The occupational therapy in the context of assistence for mother/family and interned newborn baby in the unit therapy intensive

O objetivo deste artigo é relatar a experiência da atuação da Terapia Ocupacional no Hospital Sofia Feldman, visando uma assistência integral e humanizada à mulher e ao recém-nascido. Para isso, são descritas as ações desenvolvidas junto à gestante de risco e à mãe e à família de recém-nascido internado em Unidade de Terapia Intensiva Neonatal (UTIN), respaldadas pelo referencial teórico e filosófico do cuidado centrado na família. Percebe-se que essa experiência tem possibilitado à mulher viver de forma mais tranqüila e segura a gravidez e/ou internação de seu bebê, tem favorecido o estabelecimento do vínculo mãe-filho e família em situação de prematuridade e tem contribuído na orientação às famílias sobre os cuidados com o bebê. Isso fica evidenciado na participação e adesão das mesmas aos grupos desenvolvidos e na segurança demonstrada para realizar os cuidados com o bebê durante a internação e após a alta hospitalar. Considera-se esta uma experiência ainda restrita e com escassos estudos no país, o que indica a necessidade de investimentos em conhecimentos e habilidades específicas, bem como estudos que aprofundem mais o tema abordado.The objective of this article is mention the experience of performance of Occupation Therapy on Sofia Feldman Hospital, showing an fully assistance and humanizing women and for newborn. For this there are descriptions and actions development join the pregnant of the risk and mother/family of newborn baby interned in UTI, the theory and philosophic with central care of the family. Understand that the experience has possibility for woman to live in a calmly way and safety with pregnancy and the internment of her baby, it has helped the establishment of bond son-mother and family in situation for families about baby's care. It has been evidencing the participation and adhesion with groups developing and in security demonstrate to realize the baby's care during the internment and after discharge from hospital. Consider an experience still restrict and with few studies in the country, and more than that the necessity of investment, knowledge and specific skills with deeply studies that must be add about this subject

A terapia ocupacional no contexto da assistência à mãe e à família de recém-nascidos internados em unidade de terapia intensiva

The objective of this article is mention the experience of performance of Occupation Therapy on Sofia Feldman Hospital, showing an fully assistance and humanizing women and for newborn. For this there are descriptions and actions development join the pregnant of the risk and mother/family of newborn baby interned in UTI, the theory and philosophic with central care of the family. Understand that the experience has possibility for woman to live in a calmly way and safety with pregnancy and the internment of her baby, it has helped the establishment of bond son-mother and family in situation for families about baby's care. It has been evidencing the participation and adhesion with groups developing and in security demonstrate to realize the baby's care during the internment and after discharge from hospital. Consider an experience still restrict and with few studies in the country, and more than that the necessity of investment, knowledge and specific skills with deeply studies that must be add about this subject.O objetivo deste artigo é relatar a experiência da atuação da Terapia Ocupacional no Hospital Sofia Feldman, visando uma assistência integral e humanizada à mulher e ao recém-nascido. Para isso, são descritas as ações desenvolvidas junto à gestante de risco e à mãe e à família de recém-nascido internado em Unidade de Terapia Intensiva Neonatal (UTIN), respaldadas pelo referencial teórico e filosófico do cuidado centrado na família. Percebe-se que essa experiência tem possibilitado à mulher viver de forma mais tranqüila e segura a gravidez e/ou internação de seu bebê, tem favorecido o estabelecimento do vínculo mãe-filho e família em situação de prematuridade e tem contribuído na orientação às famílias sobre os cuidados com o bebê. Isso fica evidenciado na participação e adesão das mesmas aos grupos desenvolvidos e na segurança demonstrada para realizar os cuidados com o bebê durante a internação e após a alta hospitalar. Considera-se esta uma experiência ainda restrita e com escassos estudos no país, o que indica a necessidade de investimentos em conhecimentos e habilidades específicas, bem como estudos que aprofundem mais o tema abordado

Donos de terras e escravos no Paraná: padrões e hierarquias nas primeiras décadas do século XIX Lands owners and slaves in Paraná: patterns and hierarchies in the early nineteenth century

Nas primeiras décadas do século XIX a repartição da terra no Paraná registrou um alto índice de concentração, com os fazendeiros de gado detendo as maiores propriedades. Neste artigo examina-se o uso da mão-de-obra escrava da parte dos donos da terra, assim como o acesso à terra por parte dos proprietários de escravos. Discutem-se hierarquias sociais presentes na sociedade local e a importância da terra e dos escravos na constituição dessas hierarquias. As fontes primárias empregadas na análise foram cadastros de terras e recenseamentos de população.<br>In the nineteenth century first decades the land distribution in Paraná registered a high concentration level due to the fact that the cattle farmers owned the biggest properties. This article examines the use of the enslaved labor by land owners as well as the access to the land by the slaves owners. It discusses both social hierarchies in the local society and the land and slaves importance in these hierarchies constitution. The primary sources used in the analysis were lands official records and demographic censuses

Intraoperative transfusion practices in Europe

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl and increased to 9.8 (1.8) g dl after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended

Intraoperative transfusion practices in Europe

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold