Identidade profissional do psicólogo judiciário: um estudo sobre configurações identitárias / Forensic psychologist´s professional identity: a study about identity configurations / Identidad profesional del psicólogo forense: un estudio sobre configuraciones de identidad

Este estudo objetivou descrever a identidade profissional de psicólogos judiciários, partindo do cenário contemporâneo da Psicologia Jurídica brasileira, contexto que envolve crises e conflitos sobre a forma de responder a atribuições e demandas do campo legal. Pela perspectiva da sociologia das identidades profissionais de Claude Dubar, sustenta-se a hipótese de que a identidade profissional do psicólogo judiciário depende de estratégias de compatibilização entre o pertencimento à categoria e as atribuições legais e institucionais. Participaram 95 psicólogos do quadro ativo do Tribunal de Justiça de São Paulo, que responderam a um formulário online sobre a percepção de si e do campo de atuação. Os dados foram submetidos à análise de conteúdo. Os resultados indicam a saliência da avaliação psicológica e da interdisciplinaridade na identidade profissional, e as rupturas identitárias diante de práticas verificatórias. Tais achados apontam a necessidade de participação da categoria na construção de suas atribuições; e dificuldades para o exercício das funções por limitações à autonomia profissional.(AU)

This study aimed to describe the professional identity of forensic psychologists, considering Brazil's Legal Psychology contemporary scenario which relates to a critical issues on how practitioners respond the demands of the legal system. Based on Claude Dubar's sociology of professional identities, we support the hypothesis that forensic psychologists' professional identity depends on strategies of compatibilization between belonging their reference group and the institutional attributions. There were 95 participants, all from the current staff of the Court of Justice of the state of São Paulo, who answered an online form. The data were subjected to content analysis. The results indicate a professional identity with noted salience on psychological assessment and interdisciplinarity, and the identity crises regarding verification practices. Such findings highlight the importance of practitioners taking part on the construction of their own tasks.(AU)

Este estudio tuvo como objetivo describir la identidad profesional de los psicólogos forenses, considerando el escenario de la Psicología Jurídica brasileña, que se relaciona con una crisis sobre si estos profesionales responden a las demandas del sistema legal. Teniendo en cuenta la sociología de las identidades profesionales de Claude Dubar, sostenemos la hipótesis de que la identidad profesional de los psicólogos forenses depende de estrategias de compatibilización entre la pertenencia a su grupo profesional y a instituciones. Participaron 95 psicólogos, quienes actuaban en el Tribunal de Justicia del Estado de São Paulo, a los cuales se aplicó un formulario en línea. Los datos se sometieron a análisis de contenido. Los resultados indican una identidad profesional saliente en cuanto a la evaluación psicológica y la interdisciplinariedad, pero también crisis de identidad en relación con las prácticas de verificación. Tales resultados señalan la importancia de que la categoría participe en la construcción de sus propias atribuciones.(AU)

Management algorithms for cervical cancer screening and precancer treatment for resource-limited settings.

Management algorithms for screen-positive women in cervical cancer prevention programs have undergone substantial changes in recent years. The WHO strongly recommends human papillomavirus (HPV) testing for primary screening, if affordable, or if not, then visual inspection with acetic acid (VIA), and promotes treatment directly following screening through the screen-and-treat approach (one or two clinic visits). While VIA-positive women can be offered immediate ablative treatment based on certain eligibility criteria, HPV-positive women need to undergo subsequent VIA to determine their eligibility. Simpler ablative methods of treatment such as cryotherapy and thermal coagulation have been demonstrated to be effective and to have excellent safety profiles, and these have become integral parts of new management algorithms. The challenges faced by low-resource countries are many and include, from the management perspective, identifying an affordable point-of-care HPV detection test, minimizing over-treatment, and installing an effective information system to ensure high compliance to treatment and follow-up.

Application fields for the new Object Management Group (OMG) Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN) in the perioperative field.

PURPOSE: Medical processes can be modeled using different methods and notations. Currently used modeling systems like Business Process Model and Notation (BPMN) are not capable of describing the highly flexible and variable medical processes in sufficient detail. METHODS: We combined two modeling systems, Business Process Management (BPM) and Adaptive Case Management (ACM), to be able to model non-deterministic medical processes. We used the new Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN). RESULTS: First, we explain how CMMN, DMN and BPMN could be used to model non-deterministic medical processes. We applied this methodology to model 79 cataract operations provided by University Hospital Leipzig, Germany, and four cataract operations provided by University Eye Hospital Tuebingen, Germany. Our model consists of 85 tasks and about 20 decisions in BPMN. We were able to expand the system with more complex situations that might appear during an intervention. CONCLUSION: An effective modeling of the cataract intervention is possible using the combination of BPM and ACM. The combination gives the possibility to depict complex processes with complex decisions. This combination allows a significant advantage for modeling perioperative processes.

