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Medisan ; 23(2)mar.-abr. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1002635


Se realizó una investigación de casos y controles de pacientes adultos ingresados en el Hospital Provincial Docente Dr Joaquín Castillo Duany de Santiago de Cuba, durante 5 meses del 2017, con el propósito de estimar el efecto de determinados factores de riesgo como modificadores de la estadía hospitalaria, así como la magnitud del impacto en la potencial reducción del grado de exposición a estos. El grupo de estudio fue conformado por 40 pacientes y el de control por 80. Predominaron las lesiones osteomioarticulares en ambos grupos (con un total de 23,3 por ciento); en tanto, para los casos resultó más frecuente una estadía hospitalaria de 13 días y para los controles fue igual o superior a los 7 días como promedio. Entre los factores de riesgo fueron definidos, con un nivel de confianza de 95 por ciento, la edad superior a los 65 años (OR: 4; IC 95 por ciento: 1,2-17), la ocurrencia de episodios adversos (OR: 26; IC 95 por ciento: 8,1-80,3) y los retrasos en las decisiones médicas (OR: 19; IC 95 por ciento: 4-89). Pudo concluirse que el diseño epidemiológico permitió establecer relaciones de causalidad en la prolongación de la estadía hospitalaria y cuantificar la magnitud de su reducción si se controlan o eliminan los riesgos

An investigation of cases and controls in adult patients admitted at Dr Joaquín Castillo Duany Provincial Hospital from Santiago de Cuba was carried out during 5 months in 2017, with the purpose of estimating the effect of certain risk factors as modifiers of the hospital stay, as well as the magnitude of the impact in the potential reduction of the exposure degree to those factors. The study group was formed by 40 patients and the control group by 80. The osteomioarticular lesions prevailed in both groups (with a total of 23.3 percent); as long as, for the cases it was more frequent a hospital stay of 13 days and for the controls, equal or longer than 7 days as average. Among the risk factors were defined, with a confidence level of 95 percent, the age older than 65 years (OR: 4; IC 95 percent: 1.2-17), the occurrence of adverse episodes (OR: 26; IC 95 percent: 8.1-80.3) and the delays in the medical decisions (OR: 19; IC 95 percent: 4-89). It could be concluded that the epidemiological design allowed to establish causality relationships in the continuity of the hospital stay and to quantify the magnitude of its reduction if risks are controlled or eliminated

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fatores de Risco , Indicadores de Qualidade em Assistência à Saúde/ética , Gestão em Saúde , Hospitalização , Fatores Epidemiológicos , Administração Hospitalar
Trials ; 19(1): 334, 2018 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-29941000


BACKGROUND: Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The lack of consensus on answers to these questions highlights the need for ethical guidance. MAIN BODY: Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. CONCLUSION: While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research.

Assistência à Saúde/ética , Comitês de Ética em Pesquisa , Pesquisa sobre Serviços de Saúde/ética , Melhoria de Qualidade/ética , Indicadores de Qualidade em Assistência à Saúde/ética , Projetos de Pesquisa , Assistência à Saúde/normas , Pesquisa sobre Serviços de Saúde/normas , Humanos , Formulação de Políticas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Projetos de Pesquisa/normas
AMA J Ethics ; 20(1): 278-287, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29542438


Maternal and neonatal mortality statistics foreground some possible causes of death at the expense of others. Political place (nation, state) and place of birth (hospital, home) are integral to these statistics; respect for women as persons is not. Using case examples from Malawi and the United States, I argue that the focus on place embedded in these indicators can legitimate coercive approaches to childbirth. Qualitative assessments in both cases reveal that respectful care, while not represented in current indicators, is critical for the health of women and newborns. Perinatal outcomes measures thus must be rethought to ensure ethical and safe maternity care. This rethinking will require new questions and new methods.

