RESUMO
Abstract This work analyzed the pharmacotherapeutic problems identified by the clinical pharmacist in an intensive care unit (ICU) and the acceptance of pharmaceutical interventions in solving these problems. This is a descriptive cross-sectional retrospective study, carried out in the adult ICU of a public hospital. All patients hospitalized during the study period had their pharmacotherapy monitored and those whose stay at the ICU lasted less than 24 hours were excluded. The pharmacotherapeutic problems were classified according to type, cause, acceptability/implementation, mode of intervention, outcome and related pharmacotherapeutic group. 302 patients were followed up and 350 pharmacotherapeutic problems were identified. Most of them were classified as unnecessary drug-treatment (n=186; 53.1%). The most frequent causes were excessive drug administration (n=181; 97.3%), and antimicrobials was the main group of drugs associated to that type of problem. 350 pharmaceutical interventions were performed, highlighting "prescriber informed only" (n=178; 50.9%), with an average acceptability of 90.7%, with those carried out on site being more effective (93.4%). The number of pharmacotherapeutic problems that were totally solved was 282 (80.6%). Clinical pharmacy activities in the ICU identified, prevented and corrected pharmacotherapeutic problems, contributing to the optimization of pharmacotherapy in aspects related to the need, efficacy and safety of treatments.
Assuntos
Humanos , Masculino , Feminino , Pacientes/classificação , Assistência Farmacêutica/ética , Unidades de Terapia Intensiva/organização & administração , Organização e Administração/normas , Farmacêuticos/classificação , Preparações Farmacêuticas/administração & dosagem , Segurança do Paciente/normas , Prática Farmacêutica Baseada em Evidências/tendênciasRESUMO
Introducción: Los documentos normativos establecen el estado del arte relacionado con determinado campo del conocimiento. Existe una gran cantidad de normas relacionadas con los servicios de salud y su gestión, cuya aplicación es relevante en este sector. Objetivo: Exponer la importancia de las normas técnicas en la formación de los profesionales en ingeniería biomédica, tecnología y administración en salud. Desarrollo: Diferentes aspectos relacionados con el desempeño y las funciones de los profesionales en ingeniería biomédica, tecnología de la salud y administración en salud están recogidos en normas técnicas internacionales y en otras de carácter nacional, que resultan pertinentes y de gran utilidad para su formación en el nivel de grado y el posgrado. Conclusiones: Las profesiones abordadas requieren emplear los documentos normativos relacionados con sus funciones para contribuir con la calidad de los servicios de salud; de ahí la pertinencia de su incorporación en los planes de estudio de estas carreras(AU)
Introduction: Normative documents establish the state of the art related to a certain field of knowledge. There is a large number of standards related to health services and their management, whose application is relevant in this sector. Objective: To show the importance of technical standards in the training of professionals from the fields of biomedical engineering, health technology and health management. Development: Different aspects related to the performance and functions of professionals from the fields of biomedical engineering, health technology and health management are gathered in international and other national technical standards, relevant and useful for their training at the undergraduate and postgraduate levels. Conclusions: The addressed professions require the use of normative documents related to their functions in order to contribute to the quality of health services, hence the relevance of their incorporation into the curriculums of these major(AU)
Assuntos
Humanos , Organização e Administração/normas , Engenharia Biomédica/normas , Tecnologia Biomédica/normas , Administração em Saúde/normas , Capacitação Profissional , Qualidade da Assistência à Saúde/tendênciasRESUMO
Trata-se do Volume 1 da coleção "Normas de Conduta Técnica e Gestora para Profissionais do SAMU 192 - Regional Fortaleza" (SAMUFor), que publiciza o Regimento Interno do SAMUFor. Divide-se em três capítulos: 1. Normatização Vigente; 2. Normatização Municipal Vigente; e 3. Regimento Interno SAMUFor. Esse terceiro capítulo divide-se em: Regimento Interno do SAMU 192 Regional Fortaleza; Regimento Interno da Gerência SAMUFor; Regimento Interno dos Órgãos de Assessoria da Gerência do SAMUFor; Regimento Interno do Núcleo Médico; Regimento Interno do Núcleo de Enfermagem; Regimento Interno do Núcleo de Farmácia; Regimento Interno do Núcleo Administrativo; Regimento Interno do Núcleo de Educação Permanente; e Regimento Interno da Central de Regulação das Urgências