Guía para la elaboración de procedimientos / Guide for the development of procedures

Para el fortalecimiento del rol rector de la SESAL se establece como una función sustantiva definir el marco normativo sanitario, tal como lo establece el Acuerdo No.406 que aprue- ba el Reglamento Interno de Organización y Funciones de la Secretaría de Salud del 15 de mayo del 2014. La Dirección General de Normalización es responsable de conducir la formulación y actua- lización del marco normativo de los procesos de atención en salud y el marco normativo sanitario que garantice la calidad en salud, continuando con la estandarización de la es- tructura documental de la SESAL pone a la disposición la Guía para Elaboración de Proce- dimientos. El documento contiene las directrices para la elaboración de procedimientos, con el pro- pósito de ordenar y homogeneizar los procedimientos legales, técnicos y administrativos para obtener los resultados deseados en beneficio de la salud de la población...(AU)

Biodosimetry: Medicine, Science, and Systems to Support the Medical Decision-Maker Following a Large Scale Nuclear or Radiation Incident.

The public health and medical response to a radiological or nuclear incident requires the capability to sort, assess, treat, triage and to ultimately discharge, refer or transport people to their next step in medical care. The size of the incident and scarcity of resources at the location of each medical decision point will determine how patients are triaged and treated. This will be a rapidly evolving situation impacting medical responders at regional, national and international levels. As capabilities, diagnostics and medical countermeasures improve, a dynamic system-based approach is needed to plan for and manage the incident, and to adapt effectively in real time. In that the concepts and terms can be unfamiliar and possibly confusing, resources and a concept of operations must be considered well in advance. An essential underlying tenet is that medical evaluation and care will be managed by healthcare professionals with biodosimetry assays providing critical supporting data.

Impact of an Atrial Fibrillation Decision Support Tool on thromboprophylaxis for atrial fibrillation.

BACKGROUND: Appropriate thromboprophylaxis for patients with atrial fibrillation (AF) remains a national challenge. METHODS: We hypothesized that provision of decision support in the form of an Atrial Fibrillation Decision Support Tool (AFDST) would improve thromboprophylaxis for AF patients. We conducted a cluster randomized trial involving 15 primary care practices and 1,493 adults with nonvalvular AF in an integrated health care system between April 2014 and February 2015. Physicians in the intervention group received patient-level treatment recommendations made by the AFDST. Our primary outcome was the proportion of patients with antithrombotic therapy that was discordant from AFDST recommendation. RESULTS: Treatment was discordant in 42% of 801 patients in the intervention group. Physicians reviewed reports for 240 patients. Among these patients, thromboprophylaxis was discordant in 63%, decreasing to 59% 1 year later (P = .02). In nonstratified analyses, changes in discordant care were not significantly different between the intervention group and control groups. In multivariate regression models, assignment to the intervention group resulted in a nonsignificant trend toward decreased discordance (P = .29), and being a patient of a resident physician (P = .02) and a higher HAS-BLED score predicted decreased discordance (P = .03), whereas female gender (P = .01) and a higher CHADSVASc score (P = .10) predicted increased discordance. CONCLUSIONS: Among patients whose physicians reviewed recommendations of the decision support tool discordant therapy decreased significantly over 1 year. However, in nonstratified analyses, the intervention did not result in significant improvements in discordant antithrombotic therapy.

Práticas de monitoramento na gestão municipal em saúde e sua interface com a enfermagem / Prácticas de monitoría en la gestión principal de salud y su interfaz con la enfermería / Monitoring practices in municipal healthcare management and their interface with nursing

RESUMO Objetivo Analisar as práticas de monitoramento desenvolvidas pelos municípios e as interfaces com a prática da Enfermagem. Métodos Estudo exploratório descritivo com abordagem qualitativa, realizado nos seis municípios da Região de Saúde 10 do Rio Grande do Sul. Foram realizadas entrevistas semiestruturadas junto a seis gestores de saúde e um assessor, com análise de conteúdo. Resultados As categorias finais que emergiram dos resultados foram “Práticas de monitoramento na gestão municipal em saúde” e “Dificuldades de implantação do monitoramento pelos gestores”. Conclusões Os gestores apontaram potencialidades e fragilidades nas práticas de monitoramento municipal de saúde. A incorporação deste processo é primordial à prática dos profissionais, especialmente da enfermagem, promovendo um incremento no uso de novas ferramentas que propiciam a inovação para subsidiar a tomada de decisão.

