíno." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/184893.

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No intuito de simplificar a gastrostomia endoscópica percutânea (GEP) suprimindo- se a utilização de um endoscópio ou métodos de imagem, a gastrostomia magnética percutânea (GMP) foi concebida como nova opção técnica. Objetivo: investigar factibilidade de nova técnica para GMP por estudo experimental controlado, comparada à técnica GEP. Método: quatorze porcos foram submetidos a GEP (grupo ENDO, 7 animais) ou a GMP (grupo MAG), e submetidos a eutanásia 7 dias após o procedimento. Foram avaliados sucesso técnico, peso, tempo de procedimento e número de ocorrências/complicações (complicação menor – sem necessidade de nova intervenção). Para análise estatística foram aplicados o teste não paramétrico de Mann-Whitney e o teste exato de Fisher. Valores de p<0.05 indicaram significância estatística. Resultados: Todos os procedimentos realizados foram tecnicamente bem-sucedidos. Doze animais apresentaram evolução pós-operatória favorável. Dois animais (um de cada grupo) foram a óbito precocemente, não atribuível ao acesso gástrico. Houve no total 5 ocorrências/ complicações menores (4 no grupo MAG), sendo 3 dessas relacionadas ao tubo de gastrostomia. Houve maior perda de peso no grupo MAG comparado ao grupo ENDO, com significância estatística (peso médio em gramas 115±131(desvio-padrão) e -83±128, respectivamente, p=0,04). O tempo de procedimento foi maior para o grupo MAG comparado ao grupo ENDO, com significância estatística (tempo médio em segundos 471±140 e 882±239, respectivamente, p=0,001). Conclusão: a gastrostomia percutânea magnética é tecnicamente factível, porém necessita de melhorias no dispositivo devido a complicações relacionadas ao tubo de gastrostomia. Comparado ao método tradicional endoscópico, a gastrostomia magnética apresentou maior tempo de procedimento e maior perda de peso.
In order to simplify a Percutaneus Endoscopic Gastrostomy (PEG) procedure and obviate the need of imaging methods, a Percutaneous Magneticallyguided Gastrostomy (PMG) has been conceived. OBJECTIVE to investigate preclinical application of a novel magnetic device for PMG through an experimental controlled trial compared to PEG. METHODS fourteen domestic pigs were assigned for ENDO group (undergoing PEG, 7 animals), and MAG group (undergoing PMG). All animals were euthanized 7 days after procedure. Aspects related to technical success, procedure duration and clinical outcome (weight changes, event/complication rate) were evaluated. These were statisctically evaluated using Mann-Whitney (non-parametric) and Fisher’s exact test. Values of p<0.05 were considered statistically significant. RESULTS technical success was achieved for all animals undergoing the procedures. Of these, 12 had a favorable clinical outcome. Two animals died in less than 24 hours (one from each group), not directly related to gastric access. There were 4 minor complications (4 of them for group MAG), and 3 of these were tube-related. Weight loss was statistically significantly higher for group MAG (mean weight in grams 115±131(standard-deviation) e - 83±128, respectively, p=0.04). The procedural time was statistically significant higher for group MAG compared to ENDO (mean time in seconds 471±140 e 882±239, respectively, p=0.001). CONCLUSION a magnetically-guided percutaneous gastrostomy without imaging is technically feasible, however a device improvement is needed because of tube-related complications. Compared to percutaneous endoscopic gastrostomy, the magnetically-guided percutaneous gastrostomy technique is more time-consuming and had more weight loss.
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Gunnell, Sarah. "Percutaneous Endoscopic Gastrostomy Placement Time in People with Cystic Fibrosis." DigitalCommons@USU, 2002. https://digitalcommons.usu.edu/etd/5485.

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A retrospective chart review was conducted on pediatric patients at the Intermountain Cystic Fibrosis Center who had a percutaneous endoscopic gastrostomy (PEG) placed between 1993 and 1999. Height velocity improved significantly in the group of patients with a PEG placed; however, pulmonary function declined more significantly over time. Questionnaires regarding attitude toward PEG placement were sent to patients enrolled in accredited cystic fibrosis centers in the mountain west region and to their parents. The overall response rate was 54.25% for the PEG questionnaire and 24% for the non-PEG questionnaire. Ninety-six percent of the patients with a PEG reported that weight was a problem at time of placement, and 91% reported weight gain after PEG ill placement. Sixty-four percent of the patients with a PEG reported that they would have a PEG placed if they made the decision again. Of the patients without a PEG, 60.7% thought a PEG looked bad, and 59.2% would be embarrassed to have a PEG. Forty-nine percent of patients without a PEG expressed a lack of knowledge of the pros and cons of PEG placement and 35.4% had no opinion about their knowledge of PEGs. PEG placement can be beneficial in improving nutritional status. Optimal time for PEG placement may be earlier rather than after pulmonary function has declined. People with a PEG have felt positive toward placement, and those without a PEG seem to lack knowledge about the pros and cons of PEG placement.
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Brotherton, Ailsa M. "The impact of percutaneous endoscopic gastrostomy feeding on quality of life." Thesis, University of Central Lancashire, 2005. http://clok.uclan.ac.uk/19006/.

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The provision of enteral feeding continues to increase with approximately 20,000 people in the United Kingdom feeding at home. Health care professionals have an ethical duty to recognise and treat malnutrition, though in clinical practice they are often faced with difficult decisions to ensure that the benefits of tube feeding are greater than the burdens; that the provision of a tube feed is in the patient's best interests. The aim of this study was to evaluate how the provision of enteral nutrition via a Percutaneous Endoscopic Gastrostomy (PEG) impacts on the Quality of Life (QoL) of patients from the patients' and carers' perspectives. Initially, QoL was measured using the SF36 Health questionnaire. A longitudinal, prospective pilot study was undertaken including clinical and QoL assessments prior to PEG placement, and at one week, one month, three months and six months following PEG insertion. The results of the pilot study of 22 patients clearly demonstrated that the SF-36 was not an appropriate tool for measuring QoL in this patient group. A semi-structured interview approach was developed to determine the concerns relating to PEG feeding and how feeding impacted on QoL. Health care professionals' views were also sought using a postal questionnaire and the results compared to those of patients and carers. These data informed the development of a preliminary QoL assessment tool which involved item generation, item reduction, response scale generation and pre-testing for acceptability and feasibility. Sixteen adult patients, 27 carers of adults and 24 carers of children were interviewed. In general, patients living in their own home viewed their QoL as acceptable. However, the carers of adult patients were less positive about the patients QoL. In contrast, the carers of children frequently reported their child's QoL to be acceptable. The reported impact of feeding on daily and social lives ranged from the PEG feeding being totally disruptive to the PEG having no impact at all. Delayed and disturbed sleep, restricted ability to go out, difficulties finding a place outside the home to feed, childcare problems, the negative attitudes of others towards feeding and family divisions emerged as key issues and concerns. A wide range of feelings towards the PEG feeding including feelings of anger, gratitude, relief and fear were expressed. Healthcare professionals, carers and patients disagreed on key issues of patient and carer involvement in the decision making process, the quantity of information provided prior to PEG placement, appropriateness of patient selection for the procedure and acceptability of QoL. The delivery of patient centred care must be based on appropriate patient selection, decisionmaking, setting of treatment goals for PEG feeding and the evaluation of the impact of treatment. Current generic QoL measures are highly likely to be inappropriate to measure the impact of feeding upon QoL and a validated PEG specific QoL tool is required to measure the impact of PEG feeding upon QoL. A research proposal has been developed to fully validate the tool for use in clinical practice. The impact of PEG feeding on QoL was variable. Although it is recognised that the results are not generalisable to wider populations, the results support increased patient and carer involvement in the decision-making process, more appropriate information, timely explanations of the procedure and flexible care in the community to meet patients' needs.
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CAMPOLI, Paulo Moacir de Oliveira. "Validação da gastrostomia endoscópica percutânea realizada pela técnica de punção com o uso de uma nova variante técnica de gastropexia." Universidade Federal de Goiás, 2010. http://repositorio.bc.ufg.br/tede/handle/tde/1568.