Assuntos
Regimentos , Atenção à Saúde/organização & administração , Serviços de Atendimento/organização & administração , Serviços Médicos de Emergência/organização & administração , Organização e Administração/normas , Emergências , Serviços Médicos de Emergência/legislação & jurisprudênciaRESUMO
Reverse engineering is a burning issue in Integrated Circuit (IC) design and manufacturing. In the semiconductor industry, it results in a revenue loss of billions of dollars every year. In this work, an area efficient, high-performance IC camouflaging technique is proposed at the physical design level to combat the integrated circuit's reverse engineering. An attacker may not identify various logic gates in the layout due to similar image output. In addition, a dummy or true contact-based technique is implemented for optimum outcomes. A library of gates is proposed that contains the various camouflaged primitive gates developed by a combination of using the metal routing technique along with the dummy contact technique. This work shows the superiority of the proposed technique's performance matrix with those of existing works regarding resource burden, area, and delay. The proposed library is expected to make open source to help ASIC designers secure IC design and save colossal revenue loss.
Assuntos
Engenharia/tendências , Organização e Administração/normas , Medidas de Segurança/tendências , Semicondutores , Humanos , Indústrias/tendências , MilitaresRESUMO
INTRODUCTION: The Centers for Disease Control and Prevention states that tobacco use is the largest and most preventable cause of disease and mortality in the United States. The Joint Commission implemented inpatient tobacco treatment measures (TTMs) in 2012 to encourage healthcare systems to create processes that help patients quit tobacco use through evidence-based care. METHODS: A tobacco cessation care delivery system was implemented at James A. Haley Veterans' Hospital and Clinics, which included: standardized pathways within the Veterans Health Administration (VHA) electronic health record system to improve nicotine replacement therapy ordering; evidence-based tobacco cessation counseling; and improved care coordination for tobacco cessation treatment through the use of technological innovation. RESULTS: Outcomes were obtained from the VHA quality metric reporting system known as Strategic Analytics for Improvement and Learning (SAIL). TOB-2 and TOB-3 (two Joint Commission inpatient TTMs) equivalent to tob20 and tob40 within SAIL improved by greater than 300% after implementation at James A. Haley Veterans' Hospital and Clinics. CONCLUSION: Implementation of a tobacco cessation care system at James A. Haley Veterans' Hospital and Clinics enhanced interdisciplinary coordination of tobacco cessation care and resulted in improvements of The Joint Commission inpatient TTMs by greater than threefold.
Assuntos
Atenção à Saúde/normas , Registros Eletrônicos de Saúde/normas , Prática Clínica Baseada em Evidências/normas , Organização e Administração/normas , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/normas , Abandono do Hábito de Fumar/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Currículo , Educação Médica Continuada , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , United States Department of Veterans AffairsRESUMO
Feedback pedagogies and research tend to focus on immediate corrective actions rather than learning for the longer term. This approach means that feedback may not support trainees who are managing complex, competing, and ambiguous practice situations, often with limited supervision. There is an opportunity to consider how feedback can help medical trainees sustain their own development into the future, including when they have completed formal training. This article explores how feedback pedagogies can facilitate medical trainees' abilities to develop challenging aspects of practice across multiple clinical environments to eventually practice without supervision. From a sociocultural perspective, clinical training takes place within a practice curriculum; each clinical environment offers varying opportunities, which the trainees may choose to engage with. The authors propose feedback as an interpersonal process that helps trainees make sense of both formal training requirements and performance relevant information, including workplace cues such as patient outcomes or colleagues' comments, found within any practice curriculum. A significant pedagogic strategy may be to develop trainees' evaluative judgment or their capability to identify and appraise the qualities of good practice in both themselves and others. In this way, feedback processes may help trainees surmount complex situations and progressively gain independence from supervision.
