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Many factors collaborate to increase discharge at request: Giving up on the request During the hospitalisation period, the patient faces moments of loneliness, especially when the visitation time of loved ones and relatives is reduced or when they can not visit the patient for different reasons.
To the dependence on the care of others are added practices that constitute the day to day in the hospital, where the body of the patient happens to be the main place of diverse manipulations, realised by many hands: We learned that several factors may contribute to attenuate the stress generated by the hospitalisation.
Patients, when asked what would change their minds about asking for discharge highlighted several different possibilities: Several possibilities were pointed out by the patients as a reason to avoid discharge at request; however, among those cited, the one that attracts the most attention is related to the delay in the results of the exams.
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The fact that they have to wait for the result of an exam causes great stress on the patient who has been hospitalised for many days. The delay of the results, therefore, influences the capacity of the user to withstand the inconvenience of staying in the institution and can affect the health of the population, leading them to seek easier ways, such as self-medication, treatment abandonment, among others Returning to the findings of this research, we identified in the group of professionals that One of the interviewees exemplifies this question: Thus, we see that the professional repeats the same claim of the category discussed above, always referring to the absence of the family as a determining factor in the discharge at request.
It is evident that there is a lack of defining practices to promote the inclusion of family members in the hospital space, since many of them find it difficult to understand that they are fully entitled to accompany the patient in the hospita Other professionals corroborate this statement: However, family members agree to take responsibility after the discharge against medical advice, understanding that the patient is tired or has other difficulties that prevent her from staying hospitalised.
Conduct of the process of discharge at request Discharge at request is a unique procedure and requires a set of instruments, such as the form or term used in the discharge request. Informed consent may be oral or written, but the written form, especially from a legal point of view, is the most advisable.
It is worth mentioning that in some institutions, the term is signed by a relative who will be responsible for the discharge at request, that is, the document is not signed only by the patient. In the hospital where this research was carried out, the willingness of the patient to self discharge is conducted through a specific process: A multi professional team and physician talk with the patient about their clinical situation, advise on the risks of the decision and, if they are not successful in the attempt to dissuade the patient, then the doctor writes the report summarising the circumstances of the discharge, and the patient and a family member sign the agreement on the discharge at request.
We see that information is crucial to the process of conducting discharge at request, whereas the patient should be aware of all the risks and consequences of her attitude. Thus, one can see how medical opinion still has great importance for patients in relation to other professional categories. Discharge at request requires a specific flow. Given this, it can be said that the process is not so bureaucratic for the patient, even because it is not the patient who must follow the procedures defined in the hospital process of discharge at request.
Now, the professionals consider what has been characterised as a bureaucracy to be essential, either because it responds to the demands for recording the situation or even because they believe that the longer the discharge process takes to be completed, the greater the chances of convincing the patient to give up the idea.
In this context, we observed that some professionals, due to the risks to which the patient is exposed, were disappointed by not being able to reverse their decision, even considering their right to decide on the matter. Another issue observed is that generally the time of the decision of the patient is not always the same of the team, because from the moment that the patient requests to be discharged, the routine of the professional is changed, that is, he or she leaves aside the care to other patients in order to try to change the decision of the patient, generating tension in the context of the work.
Small variations in positioning the plaque on the ocular surface may generate a less effective treatment. Thus, in this work an eyeball phantom and a seed accommodation system similar to a commercially eye plaque model ROPES with diameter of 15 mm, were developed both in solid water Gammex to conduct the study of the possible variation in the dose deposition inside the eye phantom.
Radiochromic films were used to record isodose curves of two orthogonal plans within the simulator. The results showed that there is a difference in the dose deposition for the two orthogonal plans studied.
This difference is 8. Thus, a difference in dose that occurs due to the asymmetrical distribution of seeds on the eye plaque may interfere with the treatment, making it less effective.
Normality was not verified for the variables corresponding to the muscle diameter and thus, the nonparametric Kruskal-Wallis test with the Dunn post test was used.
As for the body mass variable, normality was verified and thus the dependent Student t test was used for the intragroup analysis, in the pre and post-training moments. Muscular strength training protocol. Measurement of the smallest diameter of muscle fibers. From the analysis of muscle fibers, distinct morphologies were observed in the different groups of animals, both in the analyses obtained from the HE staining and in the NADH-TR reaction Figs.
Thus, in general, when observing the HE cuts, an increase in the MF diameter was noted in all groups, independent of the treatment. In addition, after performing the morphometric analyzes measurements of diameter it was observed that the groups of animals responded differently to treatment Figs.
It was verified that when analyzing the fibers in a general manner through the HE staining method, all experimental groups demonstrated hypertrophy of muscle fibers.
Analysis of body mass in the pre- and post-training moments. Control and GH group. Strength Training Group D: Strength Training and GH group. Staining with hematoxylin and eosin HE of muscle fibers at 10X magnification.
Strength training and GH group. Arrows indicate muscle fibers. Analysis of fast and slow twitch muscle fibers through the nicotinamide adenine dinucleotide tetrazolium reductase reaction NADH-TR.
Diameter of Muscle Fibers through the staining with hematoxylin and eosin HE. Statistical difference when compared to the C group. Diameter of slow twitch muscle fibers through the nicotinamide adenine dinucleotide tetrazolium reductase reaction NADH-TR. Diameter of fast twitch muscle fibers through the nicotinamide adenine dinucleotide tetrazolium reductase reaction NADH-TR.
The measurements were performed from the smallest diameter of the muscle fibers and specific measures of fast FMCR and slow twitch fibers FMCL were also carried out. It is known that the use of water jumps can recover volume of muscle tissue lost after immobilization Antunes et al.
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In addition to causing hypertrophy of muscle fibers Moret et al. Differently, the FMCL adapt better to the application of stimuli with less force of contraction and performed for long periods of time, as in the specific case of aerobic training. Specificity of physical exercise can increase cellular organelles, such as mitochondria, and thus increase the intramuscular energy substrates and their improved utilization in the aerobic metabolism Castoldi et al.
This finding confronts those presented by Castoldi et al. Moreover, Castoldi et al. This may explain the lower adaptation when compared to the study by Castoldi et al. Future research, analyzing different muscle groups, is likely to add to the results observed in the present study.
In addition to the PT, the present study examined the alterations caused by GH.