How did healthcare professionals define patient engagement in quality management? A survey study.

BACKGROUND: Patient and family engagement (PFE) can positively impact the patient experience and care process outcomes. There is no unique type of PFE, and the process is usually defined by the quality management department or professionals responsible for this process in the hospital. The objective of this study is to define PFE in quality management based on the professional's perspective. METHOD: A survey was carried out with 90 professionals from Brazilian hospitals. There were two questions aimed at understanding the concept. The first was a multiple-choice question to identify synonyms. The second was an open-ended question to develop the definition. A content analysis methodology was employed by applying techniques for thematic and inferential analysis. RESULTS: Three words were classified as synonyms by more than 60% of respondents: involvement, participation, and centered care. The participants described patient participation at both the individual (related to the treatment) and organizational levels (related to quality improvement). The PFE in the treatment is related to the development, discussion and decision-making about the therapeutic plan, participation in each step of care, and knowledge of the institution's quality and safety processes. At the organizational level, engagement in quality improvement includes the involvement of the P/F in all processes of the institution, from strategic planning to the design or improvement processes, as well as active participation in institutional committees or commissions. CONCLUSION: The professionals defined engagement in two levels (individual and organizational) and the results suggest that their point of view can influence the practice in the hospitals. Professionals of hospitals that implemented mechanisms of consult defined PFE more in the individual level. On the other hand, professionals of hospitals that implemented mechanisms of involvement considered PFE more focus in the organizational level.

How do hospitals engage patients and family members in quality management? A grounded theory study of hospitals in Brazil.

BACKGROUND: Patient and family engagement (PFE) is considered an essential element of the transformation of the healthcare system. However, it is characterised by its complexity and a small number of institutions that have implemented the mechanisms of engagement. OBJECTIVE: To understand PFE in quality management (QM) in the hospital environment. DESIGN: A qualitative approach was guided by the grounded theory based in Straussian perspective. Data were gathered using semistructured interviews. The coding was performed by excerpts, using an inductive approach and the constant comparison technique. SETTING AND PARTICIPANTS: A total of seven Brazilian hospitals were selected based on the theoretical sampling technique. RESULTS: A total of five categories emerged, namely: patient partner, mechanisms of engagement, internal structure for engagement, maturity of the QM system and openness to change. Externally, three contextual factors can impact the engagement: the local health system, the profile of the community and the change in access to the information. At the centre of the change is the balance in power relations between patients and professionals, the sharing of information from the hospital and a proactive attitude towards improving services. CONCLUSIONS: The PFE involves a cultural and process change. Cultural change is represented by 'openness', that is, openness to learn, to listen and to consider new perspectives. The change in processes is in turn characterised by the phrase 'test and venture' because the model to be adopted may be different between hospitals. The patient's perspective allows actions to be driven towards what really matters to them, ensuring quality of service and safety, obtaining a new perspective to understand and solve problems, and stimulating a sense of urgency, more empathy and compassion in professionals.

Application of neural network to simulate the behavior of hospitalizations and their costs under the effects of various polluting gases in the city of São Paulo.

This work aims to obtain an artificial neural network to simulate hospitalizations for respiratory diseases influenced by pollutant gaseous such as CO, PM10, PM2.5, NO2, O3, and SO2 emitted from 2011 to 2017, in the city of São Paulo. The hospitalization costs were also be calculated. MLP and RBF neural networks have been tested by varying the number of neurons in the hidden layer and the type of equation of the output function. The following pollutants and its concentration range were collected considering the supervision of Alto Tiete station set, in several neighborhoods in the city of São Paulo, from in the period 2011 to 2017: 28-63 µg/m3 of PM2.5, 52-110 µg/m3 of PM10, 49-135 µg/m3 of O3, 0.8-2.6 ppm CO, 41-98 µg/m3 of NO2, and 3-16 µg/m3 of SO2. Results showed that a RBF neural network with 6 input neurons, 13 hidden layer neurons, and 1 output neuron, using BFGS algorithm and a Gaussian function to neuronal activation, was the best fitted to the experimental datasets. So, knowing the monthly concentration of gaseous pollutions was possible to predict the hospitalization of 1464 to 3483 ± 510 patients, with costs between 570,447 and 1,357,151 ± 198,171 USD per month. This way, it is possible to use this neural network to predict the costs of hospitalizing patients for respiratory diseases and to contribute to the decision-making of how much the government should spend on health care.

Effects of cryoprotectant and plunging temperature in liquid nitrogen on the in vitro and in vivo development of murine morulae

The effects of plunging temperature in liquid nitrogen and cryoprotectant dilution methods were evaluated for compacted mouse morulae frozen in 1.5 M ethylene-glycol (E), 1.5M propylene-glycol (P) or 1.4M glycerol (G). Morulae were equilibrated for 10 minutes in cryoprotectant solution and loaded into 0.25 ml straws with cryoprotectant solution in 3 columns (groups E1, P1, G1) or cryoprotectant in the center and PBS in the lateral columns (E2, P2). Straws were cooled at 0.5§C/min to -25 or -30§C and plunged into liquid nitrogen. Straws were thawed in water at 22§C for 20 seconds. Cryoprotectant was diluted in 3 steps for group G1 and in one step for groups E1 and P1 (direct transfer to PBS + 10 por cento FCS) and E2 and P2 (shaken to mix the 3 columns before transferring to PBS+ 10 por cento FCS). Plunging temperature had no significant effect on the proportion of morulae developed to blastocysts in vitro; this proportion was higher (p < 0.0001) in E1 (69.2 por cento) than in E2 (60.3 por cento), G1 (51.9 por cento) and combined for P1 and P2 (46.9 por cento). In second experiment, the proportion of transferred morulae that developed to viable fetuses was lower (p < 0.07) for E1-25 than for E1-30, G1-30, E2-25 or unfrozen (control) embryos (8.7, 20.0, 20.0, 17.4 and 19.8 por cento, respectively). In conclusion, the ethylene glycol diluted directly in PBS (E1) exhibit the highest rate of in vitro embryos development, but based on in vivo embryos development was more efficacious in plunging temperature at -30§C (E1-30)