Assuntos
Competência Clínica/estatística & dados numéricos , Organização e Administração/normas , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Atitude do Pessoal de Saúde , Currículo , Retroalimentação , Humanos , Internato e Residência , Local de Trabalho/psicologiaAssuntos
Pediatras/estatística & dados numéricos , Assistentes Médicos/provisão & distribuição , Medicina Estatal/legislação & jurisprudência , Recursos Humanos/estatística & dados numéricos , Humanos , Organização e Administração/normas , Pediatras/tendências , Assistentes Médicos/estatística & dados numéricos , Medicina Estatal/organização & administração , Reino Unido , Recursos Humanos/tendênciasRESUMO
BACKGROUND: During the coronavirus disease-2019 (COVID-19) pandemic, Italian hospitals faced the most daunting challenges of their recent history, and only essential therapeutic interventions were feasible. From March to April 2020, the Laboratory of Advanced Cellular Therapies (Vicenza, Italy) received requests to treat a patient with severe COVID-19 and a patient with acute graft-versus-host disease with umbilical cord-derived mesenchymal stromal cells (UC-MSCs). Access to clinics was restricted due to the risk of contagion. Transport of UC-MSCs in liquid nitrogen was unmanageable, leaving shipment in dry ice as the only option. METHODS: We assessed effects of the transition from liquid nitrogen to dry ice on cell viability; apoptosis; phenotype; proliferation; immunomodulation; and clonogenesis; and validated dry ice-based transport of UC-MSCs to clinics. RESULTS: Our results showed no differences in cell functionality related to the two storage conditions, and demonstrated the preservation of immunomodulatory and clonogenic potentials in dry ice. UC-MSCs were successfully delivered to points-of-care, enabling favourable clinical outcomes. CONCLUSIONS: This experience underscores the flexibility of a public cell factory in its adaptation of the logistics of an advanced therapy medicinal product during a public health crisis. Alternative supply chains should be evaluated for other cell products to guarantee delivery during catastrophes.
Assuntos
COVID-19/terapia , Atenção à Saúde/organização & administração , Gelo-Seco , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Meios de Transporte , Doença Aguda , COVID-19/epidemiologia , COVID-19/patologia , Proliferação de Células , Sobrevivência Celular , Células Cultivadas , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Atenção à Saúde/normas , Equipamentos e Provisões Hospitalares/normas , Equipamentos e Provisões Hospitalares/provisão & distribuição , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/patologia , Doença Enxerto-Hospedeiro/terapia , Humanos , Itália/epidemiologia , Administração de Materiais no Hospital/organização & administração , Administração de Materiais no Hospital/normas , Transplante de Células-Tronco Mesenquimais/métodos , Transplante de Células-Tronco Mesenquimais/normas , Células-Tronco Mesenquimais/fisiologia , Organização e Administração/normas , Pandemias , Fenótipo , Sistemas Automatizados de Assistência Junto ao Leito/normas , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença , Meios de Transporte/métodos , Meios de Transporte/normasRESUMO
The coronavirus (coronavirus disease-2019) pandemic has changed care delivery for patients with end-stage kidney disease. We explore the US healthcare system as it pertains to dialysis care, including existing policies, modifications implemented in response to the coronavirus disease-2019 crisis, and possible next steps for policy makers and nephrologists. This includes policies related to resource management, use of telemedicine, prioritization of dialysis access procedures, expansion of home dialysis modalities, administrative duties, and quality assessment. The government has already established policies that have instated some flexibilities to help providers focus their response to the crisis. However, future policy during and after the coronavirus disease-2019 pandemic can bolster our ability to optimize care for patients with end-stage kidney disease. Key themes in this perspective are the importance of policy flexibility, clear strategies for emergency preparedness, and robust health systems that maximize accessibility and patient autonomy.
Assuntos
COVID-19 , Política de Saúde , Falência Renal Crônica/terapia , Nefrologia , Diálise Renal/métodos , Telemedicina/métodos , Instituições de Assistência Ambulatorial , Anastomose Cirúrgica , Artérias/cirurgia , Implante de Prótese Vascular , Centers for Medicare and Medicaid Services, U.S. , Segurança Computacional , Atenção à Saúde/métodos , Atenção à Saúde/normas , Planejamento em Desastres , Acessibilidade aos Serviços de Saúde , Soluções para Hemodiálise/provisão & distribuição , Hemodiálise no Domicílio/métodos , Hemodiálise no Domicílio/normas , Humanos , Organização e Administração/normas , Autonomia Pessoal , Equipamento de Proteção Individual , Garantia da Qualidade dos Cuidados de Saúde , Mecanismo de Reembolso , Diálise Renal/instrumentação , Diálise Renal/normas , SARS-CoV-2 , Telemedicina/normas , Estados Unidos , Veias/cirurgiaRESUMO
AIM: To examine the journey of safety initiatives from executive hospital management to ward. BACKGROUND: Hospital management teams are often responsible for identifying safety priorities and ensuring delivery of these. METHOD: Naturalistic study design within a large NHS Hospital Trust. Using semi-structured interviews, focus groups and secondary data analysis, the study examines the implementation of safety initiatives. RESULTS: While hospital management developed five safety initiatives, only one of these (falls prevention) was actually seen to permeate all layers of the organisation. Other initiatives stopped one layer down. Both middle management and ward staff added to the list of initiatives developed, resulting in 16 priorities. A range of positive and negative influences to successful implementation are identified. CONCLUSIONS: Safety initiatives need positive reinforcement at all levels to be addressed appropriately. The research suggests that a model related to improvement science may prove useful in ensuring that priorities are addressed. IMPLICATIONS FOR NURSING MANAGEMENT: Care should be taken to ensure that safety initiatives are successfully implemented at all levels within an organisation. Identifying priorities with staff and sharing values and priorities are a key approach to leading such initiatives.
Assuntos
Segurança do Paciente/normas , Gestão da Segurança/normas , Grupos Focais/métodos , Humanos , Organização e Administração/normas , Organização e Administração/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Quartos de Pacientes/organização & administração , Quartos de Pacientes/normas , Quartos de Pacientes/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/métodos , Pesquisa Qualitativa , Gestão da Segurança/estatística & dados numéricos , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricosRESUMO
The novel coronavirus (COVID-19) began in China in early December 2019 and rapidly has spread to many countries around the globe, with the number of confirmed cases increasing every day. An epidemic has been recorded since February 20 in a middle province in Northern Italy (Lodi province, in the low Po Valley). The first line hospital had to redesign its logistical and departmental structure to respond to the influx of COVID-19-positive patients who needed hospitalization. Logistical and structural strategies were guided by the crisis unit, managing in 8 days from the beginning of the epidemic to prepare the hospital to be ready to welcome more than 200 COVID-19-positive patients with different ventilatory requirements, keeping clean emergency access lines, and restoring surgical interventions and deferred urgent, routine activity.
Assuntos
Infecções por Coronavirus/complicações , Organização e Administração/normas , Pandemias/estatística & dados numéricos , Pneumonia Viral/complicações , COVID-19 , Defesa Civil/métodos , Defesa Civil/tendências , Infecções por Coronavirus/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Recursos em Saúde/provisão & distribuição , Hospitalização/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Itália/epidemiologia , Organização e Administração/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologiaRESUMO
Este documento da orientación provisional procura fortalecer la respuesta de los servicios hospitalarios ante la posibilidad de tener casos en el país de COVID-19, especialmente en la parte de prevención de la transmisión a del fortalecimiento de las precauciones estándar para la prevención y control de infecciones, con énfasis en el lavado de manos y el uso de equipo protección personal por parte del personal de salud. Además, provee orientaciones para organizar los servicios hospitalarios para adecuar áreas de aislamiento, cuidados intermedios y áreas de triage. El documento también orienta para la proyección de costos de insumos: Material medico quirúrgico, medicamentos, recursos humanos, entre otros como preparación para la respuesta (AU).
Assuntos
Humanos , Organização e Administração/normas , Pneumonia Viral/diagnóstico , Controle de Infecções , Infecções por Coronavirus/diagnóstico , Betacoronavirus , Assistência ao Paciente/métodos , Cadáver , Preparações Farmacêuticas/economia , Organizações , Pessoal de Saúde , Contenção de Riscos Biológicos/normas , Equipamentos e Provisões , Sistema de Vigilância em Saúde , Programa de Controle de Infecção Hospitalar , Guatemala , Resíduos de Serviços de Saúde/prevenção & controleRESUMO
Caregivers of patients often provide key support for patients after hospitalization. This qualitative metasynthesis describes caregiver perspectives about care coordination for patients discharged from the hospital. A literature search of Ovid Medline and CINAHL completed on May 23, 2018, identified 1,546 studies. Twelve articles were included in the final metasynthesis. Caregiver perspectives about care coordination were compiled into overall themes. A subanalysis of studies in which patients were discharged with home health services was completed. Five main themes emerged related to caregiver perspectives on care coordination after hospitalization: (a) Suboptimal access to clinicians after discharge, (b) Feeling disregarded by clinicians, (c) Need for information and training at discharge, (d) Overwhelming responsibilities to manage appointments and medications, and (e) Need for emotional support.Findings from this metasynthesis suggest the need for clinicians to engage with caregivers to provide support, training, and communication after hospital discharge.
Assuntos
Cuidadores/psicologia , Organização e Administração/normas , Alta do Paciente/normas , Pesquisa Qualitativa , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/tendências , Humanos , Alta do Paciente/tendências , Relações Profissional-PacienteRESUMO
AIM: To evaluate the impacts of introducing administrative support for nurse unit managers. BACKGROUND: Increased administrative load for nurse unit managers causes role stress and reduced opportunities for clinical leadership (state-wide review, Queensland, Australia). In response, a health organisation implemented a clerical 'Nurse Unit Manager Support Officer' position. METHODS: Qualitative descriptive evaluation, convenience sample (37 nurse unit managers and NUM Support Officers) and focus groups (13) provided data that were thematically analysed. RESULTS: Six impacts were identified: (a) improved nurse unit manager well-being; (b) more time to undertake clinical leadership; (c) greater efficiencies in finance, payroll and HR processes; (d) improved capacity for strategic leadership; (e) increased staff satisfaction and improved unit culture; and (f) improved succession planning. CONCLUSION: Findings reveal significant gains and benefits from the introduction of administrative support for the nurse unit manager role for the nurse unit manager and the units they manage. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse unit manager role stress can negatively impact organisational climate, performance outcomes, staff satisfaction and retention. Health organisations need to implement strategies to reduce the administrative burden for nurse unit managers. The introduction of administrative support frees up time for nurse unit managers to engage in clinical leadership, positively impacting organisational climate, performance outcomes, and staff satisfaction and retention.
