Gestão da qualidade nos serviços de hemoterapia do interior do Rio Grande do Norte: análise dos efeitos de um ciclo de melhoria

Introduction: Quality management in hemotherapy services is a crucial element for transfusion safety. However, the implementation of quality management is still a challenge  in the Brazilian context. Objective: To evaluate the effect of a cycle of improvement in hemotherapy services in the interior of Rio Grande do Norte, in compliance with the quality management criteria, elaborated based on the Potential Risk Assessment Method in Hemotherapy Services. Method: Quasi-experimental study, before and after, that verified the  compliance of 13 quality criteria, elaborated based on the Potential Risk Assessment Method  in Hemotherapy Services. Eight hemotherapy services from the interior of the state of Rio Grande do Norte participated in the study, being four Transfusion Agencies, two Collection and Transfusion Units and two Regional Blood Centers. Descriptive statistics and Pareto charts were  used to analyze the quality criteria. Results: After the improvement cycle, there was a 36.4% reduction in noncompliance. In the analysis by service, there was an increase in compliance with the criteria, varying between 7% and 50%. The implementation of protocols, internal  audit procedures and quality monitoring were the criteria that registered relatively greater adherence after the intervention, however they remained the main causes of non-conformities, both before and after the intervention. Conclusions: The improvement cycle proved to be a valid intervention in increasing the adherence of services to the quality management activities recommended by health legislation, with health surveillance having an important role in reaching the established standards.  . Introdução: A gestão da qualidade em serviços de hemoterapia é um elemento crucial para a segurança transfusional. A implementação das atividades de gerenciamento da qualidade é um desafio no contexto brasileiro. Objetivo: Avaliar o efeito de um ciclo de melhoria nos serviços de hemoterapia do interior do Rio Grande do Norte, na conformidade com os critérios de gestão da qualidade, elaborados com base no Método de Avaliação de Risco Potencial em Serviços de Hemoterapia (MARPSH). Método: Estudo quase-experimental, antes e depois, que avaliou 13 critérios de qualidade, elaborados com base no MARPSH  da Agência Nacional de Vigilância Sanitária. Participaram do estudo oito serviços de hemoterapia do interior do estado do Rio Grande do Norte, sendo quatro Agências  Transfusionais, duas Unidades de Coleta e Transfusão e dois Hemocentros Regionais. Estatísticas descritivas e gráficos de Pareto foram utilizados. Resultados: Observou-se redução de 36,4% dos problemas de qualidade após a realização do ciclo de melhoria. Na análise por serviço, houve um aumento no cumprimento dos critérios variando entre 7,0% e 50,0%. A implementação de protocolos, os procedimentos de auditoria interna e o monitoramento da qualidade foram os critérios que registraram relativamente uma maior adesão após a intervenção, todavia permaneceram como as principais causas de não conformidades, tanto antes quanto após a intervenção. Conclusões: O ciclo de melhoria demonstrou ser uma intervenção válida no aumento da adesão dos serviços às atividades de gestão da qualidade preconizadas pela legislação sanitária, tendo a Vigilância Sanitária um importante papel para alcance dos padrões estabelecidos

Impact of the anatomical location, alcoholism and smoking on the prevalence of advanced oral cancer in Brazil

To evaluate the prevalence of oral cancer in Brazil according to the clinical stage, anatomical location, alcoholism and smoking. Data referring to 31,217 cases of oral cancer, from 2000 to 2010, were obtained from the Integrator Module of the Hospital Registry of Cancer. Inconsistent data (?non-classified? cases) was eliminated and 21,160 cases were analyzed. The frequency distribution according to clinical stage, anatomical location, alcoholism and smoking was analyzed descriptively and through a binary logistic regression model (?<0.05). The clinical stage (dependent variable) was dichotomized in early stage (I and II) or advanced stage (III and IV). The year of diagnosis, anatomical location and deleterious habits (alcoholism and smoking) were considered independent variables. The most frequent characteristics were: oropharynx location (n=3856, 18.41%), clinical stage IV (n=11924, 56.09%) and combined use of alcohol and tobacco (n=19226; 61.59%). The year 2009 (p<0.01, PR = 1.162, CI-95%=1.053-1.283) and location at the base of tongue (p<0.01, PR = 2.485, CI-95% = 2.182-2.807) presented a higher prevalence ratio for advanced stage oral cancer. The combined use of alcohol and tobacco showed a higher prevalence rate for the advanced clinical stage of cancer (p<0.01, PR =1.449, CI-95%=1.382-1.520) if compared to individuals without habits, or just alcoholics. Higher prevalence of advanced stage of oral cancer is related to the localization at the base of the tongue and to the concomitant use of alcohol and tobacco. Therefore, it can be suggested that all these characteristics lead to a worse prognosis of oral cancer

