Enfermagem e lógica fuzzy: uma revisão integrativa

This study conducted an integrative review investigating how fuzzy logic has been used in research with the participation of nurses. The article search was carried out in the CINAHL, EMBASE, SCOPUS, PubMed and Medline databases, with no limitation on time of publication. Articles written in Portuguese, English and Spanish with themes related to nursing and fuzzy logic with the authorship or participation of nurses were included. The final sample included 21 articles from eight countries. For the purpose of analysis, the articles were distributed into categories: theory, method and model. In nursing, fuzzy logic has significantly contributed to the understanding of subjects related to: imprecision or the need of an expert; as a research method; and in the development of models or decision support systems and hard technologies. The use of fuzzy logic in nursing has shown great potential and represents a vast field for research.Este estudio tuvo como objetivo realizar una revisión integradora investigando como la lógica fuzzy ha sido utilizada en investigaciones con participación de enfermeros. La búsqueda de los artículos fue realizada en las bases de datos CINAHL, Embase, SCOPUS, Medline y PubMed, sin especificar un intervalo de años determinado. Fueron incluidos artículos en los idiomas: portugués, inglés y castellano; con una temática relacionada a la enfermería y a la lógica fuzzy; y con autoría o participación de enfermeros. La muestra final fue de 21 artículos, de ocho países. Para el análisis, los artículos fueron distribuidos en las categorías: teoría, método y modelo. En la enfermería, la lógica fuzzy ha contribuido significativamente para la comprensión de temas relativos a la imprecisión o a la necesidad del especialista, como método de investigación y en el desarrollo de modelos o sistemas de apoyo a la decisión y de tecnologías duras. El uso de la lógica fuzzy en la enfermería ha demostrado gran potencial y representa un vasto campo para investigaciones.Este estudo teve como objetivo realizar revisão integrativa, investigando como a lógica fuzzy tem sido utilizada em pesquisas com participação de enfermeiros. A busca dos artigos foi realizada nas bases de dados CINAHL, Embase, Scopus, MEDLINE e PubMed, sem intervalo de anos especificado. Foram incluídos artigos na língua portuguesa, inglesa e espanhola; com temática relacionada à enfermagem e à lógica fuzzy, e autoria ou participação de enfermeiros. A amostra final foi de 21 artigos, de oito países. Para análise, os artigos foram distribuídos nas categorias: teoria, método e modelo. Na enfermagem, a lógica fuzzy tem contribuído significativamente para a compreensão de temas relativos à imprecisão ou à necessidade do especialista, como método de pesquisa e no desenvolvimento de modelos ou sistemas de apoio à decisão e de tecnologias duras. O uso da lógica fuzzy, na enfermagem, tem demonstrado grande potencial e representa vasto campo para pesquisas

Nursing And Fuzzy Logic: An Integrative Review.

This study conducted an integrative review investigating how fuzzy logic has been used in research with the participation of nurses. The article search was carried out in the CINAHL, EMBASE, SCOPUS, PubMed and Medline databases, with no limitation on time of publication. Articles written in Portuguese, English and Spanish with themes related to nursing and fuzzy logic with the authorship or participation of nurses were included. The final sample included 21 articles from eight countries. For the purpose of analysis, the articles were distributed into categories: theory, method and model. In nursing, fuzzy logic has significantly contributed to the understanding of subjects related to: imprecision or the need of an expert; as a research method; and in the development of models or decision support systems and hard technologies. The use of fuzzy logic in nursing has shown great potential and represents a vast field for research.19195-20