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Percutaneous endoscopic gastrostomy (PEG) currently represents the main alternative to ensure nutritional supply in patients with prolonged or permanent inability to swallow, and yet has a functional gastrointestinal tract. PEG performed with the Pull Technique is widely used because it is easy to perform and very safe, although it is associated with high infection rates. The Introducer Technique appears to be associated with a lower infection risk, although it requires fixation of the gastric wall to the abdominal wall (gastropexy), which makes the procedure difficult to perform. This study sought to describe and validate PEG performed with the Introducer Technique with the use of a new technical gastropexy variant, besides demonstrating its benefits in relation to risk of peristomal infection. A descriptive study of the safety and feasibility of a new technical gastropexy variant with a long curved needle was performed. We then compared the two gastropexy techniques in a before-and-after design. A randomized clinical trial comparing gastrostomy tubes constructed of different materials (latex vs. silicone) was also conducted. Finally, we performed a meta-analysis evaluating peristomal infection risk between the Introducer Technique and Pull Technique. The results of these four studies are presented in four separate papers. The first study showed that the new technical gastropexy variant that uses a long curved needle is safe and feasible. The second study showed that it is associated with a lower risk of infection compared with the gastropexy technique used previously. The third study found that the silicone tubes have greater durability than latex tubes. The final meta-analysis showed that PEG performed with the Pull Technique is associated with a greater risk of infection than the Introducer Technique.
Havendo incapacidade prolongada ou permanente de deglutir, na presença de via digestiva funcionante, a gastrostomia endoscópica percutânea (GEP) representa a principal alternativa para assegurar aporte nutricional. A GEP pela Técnica de Tração é muito utilizada por ser segura e de fácil execução, porém está associada a elevados índices de infecção periostomal. A GEP realizada pela Técnica de Punção parece estar associada a baixo risco de infecção, contudo requer uma fixação da parede gástrica à parede abdominal (gastropexia) o que torna o procedimento de difícil execução. O presente estudo tem por objetivo descrever e validar um procedimento de GEP pela Técnica de Punção, que envolve uma nova variante técnica de gastropexia, além de demonstrar seus benefícios em relação ao risco de infecção periostomal. Foi realizado um estudo descritivo da segurança e exequibilidade de uma nova variante técnica de gastropexia com agulha longa e curva. Em seguida foi realizado um estudo com delineamento do tipo antes-e-depois comparando duas técnicas de gastropexia. Foi feito também um ensaio clínico randomizado comparando tubos de gastrostomia de materiais diferentes (látex versus silicone). Ao final, foi realizada uma metanálise avaliando os riscos de infecção no sítio cirúrgico entre as Técnicas de Punção e de Tração. Os resultados dos quatro estudos realizados estão apresentados na formato de quatro artigos científicos. O primeiro estudo revelou que a nova técnica de gastropexia com agulha longa e curva é segura e exequível e o segundo estudo mostrou que esta nova técnica de gastropexia está associada a menor risco de infecção que a técnica de gastropexia usada anteriormente. No terceiro estudo foi observado que os tubos de silicone têm maior durabilidade que os tubos de látex e a metanálise demonstrou que a GEP pela Técnica de Puxar está associada a maior risco de infecção que a Técnica de Punção.
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Ignagni, Esther. "Not at the table, an ethnography of feeding children by gastrostomy tube." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0003/MQ45412.pdf.

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15

Craig, Gillian Marie. "Mother knows best : gastrostomy feeding in disabled children : professional and parental discourses." Thesis, University College London (University of London), 2004. http://discovery.ucl.ac.uk/1446872/.

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This thesis explores professional and parental discourses in relation to gastrostomy feeding technologies. Drawing on resources from feminist poststructuralism as a rationale for interpreting women's accounts, it examines how these ideas can lend themselves to the study of parenting and feeding. Current clinical and research arenas bring health care providers, children and their families to make decisions about children's feeding. A prevalent medical discourse in feeding disabled children revolves around malnourishment and poor growth, prompting a perception of the need for a gastrostomy feeding tube. Interviews with 22 mothers, between 1998 and 2001, formed part of an externally funded evaluation of gastrostomy feeding which the author was employed to coordinate. The author presents a deconstruction of the research study to explore how researchers mediate between different clinical and research discourses, and analyses how the subsequent political and ethical issues impact on children and their families. Women's accounts are analysed as constructing tube feeding as an intervention that either transforms their child by rendering her as 'other', or transforms their way of relating to the child, represented through oral feeding. Tube feeding was also constructed as an infringement of the child's rights to be involved and participate in social arenas, also associated with oral feeding. Both parents and clinicians constructed feeding decisions in terms of the child's best interests but, informed by competing and contradictory discourses, arrived at different conclusions about children's care. Parental accounts are analysed in terms of complex cultural-political overdeterminations between discourses of mothering, children's rights and normative child development. This analysis suggests that the clinical focus on weight-gain may underestimate women's concerns and has implications for how services support families. Drawing on reflexive methodological debates, the author highlights the needs and responses of researchers and clinicians, and indicates how these could be better addressed.
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Kurien, Matthew. "Does a gastrostomy confer any benefits to either patients or their carers?" Thesis, University of Sheffield, 2013. http://etheses.whiterose.ac.uk/5294/.

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Introduction: A gastrostomy is an established means of providing enteral nutrition. Currently, uncertainty exists regarding the merits of this intervention particularly in certain patient subgroups. Aims: To determine if a gastrostomy confers any benefits to either patients or their carers. Methods: The first study assesses mortality in patients referred for a gastrostomy and the accuracy of the Sheffield Gastrostomy Scoring System (SGSS). Quality of life is then assessed in both gastrostomy patients and in carers using mixed methods, combining a health related quality of life questionnaire (EuroQol Group EQ-5DTM, a quantitative tool) and semi structured interviews (a qualitative tool). Factors influencing both these outcomes are then evaluated in two further studies, where variations in local practice and aftercare are assessed. Results: 1327 patients were referred for a gastrostomy between 2004-2010. Of these, 304 (23%) were declined this intervention following multidisciplinary team review. Mortality in this group was 35.5% at 30 days and 74.3% at 1 year. By comparison the mortality seen in the gastrostomy-inserted group at 30-days and 1-year respectively was 11.2% and 41.1% (p < 0.0001). Acceptable agreement was seen between predicted and actual mortality using SGSS (area under the receiver operating curve = 0.71). For quality of life (n=100), no significant change in mean EQ-5DTM index scores was noted in either patients (0.70 versus 0.71, p=0.83) or carers (0.95 versus 0.95, p=0.32) at baseline and 3 months post insertion. Variations in local practice particularly with regards to indications, timing of insertion, procedural volume and aftercare (dedicated community team reduced hospital readmissions from 23% to 2%, p=0.0001) may be contributing to some of the adverse outcomes identified following this intervention. Conclusions: The merits of gastrostomy feeding may be confined to certain patient groups. This body of work emphasizes the importance of appropriate patient selection and importance of appropriate counseling prior to gastrostomy.
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Cornwell, Sonya. "Pediatric feeding disorders: Efficacy of multidisciplinary inpatient treatment of gastrostomy tube dependent children." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9113/.

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Efficacy of multidisciplinary inpatient treatment of feeding disordered children was sought through retrospective chart review of 40 G-tube dependent children ages 22 months to 7 years. Premature births were 55% of the sample ranging from 23 to 36 weeks gestation. The majority of co-occurring medical conditions included congenital anomalies (50%), gastroesophageal reflux disease (25%) and chronic lung disease (25%). Treatment effect analyzed from pre and post treatment measures of oral and G-tube caloric intakes resulted in a significant difference from admission to discharge for both oral intake, t (39) = 5.76, p < 0.001, d = 1.02, and G-tube dependency, t(39) = 10.94, p < 0.001, d = 2.03 with both showing strong treatment effects. Results indicated a highly reliable and valid method of treating severe pediatric feeding disorders.
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Cornwell, Sonya Kelly Kimberly. "Pediatric feeding disorders efficacy of multidisciplinary inpatient treatment of gastrostomy tube dependent children /." [Denton, Tex.] : University of North Texas, 2008. http://digital.library.unt.edu/permalink/meta-dc-9113.

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Rimolo, Amanda Peixoto. "Incidência de complicações e mortalidade em pacientes submetidos a duas técnicas de gastrostomia percutânea endoscópica em adultos." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/171404.