Assuntos
Enfermeiros Administradores/psicologia , Organização e Administração/normas , Percepção , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Enfermeiros Administradores/estatística & dados numéricos , Pesquisa Qualitativa , QueenslandRESUMO
BACKGROUND: The nurse educators' role in clinical learning is to define the necessary prerequisites of an ideal clinical learning environment. OBJECTIVES: The purpose of the study was to explore and describe the Kamuzu College of Nursing (KCN) undergraduate nursing students' perspectives on clinical supervision and support in their clinical learning environment and their preferences in the clinical learning environment. METHOD: A mixed method research approach was used to explore and describe clinical supervision from the students' perspectives on the features of their actual and preferred clinical learning environment. The study's population comprised all third- and fourth-year undergraduate nursing students (n = 219). A sample (n = 125) was randomly selected from the population for the quantitative survey of which 120 questionnaires (96%) were valid for analysis. The data collection for qualitative arm of the study comprised interviews conducted through purposive sampling interviewing 20 participants. Survey results were analysed using the Statistical Package for the Social Science (Version 16) and the qualitative data were analysed using the content analysis approach where themes were generated. RESULTS: The study found that the participants were not satisfied with clinical supervision and support during clinical learning. The participants preferred improved clinical supervision and support in their clinical learning. Comparing the difference between actual and the preferred items of supervision the results were statistically significant at p < 0.05. CONCLUSION: There is a need to improve students' clinical supervision and support at KCN. Nurse educators need to plan for clinical supervision and support effectively to promote proficient nursing graduates.
Assuntos
Bacharelado em Enfermagem/normas , Organização e Administração/normas , Preceptoria/normas , Estudantes de Enfermagem/psicologia , Competência Clínica/normas , Bacharelado em Enfermagem/métodos , Docentes de Enfermagem/psicologia , Docentes de Enfermagem/normas , Humanos , Malaui , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Advocates for patient involvement argue that seeking the active contribution of patients and families in the coordination of care can help mitigate system complexity, and lead to improvements in quality. However, sociological and organisational research has identified barriers to involving patients in care planning, not least the power of, and boundaries between, multiple professional groups. This study draws on literature from Science and Technology Studies (STS) to explore the patients' role in coordinating care across professional-practice boundaries in complex care systems. Findings are drawn from a two-year ethnographic study (including 69 qualitative interviews) of hospital discharge following hip-fracture care and describe the changing role of the patient as they move out of hospital into community settings. Findings describe how 'the patient' plays a relatively passive role as boundary object while recovering from surgery within hospital, where inter-professional coordination was prescribed by evidence-based guidelines, leaving little space for patient voice. As discharge planning begins, patient involvement is both encouraged and contested by different professional groups, with varying levels of commitment to include patient subjectivities in care. As patients move into home and community settings, they, their families and carers play an increasingly active role in coordination, often in light of perceived gaps in coordination between care providers. This paper argues that whilst the need for patient and carer involvement is becoming increasingly evident, such involvement plays into, and is mediated through, existing relations between professional and practice groups. Patient and carer involvement is therefore not straightforward and should be considered across the health and care systems in order to meaningfully improve care quality.
Assuntos
Continuidade da Assistência ao Paciente/normas , Alta do Paciente/normas , Antropologia Cultural/métodos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Organização e Administração/normas , Alta do Paciente/estatística & dados numéricos , Transferência da Responsabilidade pelo Paciente , Pesquisa Qualitativa , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricosRESUMO
INTRODUCTION: One of the most serious problems in TB control is non-adherence to treatment leading to the risk of drug resistance and subsequent treatment failure. OBJECTIVES: To assess the impact of an educational strategy intervention and remote supervision on the post-discharge management of new cases of TB diagnosed in hospital on TB cure rate. Secondarily, to assess the impact of this intervention on default rate. METHODS: Randomized control trial conducted at a general, tertiary care, university affiliated hospital. New cases of TB diagnosed in hospital were included. The primary outcome was cure rate and secondary outcome was default rate. Analysis was carried out by modified intention to treat. RESULTS: A total of 169 new tuberculosis patients were enrolled. Among them, 80 were assigned to intervention group and 89 to control group. The cure rate was 71.3% in the intervention group and 58.4% in the control group. In the multivariate binary logistic regression model to evaluate the effect of the intervention, controlled by age, sex, current smoking status and directly observed treatment short, intervention was independently associated with cure rate (OR = 0.47; 95% CI: 0.24-0.94; P = 0.033).There was a significant difference in the default rate between the control and intervention groups (18.0% vs 5.0%, respectively, P = 0.039). CONCLUSION: An educational strategy intervention and remote supervision on the post-discharge management of new cases of TB with in-hospital diagnosis had a positive effect of small magnitude on cure rate. Secondarily, the treatment default rate has been significantly decreased with the intervention.
