Cuidado em Saúde Mental: um sistema para ensino em Enfermagem / Mental Health care: a system for teaching in Nursing / Atención de Salud Mental: sistema para la enseñanza en Enfermería

O presente trabalho relata o desenvolvimento de uma ferramenta informatizada para a realização de práticas na sistematização da assistência de enfermagem na área de saúde mental. Este sistema foi desenvolvido para uso na disciplina de Enfermagem Psiquiátrica da graduação em Enfermagem da Universidade Federal de Pernambuco. Método: Seu desenvolvimento se baseou na teoria das necessidades humanas básicas, de Wanda A. Horta e Dorothea Elizabeth Orem, e utilizou como terminologias de referência: CIPE (Classificação internacional para a prática de enfermagem), NIC (Classificação das intervenções de enfermagem) e NOC (Classificação de resultados de enfermagem). Resultados: O sistema foi desenvolvido para plataforma Web para uso em atividades práticas em laboratório de informática ou em atividades extraclasse para discussão de casos clínicos pelos estudantes. O protótipo foi avaliado preliminarmente por estudantes de enfermagem em atividades práticas nas disciplinas de Enfermagem Psiquiátrica e Informática em Saúde. Conclusão: A ferramenta proposta contribui para a racionalização e segurança do cuidado de enfermagem, possibilitando o exercício e consolidação dos conhecimentos do estudante em saúde mental...

This paper describes the development of a computerized tool to conduct practices in the nursing process in mental health. This system was developed for use in the Psychiatric nursing classes of the Nursing school at the Federal University of Pernambuco. Method: Its development was based on the Theory of basic human needs of Wanda A. Horta and Dorothea Elizabeth Orem, also, had used as main terminologies: ICNP (International Classification of Nursing Practice), NIC (Nursing Interventions Classification) and NOC (Nursing Outcomes Classification). Results: The application system was developed for the Web platform and has been used in practical activities in computer labs or in extra-class activities for discussion of clinical cases by students. The prototype was preliminarily evaluated by students in practical activities in the disciplines of Psychiatric nursing and Health informatics. Conclusion: This work contributes to developing of student confidence to carry out the nursing process in mental health in his/her future professional activities...

Este artículo describe el desarrollo de una herramienta informática para llevar a cabo prácticas en el proceso de sistematización de enfermería en salud mental. Este sistema fue desarrollado para uso en las clases de Enfermería Psiquiátrica del grado en Enfermería de la Universidad Federal de Pernambuco. Método: Su desarrollo se basó en la teoría de las necesidades humanas básicas, de Wanda A. Horta y Dorothea Elizabeth Orem, y empleó como terminologías principales las siguientes: CIPE (Clasificación Internacional de la práctica de enfermería), NIC (Clasificación de intervenciones de enfermería) y NOC (Clasificación de resultados de enfermería). Resultados: El sistema de aplicación fue desarrollado para la plataforma Web y se ha utilizado en las actividades prácticas en los laboratorios de informática, o en actividades extra clase para la discusión de casos clínicos por los estudiantes. El prototipo fue evaluado preliminarmente por los estudiantes de enfermería en las actividades prácticas en las disciplinas de Enfermería psiquiátrica y Informática de salud. Conclusión: Este trabajo contribuye al desarrollo de la confianza de los estudiantes para llevar a cabo el proceso de enfermería en salud mental en su futuro profesional...

Optimal selection of biological tissue using the energy dissipated in the first loading cycle.

Calf pericardium, similar to that used in the manufacturing of prosthetic valve cusps, was fatigue tested. After six batches of 100 cycles of 1 MPa of loading pressure, half of the samples broke. The mean energy dissipated in the first cycle by the surviving samples was 0.16 J, which is lower than the 0.28 J dissipated by the specimens that broke (p = 0.005). The hysteresis of the first cycle was characteristic and different from the following ones and correlated superbly with fatigue resistance. Setting a threshold value for the energy of the first cycle of 0.20 J, the performance index (the percentage of true predictions) was almost 80%, and the area under the ROC curve was 0.823 (maximum value is 1). When including the mean thickness in the selection parameters, as an indirect measure of the specimen mass, the performance index grew over 95%, meaning that the error of the predictions was less than 5%. Combining both parameters in one, a high performance index is maintained at 87.5% and the area under the ROC curve increases to 0.917. This non-destructive method should help optical methods in the process of selecting the most appropriate and homogenous biological material.

Propagation of tears in pericardium from young bulls: influence of the suture.

The tearing of the collagen fibers of biological materials utilized in implants or bioprostheses is an important, and sometimes early cause of the failure of these devices. We studied the force necessary to propagate a tear in a biomaterial, pericardium from young bulls, and the influence of the suture. An Elmendorf pendulum capable of measuring the force necessary to tear a given length of tissue was employed. We analyzed 112 trials (70%) that proved valid after achieving the homogeneity of the samples according to their thickness, thus making the results comparable. Mean forces ranging between 19.87 and 150 N were required to propagate tears measuring from 0.25 to 2.0 cm. In the samples with a 1-cm-long suture, sewn using an edge-to-edge technique, the propagation of the tear required a mean force of 15.75 N when the suture was made of nylon and 28.73 N when Prolene was utilized. When these results were compared with the mean recorded in an unsutured control series (56.76 N), the loss of resistance was significant in both sutured series (P = 0.000 and P = 0.011, respectively). Finally, the equation that relates the force (y) with the length of the tear made in unsutured tissue (x) was also obtained: y = 58.14 + 9.62x(2) (R(2) = 0.924). The force necessary to produce a microtear, thus estimated, can be utilized as a parameter for comparison.