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Introdução: A gastrostomia percutânea endoscópica (PEG) é utilizada como via de nutrição para pacientes sem capacidade de utilizar a via oral para manter ingestão suficiente. A disfagiaé uma das principais razões para a indicação da PEG, sendo geralmente atribuída a processos neurodegenerativos. Diferentes técnicas e tipos de sonda são utilizadas para confecção da PEG. A técnica de Tração é o método original, na qual a sonda é tracionada a partir de uma pequena incisão na parede abdominal, através a boca e do esôfago até estar posicionada junto da parede gástrica. A técnica de punção com gastropexia é uma variante da técnica de punção original, na qual a sonda não passa pela cavidade oral. Nesta técnica, após fixação do estômago na parede abdominal com uso de pontos, a sonda é introduzida diretamente através da parede abdominal sob visão endoscópica. De acordo com a técnica, diferentes modelos de sondas podem ser utilizadas, cada uma com diferentes tipos de retentores internos. Os retentores internos maiscomuns são: em forma de diamante, em forma de cogumelo, disco rígido e balão. Possivelmente, tanto a técnica de inserção como os modelos de sondas e retentores utilizados podem estar associados a diferentes desfechos. O objetivo deste estudo foi avaliar a incidência podem estar associados a diferentes desfechos. O objetivo deste estudo foi avaliar a incidência. Métodos: Foi realizada uma coorte histórica na qual foram incluídos todos os pacientes maiores de 18 anos submetidos à colocação de uma primeira PEG entre janeiro de 2010 e dezembro de 2015 no Hospital Moinhos de Vento, um hospital privado em Porto Alegre, sul do Brasil. Os dados foram coletados em formulário padronizado através de uma busca no sistema informatizado da Instituição. Para complementação dos dados foi realizada uma busca nos prontuários digitalizados, e em algumas situações realizado contato telefônico. Resultados: Foram identificados 245 pacientes, sendo 200 submetidos a técnica de tração (Pull) e 45 à técnica de punção com gastropexia (Push com gastropexia). A média da idade foi 80,3±13,3 anos. Cento e trinta e quatro (54,7%) pacientes eram do sexo feminino. O período médio de seguimento foi de 17,2±14,6 meses. A indicação mais comum foi doença neurodegenerativa (62,4%), seguido por acidente vascular cerebral (AVC) (16,3%). Todos os pacientes realizaram profilaxia com antibiótico no dia do procedimento. A mediana de dias de internação pós PEG foi de 8 dias. O modelo de sonda mais utilizado foi o retentor em forma de diamante (51,8/%). A colocação da PEG foi bem-sucedida em 99,6% dos casos. A mortalidade geral foi de 42,4% (104/245) durante o período de seguimento. Nenhum óbito foi atribuído diretamente a complicações relacionadas ao procedimento. Entretanto, três pacientes faleceram dentro de 48 horas após o procedimento: um por sepse respiratória, outro por parada cardiorrespiratória e o terceiro que realizou a PEG ambulatorial teve morte súbita no domicílio. A taxa de complicações (maiores ou menores) foi de 23,6%, sendo a mais frequente, a retirada acidental da sonda, que ocorreu em 17,1% dos pacientes em algum momento do seu seguimento. Não foi observada diferença entre as técnicas de realização da PEG gastrostomia com a incidência desta complicação. O tempo até a retirada acidental da sonda foi menor entre os pacientes cujas sondas tinham o retentor interno em forma de diamante em relação aos demais retentores (p = 0,02). Sepultamento do retentor interno (Buried Bumper Syndrome) ocorreu em 5,4% dos casos, todos submetidos a técnica de tração (p = 0,08). Pacientes portadores de sonda com retentor em forma de diamante apresentaram maior incidência de complicações gerais (p = 0,02) e de retirada acidental (p = 0,01), comparativamente aos pacientes portadores de sondas com outros tipos de retentor. Conclusões: A PEG é uma técnica segura, com baixa taxa de mortalidade diretamente associada ao procedimento. Entretanto, devido a população na qual o procedimento é realizado, a mortalidade geral é elevada. Complicações menores são frequentes, independentemente da técnica ou tipo de sonda utilizada, porém a técnica e o tipo de sonda parecem associadas a um perfil diferente de complicações. Perspectivas: O desenvolvimento da técnica, o desenvolvimento de materiais com melhor perfil de segurança e, especialmente, o aprimoramento das orientações e cuidados pós-gastrostomia são necessários para reduzir a incidência de complicações em pacientes submetidos a esse tipo de procedimento. Novos estudos comparando de maneira prospectiva e randomizada diferentes técnicas e modelos de sonda são necessários para determinar se há uma técnica ou modelo a ser utilizado como primeira escolha.
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Holt, Karen Margaret. "Exploring information sharing with families making decisions about gastrostomy feeding for children with neurodisabilities." Thesis, University of Newcastle upon Tyne, 2017. http://hdl.handle.net/10443/3952.

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Feeding difficulties are common in children with neurodisabilities. If children have problems safely swallowing adequate food or fluid, gastrostomy (GT) feeding via a tube through the abdominal wall may be offered to augment or replace oral feeding. Systematic reviews have indicated that the risks and benefits of the procedure in this patient group are unclear. Prior retrospective research has highlighted how for mothers, uncertainty about this procedure can result in decisional stress and conflict, leading to delays in GT placement. By contrast, high levels of maternal satisfaction with the GT tube have been identified once it has been placed. The perceptions and experiences of other stakeholders taking part in the decision-making process, most notably fathers, has not yet been explored. This study aimed to investigate GT decision-making experiences for families with children with neurodisabilities. The first arm of the study is retrospective and uses an Interpretative Description to explore the perspectives of 26 family members and seven healthcare professionals involved in making decisions about GT placement. This is reinforced by two short interviews with children with neurodisabilities who had the decision made about them. In the second arm of the project, a longitudinal study was completed with one family, including analysis of the clinical encounters where the family actively discuss GT placement with their clinical team. Four key themes have been identified: maternal embodiment, the pleasure and commensality of food and drink, feeding as care, and normalisation and stigma. Key differences in the views of mothers, fathers and other stakeholders emerged around these themes. This research also demonstrates how GT decision-making needs to be understood as a distributed process across time and place. Clinical encounters require delicate interactional work. They should provide the interactional space to allow stakeholders the opportunity to participate in the processes of information sharing, evaluation of risks and benefits, and decision-making around feeding method.
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Hart, Catherine K. "Health-related Quality of Life in Children with Aerodigestive Disorders." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin151091845523319.

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22

Mendes, Amanda Elias. "Indicação da gastrostomia em pacientes com esclerose lateral amiotrófica: critérios fonoaudiológicos." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-12082015-153452/.

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Introdução: A esclerose lateral amiotrófica (ELA) é uma doença neurodegenerativa progressiva, de etiologia desconhecida, que envolve os neurônios motores do córtex cerebral, do tronco encefálico e da medula espinhal. O comprometimento dos neurônios motores inferiores causa disfagia, distúrbios de fala e outros sintomas, como fraqueza muscular global e sintomas respiratórios. A dificuldade de deglutição ou disfagia pode causar complicações, como pneumonia aspirativa, má nutrição e desidratação, e afeta a qualidade de vida destes pacientes, sendo necessária a indicação de via alternativa de nutrição. Atualmente, esta indicação é dada subjetivamente pelo exame clínico e funcional realizado pela equipe multidisciplinar, de acordo com a deterioração dos parâmetros da função respiratória, do estado nutricional e de comprometimentos na deglutição. Objetivos: objetivo geral: verificar se a redução de pressão de língua pode ser indicadora de necessidade de gastrostomia (GEP) como via alternativa de nutrição em pacientes com diagnóstico de ELA. Objetivos específicos: verificar se há redução significativa nas medidas funcionais e de pressão de lábio, de língua e de bochecha entre o momento da primeira avaliação e da indicação da GEP; avaliar o tempo desde o primeiro sintoma da doença até a indicação da GEP; verificar se o tempo de indicação da GEP foi influenciado por variáveis demográficas, manifestação clínica inicial (espinhal ou bulbar), condições clínicas, medidas funcionais globais e de deglutição, com destaque para pressão de língua, de lábios e de bochechas. Métodos: Foram estudados longitudinalmente 63 pacientes, avaliados do ponto de vista fonoaudiológico com os instrumentos: escala ASHA, escala ALSFRS, avaliação funcional, medida de pressão dos órgãos fonoarticulatórios com o aparelho IOPI, encaminhamento para videoendoscopia da deglutição (VED) e capacidade vital forçada (CVF) no momento da indicação da GEP. Resultados: Os pacientes tinham faixa etária entre 28 e 79 anos (média de 58 anos de idade), com média de 7,04 anos de escolaridade, tempo médio de doença no momento da avaliação inicial de 34,96 meses, 32% manifestação clínica inicial da forma bulbar, 39,5% espinhal membros superiores e 28,5% espinhal membros inferiores, porém, na avaliação fonoaudiológica inicial, todos apresentavam alguma queixa de acometimento bulbar. Cinquenta pacientes foram encaminhados à GEP, 1 foi a óbito e 12 mantiveram dieta via oral exclusiva até o término do estudo. Medidas funcionais e de pressão de língua, lábio e bochecha apresentaram redução significativa no agravamento da ELA (p < 0,001). Dificuldades com líquido espessado: de contenção (p=0,001), de transporte (p=0,005) e de proteção de vias aéreas inferiores (p =0,003), e com a consistência pastosa: contenção na cavidade oral, (p < 0,001) observadas em avaliações clínicas fonoaudiológicas, e a idade (p =0,014) influenciam na indicação de GEP. Conclusão: A medida de pressão de língua pode, portanto, servir como um indicador adicional, objetivo e prático para o exame do prognóstico da funcionalidade da deglutição, e, em particular, da possibilidade ou não de manutenção de vias tradicionais em pacientes com diagnóstico de ELA
Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of unknown etiology that involves motor neurons from the cerebral cortex, from the brainstem and from the spinal cord. The damage on the lower motor neurons causes dysphagia, speech disorders and other symptoms such as overall muscle weakness and respiratory symptoms. The difficulty in swallowing, or dysphasia, may cause complications such as aspiration pneumonia, malnutrition and dehydration and affects the quality of live of these patients. Thus, it is necessary to indicate and alternative form of nutrition. This indication is currently given subjectively by the clinical and functional evaluation performed by the multidisciplinary team, according to deterioration of respiratory function parameters, nutritional status and swallowing impairments. Objectives: general objective: verify if reduced tongue pressure could indicate the need for gastrostomy (PEG) as an alternative form of nutrition for patients who have been diagnosed with ALS. Specific objectives: verify if there is significant reduction on tongue, lips, and cheeks pressure as well as functional measures between the moment of the first evaluation and the indication of PEG; evaluate the time between the first symptom of the disease and the indication of PEG; verify if the time of the indication of PEG was influenced by demographic variables, initial clinical manifestation (spinal or bulbar forms), clinical conditions, global and swallowing functional measures, highlighting tongue, lips and cheeks pressure. Methods: 63 patients have been longitudinally studied. They have been assessed from the speech-language therapy point of view with the following instruments: ASHA, ALSFRS, functional evaluation, pressure measurement of the phono-articulatory organs with the IOPI, referral to videoendoscopy of swallowing and FVC at the moment of the indication of PEG. Results: The patients, whose ages ranged from 28 to 79 years old (average of 58 years old), had, on average, 7.04 years of education. They had been suffering from the disease for an average of 34.96 months at the time of the first evaluation. 32% showed initial clinical manifestation of the bulbar form, 39.5% upper limbs spinal form and 28.5% lower limbs spinal form. At the initial speech-language therapy assessment, however, all of them showed some sort of complaint regarding bulbar impairment. 50 patients were sent to PEG, 1 died and 12 continued with an oral exclusive diet until the end of this study. Tongue, lips and cheeks as well as functional measures showed significant decrease with the aggravation of ALS (p < 0,001). Difficulties with thickened liquid: with containment (p=0,001), with transport (p=0,005) and with protection of lower airways (p =0,003) and with pasty consistencies: containment in the oral cavity, (p < 0,001) observed in speech-language therapy clinical assessments, as well as age (p =0,014) have influence on the indication of PEG. Conclusion: The measure of the tongue pressure can, therefore, serve as an additional, objective and practical indicator for the evaluation of the prognosis of swallowing functionality, particularly of the possibility or not of maintenance of traditional forms in patients who have been diagnosed with ALS
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23

Guerriere, Denise Noelle. "Measuring decisional conflict in substitute decision makers, mothers' decisions about initiating gastrostomy tube feeding in children." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0009/NQ41431.pdf.

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24

Machacny, Jessica, and Ina Uutela. "ATT LEVA UTAN ATT KUNNA ÄTA : Hur det kan upplevas att vara beroende av enteral nutrition." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-39294.

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Background: Enteral nutrition is artificial nutrition, which is delivered via a tube to the gastrointestinal tract when the ability to eat is reduced. Previous research shows that both relatives and nurses think that enteral nutrition can enable continued life, but they also emphasize that it can limit everyday life. According to nurses, good knowledge about enteral nutrition and how it should be administered is needed to provide adequate care to patients. Relatives can get bad conscience if they go to social events by themselves when the family member refrain because the events often include meals. Enteral nutrition can take up the relatives everyday life and it can lead to that their previous lifestyle change and less time for themselves and their own hobbies. Aim: To describe women's experiences of being dependent on enteral nutrition. Method: A qualitative, manifest content analysis with an inductive approach. Result: It was found that well-being could be experienced and that support and good relationships were important in everyday life. The women´s relationship to food could change and they could experience limitations in everyday life and suffering. Conclusion: It was found that a joy of life could be experienced, simultaneously it was a challenge to live with enteral nutrition.
Bakgrund: Enteral nutrition är konstgjord näring som tillförs via en sond till mag-tarmkanalen när förmågan att äta blivit nedsatt. Tidigare forskning visar att både anhöriga och sjuksköterskor anser att enteral nutrition kan möjliggöra fortsatt liv, dock framhäver de att den kan begränsa vardagen. Enligt sjuksköterskor kan det behövas goda kunskaper om enteral nutrition och hur den ska administreras för att kunna ge patienter adekvat vård. Anhöriga kan få dåligt samvete om de går själva till sociala evenemang när familjemedlemmen avstår på grund av att de ofta innefattar måltider. De anhörigas tidigare livsstil kan förändras och det kan leda till mindre tid till sig själva och sina fritidsintressen, då dagarna planeras utefter enterala nutritionen. Syfte: Att beskriva kvinnors erfarenheter av att vara beroende av enteral nutrition. Metod: En kvalitativ manifest innehållsanalys. Resultat: Det framkom i resultatet att ett välbefinnande kunde upplevas och att stöd och goda relationer var viktiga i vardagen för kvinnorna. Kvinnorna fick en förändrad relation till mat och de kunde uppleva begränsningar i vardagen och ett lidande. Slutsats: Det konstaterades att livsglädje kunde upplevas, samtidigt som det var en prövning att leva med enteral nutrition.
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Fernandes, Gustavo. "Avaliação do metabolismo glicêmico e perfil entero-hormonal no pós-operatório precose em pacientes abesos graves diabéticos submetidos à gastroplastia em Y de Roux.Comparação da oferta alimentar por via oral e por gastrostomia." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5168/tde-29112017-091214/.

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INTRODUÇÃO: O diabetes mellitus tipo 2 (DM2) é uma doença correlacionada com a obesidade mórbida. O paciente obeso apresenta efeito incretínico suprimido e consequente desbalanço da homeostase glicêmica. Diversos estudos evidenciam a melhora do DM2 após a confecção da Gastroplastia com derivação intestinal em Y de Roux (GDYR). Os mecanismos de controle da glicemia podem ser de longo e curto prazo. Os mecanismos de ação precoce estão ligados à restrição calorica, melhora da resistência insulínica, da função da célula beta pancreática e retorno do efeito incretínico pelo aumento do GLP1 e GIP, porém os dados são conflitantes. MÉTODOS: Onze pacientes obesos graves diabéticos foram submetidos à GDYR com confecção de gastrostomia no remanescente gástrico após perda de peso inicial de 10%. Os pacientes foram submetidos à coleta de entero-hormônios, perfil glicêmico e Teste de Tolerância Oral à glicose (TTOG) no pré-operatório em curva temporal que foi comparado ao pós-operatório por Via Oral e por Via da Gastrostomia em até 7 dias após o procedimento. RESULTADOS: A média da idade foi 46,09±7,08 anos. No pré-operatorio, o peso médio foi 120,97±17,02 quilogramas, altura 1,67±0,11 metros, IMC médio 44,06±6,59 kg/m2, glicemia de jejum média 194,55±62,45 mg/dl e hemoglobina glicada 8,74±1,64%. Em 77,7% dos pacientes, houve remissão precoce do DM2 no pós-operatório avaliado pelo TTOG. Também foi observada queda significante da glicemia, insulinemia e do HOMA-IR independente da via administrada. Ocorreu aumento significativo do GLP1 e redução do GIP pela Via Oral pós-operatória. A Grelina não apresentou alterações. CONCLUSÃO: Evidenciou-se redução da glicemia e da resistência periférica nos primeiros dias de pós-operatório da GDYR, independente da via de passagem do alimento. A alteração no efeito incretínico (aumento do GLP1 e redução do GIP) só foi observada na Via Oral pós-operatória
INTRODUCTION: Type 2 diabetes mellitus (DM2) is a disease correlated with morbidly obesity. The obese patient has a suppressed incretin effect and consequent inbalance of glycemic homeostasis. Several studies have shown an improvement in DM2 after Gastroplasty with Roux-en-Y gastric bypass (RYGB). The mechanisms of glycemic control may be long-term and shortterm. The mechanisms of early action are linked to caloric restriction, improvement of insulin resistance, pancreatic beta cell function and return of the incretin effect through the increase of GLP1 and GIP, but the data are conflicting. METHODS: Eleven diabetic obese patients underwent RYGB with gastrostomy in gastric remnant after initial 10% weight loss. Patients were submitted to assessment of enterohormones, glycemic profile and Oral Glucose Tolerance Test (OGTT) in the preoperative period in a time curve that was compared to the postoperative period by Oral Via and Gastrostomy Via up to 7 days after the procedure .RESULTS: The mean age of the group was 46.09 ± 7.08 years. In the preoperative the mean weight was 120.97 ± 17.02 kilograms, height of 1.67 ± 0.11 meters, mean BMI of 44.06 ± 6, 59 kg/m2, mean fasting blood glucose of 194.55 ± 62.45 mg/dl and glycated hemoglobin 8.74 ± 1.64%. In 77.7% of the patients there was remission of DM2 in postoperative evaluated by the OGTT. Significant decrease in glycemia, insulinemia and HOMA-IR was also observed, regardless of the route of administration. There was a significant increase in GLP1 and reduction of GIP by the postoperative oral route. Ghrelin did not change. CONCLUSION: A reduction in glycemia and peripheral insulinal resistance was observed in early postoperative days of RYGB, independent of the food route. The change in incretin effect (increase of GLP1 and reduction of GIP) was only observed in the postoperative oral route
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Bronston, Ashley Lynn. "Use of Homemade Blenderized Formula in Gastrostomy Tube Dependent Pediatric Patients with Feeding Intolerance: A Retrospective Analysis." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1461197803.