Questionário AGRASS: Avaliação da Gestão de Riscos Assistenciais em Serviços de Saúde

OBJECTIVE: This study aims to assess the development and the validity analysis of the Assessment of Risk Management in Health Care Questionnaire (AGRASS). METHODS: This is a validation study of a measurement instrument following the stages: 1) Development of conceptual model and items; 2) Formal multidisciplinary assessment; 3) Nominal group for validity analysis with national specialists; 4) Development of software and national pilot study in 62 Brazilian hospitals 5) Delphi for validity analysis with the users of the questionnaire. In stages 3 and 5, the items were judged based on face validity, content validity, and utility and viability, by a 1-7 Likert scale (cut-off point: median &lt; 6). Accuracy and reliability of the questionnaire were analyzed with the Confirmatory Factor Analysis and the Cronbach’s alpha. RESULTS: The initial version of the instrument (98 items) was adapted during stages 1 to 3 for the final version with 40 items, which were considered relevant, of adequate content, useful, and viable. The instrument has 2 dimensions and 9 subdimensions, and the items have closed-ended questions (yes or no). The software for the automatic collection and analysis generates indicators, tables, and automatic graphs for the assessed institution and aggregated data. The adjustment indices confirmed a bi-dimensional model composed of structure and process (X2/gl = 1.070, RMSEA ≤ 0.05 = 0.847, TLI = 0.972), with high reliability for the AGRASS Questionnaire (α = 0.94) and process dimension (α = 0.93), and adequate for the structural dimension (α = 0.70). CONCLUSIONS: The AGRASS Questionnaire is a potentially useful instrument for the surveillance and monitoring of the risk management and patient safety in health services.OBJETIVO: O estudo objetiva descrever a construção e análise da validade do Questionário Avaliação da Gestão de Riscos Assistenciais em Serviços de Saúde (AGRASS). MÉTODOS: Trata-se de estudo de validação de um instrumento de medida nas etapas: 1. construção do modelo conceitual e itens; 2. apreciação formal multidisciplinar; 3. grupo nominal para análise da validade com especialistas da esfera nacional; 4. desenvolvimento de softwares e estudo-piloto nacional em 62 hospitais do Brasil; 5. Delphi para análise da validade com utilizadores do questionário. Nas etapas 3 e 5, os itens foram julgados quanto à validade de face e conteúdo, utilidade e viabilidade, em uma escala Likert de 1 a 7 (ponto de corte: mediana &lt; 6). A validade de construto e a confiabilidade foram analisadas com análise fatorial confirmatória e coeficientes α de Cronbach. RESULTADOS: A versão inicial do instrumento (98 itens) foi adaptada durante as etapas 1 a 3 para a versão com 40 itens considerados relevantes, de conteúdo adequado, úteis e viáveis. O instrumento tem duas dimensões e nove subdimensões, e os itens têm opção de resposta fechada (sim ou não). Os softwares para coleta e análise automática geram indicadores, tabelas e gráficos automáticos para a instituição avaliada e conjuntos agregados. Os índices de ajuste confirmaram o modelo bidimensional de estrutura e processo (X2/gl = 1,070, RMSEA ≤ 0,05 = 0,847; TLI = 0,972), havendo confiabilidade alta para o Questionário AGRASS (α = 0,94) e a dimensão processo (α = 0,93) e aceitável para a dimensão estrutura (α = 0,70). CONCLUSÃO: O Questionário AGRASS é um instrumento potencialmente útil para a vigilância e monitoramento da gestão de riscos e segurança do paciente em serviços de saúde

Produção de materiais de orientação para compras em formato delivery na região de Picos (Piauí) durante a pandemia de COVID-19

