OMBUDSMAN SERVICE IN HOSPITAL ADMINISTRATION: A FRIENDLY ENVIRONMENT FOR HEALTHCARE SYSTEM USERS

RESUMOObjetivos: Objetivou-se neste estudo conhecer as expectativas dos usuários quanto ao serviço de ouvidoria hospitalar; e discutir a importância da ouvidoria para a otimização do atendimento prestado e a interface com a enfermagem. Método: Trata-se de um estudo descritivo com abordagem qualitativa, desenvolvido em uma instituição de referência para terapia em traumatologia e ortopedia. São sujeitos do estudo 155 usuários em tratamento e acompanhamento ambulatorial. Para coleta de dados utilizamos um roteiro de entrevista semiestruturada. Os dados coletados foram analisados e agrupados em categorias, à luz da análise de conteúdo de Bardin. Resultados: Ao utilizar o serviço de ouvidoria, os usuários sentem-se acolhidos, pois sabem que sua solicitação será analisada e reverterá em resposta para a sua necessidade apresentada. Apontam-se como funções da ouvidoria a sua capacidade resolutiva e de atuar como órgão para reivindicar os direitos dos usuários. Conclusão: foi possível constatar que a ouvidoria exerce um papel de grande importância na instituição de saúde. Contribui com a enfermagem proporcionando uma visão ampla e detalhada da realidade, de acordo com as demandas dos usuários, podendo servir de base para o planejamento de estratégias e o desenvolvimento de ações sustentáveis para a melhoria contínua da qualidade dos cuidados de enfermagem. Descritores: Ouvidoria, enfermagem, qualidade dos cuidados de saúde, serviço de saúde.

ANALYSIS OF INDICATORS AND COST OF WORLD CLASS MAINTENANCE (WCM) IN FOREST MACHINES

The study was carried out at a forest company located in the Paraná State, Brazil, with the feller buncher, skidder and harvester. The following indicators were evaluated: mechanical availability, mean time between failures, mean time to repair, proactive maintenance index and maintenance costs, based on data obtained over a period of 18 months, contemplating the stages of implantation, maturation and stabilization of the WCM. The results showed an increase in the mechanical availability of the cutting and skidding machines from the implantation stage. The mean time between failures increased from the implantation stage, from 31.59 hours to 37.01 hours in the stabilization stage. As for the mean time to repairs, skidder and harvester presented an increase of 25.9% and 18.9% respectively; however, this increase in time represented an improvement in the quality of maintenance services, reflected in the results of mean time between failures. There was also a 31% increase in the proactive index of the machines studied, resulting in 9% reduction in maintenance costs between the deployment and stabilization stages

Cardiopulmonary exercise and 6-min walk tests as predictors of quality of life and long-term mortality among patients with heart failure due to Chagas disease

Universidade Federal de São Paulo, Div Cardiol, São Paulo, BrazilSanta Izabel Hosp, Div Cardiol, Salvador, BrazilBrazilian Clin Res Inst, São Paulo, BrazilDuke Clin Res Inst, Durham, NC USAUniversidade Federal de São Paulo, Div Cardiol, São Paulo, BrazilWeb of Scienc

Intrapupal temperature variation during Er,Cr: YSGG enamel irradiation on carries prevention

Studies have shown the cariostatic effect of Er,Cr:YSGG (2.78 mm) laser irradiation on human enamel and have suggested its use on caries prevention. However there are still no reports on the intrapulpal temperature increase during enamel irradiation using parameters for caries prevention. The aim of this in vitro study was to evaluate the temperature variation in the pulp chamber during human enamel irradiation with Er,Cr:YSGG laser at different energy densities. Fifteen enamel blocks obtained from third molars (3 x 3 x 3 mm) were randomly assigned to 3 groups (n=5): G1 - Er,Cr:YSGG laser 0.25 W, 20 Hz, 2.84 J/cm², G2 - Er,Cr:YSGG laser 0.50 W, 20 Hz, 5.68 J/cm², G3 - Er,Cr:YSGG laser 0.75 W, 20 Hz, 8.52 J/cm². During enamel irradiation, two thermocouples were fixed in the inner surface of the specimens and a thermal conducting paste was used. One-way ANOVA did not show statistically significant difference among the experimental groups (a=0.05). There was intrapulpal temperature variatio