Parto Obstétrico/normas , Mortalidade Infantil , Mortalidade Materna , Assistência Perinatal/normas , Relações Médico-Paciente/ética , Indicadores de Qualidade em Assistência à Saúde/ética , Direitos da Mulher , Causas de Morte , Coerção , Parto Obstétrico/estatística & dados numéricos , Ética Médica , Grupos Étnicos , Feminino , Parto Domiciliar , Humanos , Lactente , Saúde do Lactente , Malaui/epidemiologia , Saúde Materna , Política , Gravidez , Pesquisa Qualitativa , Respeito , Estados Unidos/epidemiologia
Soins Psychiatr ; 38(310): 29-31, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28476254


Freedom of movement is at the centre of contradictory challenges for the different people working in psychiatry, faced with a society demanding social regulation and safety, and the desire of institutions to provide high quality care. This freedom, and more globally the respect of patients' civil rights, are an indicator of the expected quality of care. Taking these rights into consideration does not mean neglecting safety, but attempts to put it into perspective. This article presents the clinical case of a patient.

Transtornos Mentais/enfermagem , Transtornos Mentais/reabilitação , Defesa do Paciente/legislação & jurisprudência , Isolamento de Pacientes/legislação & jurisprudência , Isolamento de Pacientes/psicologia , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Restrição Física/psicologia , Idoso de 80 Anos ou mais , Internação Compulsória de Doente Mental/legislação & jurisprudência , Delusões/enfermagem , Delusões/psicologia , Ética em Enfermagem , Evolução Fatal , Feminino , França , Hospitais Psiquiátricos/ética , Hospitais Psiquiátricos/legislação & jurisprudência , Humanos , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Defesa do Paciente/ética , Isolamento de Pacientes/ética , Transtornos Psicóticos/enfermagem , Transtornos Psicóticos/psicologia , Indicadores de Qualidade em Assistência à Saúde/ética , Restrição Física/ética , Comunidade Terapêutica , Recusa do Paciente ao Tratamento/ética , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Recusa do Paciente ao Tratamento/psicologia
Respir Med ; 125: 19-23, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28340857


OBJECTIVE: Socioeconomic differences in quality of care have been suggested to contribute to inequality in clinical prognosis of COPD. We examined socioeconomic differences in the quality of COPD outpatient care and the potential of a systematic quality improvement initiative in reducing potential socioeconomic differences. METHODS: A mandatory national quality improvement initiative has since 2008 monitored the quality of COPD care at all national pulmonary specialized outpatient clinics in Denmark using six evidence-based process performance measures. We followed patients aged ≥30 years with a first-ever outpatient contact for COPD during 2008-2012 (N = 23,741). Adjusted year-specific relative risks (RR) of fulfilling all relevant process performance measures was compared according to ethnicity, education, income, employment, and cohabitation using Poisson regression. RESULTS: Quality of care improved following the implementation of the clinical improvement initiative with 11% of COPD patients receiving optimal care in 2008 compared to 57% in 2012. Substantial socioeconomic differences were observed the first year: immigrants (RR 0.41, 95% CI 0.21-0.82), the unemployed (RR 0.37, 95% CI 0.18-0.74), disability pensioners (RR 0.63, 95% CI 0.46-0.87) and patients living alone (RR 0.80, 95% CI 0.60-0.97) were less likely to receive all relevant care processes, whereas those with highest education (RR 1.22, 95% CI 0.92-1.63) were more likely to receive these processes. These differences were eliminated during the study period. CONCLUSION: A systematic quality improvement initiative including regular audits, knowledge sharing, and detailed disease-specific recommendations for care improvement may increase the overall quality of care and considerably modify the substantial socioeconomic inequalities in COPD management.

Assistência Ambulatorial/normas , Ambulatório Hospitalar/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Melhoria de Qualidade/normas , Qualidade da Assistência à Saúde/normas , Fatores Socioeconômicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Auditoria Clínica/métodos , Dinamarca/epidemiologia , Gerenciamento Clínico , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Indicadores de Qualidade em Assistência à Saúde/ética , Risco , Classe Social
In. González Menéndez, Ricardo Ángel. La vocación médica en el mundo actual. La Habana, ECIMED, 2017. .
Monografia em Espanhol | CUMED | ID: cum-64965
Trials ; 16: 375, 2015 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-26303892


BACKGROUND: Randomized controlled trials are considered the "gold standard" for scientific rigor in the assessment of benefits and harms of interventions in healthcare. They may not always be feasible, however, when evaluating quality improvement interventions in real-world healthcare settings. Non-randomized controlled trials (NCTs) are designed to answer questions of effectiveness of interventions in routine clinical practice to inform a decision or process. The on-off NCT design is a relatively new design where participant allocation is by alternation. In alternation, eligible patients are allocated to the intervention "on" or control "off " groups in time series dependent sequential clusters. METHODS: We used two quality improvement studies undertaken in a Canadian primary care setting to illustrate the features of the on-off design. We also explored the perceptions and experiences of healthcare providers tasked with implementing the on-off study design. RESULTS AND DISCUSSION: The on-off design successfully allocated patients to intervention and control groups. Imbalances between baseline variables were attributed to chance, with no detectable biases. However, healthcare providers' perspectives and experiences with the design in practice reveal some conflict. Specifically, providers described the process of allocating patients to the off group as unethical and immoral, feeling it was in direct conflict with their professional principle of providing care for all. The degree of dissatisfaction seemed exacerbated by: 1) the patient population involved (e.g., patient population viewed as high-risk (e.g., depressed or suicidal)), 2) conducting assessments without taking action (e.g., administering the PHQ-9 and not acting on the results), and 3) the (non-blinded) allocation process. CONCLUSIONS: Alternation, as in the on-off design, is a credible form of allocation. The conflict reported by healthcare providers in implementing the design, while not unique to the on-off design, may be alleviated by greater emphasis on the purpose of the research and having research assistants allocate patients and collect data instead of the healthcare providers implementing the trial. In addition, consultation with front-line staff implementing the trials with an on-off design on appropriateness to the setting (e.g., alignment with professional values and the patient population served) may be beneficial. TRIAL REGISTRATION: Health Eating and Active Living with Diabetes: identifier: NCT00991380. Date registered: 7 October 2009. Controlled trial of a collaborative primary care team model for patients with diabetes and depression: Identifier: NCT01328639 Date registered: 30 March 2011.

Depressão/terapia , Diabetes Mellitus Tipo 2/terapia , Seleção de Pacientes , Atenção Primária à Saúde/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Comportamento de Redução do Risco , Idoso , Alberta/epidemiologia , Atitude do Pessoal de Saúde , Conflito de Interesses , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Dieta para Diabéticos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Seleção de Pacientes/ética , Atenção Primária à Saúde/ética , Escalas de Graduação Psiquiátrica , Melhoria de Qualidade/ética , Indicadores de Qualidade em Assistência à Saúde/ética , Pesquisadores/psicologia , Inquéritos e Questionários , Resultado do Tratamento
J Patient Saf ; 11(3): 174-84, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24618642


As many as 1 in 10 patients is harmed while receiving hospital care in wealthy countries. The risk of health care-associated infection in some developing countries is as much as 20 times higher. In response, in many global regions, increased attention has turned to the implementation of a broad program of safety research, encompassing a variety of methods. Although important international ethical guidelines for research exist, literature has been emerging in the last 20 years that begins to apply such guidelines to patient safety research specifically. This paper provides a review of the literature related to ethics, oversight, and patient safety research; identifies issues highlighted in articles as being of ethical relevance; describes areas of consensus regarding how to respond to these ethical issues; and highlights areas where additional ethical analysis and discussion are needed to provide guidance to those in the field.