RESUMEN Objetivo Analizar las prácticas de monitoreo desarrolladas por los municipios y las interfaces con las prácticas de enfermería. Métodos Estudio exploratorio descriptivo con un enfoque cualitativo realizado en los 6 municipios de la Región de Salud 10 de Rio Grande del Sur. Fueron realizadas entrevistas semiestructuradas junto a seis gestores de salud y un asesor, con análisis de contenido. Resultados Las categorías finales que surgieron a partir de los resultados fueron “Prácticas de monitoreo en la gestión principal de salud” y “Dificultades de aplicación de monitoreo por los gestores”. Conclusiones Los gestores señalaron fortalezas y debilidades en las prácticas de monitoreo de salud municipales. La incorporación de ese proceso es primordial para la práctica de los profesionales, especialmente los de enfermería, promoviendo un incremento en el uso de nuevas herramientas que propician la innovación para subsidiar la toma de decisión.

ABSTRACT Objective To analyse the healthcare monitoring practices of the local government and its interfaces with nursing. Methods This is a descriptive, exploratory, and qualitative study conducted in six municipalities in the 10th health region of the state of Rio Grande do Sul. Data were collected through semi-structured interviews with six healthcare managers and one adviser, and subjected to content analysis. Results The results led to the final categories, “Monitoring practices in municipal healthcare management” and “Difficulties of managers in implementing monitoring”. Conclusion The managers pointed out potentialities and weaknesses in the monitoring practices of municipal healthcare. This process is critical for the practice of healthcare workers, especially nurses, since it encourages the use of new tools and innovations that support decision making.

A conceptual framework for organizational readiness to implement nutrition and physical activity programs in early childhood education settings.

Across multiple sectors, organizational readiness predicts the success of program implementation. However, the factors influencing readiness of early childhood education (ECE) organizations for implementation of new nutrition and physical activity programs is poorly understood. This study presents a new conceptual framework to measure organizational readiness to implement nutrition and physical activity programs in ECE centers serving children aged 0 to 5 years. The framework was validated for consensus on relevance and generalizability by conducting focus groups; the participants were managers (16 directors and 2 assistant directors) of ECE centers. The framework theorizes that it is necessary to have "collective readiness," which takes into account such factors as resources, organizational operations, work culture, and the collective attitudes, motivation, beliefs, and intentions of ECE staff. Results of the focus groups demonstrated consensus on the relevance of proposed constructs across ECE settings. Including readiness measures during program planning and evaluation could inform implementation of ECE programs targeting nutrition and physical activity behaviors.

Interpretable associations over DataCubes: application to hospital managerial decision making.

The world concern about the costs of the health care systems has raised the importance of counting on precise and interpretable tools, that help the health care institution's managers to make decisions to optimize the use of health resources. In this paper we propose a new Classification based on Association Rules (CAR) algorithm that improves the interpretability of the results, making it specially useful for decision making. Changing the usual way to obtain the rules we follow four goals: first to improve the interpretability of the result by obtaining rules meaningful and interpretable by themselves, secondly to reduce the complexity of the result obtaining a lower number of rules; thirdly, to obtain simpler rules, with less size in number of antecedents; and finally to avoid the usual over-fitting problem of the classification methods by obtaining a generic final result set, where specific rules for specific cases are avoided unless they are necessary. To prove the utility of our proposal we have used it in an example of decision support regarding the planning of the surgery rooms.

Total staff costs to implement a decision support system in nursing / Custo total com pessoal para implementação de um sistema de apoio à decisão em enfermagem / Costo total con personal para implementación de un sistema de apoyo a la decisión en enfermería

OBJECTIVE: to identify the direct labor (DL) costs to put in practice a decision support system (DSS) in nursing at the University Hospital of the University of São Paulo (HU-USP). METHOD: the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes. RESULTS: the DL cost corresponded to R$ 752,618.56 (100%), R$ 26,000.00 (3.45%) of which were funded by a funding agency, while R$ 726,618.56 (96,55%) came from Hospital and University resources. CONCLUSION: considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing. .