Assuntos
Intervenção Educacional Precoce/métodos , Organização e Administração/normas , Alta do Paciente/normas , Tuberculose/tratamento farmacológico , Adulto , Idoso , Brasil/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Estudos Prospectivos , Atenção Terciária à Saúde/normas , Falha de Tratamento , Tuberculose/diagnóstico , Tuberculose/mortalidadeRESUMO
BACKGROUND: The frequency of being exposed to work-related violence and threats is high in employees working in the human service sector. The question is whether certain employees are particularly exposed to violence and threats than others. OBJECTIVE: This study examined whether particular employees were especially exposed to work-related violence and threats due to personal characteristics, coping styles, attitudes or participating in violence prevention training. We also examined the role played by supervisors. METHODS: Questionnaire data were collected in 2010 and 2011. In all, 3584 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Service participated. We used multivariate logistic regression analyses. RESULTS: We found persons high on the extroversion and introversion scales were associated with statistical significant increased risk for work-related threats. Furthermore, accepting attitudes concerning work-related violence were also statistical significant associated with increased the risk for both work-related threats and violence. Associations between coping styles and work-related threats and violence were very small and statistically non-significant and we found no effect of violence prevention training. The risk for work-related threats for persons high on the extroversion scale was decreased if supervisor violence prevention behaviour was high. Furthermore, if supervisor prevention behaviour was high, prevention training decreased the risk for work-related violence. However, these associations weren't statistically significant. CONCLUSION: The results stress that effective prevention requires involvement of both employees and supervisors.
Assuntos
Organização e Administração/normas , Violência no Trabalho/psicologia , Adaptação Psicológica , Adulto , Estudos de Coortes , Extroversão Psicológica , Feminino , Humanos , Introversão Psicológica , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Organização e Administração/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , Fatores de Risco , Autoeficácia , Inquéritos e Questionários , Violência no Trabalho/estatística & dados numéricosRESUMO
Objective: To compare the cumulative pregnancy rate (CPR) for experienced clinicians and trainees naive to the skill of embryo transfer (ET) during an assisted reproductive treatment (ART) cycle. To establish the minimum number of procedures required to achieve consistent outcomes. Method: A non-interventional retrospective observational cohort study looking at all consecutive ETs undertaken over a 5-year study period. The CPR was determined by a self-reported urinary home pregnancy test undertaken 16 days after oocyte retrieval. Results: The CPR did not differ between an experienced clinician (39%) and trainee (45%) for the first 50 (p=0.41) and last 50 (40.7% versus 42.7%) (p=0.81) ET procedures. The CPR for the individuals remained consistent with their peaks and troughs mirroring the overall success rate of the unit. This pattern continued when the data was further stratified for co-variables (age [≤37 years of age], catheter type [soft] and embryo quality [expanded blastocyst of grade ≥2]): CPRs for experienced clinicians was 65.7% (first 50 transfers) and 40.9% (last 50 transfers); CPR for trainees was 66.7% (first 50 transfers) and 53.6% (last 50 transfers); p=0.95 and p=0.37, respectively. The trainees, however, were more likely to use a stylet catheter with a 2-step transfer technique, with a cost over clinical implication. Furthermore, patients expressed a preference for an experienced clinician to perform their procedure, despite being informed that the grade of the clinician had no impact on the cycle outcome after an analysis of the unit's data. Conclusion: The clinician's grade and duration of service have not been shown to significantly impact the outcome of the ART cycle. The findings, however, should be interpreted with caution, as they reflect the culture of training in the unit, where there is a strong emphasis on adequate direct and indirect supervision. Furthermore, the relationship between the volume of work and outcomes is established in postgraduate medical education, with the exact number required to achieve clinical competence being dependent on the procedure and intensity of the workload.