Ética Médica , Pesquisa sobre Serviços de Saúde/ética , Segurança do Paciente , Humanos , Indicadores de Qualidade em Assistência à Saúde/ética , Gestão da Segurança
Rev. esp. med. legal ; 40(3): 97-102, jul.-sept. 2014.
Artigo em Espanhol | IBECS | ID: ibc-124849


Introducción. El Hospital Clínic de Barcelona (HCB) es el centro de referencia para la atención a las agresiones sexuales (AS) en esta ciudad. Cuando se denuncia lo sucedido, el médico forense se desplaza al hospital. Su tiempo de llegada al mismo forma parte de los indicadores de calidad de la atención que se realiza. El objetivo de este trabajo es describir las características de los casos de AS atendidos en el HCB y conocer si se cumplen los estándares de calidad establecidos. Material y métodos. Estudio retrospectivo de las 1.203 personas atendidas en el servicio de urgencias del HCB con el diagnóstico de AS, del año 2007 al 2012. Resultados. La edad media de los pacientes fue de 29 años (DE: 11) y el 94% fueron mujeres. El agresor fue una persona desconocida en la mayoría de los casos, aunque el 40% fue conocido. Los pacientes estuvieron en el servicio de urgencias una mediana de 3,3 h. El médico forense llegó al hospital en una mediana de 42 min. La mayoría (80%) de las personas agredidas denunciaron a sus agresores, pero se observó una tendencia a disminuir esta conducta a lo largo del período de estudio. Conclusiones. El tiempo de estancia en urgencias observado lo consideramos bueno pero mejorable; no parece estar influido por el tiempo de desplazamiento del médico forense. Creemos necesaria una revisión de los circuitos de atención a las víctimas de AS, pues lo deseable sería que todas denunciaran (AU)

Introduction. The Hospital Clínic of Barcelona (HCB) is the centre of reference for the treatment of sexual assault (SA) in this city. When the victim reports the offence, medical examiners go to the hospital. The time for the medical examiner to arrive to the HCB is included in the quality of care indicators. The aim of this study is to describe the characteristics of the cases of SA treated in the HCB and to know if the established quality standards are fulfilled. Material and methods. Retrospective study of the 1.203 patients treated in the emergency service of the HCB with the diagnosis of SA, between 2007 and 2012. Results. The mean age of the patients was 29 years old (SD: 11) and 94% were women. The attacker was an unknown person in most cases but in 40% they were known to the victim. The median duration of the victims’ stay in the emergency service was 3.3 hours. The medical examiner arrived at the hospital in a median time of 42 minutes. The majority (80%) of the victims reported the offence but a downward trend was observed during the study period. Conclusions. The observed duration of the stay in the emergency service is considered good but can be improved; it does not seem to be influenced by the time needed by the medical examiner to arrive at the hospital. We recommend a review of the healthcare circuits for SA victims since it would be desirable that all of them reported the offence (AU)

Humanos , Masculino , Adulto , Indicadores de Qualidade em Assistência à Saúde/ética , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Indicadores de Qualidade em Assistência à Saúde/normas , Delitos Sexuais , Delitos Sexuais/legislação & jurisprudência , Emergências , Medicina de Emergência/legislação & jurisprudência , Estudos Retrospectivos
Ann Thorac Surg ; 92(3 Suppl): S2-11, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21867789


Cardiac surgical report cards have historically been mandatory. This paradigm changed when The Society of Thoracic Surgeons recently implemented a voluntary public reporting program based on benchmark analyses from its National Cardiac Database. The primary rationale is to provide transparency and accountability, thus affirming the fundamental ethical right of patient autonomy. Previous studies suggest that public reporting facilitates quality improvement, although other approaches such as confidential feedback of results and regional quality improvement initiatives are also effective. Public reporting has not substantially impacted patient referral patterns or market share. However, this may change with implementation of healthcare reform and with refinement of public reporting formats to enhance consumer interpretability. Finally, the potential unintended adverse consequences of public reporting must be monitored, particularly to assure that hospitals and surgeons remain willing to care for high-risk patients.

Benchmarking/ética , Benchmarking/tendências , Procedimentos Cirúrgicos Cardíacos/ética , Procedimentos Cirúrgicos Cardíacos/tendências , Ética Médica , National Practitioner Data Bank/estatística & dados numéricos , /tendências , Indicadores de Qualidade em Assistência à Saúde/ética , Indicadores de Qualidade em Assistência à Saúde/tendências , Comportamento do Consumidor , Retroalimentação , Previsões , Reforma dos Serviços de Saúde/ética , Reforma dos Serviços de Saúde/tendências , Indicadores Básicos de Saúde , Humanos , Autonomia Pessoal , Melhoria de Qualidade/ética , Melhoria de Qualidade/tendências , Responsabilidade Social , Estados Unidos
J Eval Clin Pract ; 17(5): 894-8, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21797949


Pay-for-performance schemes reward standardized professional behaviours associated with effective care. However, they neglect the significance of virtue and devalue and erode professional motivation based on virtue. Pay for training to cultivate virtue, and/or pay-for-virtue, may mitigate these dangers. Although virtue is typically considered its own reward, and the assessment of virtue is problematic, pay-for-virtue could involve (1) stringent checks on the appropriateness of the standardized care currently rewarded by pay-for-performance for individual patients or (2) pay for indicators of virtue. These indicators could be based on virtues identified from a framework of universal virtues and through logical inferences from features of practice. It is possible that pay-for-virtue could ultimately strengthen health professionals' intrinsic motivation for good practice, but this and the broader effects of pay-for-virtue would need careful investigation.

Planos de Incentivos Médicos/ética , Planos de Incentivos Médicos/organização & administração , Relações Médico-Paciente , Virtudes , Educação Médica , Humanos , Motivação , Indicadores de Qualidade em Assistência à Saúde/ética , Indicadores de Qualidade em Assistência à Saúde/organização & administração
Physis (Rio J.) ; 21(1): 113-127, 2011. tab
Artigo em Português | LILACS | ID: lil-586050


O objetivo deste estudo é analisar os sentidos atribuídos por usuários homens ao atendimento que lhes é prestado no âmbito da atenção básica à saúde, buscando subsidiar a construção de indicadores qualitativos de satisfação em relação ao uso desses serviços por usuários masculinos. Trata-se de uma pesquisa qualitativa, envolvendo entrevistas semiestruturadas com 201 usuários de quatro estados brasileiros. A análise se baseia no método de interpretação de sentidos, ancorando-se em princípios hermenêutico-dialéticos. Em termos de resultados, os usuários apontam critérios para avaliar positivamente os serviços, tomando como referências um atendimento comunicativo e atencioso, que lhes faça algo e que revele prontidão. Conclui-se que os homens usuários idealizam e reivindicam uma dada forma de atendimento considerada boa e que, a princípio, poderia servir para se discutir o atendimento de mulheres também. Entretanto, em razão da socialização que homens e mulheres experimentam, são reforçadas as diferenças entre o ser usuário homem e ser usuário mulher. Por outro lado, tanto no que tange aos profissionais quanto aos usuários, essa mesma segmentação por gênero pode contribuir para que se acirrem as impossibilidades de se lidar com as especificidades de homens e mulheres, em termos de demandas da saúde.

This study aims to analyze the meanings attributed by male users to the health care provided to them by the primary health care. It also tries to hook up the construction of qualitative indicators of satisfaction with the use of such services by males. For this purpose, a qualitative study was conducted, involving semi-structured interviews with 201 users from four Brazilian federal states. The data has been analyzed under the method of interpretation of meanings inbuilt in hermeneutic-dialectical principles. As for the results, users were asked to point toward criteria to evaluate positively the services, taking as reference a communicative and attentive service, as long as it makes a difference to them as well as bring up readiness. As a conclusion, it was found that male users outlook the services through rose-tinted glasses and therefore claim a particular form of care grounded on that assumption. Moreover, this conclusion could also be used to discuss the health care of women as well. On the other hand, due to the socialization that men and women experience, differences between male and female users could be reinforced. Conversely, regarding to both professionals and users, this gender segmentation may add to bring about the impossibilities of dealing with the specifics of men and women in terms of public health care demands.