OBJETIVO: identificar os custos com mão de obra direta para a implementação de um sistema de apoio a decisão em enfermagem no Hospital Universitário da Universidade de São Paulo. MÉTODO: o desenvolvimento do sistema de apoio à decisão foi mapeado em quatro subprocessos: concepção, elaboração, construção e transição. Calculou-se a mão de obra direta utilizando-se a somatória do salário-base, por categoria profissional, mais os quinquênios, verbas de representação e encargos sociais, dividindo-os pelo número de horas contratuais, obtendo-se o salário-hora/profissional que foi multiplicado pelo tempo despendido em cada atividade dos subprocessos. RESULTADOS: o custo da mão de obra direta correspondeu a R$752.618,56 (100%), sendo R$26.000.00 (3,45%) procedentes de financiamento de órgão de fomento e R$726.618,56 (96,55%) de recursos do Hospital e da Universidade. CONCLUSÃO: do custo total com mão de obra direta, 72,1% referiu-se aos honorários dos profissionais de empresa de consultoria em informática e 27,9% destinou-se à mão de obra direta de profissionais do Hospital Universitário e da Escola de Enfermagem. .

OBJETIVO: identificar los costos con mano de obra directa (MOD) para la implementación de un sistema de apoyo a la decisión (SAD) en enfermería en el Hospital Universitario de la Universidad de Sao Paulo (HU-USP). MÉTODO: el desarrollo del SAD fue mapeado en cuatro subprocesos: Concepción, Elaboración, Construcción y Transición. Se calculó la MOD utilizando la sumatoria del salario base por categoría profesional más los quinquenios, verbas de representación y encargos sociales, dividiéndola por el número de horas contractuales, obteniéndose el salario hora/profesional que fue multiplicado por el tiempo utilizado en cada actividad de los subprocesos. RESULTADOS: el costo de la MOD correspondió a R$ 752.618,56 (100%), siendo R$ 26.000.00 (3,45%) procedentes de financiamiento de órgano de fomento y R$ 726.618,56 (96,55%) de recursos del Hospital y de la Universidad. CONCLUSIÓN: del costo total con MOD, 72,1% se refirió a los honorarios de los profesionales de empresa de consultoría en informática y 27,9% se destinó a la MOD de profesionales del HU y de la Escuela de Enfermería. .

Improving decision quality in healthcare with an Error Prevention Model (EPM).

Human factors involved in decision quality are critical issues in healthcare. In this paper, issues related to the impact of human factors on decision quality in healthcare are considered. Specifically, the focus is on the issue of reducing human error as well as improving decision quality. An Error Prevention Model (EPM) is presented for considering tools and techniques that can be used to analyze complex errors that may be considered latent.

HTA decision support system for sustainable business continuity management in hospitals. The case of surgical activity at the University Hospital in Florence.

BACKGROUND: A fundamental element of the social and safety function of a health structure is the need to guarantee continuity of clinical activity through the continuity of technology. OBJECTIVE: This paper aims to design a Decision Support System (DSS) for medical technology evaluations based on the use of Key Performance Indicators (KPI) in order to provide a multi-disciplinary valuation of a technology in a health structure. METHODS: The methodology used in planning the DSS followed the following key steps: the definition of relevant KPIs, the development of a database to calculate the KPIs, the calculation of the defined KPIs and the resulting study report. Finally, the clinical and economic validation of the system was conducted though a case study of Business Continuity applied in the operating department of the Florence University Hospital AOU Careggi in Italy. RESULTS: A web-based support system was designed for HTA in health structures. The case study enabled Business Continuity Management (BCM) to be implemented in a hospital department in relation to aspects of a single technology and the specific clinical process. Finally, an economic analysis of the procedure was carried out. CONCLUSIONS: The system is useful for decision makers in that it precisely defines which equipment to include in the BCM procedure, using a scale analysis of the specific clinical process in which the equipment is used. In addition, the economic analysis shows how the cost of the procedure is completely covered by the indirect costs which would result from the expenses incurred from a broken device, hence showing the complete auto-sustainability of the methodology.

Malaria elimination: moving forward with spatial decision support systems.

Operational challenges facing contemporary malaria elimination have distinct geospatial elements including the need for high-resolution location-based surveillance, targeted prevention and response interventions, and effective delivery of essential services at optimum levels of coverage. Although mapping and geographical reconnaissance (GR) has traditionally played an important role in supporting malaria control and eradication, its full potential as an applied health systems tool has not yet been fully realised. As accessibility to global positioning system (GPS), geographic information system (GIS) and mobile computing technology increases, the role of an integrated spatial decision support system (SDSS) framework for supporting the increased operational demands of malaria elimination requires further exploration, validation and application; particularly in the context of resource-poor settings.

New methods for clinical pathways-Business Process Modeling Notation (BPMN) and Tangible Business Process Modeling (t.BPM).

PURPOSE: Clinical pathways (CP) are nowadays used in numerous institutions, but their real impact is still a matter of debate. The optimal design of a clinical pathway remains unclear and is mainly determined by the expectations of the individual institution. The purpose of the here described pilot project was the development of two CP (colon and rectum carcinoma) according to Business Process Modeling Notation (BPMN) and Tangible Business Process Modeling (t.BPM). METHODS: BPMN is an established standard for business process modelling in industry and economy. It is, in the broadest sense, a computer programme which enables the description and a relatively easy graphical imaging of complex processes. t.BPM is a modular construction system of the BPMN symbols which enables the creation of an outline or raw model, e.g. by placing the symbols on a spread-out paper sheet. The thus created outline can then be transferred to the computer and further modified as required. CP for the treatment of colon and rectal cancer have been developed with support of an external IT coach. RESULTS: The pathway was developed in an interdisciplinary and interprofessional manner (55 man-days over 15 working days). During this time, necessary interviews with medical, nursing and administrative staffs were conducted as well. Both pathways were developed parallel. Subsequent analysis was focussed on feasibility, expenditure, clarity and suitability for daily clinical practice. The familiarization with BPMN was relatively quick and intuitive. The use of t.BPM enabled the pragmatic, effective and results-directed creation of outlines for the CP. The development of both CP was finished from the diagnostic evaluation to the adjuvant/neoadjuvant therapy and rehabilitation phase. The integration of checklists, guidelines and important medical or other documents is easily accomplished. A direct integration into the hospital computer system is currently not possible for technical reasons. CONCLUSION: BPMN and t.BPM are sufficiently suitable for the planned modelling and imaging of CP. The application in medicine is new, and transfer from the industrial process management is in principle possible. BPMN-CP may be used for teaching and training, patient information and quality management. The graphical image is clearly structured and appealing. Even though the efficiency in the creation of BPMN-CP increases markedly after the training phase, high amounts of manpower and time are required. The most sensible and consequent application of a BPMN-CP would be the direct integration into the hospital computer system. The integration of a modelling language, such as BPMN, into the hospital computer systems could be a very sensible approach for the development of new hospital information systems in the future.

Updating and normalization of the Nursing Management Minimum Data Set element 6: patient/client accessibility.

Patient/client accessibility is one of 18 Nursing Management Minimum Data Set data elements developed to evaluate contextual factors at the nursing unit or service level of care. The Nursing Management Minimum Data Set 06 patient/client accessibility was developed to capture variability in time and distance required to access patients. Variability in access to patients, needed supplies, equipment, and information for patient care has an impact on the amount of time available for direct patient care. Limitations in time available to provide safe and quality care may negatively affect patient outcomes, nurse retention, and, as a result, a healthcare organization's accreditation and finances. Since 2005, the first five Nursing Management Minimum Data Set data elements have been incorporated into the publicly accessible healthcare data set Logical Observation Identifier Names and Codes, thereby making results derived from these nursing management data elements available for empirical use. A critical review of the literature and other healthcare resources was conducted to update patient/client accessibility. A consensus approach was used by an interdisciplinary panel of experts to finalize recommendations for revisions. The name, conceptual and operational definitions, and measures were updated. The revised data element is titled "client accessibility." The conceptual and operational definitions were expanded and measures changed to increase validity and reliability of data collection. The updated conceptual definition is "the time, distance, and method to connect the nurse/provider and client for an encounter and includes the information, supplies, equipment, and personnel required for the encounter." The Nursing Management Minimum Data Set can provide individuals responsible for managing and financing nursing resources with quantifiable data regarding the context of nursing care. At present, healthcare costs are rising at an unsustainable rate, and many national healthcare outcomes are worsening. More information is needed to identify potential areas of improvement in the management and funding of nursing care. The update and use of Nursing Management Minimum Data Set 06 data element client accessibility may help to identify problem areas associated with nursing time, distance traveled, and methods used to provide patient care. Such empirical evidence may support better informed decisions on caseloads in diverse settings, hospital designs, methods used to provide care, and fiscal requirements.