Evaluating and monitoring analgesia and sedation in the intensive care unit

Management of analgesia and sedation in the intensive care unit requires evaluation and monitoring of key parameters in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management, including patient-focused titration of medications to specific end-points. The need for frequent measurement reflects the dynamic nature of pain, agitation, and sedation, which change constantly in critically ill patients. Further, close monitoring promotes repeated evaluation of response to therapy, thus helping to avoid over-sedation and to eliminate pain and agitation. Pain assessment tools include self-report (often using a numeric pain scale) for communicative patients and pain scales that incorporate observed behaviors and physiologic measures for noncommunicative patients. Some of these tools have undergone validity testing but more work is needed. Sedation-agitation scales can be used to identify and quantify agitation, and to grade the depth of sedation. Some scales incorporate a step-wise assessment of response to increasingly noxious stimuli and a brief assessment of cognition to define levels of consciousness; these tools can often be quickly performed and easily recalled. Many of the sedation-agitation scales have been extensively tested for inter-rater reliability and validated against a variety of parameters. Objective measurement of indicators of consciousness and brain function, such as with processed electroencephalography signals, holds considerable promise, but has not achieved widespread implementation. Further clarification of the roles of these tools, particularly within the context of patient safety, is needed, as is further technology development to eliminate artifacts and investigation to demonstrate added value

Exploring the Effects of the Presence or Absence of Sleep Architecture and Critically Ill Patient Outcomes

University of Minnesota Ph.D. dissertation. May 2019. Major: Nursing. Advisor: Ruth Lindquist. 1 computer file (PDF); ix, 123 pages.Abstract Background: Sleep disturbances and deprivation are known to exist in the critically ill patient. Over a 24-hour period, the critically ill can have 7-9 hours of sleep, but as much as 50% of that sleep can occur during daytime hours, signifying significant sleep fragmentation. Furthermore, some critically ill patients have been found to have abnormal brain waves that obliterate normal sleep architecture. These patients are without conventional sleep markers exhibiting no Stage II sleep spindles, minimal rapid eye movement sleep, and slow background brain wave reactivity. Disrupted sleep has been associated with delirium, weakened immune system, impaired wound healing, nitrogen imbalance, and negative cardiac, pulmonary, and neurological consequences which may all lead to negative patient outcomes. Objective: The objective of this dissertation was to explore factors and outcomes associated with sleep disturbances in critically ill patients. The state of knowledge related to sleep and delirium in critically ill patients were explored. The tools and challenges of measuring sleep in patients while in the intensive care unit (ICU) were also explored. Methods: Using a data base from retrospective chart review of 84 subjects, factors and outcomes related to the presence or absence of sleep in critically ill patients were explored. Literature reviews determined the state of knowledge related to sleep and delirium and the measurement of sleep in critically ill patients. Results. Severity of disease was significantly associated the absence of sleep architecture in both the continuous electroencephalogram (cEEG) 1 to 2- and 1 to 5-day groups. Propofol was significantly associated with the presence or absence of sleep architecture in the day 1-2 group. After adjusting for age and medications, serum creatinine and neurologic physiologic state during days 1 to 2 of cEEG are factors associated with no sleep architecture using bi-variate analysis. Multivariate logistic regression adjusting for age and medications during Days 1-2 cEEG found abnormal serum creatinine to be statically significant. After adjusting for age and medications, encephalopathy and developmental disability were factors significantly associated with no sleep architecture in the Day 1-5 group. . Multivariate logistic regression adjusting for age and medication during days 1-5 cEEG found the physiologic states of encephalopathy and developmental disability to be significantly associated with the absence of sleep architecture. The patient outcomes of increased mechanical ventilation days, ICU length of stay and hospital length of stay were associated significantly with no sleep architecture during Days 1-2 cEEG. In the 1-5 Days cEEG group, hospital length of stay was significantly associated with no sleep architecture. Post-hospitalization transfer location was associated with no sleep architecture for both cEEG groups. Discharge to home was associated with the presence of sleep architecture. Conclusions: Certain patient characteristics are associated with the presence or absence of sleep architecture. The presence or absence of sleep architecture may impact patient outcomes. The exploratory study indicates that future prospective research with larger sample sizes and sleep architecture specifics is needed to advance the state of knowledge. While delirium theoretically may be related to sleep disturbances, more research is needed to determine if a correlation exists. Measuring sleep architecture in ICU patients can be challenging. Critical illness can impact the reliability and accuracy of sleep measurement tools including the gold standard polysomnography. Researchers need to be clear in their research goals and know the challenges related to the various sleep measurement tools

Is skin conductance a predictor of arousal, noxious stimuli and pain in the sedated and anaesthetized patient?