MANUTENÇÃO PREVENTIVA COMO DETERMINANTE PARA REDUÇÃO DE CUSTOS DE MANUTENÇÃO DE UM FELLER BUNCHER

Este trabalho avaliou a atividade de manutenção mecânica de um feller buncher empregando a World Class Maintenance (WCM), que utiliza como premissa a manutenção preventiva, visando a redução dos custos de produção e melhor aproveitamento dos recursos disponíveis. O trabalho foi conduzido em plantios de Pinus taeda e Eucalyptus grandis de uma empresa florestal localizada no estado do Paraná, Brasil. A análise contemplou três períodos subsequentes de seis meses, sendo eles: implantação, amadurecimento e estabilização do modelo WCM. A avaliação foi realizada por meio da determinação dos índices de disponibilidade mecânica, consumo de óleo hidráulico e custos da manutenção. Os resultados mostraram que houve aumento na disponibilidade mecânica do equipamento de 1,75%. Para o consumo de óleo hidráulico, após o período de implantação, houve redução de 63%, reflexo este das manutenções preventivas realizadas durante as atividades.  O custo de manutenção no modelo WCM apresentou redução de 14,4%, ocasionado pelo investimento de infraestrutura e treinamento de mecânicos e operadores. O modelo o WCM mostrou aplicabilidade na manutenção de equipamentos de corte florestal, com potencial de melhorias em relação à segurança operacional, capacidade produtiva e aumento da vida útil dos mesmos

Blood Pressure, Metabolic and Autonomic Responses to Insulin and Intralipid (R) Infusion in Chagasic Patients

Background: Intralipid (R) and heparin infusion results in increased blood pressure and autonomic abnormalities in normal and hypertensive individuals. Objective: To evaluate insulin sensitivity and the impact of Intralipid (R) and heparin (ILH) infusion on hemodynamic, metabolic, and autonomic response in patients with the indeterminate form of Chagas' disease. Methods: Twelve patients with the indeterminate form of Chagas' disease and 12 healthy volunteers were evaluated. Results: Baseline blood pressure and heart rate were similar in both groups. Plasma noradrenaline levels were slightly increased in the Chagas' group. After insulin tolerance testing (ITT), a significant decline was noted in glucose in both groups. ILH infusion resulted in increased blood pressure in both groups, but there was no significant change in plasma noradrenaline. The low-frequency component (LF) was similar and similarly increased in both groups. The high-frequency component (HF) was lower in the Chagas' group. Conclusion: Patients with the indeterminate form of Chagas' disease had increased sympathetic activity at baseline and impaired response to insulin. They also had a lower high-frequency component and impaired baroreflex sensitivity at baseline and during Intralipid (R) and heparin infusion. (Arq Bras Cardiol 2012;98(3):225-233)FAPESPFAPES

Maxillofacial and dental-related injuries from a Brazilian forensic science institute : victims and perpetrators characteristics and associated risk factors

Trauma due to external causes represents one of the greatest challenges for public health services in different regions around the world. This study aimed to determine the prevalence of facial trauma, associated risk factors, and classification of body injuries in individuals who underwent forensic examination in a Brazilian center. Data were collected at the Ceará State Forensic Medicine unit in a 12-year period. Sociodemographic data related to the etiological agent and lesions resulting from the bodily injury were recorded. Among 1,031 physical injury exams, physical aggression (p<0.001), male victims aged between 21 and 30 years (p<0.001), salaried workers (p<0.001), and soft tissue and dentoalveolar injuries were significant findings. Regarding aggression, domestic violence was prevalent (p<0.001), perpetrated by the victim?s partner (p<0.001), using a blunt instrument during the aggression (p<0.001), and directly associated with soft tissue injury (p<0.001). In traffic accidents, the most common type was motorcycle accident (p<0.001), on weekdays (p=0.036), at nighttime (p=0.134), showing a significant association with bone fractures (p=0.001). Oral and maxillofacial injuries obtained from a Brazilian forensic science center were significantly associated with sociodemographic and etiological factors