Determination of the force necessary for the propagation of tears in ostrich and calf pericardium.

The durability of prosthetic heart valve leaflets made of biological materials is limited. A tear in the biomaterial accelerates their early failure, but microtearing of the collagen fibers may be responsible for their medium-term failure. We studied the force necessary to propagate tearing in two biomaterials: ostrich and calf pericardium. One hundred twenty samples of each tissue were tested in an Elmendorf pendulum capable of measuring the force required to tear a tissue in which a predefined slit had been made. The forces required to produce tears, ranging between 2.5 and 0.25 cm in length, were determined. For ostrich pericardium, this force ranged between 67.67 and 4.80 newton, while that required to tear the same lengths of calf pericardium ranged between 70.67 and 4.70 newton. The function that relates the tearing force to the length of the tear was expressed as follows: y = 20.62x + 1.77x(2) (R(2) = 0.923) for ostrich pericardium and y = 45.57x - 7.21x(2) (R(2) = 0.936) for calf pericardium, where y is the force in newton and x is the length in centimeter. Calf pericardium was found to have a greater resistance to tearing. However, these results should be interpreted with caution owing to the fact that the thickness of the majority of the samples of ostrich pericardium was significantly less than that of calf pericardium. A more careful selection and utilization of adult ostrich pericardium would probably improve these results.

Mechanical resistance of a new biomaterial, ostrich pericardium, and a new method of joining tissues combining suturing and a biological adhesive.

We studied the mechanical behavior in response to tensile stress of samples of ostrich pericardium bonded with a cyanoacrylate glue or sewn with a rectangular, overlapping suture that was subsequently sealed with the same bioadhesive. Seventy-two trials were performed in three series of 24 samples each: series AG, glued with an overlap of 1 cm2; series ASG, sewn with a rectangular, overlapping suture and sealed; and series AC, control samples that were left intact. The mean stress at rupture in series AG (glued) was 0.1 MPa, much lower than the working stress of a human valve leaflet, which is approximately 0.25 MPa. In the control series, this stress was 26.28 MPa. At rupture in series ASG (sutured/glued), the suture material was being subjected to a stress of 64.91 MPa, thus confirming the existence of an interaction between the suture and the shear stress exerted by the suture on the samples of pericardium. In series ASG, the mean value for the resistance to rupture when measured in machine kg was 8.83 kg, lower than but similar to that recorded in the control series AC (10.26 kg). The percentages of reversible deformation, or elongation, once the samples were torn were similar in series AC (19.15%) and ASG (21.93%). This phenomenon can only be explained by the damage to the collagen fibers in the area around the rupture, while other more distant regions work at a lower load within the elastic limit. We conclude that cyanocrylate adhesives alone are not suitable as bonding materials in cardiac bioprostheses. The results with the rectangular, overlapping suture, when subsequently sealed with an adhesive, can be considered good because, although this approach does not impede shear stress, it does maintain an excellent degree of resistance to rupture of the samples thus joined. We stress the need to take into account the concentration of the load in the design of bioprostheses.

Resistance to tearing of calf and ostrich pericardium: Influence of the type of suture material and the direction of the suture line.

The tearing of the valve leaflet of a cardiac bioprosthesis can cause early failure of this device, which is employed to replace a diseased native valve. This report involves the study of the behavior of 312 tissue samples (152 of calf pericardium and 160 of ostrich pericardium) treated with glutaraldehyde and subsequently subjected to tear testing. The samples were cut in the two principal directions: longitudinally, or root to apex, and transversely. They included a series of control samples that were left unsutured, and the remaining samples were repaired with the use of two different suture techniques: a running suture in the direction of the load and a telescoping suture perpendicular to the load. Four commercially available suture materials were employed: Pronova, nylon, Gore-Tex, or silk. The unsutured control samples of both types of pericardium exhibited a similar anisotropic behavior in the tear test. The mean resistance to tearing of the calf pericardium was 24.29 kN m in samples cut longitudinally and 34.78 kN m in those cut transversely (p =.03); the values were 28.08 kN m and 37.12 kN m (p =.002), respectively, in ostrich pericardium. The series repaired with the telescoping suture always exhibited greater resistance to tearing, with values that ranged between 44.34 and 64.27 kN for the samples of calf pericardium and from 41.65 to 47.65 kN for those obtained from ostrich. These assays confirm the anisotropic behavior of calf and ostrich pericardium treated with glutaraldehyde when subjected to tear testing, as well as the loss of this behavior in ostrich pericardium after suturing. Suturing techniques, such as the telescoping model, that provide a greater resistance to tearing should be studied for use in the design of the valve leaflets of cardiac bioprostheses made of biological materials.