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27

Mark, Lindsay. "The Role of the Speech Language Pathologist in the Treatment of Patients with Percutaneous Endoscopic Gastrostomy Tubes." Cleveland State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=csu1624292292143869.

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28

Cornwell, Sonya L. "Pediatric Feeding Disorders: A Controlled Comparison of Multidisciplinary Inpatient and Outpatient Treatment of Gastrostomy Tube Dependent Children." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc33140/.

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The efficacy of multidisciplinary inpatient and outpatient treatment for transitioning children with severe pediatric feeding disorders from gastrostomy tube dependency to oral nutrition was investigated utilizing caloric and fluid intakes as an outcome measure. The study involved 29 children ages 12 months to 5 years of age with gastrostomy tube dependency. Treatments were provided by speech therapists, occupational therapist, dietician and psychologist for a 30 day period. Four treatment groups were evaluated and average intakes compared at 4 observation periods including pretreatment, initiation of treatment, completion of treatment at 30 days and 4 month follow-up. Children receiving inpatient treatment for feeding disorders evidenced significant differences in oral caloric intake from pretreatment to discharge than outpatient treatment (p < .01) and wait list control group (p = .04). Oral caloric intake from discharge to 4 month follow up yielded no significant differences indicating treatment gains were maintained. Change in environment and caretaker showed a significant effect for the inpatient group (d = 1.89). Effects of treatment by age and weight at 4 month follow up were also analyzed.
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Beasley, Elizabeth S. "Impact of gastrostomy tube feedings on survival is affected by pulmonary function in individuals with cystic fibrosis." [Gainesville, Fla.] : University of Florida, 2003. http://purl.fcla.edu/fcla/etd/UFE0001429.

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30

Zacarin, Clara Ferraz Lazarini. "Estomias gastrointestinais em crianças e adolescentes: experiência da família." Universidade Federal de São Carlos, 2014. https://repositorio.ufscar.br/handle/ufscar/3274.

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Gastrointestinal stoma are openings in the skin that enable the extracorporeal communication of the stomach or intestine to gain access to the body when there is need to divert traffic from the normal supply or disposal. The ostomy of the gastrointestinal tract in children are part of malignancies, benign, inflammatory, congenital or traumatic treatments. Having a stoma in childhood and/or adolescence makes physical and psychological changes, because of organic immaturity, and affects the body integrity, social interaction and quality of life. Caring for a child with ostomy brings impacts to the family and generates hard demand of permanent and specific care. This study aimed to understand the experience of families with children and adolescents who have gastrointestinal stomas. Qualitative approach was used, in light of Symbolic Interactionism as a theoretical framework and the methodological framework of Narrative Analysis. For data collection, were used conducted interviews by guiding questions and during the same interviews were made the construction of the genogram and ecomap to characterize the family . Interviews were conducted with 16 families, 12 with children and 4 with adolescents with gastrointestinal stoma using outpatient nutritional or ostomy services. In six families the children had intestinal stomas and ten had gastrostomy. The analysis process has resulted in 6 themes and categories: 1. Impact of unexpected illness (Facing the stoma as a consequence / Senso undergone a many procedures); 2 Acceptation of the ostomy (having difficulty accepting the stoma / Leaving reach the limit); 3 - Changes in family life (Adapting to the managements of the devices / Leaving aside the social life); 4 - Helplessness on the walk (having superficial support / Living with prejudice); 5 - Benefits of ostomy; 6 - Search the social reintegration (Seeing the power social interaction / Waiting for reversal). The results of this study allowed us to understand that the family of the child or adolescent with gastrointestinal stoma goes through a process of progressive experience and acceptance of the condition of the child, which starts with the impact of the diagnosis of unexpected illness. Feelings like fear and insecurity are evidenced by distancing and denial of the need to make the stoma. After the acceptance and learning period, the family notice the clinical and health improves of the child, but goes through prejudice situations and alienation of the extended family, difficulties in maintaining employment, and maternal burden in the care of the ostomy´s son. The support network is reduced and there is only strengthened ties among members of the nuclear family. Even before the difficulties the family has a positive view of the stoma, but crave reenter the child/adolescente in society through the stoma reversal in the case of intestinal and through oral feeding, at the gastrostomy, even when it is permanent. The results of this study make it possible to broaden our understanding of the experience, which in turn improves the care of these families, Being a breakthrough for the field of nursing.
Estomas gastrointestinais são aberturas na pele que possibilitam a comunicação do estomago ou intestino com o meio externo para se ter acesso ao órgão quando há necessidade de desviar o trânsito normal da alimentação ou eliminação. As estomias do trato gastrointestinal em crianças fazem parte de tratamentos de doenças malignas, benignas, inflamatórias, congênitas ou traumáticas. Ter um estoma na infância e/ou adolescência gera alterações físicas e psicológicas, principalmente devido à imaturidade orgânica, e afeta a integridade corporal, o convívio social e a qualidade de vida. Cuidar de um filho estomizado provoca impactos na família e gera grande demanda de cuidados permanentes e específicos. Este estudo teve como objetivo compreender a experiência da família de crianças e adolescentes que tem estomias gastrointestinais. Foi utilizada abordagem qualitativa, sob a luz do Interacionismo Simbólico como referencial teórico e como referencial metodológico a Análise de Narrativa. Para a coleta de dados utilizou-se entrevistas conduzidas por questões norteadoras e durante as mesmas realizou-se a construção do genograma e ecomapa, para a caracterização familiar. Foram entrevistadas 16 famílias, sendo 12 com crianças e 04 com adolescentes com estomas gastrointestinais que utilizam um serviço ambulatorial de nutrição ou de ostomizados. Em seis famílias os filhos tinham estomias intestinais e dez tinham gastrostomias. O processo de análise resultou em 6 temas principais, e suas categorias: 1- Impacto da enfermidade inesperada (Encarando o estoma como consequência/ Senso submetido a muitos procedimentos); 2- Aceitação da estomia (Tendo dificuldade em aceitar o estoma/ Deixando chegar no limite); 3- Mudanças na vida familiar (Adaptando-se aos manejos dos dispositivos/ Deixando a vida social de lado); 4- Desamparo na caminhada (Tendo apoio superficial / Convivendo com o preconceito); 5- Benefícios da estomia; 6- Busca da integração social (Vendo na alimentação a interação social/ Esperando pela reversão). Com os resultados deste estudo foi possível compreender que a família da criança ou adolescente com estoma gastrointestinal passa por um processo de vivência e aceitação progressiva da condição do filho, que inicia com o impacto do diagnóstico da enfermidade inesperada. Sentimentos como medo e insegurança são evidenciados pelo distanciamento e negação da necessidade de fazer a estomia. Após o período de aceitação e aprendizados de como lidar, a família percebe a melhora clínica e de saúde do filho, mas passa por situações de preconceito e afastamento da família extensa, por dificuldades em manter o emprego, além da sobrecarga materna no cuidado ao filho estomizado. A rede de apoio é reduzida e só há laços fortalecidos entre os integrantes da família nuclear. Mesmo diante das dificuldades a família tem uma visão positiva da estomia, porém almeja reinserção da criança/adolescente na sociedade através da reversão da estomia, no caso das intestinais, e por meio da alimentação via oral, nas gastrostomias, mesmo quando é definitiva. Os resultados deste estudo possibilitam ampliar o entendimento da vivencia desta experiência, que por sua vez permite melhorar o atendimento a essas famílias, sendo este um avanço para a área da enfermagem.
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Bills, Hannah Bowman. "USE OF HOMEMADE BLENDERIZED FORMULA IN GASTROSTOMY TUBE DEPENDENT PEDIATRIC PATIENTS WITH FEEDING INTOLERANCE: A SERIES CASE STUDY." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1429044001.

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32

Goggin, Emily Clare Sither. "THE IMPACT OF DYSPHAGIA AND GASTROSTOMY ON QUALITY OF LIFE IN CAREGIVERS OF PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS." UKnowledge, 2019. https://uknowledge.uky.edu/commdisorders_etds/14.

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There is little research studying the relationship between caregiver quality of life and gastrostomy, a palliative intervention recommended to manage dysphagia and malnutrition in patients diagnosed with Amyotrophic Lateral Sclerosis (ALS). To facilitate a more comprehensive assessment of treatment effectiveness and to better guide patients and their families, this study investigated the relationship between gastrostomy, caregiver strain, and patient disease-related factors. Patients with bulbar-onset ALS and their caregivers were recruited regardless of their decision to accept or decline future gastrostomy. Caregivers completed the Modified Caregiver Strain Index (MCSI) to assess levels of caregiver strain as an index of quality of life. Surveys were completed at 3-month intervals prior to gastrostomy and at a single time point following gastrostomy. Of 13 patient-caregiver dyads recruited, 1 dyad completed both phases of the study as of yet. This caregiver reported increased caregiver strain following gastrostomy. Medical interventions aimed at managing dysphagia, such as gastrostomy, may not have a predictable impact on caregiver strain, as indexed by the MCSI, or changes in caregiver strain may reflect characterological differences among patient-caregiver dyads. Other psychosocial factors within a given patient-caregiver dyad may be stronger predictors of caregiver strain, burden, and quality of life in caregivers.
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Villela, Emanuele Lima. "Avaliação da durabilidade dos diferentes modelos de sondas de troca de gastrostomia." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5147/tde-12062013-121559/.

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Introdução: No acompanhamento diário de pacientes que realizam troca de sonda de gastrostomia endoscópica percutânea (GEP), observa-se a preco- cidade com que ocorrem essas trocas devido à curta durabilidade da sonda, especialmente decorrente da ruptura do balão interno da sonda. Objetivo: Este estudo prospectivo visou à avaliação da durabilidade de cinco diferen- tes marcas de sondas de troca de GEP. Método: Cem procedimentos con- secutivos de troca de sonda de GEP (realizados em 65 pacientes) foram dis- tribuídos, a cada grupo de 20 procedimentos, em cinco grupos determinados pelas marcas de sondas avaliadas (Kangaroo®, Wilson Cook®, Silmag®, Fre- ka® e Bard®). Conforme o protocolo proposto, após a troca, os pacientes fo- ram seguidos ao longo de seis meses, e, nesse período, foram realizadas três avaliações para verificação de eventuais intercorrências. Para avaliação da durabilidade das sondas, foi considerado o período de permanência dos pacientes no protocolo, determinada pelo término do período de estudo ou pela necessidade de troca da sonda por ruptura do balão ou desgaste do tubo ou da tampa. As curvas de durabilidade das sondas foram determina- das pelo Método de Kaplan Meier e pelo Modelo de Regressão de Cox. Resultados: Houve variações importantes na durabilidade das sondas quando considerados os três motivos de troca da sonda associados. Essa diferença não foi observada quando se considerou apenas a ruptura do balão, cujas ocorrências se mostraram associadas com pacientes em uso de GEP por distúrbios neurológicos sem diagnóstico. A durabilidade das sondas foi tanto menor, quanto maior o número de trocas anteriores. Conclusões: A marca da sonda de troca de GEP não influenciou a sua durabilidade quando deter- minada pela ruptura do balão, mas, quando determinada também por des- gaste em tubo e tampa, as sondas Wilson Cook® apresentaram durabilidade significativamente maior do que as sondas Silmag® e Bard®. O número de trocas anteriores se mostrou fator determinante de menor durabilidade das sondas
Introduction: During the follow-up of patients after replacement of percuta- neous endoscopic gastrostomy (PEG) tubes, the early need of new replace- ments seems to be consequence of the short durability of the tubes, espe- cially due to the rupture of their internal balloon. Objectives: In this prospec- tive study, the durability of five different PEG tubes was estimated. Methods: One hundred consecutive procedures (in 65 patients) for replacing PEG tubes were divided into five groups determined by the tubes model: Kanga- roo®, Wilson Cook®, Silmag®, Freka® and Bard®. According to the protocol developed for the study, patients were followed up along six months, and three evaluations for verifying eventual outcomes were carried out during this period. Estimation of the tubes durability considered the time patients re- mained in the protocol, which was determined by the termination of the follow up period or by the need for replacing the tubes due to the balloon rupture or to the loss of use of tube or cover. Curves of tubes durability were estab- lished by applying the Kaplan-Meier Method and the Cox Regression Model. Results: Important variations of the tubes durability were observed when the three causes for replacement were considered all together. Differences were not observed when considered only the balloon rupture, which was associated with patients using PEG in virtue of not specified neurologic disorders. Shorter tubes durability was associated with more previous replacements. Spontaneous opening of the cover and slipping of the external protection were significantly less frequent in the Freka® tubes, although such outcomes did not determined the tubes durability. Conclusion: The model of PEG re- placement tubes did not influence their durability regarding the balloon rup- ture alone. Considering such occurrence associated with problems in tubes or covers, the longest durability was observed in Wilson Cook®, followed by Freka, ® Kangaroo®, Silmag® and Bard® tubes. The number of previous re- placements showed to be determining factor for the tubes durability
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Legge, Alexandra. "Percutaneous endoscopic gastrostomy (PEG) at home : an exploratory study of family carers' experiences and the relationships between their perceptions and distress." Thesis, University of Hull, 2007. http://hydra.hull.ac.uk/resources/hull:6634.

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Background: As PEG techniques have improved, its use within the community has increased. There is limited research exploring the effects of PEG care on family members that carry out the process. Small qualitative studies have found that caring for an individual with a PEG can have psychosocial effects and can cause distress. Despite this finding there is little understanding of the psychological impact that carers' experience with the introduction of PEG. This study aims to understand the possible relationships between family carers' perceptions of the PEG and their psychological distress. Method and Results: This explorative cross sectional study measured carers' perceptions and distress. An open-ended questionnaire was also administered verbally. Data on 39 family carers was gathered. Approximately half had some level of clinical distress. The majority perceived that their relative's PEG would remain for a long time. Perceptions of negative PEG identity and emotional representations were found to relate to increased guilt. No relationships were found between perceptions and anxiety or depression. Carers reported that they often felt under prepared and alone when their relative was discharged with a PEG. In time carers described that they adapted and accepted the changes involved in home PEG care. Conclusions: The five perception constructs of the SRM appear to be relevant to PEG carers. Despite the lack of significant relationships between perceptions and distress, carers describe cognitive behavioural patterns within their descriptions of PEG experience. Methodological triangulation is used to discuss the findings and the rationale behind service suggestions are presented.
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Retes, Felipe Alves. "Gastrostomia endoscópica em pacientes com neoplasia de cabeça e pescoço: comparação da técnica de introdução com gastropexia e técnica de tração." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5168/tde-07082017-100527/.