Humanos , Masculino , Atenção Primária à Saúde/ética , Comportamento do Consumidor , Saúde do Homem/ética , Saúde do Homem/etnologia , Ética Profissional , Indicadores de Qualidade em Assistência à Saúde/ética , Serviços de Atendimento/ética , Serviços de Atendimento/legislação & jurisprudência , Serviços de Atendimento/organização & administração , Serviços de Atendimento
Inform Health Soc Care ; 34(4): 231-43, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19919300


The Internet has made it possible for patients and their families to access vast quantities of information that previously would have been difficult for anyone but a physician or librarian to obtain. Health information websites, however, are recognised to differ widely in quality and reliability of their content. This has led to the development of various codes of conduct or quality rating tools to assess the quality of health websites. However, the validity and reliability of these quality tools and their applicability to different health websites also varies. In principle, rating tools should be available to consumers, require a limited number of elements to be assessed, be assessable in all elements, be readable and be able to gauge the readability and consistency of information provided from a patient's view point. This article reviews the literature on the trends of the Internet use for health and analyses various codes of conduct/ethics or 'quality tools' available to monitor the quality of health websites from a patient perspective.

Informação de Saúde ao Consumidor/normas , Internet , Indicadores de Qualidade em Assistência à Saúde , Humanos , Indicadores de Qualidade em Assistência à Saúde/ética , Reprodutibilidade dos Testes
Clin Orthop Relat Res ; 467(10): 2548-55, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19641973


While all of medicine is under pressure to increase transparency and accountability, joint replacement subspecialists will face special scrutiny. Disclosures of questionable consulting fees, a demographic shift to younger patients, and uncertainty about the marginal benefits of product innovation in a time of great cost pressure invite a serious and progressive response from the profession. Current efforts to standardize measures by the National Quality Forum and PQRI will not address the concerns of purchasers, payors, or policy makers. Instead, they will ask the profession to document its commitment to appropriateness, stewardship of resources, coordination of care, and patient-centeredness. One mechanism for addressing these expectations is voluntary development of a uniform national registry for joint replacements that includes capture of preoperative appropriateness indicators, device monitoring information, revision rates, and structured postoperative patient followup. A national registry should support performance feedback and quality improvement activity, but it must also be designed to satisfy payor, purchaser, policymaker, and patient needs for information. Professional societies in orthopaedics should lead a collaborative process to develop metrics, infrastructure, and reporting formats that support continuous improvement and public accountability.

Artroplastia de Substituição/normas , Custos de Saúde para o Empregador/normas , Pessoal de Saúde/normas , Seguro Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Responsabilidade Social , Idoso , Artroplastia de Substituição/economia , Artroplastia de Substituição/ética , Conflito de Interesses , Qualidade de Produtos para o Consumidor , Análise Custo-Benefício , Fraude/prevenção & controle , Reforma dos Serviços de Saúde , Pessoal de Saúde/economia , Pessoal de Saúde/ética , Humanos , Seguro Saúde/economia , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/normas , Prótese Articular , Pessoa de Meia-Idade , Padrões de Prática Médica/economia , Padrões de Prática Médica/normas , Má Conduta Profissional , Desenvolvimento de Programas , Desenho de Prótese , Opinião Pública , Indicadores de Qualidade em Assistência à Saúde/economia , Indicadores de Qualidade em Assistência à Saúde/ética , Sistema de Registros , Reoperação , Avaliação da Tecnologia Biomédica/economia , Avaliação da Tecnologia Biomédica/normas , Resultado do Tratamento , Estados Unidos
Gac. sanit. (Barc., Ed. impr.) ; 22(5): 498-499, oct. 2008.
Artigo em Espanhol | IBECS | ID: ibc-61236