Introduction: The rapid spread of COVID-19 has prompted the proposition of likewise agile actions in order to contain the contagion of the disease, while the trade is under pressure to seek new sales strategies to reduce economic impacts. These actions must mainly observe scientific evidence in order to ensure the health of the population. Objective: To expose the process of formulating written protocols and educational graphic inserts, in order to reduce the viral transmission of SARS-CoV-2 through purchases in the delivery mode. Method: This is a descriptive work of the stages of development of an intervention technology for the city of Picos (Piauí, Brazil) during the COVID-19 pandemic, based on the collection of information on scientific bases made available by renowned institutions. Results: Flexible protocols were obtained to the peculiarities of each customer and trader. The final result, in the form of illustrated leaflets, received a seal of approval by Oswaldo Cruz Foudation, in its complementary action to the “Se Liga no Corona” campaign. Conclusions: It is concluded that the protocols are presented as a possibility of promoting awareness in relation to the delivery shopping practices, resting necessary for the next studies to evaluate the applicability of the brochures, and to monitor their effectiveness and possible reformulation needs.Introdução: A rápida disseminação da COVID-19 tem solicitado a propositura de ações igualmente ágeis no sentido de contenção do contágio da doença, ao mesmo passo o comércio é pressionado a buscar novas estratégias de vendas para reduzir os impactos econômicos. Essas ações devem observar sobretudo evidências científicas a fim de zelar pela saúde da população. Objetivo: Expor o processo de formulação de protocolos escritos e encartes gráficos educativos, no sentido de diminuir a transmissão viral do SARSCoV- 2 por meio de compras na modalidade delivery. Método: Trata-se de um trabalho descritivo das etapas de elaboração de uma tecnologia de intervenção para a cidade de Picos (Piauí) durante a pandemia de COVID-19, a partir da coleta de informações em bases científicas e disponibilizadas por instituições renomadas. Resultados: Obteve-se protocolos adequados às peculiaridades de cada cliente e comerciante. O resultado final, em formato de folhetos ilustrados, recebeu selo de aprovação da Fundação Oswaldo Cruz, na sua ação complementar à campanha “Se Liga no Corona”. Conclusões: Os protocolos se apresentam como uma possibilidade de promoção da conscientização em relação às práticas de compras delivery, sendo necessário nos próximos estudos avaliar a aplicabilidade dos folhetos, acompanhar sua eficácia e possíveis necessidades de reformulação

Head and Maxillofacial Injuries in Child and Adolescent Victims of Automotive Accidents

Background. Victims of motor vehicle accidents may suffer multiple lesions, including maxillofacial injuries. The aim of this study was to evaluate the prevalence and factors associated with head, facial, and maxillofacial injuries in child and adolescent victims of automobile accidents. A cross-sectional study was carried out with analysis of forensic medical reports from the Legal Medical Institute of Campina Grande, Brazil, between January 2008 and December 2011. Descriptive and inferential statistical analysis was conducted using the chi-square test (α = 0.05). From 1613 medical reports analyzed, the sample is composed 232 (14.4%) reports referring to child and adolescent victims of automobile accidents aged 0–19 years of both sexes. Victims were mostly adolescents aged from 15 to 19 years (64.2%), males (73.7%), and motorcyclists (51.3%). More than half of the victims had single lesions (54.3%) located in the head (20.7%) and face (21.6%). Head injuries occurred more frequently in children aged 0–4 years (53.8%, PR = 5.065, 95% CI = 1.617–5.870) and pedestrians (30.4%, PR = 2.039, 95% CI = 1.024–4.061), while facial and maxillofacial injuries occurred in higher proportion among females (31.1%, PR = 0.489, 95% CI = 0.251–0.954). Our findings suggest that accidents involving motorcyclists are the most prevalent, affecting male adolescents aged from 15 to 19 years, resulting in a high frequency of injuries in the head and face regions

Conhecimento das mães de crianças internadas em um hospital universitário acerca da diarreia

Investigación cualitativa, cuyo objetivo fue describir los conocimientos de madres acerca de la diarrea. Llevado a cabo con ocho madres de niños en hospital universitario de Santa Cruz, Rio Grande do Norte, Brasil, en 2012. Recolección de datos realizada a través de entrevista abierta, con análisis basada en Bardin. Del análisis, surgieron las categorías: comprensión de la diarrea y prevención/tratamiento de la diarrea. En cuanto a la comprensión de la diarrea, las madres conceptuaron y entendieron a partir de síntomas, errores/hábitos de alimentación y/o creencias culturales. En cuanto a la prevención y tratamiento de la enfermedad, señalaron higiene y limpieza del hogar como medida de precaución, y la importancia de medidas domiciliarias y atención hospitalaria. Las entrevistadas presentaron conocimientos básicos de la patología, siendo necesarios nuevos estudios para delimitar laguna entre conocimiento de las madres y recurrencia de casos de diarrea, que causa hospitalizaciones y gastos en tratamientos innecesarios

Knowledge of the mothers of hospitalized children in a university hospital regarding diarrhea

This qualitative research aimed at identifying the knowledge of the mothers regarding diarrhea. It was conducted with eight mothers of hospitalized children in a university hospital located in Santa Cruz, Rio Grande do Norte, Brazil, in 2012. Data were collected through open interviews and the analysis was based on Bardin. The categories emerging from the analysis were: understanding diarrhea and preventing/treating diarrhea. Regarding the understanding of diarrhea, mothers conceptualize and understand it from the symptoms, habits/eating mistakes and/or cultural beliefs. Concerning the prevention and treatment of the disease, the mothers highlight hygiene and home cleaning as preventive measures, as well the importance of home and hospital care measures. The interviewees have basic knowledge of pathology, further studies are necessary in order to define the current gap between the knowledge of mothers and recurrence of diarrhea cases, resulting in hospitalization and expenses with unnecessary treatment.\u