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Introdução: O câncer de cabeça e pescoço (CCP) ocupa mundialmente a sétima posição em incidência. Até dois terços dos pacientes com CCP podem apresentar disfagia já no diagnóstico da doença. A gastrostomia endoscópica percutânea (GEP) é, atualmente, o método de escolha para oferecer suporte nutricional por longo prazo. A técnica de tração é a mais utilizada por sua simplicidade e baixa morbidade. Entretanto, em pacientes com CCP, a presença de estenoses benignas ou malignas pode dificultar ou impedir a realização do procedimento, além de estar associada a maiores taxas de infecção local e implante tumoral para o sítio de punção da gastrostomia, quando comparada à técnica de introdução com gastropexia. Objetivo: Comparar as técnicas de GEP de tração e de introdução com gastropexia em pacientes com CCP. Métodos: Análise retrospectiva de banco de dados coletado prospectivamente, sobre pacientes com câncer de cabeça e pescoço submetidos à gastrostomia endoscópica percutânea. A técnica de tração foi realizada utilizando-se o kit de gastrostomia PEG 24® PULL METHOD (Cook Medical, Bloomington, Estados Unidos), enquanto a técnica de introdução com gastropexia foi realizada utilizando-se o kit de gastrostomia Freka® Pexact 15 (Fresenius-Kabi, BadHomburg, Alemanha). Resultados: 314 pacientes com câncer de cabeça e pescoço foram encaminhados para realização de GEP. O procedimento foi realizado com sucesso em 309 pacientes (98,4%), sendo 172 gastrostomias pela técnica de tração (GT) e 137 pela técnica de introdução (GI). Os dois grupos foram semelhantes em relação à idade, gênero, média dos níveis séricos de albumina e uso de anticoagulantes ou antiagregantes plaquetários. Os pacientes no GI, no entanto, apresentavam menor índice de Karnofsky (p=0,019) e maior presença de traqueostomia (p=0,003) e trismo (p < 0,001). A localização do tumor foi semelhante entre os dois grupos, no entanto, o estadiamento foi diferente. A maioria nos dois grupos apresentavam tumores estadio IV, entretanto alguns pacientes no grupo de tração apresentavam estadio I e II, enquanto no grupo de introdução não. A taxa total de complicações foi de 36,9%, sendo 5,8% maiores e 31,1% menores. As taxas de complicações imediatas e tardias foram de 6,5% e 30,4%, respectivamente. Não houve diferença estatisticamente significativa dessas taxas entre os dois grupos. Em relação às complicações isoladamente, as únicas que apresentaram diferença significativa foram sangramento menor no local da gastrostomia (p=0,006) e disfunção precoce da sonda (p=0,005), sendo ambas mais frequentes no grupo de introdução. Houve apenas um óbito relacionado ao procedimento, no GT. A mortalidade em 30 dias foi de 20,7%, semelhante entre os grupos. Conclusão: As duas técnicas de GEP apresentam altos índices de sucesso técnico em pacientes com CCP, porém com altos índices de complicações menores. A técnica de introdução com gastropexia apresenta risco aumentado de sangramento menor no local da gastrostomia e de disfunção precoce da sonda quando comparada à técnica de tração
Background: Head and neck cancer (HNC) is the seventh most frequent neoplasm in the world. Up to two-thirds of HNC patients present with dysphagia at diagnosis. Gastrostomy is the method of choice to provide long term tube feeding in patients who are unable to swallow. Percutaneous endoscopic gastrostomy (PEG) with the pull technique is the preferred procedure due to its simplicity and low complication rate. However, in HNC patients, severe stenosis or trismus may preclude the passage of the endoscope and there is an increased infection and PEG site metastasis rates, when compared to the introducer technique. Aim: Compare the pull and introducer with gastropexy PEG techniques in patients with HNC. Methods: Retrospective analysis of a prospectively collected database of HNC patients who underwent PEG. The pull technique was performed with the PEG 24® PULL METHOD (Cook Medical, Bloomington, United States) kit, while the introducer with gastropexy technique was done with the Freka® Pexact 15 (Fresenius-Kabi, BadHomburg, Germany) kit. Results: 314 patients with HNC were sent to the endoscopy unit for PEG. The procedure was successful in 309 (98,4%) patients. The pull technique was employed in 172 patients (PG) while the introducer technique with gastropexy was used in 137 patients (IG). Both groups were similar regarding age, gender, albumin level and the use of anticoagulant or antiplatelet drugs. However patients in the IG had a lower Karnofsky status (p=0,019) and presented more frequently tracheostomy (p=0,003) and trismus (p < 0,001). Although the tumor location was similar in both groups, the staging was different. Most patients presented with stage IV disease in both groups, however in the PG there were more patients with stage I or II. Overall complication rate was 36,9%, with 5,8% of major complications and 31,1% of minor complications. Immediate and late complication rates were 6,5% and 30,4%, respectively. These complications rates were similar in both groups. When the complications were analyzed individually, the IG presented higher minor bleeding (p=0,006) and tube dysfunction (p=0,005) rates. There was only one death directly related to the PEG, in the PG. The 30-day mortality was 20,7%, similar in both groups. Conclusion: The two PEG techniques present high technical success rate in patients with head and neck cancer, however with high minor complications rates. The introducer with gastropexy technique presents higher minor bleeding and tube dysfunction rates when compared to the pull technique
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Stanich, Patricia [UNIFESP]. "Relevância dos aspectos nutricionais na sobrevida de pacientes com Doença do Neurônio Motor." Universidade Federal de São Paulo (UNIFESP), 2011. http://repositorio.unifesp.br/handle/11600/10061.

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Stanich P. Relevância dos aspectos nutricionais na sobrevida de pacientes com Doença do Neurônio Motor. São Paulo; 2001. [Tese de Doutorado- Escola Paulista de Medicina – Universidade Federal de São Paulo]. Objetivos. Avaliar o efeito dos aspectos nutricionais na sobrevida de pacientes com Doença do Neurônio Motor (DNM) e apresentar as variáveis preditivas para a indicação de terapia nutricional enteral, por gastrostomia endoscópica percutânea (GEP). Material e Métodos. Foi um estudo longitudinal tipo coorte retrospectiva, de 2000 a 2008, e a casuística constituída por 128 pacientes com DNM. Variáveis clínicas, nutricionais e respiratórias foram analisadas. As análises foram conduzidas adotando-se a sobrevida como variável dependente. A sobrevida foi avaliada pela Curva de Kaplain - Meier. As variáveis que apresentaram nível de significância de 20% (p< 0,20) foram selecionadas para o modelo de regressão proporcional de Cox. Resultados. Cento e onze pacientes realizaram a gastrostomia, sendo 59 com a forma apendicular (ELA) e 52 com a forma bulbar (PBP). A desnutrição estava presente em 32% da população antes da GEP, com maior frequência nos pacientes com ELA. O tempo de sobrevida após a GEP foi de 11 meses para os pacientes com PBP e 16 meses para ELA (p< 0,05). As variáveis associadas à sobrevida foram: precocidade na indicação da GEP; redução de CVF %, idade e IMC antes da GEP (hazard ratio de 0, 254 e p = 0, 007) para os pacientes com ELA e exclusão da alimentação por via oral e traqueostomia (hazard ratio de 0, 345 e p= 0, 014) para os pacientes com PBP. Ao final do modelo as variáveis mais associadas com a sobrevida foram precocidade na indicação de GEP, exclusão da alimentação por via oral, para os pacientes com PBP e estado nutricional antes da GEP para os pacientes com ELA. Conclusões. A inserção precoce de gastrostomia endoscópica percutânea, a partir do momento diagnóstico, foi fator protetor para a sobrevida dos pacientes. A desnutrição foi fator prognóstico ruim, especialmente para os pacientes com ELA. Vigilância nutricional durante a evolução da doença pode melhorar os resultados quando o objetivo é aumentar a sobrevida de pacientes com DNM/ELA.
Aims. To evaluate the effect of nutrition on survival of patients with Motor Neurone Disease (MND) and present the predictor variables for indications of nutritional therapy, percutaneous endoscopic gastrostomy (PEG). Methods. It was a retrospective longitudinal cohort study, from 2000 to 2008, and the sample consisted of 128 patients with MND. The variables investigated were clinical, nutritional and respiratory were analysed. Analyses were conducted by adopting the survival as the dependent variable. The survival curve was evaluated by Kaplain - Meier. The variables that had a significance level of 20% (p <0.20) were selected for the proportional regression model of Cox. Results. One hundred and eleven patients underwent gastrostomy, and 59 limb onset (ALS) and 52 with bulbar onset (PBP). Malnutrition was present in 32% of the population before PEG, most frequently in patients with limb onset. The survival time after PEG was 10.5 months for patients with PBP and 16 months for ALS (p <0.05). Variables associated with survival were: early indication in the PEG, for ALS and PBP; reduction of FVC% and BMI before PEG (hazard ratio of 0, 254, p = 0, 007) for patients with limb onset and exclusion of oral feeding and tracheostomy (hazard ratio of 0, 345, p = 0, 014) for patients with bulbar onset. Conclusions. Early insertion of percutaneous endoscopic gastrostomy, from the time diagnosis was a protective factor for patient survival. Malnutrition was a bad prognostic factor, especially for patients with limb onset. Nutritional surveillance for disease progression may improve results when the goal is to increase the survival of patients with MND / ALS.
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BV UNIFESP: Teses e dissertações
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37

Al-Momani, Hafez. "Comparison of the microbiological profile of sputum and percutaneous endoscopy gastrostomy fed gastric juice aspirate in Cystic Fibrosis patients : descriptive evidence of a potential aerodigestive microbiome." Thesis, University of Newcastle upon Tyne, 2017. http://hdl.handle.net/10443/3900.