Hudledningsevne som mål på smertefulle stimuli. Lege og forsker Ann Christin Gjerstad har sett på en metode for å oppdage ubehag og smerte hos pasienter som ligger på sykehus og av ulike grunner ikke kan meddele seg på vanlig måte. Dette er gjort ved hjelp av hudledningsevne som måler svetteutsondring i håndflater eller under føttene. En fryktet komplikasjon for pasienter som skal gjennom et sykehusopphold er muligheten for å oppleve smerte uten mulighet til å få kommunisert dette til omgivelsene på grunn av sederende narkose midler, muskelparalyserende midler eller fordi pasienten ligger intubert undre opphold på intensivavdeling eller i forbindelse med kirurgi. Smerte under intensivopphold og under narkose er også noe av det anestesilegen frykter mest å overse. Det er anslått at mellom 0.13 og 0.18 prosent av pasienter under narkose har en oppvåkningsepisode som de senere kan huske og at ca 30 prosent av disse rapporterer om opplevelse av smerte. Hos små barn på en intensivavdeling er en usikker på forekomsten av ubehag og smerte fordi disse barna i etterkant også verbalt har vanskelig for å uttrykke hva de har opplevd. I sin avhandling Is skin conductance a predictor of arousal, noxious stimuli and pain in the sedated and anaesthetized patient? har Ann Christin Gjerstad og hennes medarbeidere vist at hudledningsevne kan reflektere antatt smertefulle stimuli hos små barn som ligger kunstig ventilert ved en intensivavdeling og hos voksne kvinner ved innledningen til generell narkose og kirurgi. Hudledningsevne reflekterte også antatt ubehagelige lydstimuli ved økende bevissthetssløring frem mot bevissthetstap og kunne forutsi oppvåkning etter generell narkose

Towards respiratory muscle-protective mechanical ventilation in the critically ill: technology to monitor and assist physiology

Inadequate delivery of ventilatory assist and unphysiological respiratory drive may severely worsen respiratory muscle function in mechanically ventilated critically ill patients. Diaphragm weakness in these patients is exceedingly common (>60% of patients) and associated with poor clinical outcomes, including difficult ventilator liberation, increased risks of intensive care unit (ICU) and hospital readmission, and mortality. The underlying mechanisms of diaphragm dysfunction were extensively discussed in this thesis. Pathways primarily include the development of diaphragm disuse atrophy due to muscle inactivity or low respiratory drive (strong clinical evidence), and diaphragm injury as a result of excessive breathing effort due to insufficient ventilator assist or excessive respiratory drive (moderate evidence, mostly from experimental work). Excessive breathing effort may also worsen lung injury through pathways that include high lung stress and strain, pendelluft, increased lung perfusion, and patient-ventilator dyssynchrony. Relatively little attention has been paid to the effects of critical illness and mechanical ventilation on the expiratory muscles; however, dysfunction of these muscles has been linked to inadequate central airway clearance and extubation failure. The motivation for performing the work presented in this thesis was the hypothesis that maintaining physiological levels of respiratory muscle activity under mechanical ventilation could prevent or attenuate the development respiratory muscle weakness, and hence, improve patient outcomes. This strategy, integrated with lung-protective ventilation, was recently proposed by international experts from different professional societies (this thesis), and is referred to as a combined lung and diaphragm-protective ventilation approach. Today, an important barrier for implementing and evaluating such an approach is the lack of feasible, reliable and well-understood modalities to assess breathing effort at the bedside, as well as strategies for assisting and restoring respiratory muscle function during mechanical ventilation. Furthermore, monitoring breathing effort is crucial to identify potential relationships between patient management and detrimental respiratory (muscle) function that can be targeted to improve clinical outcomes. In this thesis we identified and improved monitoring modalities for the diaphragm (Part I), we investigated the impact of mechanical ventilation on the respiratory pump, especially the diaphragm (Part II), and we evaluated a novel strategy for maintaining expiratory muscle activity under mechanical ventilation (Part III)

Enteraalne toitmisravi, seedetrakti düsfunktsioon ja soole biomarkerid intensiivravipatsientidel