Los indicadores de la calidad de la prescripción de gradopotencial de uso (IGPU) se definen como la proporción querepresenta el consumo de determinados principios activos frenteal consumo total de su categoría anatómica terapéutica.En los últimos años, los IGPU que se han ido definiendo ennuestro país utilizan la dosis diaria definida (DDD) como unidadde medida. Y aunque la DDD no es necesariamente iguala la dosis terapéutica equivalente (DTE), se ha argumentadoque es una unidad de medida estándar y, por tanto, válida.Esto podría no ser correcto, ya que las relaciones entreDTE y DDD son distintas en los diferentes fármacos, inclusodentro de la misma categoría anatómica terapéutica. Por ello,la utilización de las DDD en los IGPU puede llevar a incentivaro desincentivar la prescripción de un fármaco en funciónde su relación DTE/DDD(AU)

Quality prescription indicators of use potential level (UPLI)are defined as the proportion that represents consumption ofspecific active principles as opposed to the total consumptionof the anatomical therapeutic category. The UPLIs that havegradually been defined in Spain employ the defined daily dose(DDD) as the unit of measurement. Although the DDD is notnecessarily the same as the therapeutic equivalent dose (TED),some authors have argued that the DDD is a standard unit ofmeasurement and is therefore valid.However, this view may not be correct, given that the relationshipsbetween the TED and the DDD differ, depending onthe drug, even within the same anatomical therapeutic category.Therefore, the use of DDDs in UPLI s may lead to prescriptionof a medicine being encouraged or discouraged dependingon its TED/DDD ratio(AU)

Indicadores de Qualidade em Assistência à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/normas , Prescrições de Medicamentos/estatística & dados numéricos , Dosagem/políticas , Dosagem/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/classificação , Indicadores de Qualidade em Assistência à Saúde/ética , Indicadores de Qualidade em Assistência à Saúde/tendências , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Relação Dose-Resposta a Droga , Posologia/estatística & dados numéricos
Acta bioeth ; 12(2): 211-217, 2006.
Artigo em Espanhol | LILACS | ID: lil-441457


La homofobia está presente en todo discurso, sólo que por la normalización de ciertas conductas de rechazo hacia los homosexuales no nos percatamos. Este artículo analiza específicamente el discurso homofóbico del personal de salud. La ética profesional dicta que este personal trate con respeto y dignidad a los pacientes; sin embargo, se ha comprobado que existen actitudes prejuiciadas en las instituciones de salud que disminuyen la posibilidad de ayuda al paciente y generan mala relación y desconfianza.

The homophobia is present in all social discourses, but we do not realize it due to the normalization of certain rejection behaviors against homosexual persons. This paper analyzes specifically the homophobic discourse of health care personnel. The professional ethics dictates this personnel treats with respect and dignity to all patients. Nevertheless it has been proved that there are some prejudice attitudes in health care centers which diminish the possibility of health care assistances to patients and generate a poor and distrusted relationship between the health care professional and the patient.

A homofobia está presente em todo discurso, e não nos damos conta de certas condutas de rejeição aos homossexuais. Este artigo analisa especificamente o discurso homofóbico dos profissionais da saúde. A ética profissional diz que estes profissionais tratem com respeito e dignidade ao paciente, contudo, comprovou-se que existem atitudes prejudiciais nas instituições de saúde que diminuem a possibilidade de ajuda ao paciente e geram uma relação de desconfiança.

Humanos , Masculino , Feminino , Bioética , Homossexualidade/ética , Indicadores de Qualidade em Assistência à Saúde/ética , Preconceito , Estereotipagem