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Gastro-Oesophageal Reflux (GOR) occurs in Cystic Fibrosis and is associated with deteriorating lung function. The hypothesis of this project is that the CF gastric and lung microbiome are related suggesting potential bidirectional transmission of pathogens through swallowing and aspiration of gastric contents. Gastric pepsin and bile might impact upon the lung microbiome and potentially exacerbate pulmonary disease. Paired gastric and sputum cultures were obtained from 18 adult CF patients receiving percutaneous endoscopic gastrostomy (PEG) feeding. Non-CF gastric juice samples were obtained from 14 patients without known lung disease through endoscopy. Bacterial and fungal isolates were identified by culture and next generation sequencing (NGS) of the 16S rRNA gene. The impact of pepsin, pH and bile acids on the growth and behaviour of Pseudomonas aeruginosa (PA) were tested. Culture-based and molecular-based approach demonstrated that the bacterial species present in CF gastric juice were different compared to the control group (non-CF patients). A high rate of pathogenic bacteria and organisms such as PA and Non-Tuberculosis Mycobacterium (NTM) were isolated from CF gastric juice samples and PEG tubes. Identical strains of PA and NTM in sputum and gastric juice from the same patient were isolated. Gastric juice samples and the PEG tube of 3 patient were positive for PA or NTM and had no PA or NTM present in the their sputum samples. This suggests that PA can survive acid environments in the presence of pepsin and bile acids. The hostile gastric environment may have a negative effect upon PA growth and induce drug resistant biofilm formation. In conclusion, the stomach is a potential microbiological niche where organisms relevant to CF pathophysiology can survive particularly for biofilm PA and NTM. This may be influenced by CF related gastrointestinal pathophysiology, antibiotic therapy and acid suppression.
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38

Mitchell, Scott, John P. Williams, Harsimrandeep Bhatti, Toufic Kachaamy, Jeffrey Weber, and Glen J. Weiss. "A retrospective matched cohort study evaluating the effects of percutaneous endoscopic gastrostomy feeding tubes on nutritional status and survival in patients with advanced gastroesophageal malignancies undergoing systemic anti-cancer therapy." PUBLIC LIBRARY SCIENCE, 2017. http://hdl.handle.net/10150/626471.

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Background Many patients with cancer or other systemic illnesses can experience malnutrition. One way to mitigate malnutrition is by insertion of a percutaneous endoscopic gastrostomy feeding tube (PEG tube). The goal of this retrospective matched cohort study is to evaluate if PEG tube placement improved nutritional status and overall survival (OS) in advanced gastro-esophageal (GE) cancer patients who are undergoing anti-neoplastic therapy. Methods GE cancer patients who were treated and evaluated by a nutritionist and had at least 2 nutritionist follow-up visits were identified. Patients with PEG tube were matched to patients that did not undergo PEG placement (non-PEG). Clinical characteristics, GE symptoms reported at nutrition follow-up visits, and OS were recorded. Results 20 PEG and 18 non-PEG cases met criteria for further analyses. After correction for multiple testing, there were no OS differences between PEG and non-PEG, treatment naive and previously treated. However, PEG esophageal carcinoma has statistically significant inferior OS compared with non-PEG esophageal carcinoma. PEG placement did not significantly reduce the proportion of patients with weight loss between the initial nutrition assessment and 12-week follow-up. Conclusions In this small study, PEG placement had inferior OS outcome for GE esophageal carcinoma, no improvement in OS for other evaluated groups, and did not reduce weight loss between baseline and 12-week follow-up. Unless there is prospective randomized trial that can show superiority of PEG placement in this population, PEG placement in this group cannot be endorsed.
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39

Prevosteau-Noel, Elisabeth. "Gastrostomie endoscopique percutanée : expérience biterroise." Montpellier 1, 1991. http://www.theses.fr/1991MON11202.

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40

Faustino, Annie, and Marie Viper. "Att leva med gastrostomi : ur ett psykosocialt perspektiv." Thesis, Sophiahemmet Högskola, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-1660.

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41

BRISSWALTER, LIONEL. "La gastrostomie percutanee endoscopique : a propos d'une serie de 48 observations." Besançon, 1990. http://www.theses.fr/1990BESA3103.

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42

BARTHELEMY, HELENE. "Gastrostomie endoscopique percutanee : indications en geriatrie." Nice, 1993. http://www.theses.fr/1993NICE6526.

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43

Bryngelsson, Katrin, and Agneta Ericsson. "Upplevelser av att nutrieras via gastrostomi eller parenteral nutrition." Thesis, Halmstad University, School of Social and Health Sciences (HOS), 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-2932.

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Problemformulering: Patienters upplevelser av att nutrieras via gastrostomi eller parenteral nutrition (PN) är ett förbisett område. Det är viktigt att sjuksköterskan har en helhetssyn på patienten för att kunna ge god omvårdnad. Syftet med litteraturstudien var att beskriva patienters upplevelser av att nutrieras i hemmet via gastrostomi eller PN. Metoden var en systematisk litteraturstudie, där elva artiklar bearbetades och analyserades utifrån problemområdet. Resultat och Konklusion: När patienter behandlades i hemmet med antingen gastrostomi eller PN förändrades det dagliga livet för dem. Patienterna upplevde både positiva och negativa effekter av att nutrieras i hemmet. Det positiva med behandlingarna var enligt patienterna att de blev välnutrierade och att behandlingen räddade deras liv. Det negativa med behandlingarna var att de kunde ge fysiska, psykiska och sociala begränsningar. Trots de negativa effekterna upplevde patienterna att de positiva effekterna av behandlingen övervägde de negativa. Implikation: Det finns behov av ytterligare forskning inom området för att sjuksköterskor ska få bättre kunskap om patienters upplevelser av att nutrieras via gastrostomi och PN.

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Pettersson, Cecilia. "Patienter och anhörigas dagliga liv med gastrostomi : En litteraturstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap, HV, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-18718.

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Syfte: Syftet med studien är att beskriva patienter och anhörigas erfarenheter av det dagliga livet med gastrostomi. Metod: En systematisk litteraturstudie användes som metod.  Sökningar efter artiklar som svarade mot syftet gjordes i databaserna CINAHL, PubMed och PsycINFO. Sju artiklar identifierades; sex av dessa var kvalitativa och en var kvantitativ. En innehållsanalys utfördes för att analysera och förtydliga de framtagna artiklarnas resultat.Resultat: Patienter och anhöriga saknar adekvata kunskaper initialt i gastrostomibehandlingen. Patienter och anhöriga upplever även att kunskaper om gastrostomi saknas hos sjuksköterska och dietist efter sjukhusvistelse. Både patienter och anhöriga upplever ett utanförskap och begränsningar i det dagliga livet till exempel i samband med semester, att äta ute, fira födelsedagar och andra sociala tillställningar. Hos både patienter och anhöriga förekommer ambivalenta känslor som till exempel samtida känslor av lättnad, tacksamhet, frustration och ilska över gastrostomibehandlingen.Slutsatser: Vid en gastrostomibehandling påverkas hela familjen. En gastrostomibehandlingen kan medföra känslor av utanförskap och saknad av det sociala livet, samt ambivalenta känslor över behandlingen. Det är önskvärt att sjuksköterskan förutom att ge adekvat information, stöd och ha ett övergripande ansvar för patienterna, stödjer familjen genom att lyfta fram föreställningar som finns i familjen angående behandlingen. Exempelvis genom att använda hälsostödjande samtal som metod.
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45

Gehin, Mathilde De Korwin Jean-Dominique. "Réflexions éthiques sur l'information et le consentement éclairé pour la pose de gastrostomie percutanée endoscopique utilisation des focus groupes pour l'élaboration de documents d'aide à l'information et à la décision /." [S.l.] : [s.n.], 2008. http://www.scd.uhp-nancy.fr/docnum/SCDMED_T_2008_GEHIN_MATHILDE.pdf.

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PIELLARD, THIERRY. "La gastrostomie endoscopique percutanee : a propos de 23 observations." Lyon 1, 1992. http://www.theses.fr/1992LYO1M146.

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BOISSIERE, JEAN-CLAUDE. "Gastrostomie percutanee endoscopique : a propos de 65 cas." Rennes 1, 1993. http://www.theses.fr/1993REN1M074.

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Pimenta, Joana Novais. "Gastrostomia Endoscópica Percutânea. A usa importância na Criança." Master's thesis, Instituto de Ciências Biomédicas Abel Salazar, 2009. http://hdl.handle.net/10216/52832.

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Pimenta, Joana Novais. "Gastrostomia Endoscópica Percutânea. A usa importância na Criança." Dissertação, Instituto de Ciências Biomédicas Abel Salazar, 2009. http://hdl.handle.net/10216/52832.

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50

Sernetz, Friederike. "Prospektive Studie bei Patienten mit Perkutaner Endoskopischer Gastrostomie (PEG)." Diss., lmu, 2004. http://nbn-resolving.de/urn:nbn:de:bvb:19-21819.

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