Väitekirja elektrooniline versioon ei sisalda publikatsiooneOrganpuudulikkuste diagnoosimine ja ravi on üks intensiivravi nurgakividest, kuid seedetrakti puudulikkus on ebapiisavalt defineeritud ning diagnoosimine põhineb siiani peamiselt subjektiivsel kliinilisel läbivaatusel. Võimalikud ravimeetodid seedetrakti probleemide lahendamiseks intensiivravipatsientidel ning nende tõenduspõhisus on vähesed. Uurimistöö keskendus enteraalse toitmisravi läbiviimisele ja jälgimisele, seedetrakti düsfunktsiooni ja puudulikkuse diagnoosimisele ja mõju selgitamisele ning kõrgenenud kõhukoopasisese rõhu ravivõimaluste uurimisele intensiivravihaigetel. Leidsime, et pärast enteraalse toitmise protokolli kasutuselevõttu manustati intensiivravipatsientidele esimese nädala jooksul oluliselt rohkem toiduenergiat enteraalse toitmise teel ilma komplikatsioonide sagenemiseta. Samaaegselt aga vähenes veenisisene toitmine ning kokkuvõttes ka nädala summaarne toiduenergia hulk. Tulemused viitavad vajadusele toitmisravi komplekssemalt planeerida. Järgmises uuringus järeldasime, et soole funktsiooni peegeldava biomarkeri tsitrulliini ning kahjustuse markeri I-FABP-i määramine ei võimalda enteraalse toitmisravi edukust hinnata ning nende roll toitmisravi juhtimisel on hetkel ebaselge. Kõrgenenud kõhukoopasisene rõhk on intensiivravipatsientidel sage probleem, mille ilmnemine on seotud kehvemate ravitulemustega, kuid ravivõtted on piiratud. Meie uurimistöö osutab ühe ravimeetodi, sedatsiooni süvendamise, vähesele toimele ja võimalikele kõrvaltoimetele. Kuivõrd ligi veerandil patsientidest on raviefekt siiski hea, võib seda ravivõtet vajaduse korral kaaluda. Seedetrakti puudulikkuse teke on seotud halvemate ravitulemustega. Nii primaarne, st kõhukoopa patoloogiaga seotud, kui sekundaarne, muu põhjusega seedetrakti puudulikkus on seotud kõrge suremusega. Sekundaarse põhjusega seedetrakti puudulikkuse juhud leiavad sagedamini aset hilisemal intensiivraviperioodil, patsientide seisund on raskem ning ravitulemused võivad olla kehvemad. Töötasime välja seedetrakti sümptomite ja kõrgenenud kõhukoopasisese rõhu raskusastmete kombinatsioonil põhineva kliinilise skoori seedetrakti düsfunktsiooni hindamiseks, mis on vajalik nii kliinilises kui teadustöös. Skoori võime ennustada suremust oli hea ning järgmise sammuna on vajalik valideerimisuuring.The diagnosis and treatment of organ failures is a cornerstone of intensive care. Gastrointestinal failure is insufficiently defined and diagnosis is mostly based on subjective clinical assessment. Treatment options of gastrointestinal problems are limited and the underlying evidence poor. Research in this dissertation focused on the management of enteral nutrition, the diagnosis and impact of gastrointestinal dysfunction and the treatment of intra-abdominal hypertension. After implementing an enteral feeding protocol, significantly more calories were delivered via the enteral route during the first week of intensive care without an increase in complications. In parallel, the delivery of parenteral calories decreased and overall less calories were provided during the first week. This highlights the need to plan for more comprehensive planning of nutritional interventions. Intra-abdominal hypertension is frequent in intensive care patients and associated with worse outcomes. Deepening of sedation as a treatment option has an overall small effect on intra-abdominal pressure, but may cause hemodynamic disturbances. Nevertheless, deeper sedation decreases intra-abdominal pressure by a greater amount in some patients and therefore this method can be considered if treatment is needed. Development of gastrointestinal failure is associated with poor treatment outcomes. Both primary and secondary gastrointestinal failure are related to high mortality. Secondary gastrointestinal failure tends to occur later in the course of critical illness in more severely ill patients and may carry a worse prognosis. A clinical score to quantify gastrointestinal dysfunction was developed based on gastrointestinal symptoms and intra-abdominal hypertension. The ability of the score to predict mortality was good and as a next step, validation studies are needed.https://www.ester.ee/record=b546596