A influência da pandemia na gestão estratégica: estudo de caso na unidade local de saúde do nordeste

Mestrado APNORDurante a pandemia, tudo foi afetado, desde pessoas a empresas. Claramente, os hospitais não poderiam ficar indiferentes, sendo aqueles que passaram e passam pelos maiores desafios. Assim, seria interessante estudar como a pandemia veio a afetar esse setor e de que forma os hospitais se adaptaram à nova realidade. Com o intuito de aprofundar os conhecimentos adquiridos ao longo do período académico, foi realizado um estágio curricular no Gabinete de Planeamento e Controlo (GPC) da Unidade Local de Saúde do Nordeste (ULSNE). O tema escolhido passa pelo estudo da influência da COVID-19 na ULSNE para perceber quais os principais desafios sentidos pela instituição e de que forma se adaptou. Para isso, foi definida a problemática de investigação, concretamente qual a influência da pandemia na gestão estratégica? Visando identificar de que forma a COVID-19 influenciou a gestão estratégica da ULSNE, analisando os desafios e oportunidades que surgiram desse período. Este estudo foca-se numa metodologia mista (MM), i.e., qualitativa e quantitativa. Os dados utilizados serão de origem primária e secundária, especificamente as fontes primárias recaíram em entrevistas semiestruturadas com o Conselho de Administração (CA) e, as fontes secundárias passaram pela recolha e análise de relatórios de contas e pesquisa em plataformas digitais. Os resultados do estudo confirmam impactos bastante significativos na área da saúde, onde a ULSNE não foi exceção. Foi um período complicado onde sem a dedicação dos profissionais de saúde seria impossível. As horas trabalhadas aumentaram, traduzindo-se num aumento de stress e cansaço dos profissionais, a atividade programada foi suspensa provocando um aumento nas listas de espera, as idas às urgências diminuíram nos primeiros tempos, os indicadores de qualidade e eficiência foram bastante afetados e os gastos para a compra de equipamentos de proteção, ventiladores, entre outros, não estavam contemplados no plano orçamental aumentaram levando a um aumento na dívida.During the pandemic, everything was affected, from people to businesses. Hospitals could not remain indifferent, being those who have been and are facing the most significant challenges. Thus, it would be interesting to study how the pandemic affected this sector and how hospitals adapted to the new reality. A curricular internship was carried out in the planning and control office (PCO) of the Unidade Local de saúde do Nordeste (ULSNE) to deepen the knowledge acquired during the academic period. The chosen theme is to study the impact of COVID-19 on the ULSNE to understand the main challenges faced by the institution and how it has adapted. For this purpose, a research problem was defined, what is the impact of the pandemic on strategic management? To identify the impact of COVID-19 on the strategic management of ULSNE, analysing the challenges and opportunities that emerged from this period. This study focuses on a qualitative and quantitative methodology. The data used will be primary and secondary origins. Specifically, the primary sources will be interviews with the board of directors (BOD). The secondary sources will collect and analyse account reports and digital research platforms. The results of the study confirm very significant impacts in the health sector, where ULSNE was no exception. It was a complicated period where without the dedication of health professionals it would be impossible. The hours worked increased, resulting in increased stress and tiredness of professionals, the scheduled activity was suspended, causing an increase in waiting lists, emergency room visits decreased in the early days, quality and efficiency indicators were greatly affected and expenses for the purchase of protective equipment, ventilators, among others, were not contemplated in the budget plan increased, causing the debt to rise

Metodologia para Mensuração das Atividades Características do Turismo: uma aplicação para o Brasil e suas Unidades da Federação

The purpose of this article is to propose a methodology to measure the size of characteristic activities of tourism. The proposal is based on the principle of measurement on the supply side, using the same techniques used to measure activities within the scope of National and Regional Accounts. Using data from Brazil and its Federative Units, between the years 2010 to 2015, the results found pointed out, that as far as the contribution of tourism characteristic activities to the national value added is concerned, coastal states tend to stand out, the South and Southeast regions are hegemonic in nominal terms, and it was possible to observe a real decrease in tourism in 2015.El propósito de este documento es presentar una metodología para medir el tamaño de las actividades características del turismo. La propuesta se basa en el principio de medición del lado de la oferta utilizando las mismas técnicas utilizadas para medir las actividades de las Cuentas Nacionales y Regionales. Utilizando datos de Brasil y sus Unidades Federativas, en el periodo de 2010 a 2015, los resultados encontrados señalaron que, en cuanto a la contribución de las actividades características del turismo, los estados costeros tienden a destacarse, las regiones del Sur y Sudeste tienen gran importancia en términos nominales y se ha verificado una disminución real del turismo en 2015O objetivo desse artigo é propor uma metodologia para mensurar o tamanho das atividades características do turismo. A proposta parte do princípio da mensuração pelo lado da oferta utilizando as mesmas técnicas empregadas para mensuração das atividades no âmbito das Contas Nacionais e Regionais. Utilizando dados do Brasil e de suas Unidades da Federação, entre os anos de 2010 a 2015, os resultados encontrados apontaram que quanto a contribuição das atividades características do turismo no valor adicionado nacional, os estados litorâneos tendem a se destacar, as regiões Sul e Sudeste são hegemônicas em termos nominais e foi possível observar um decrescimento real no turismo em 2015

Rediseño de actividades de enfermería para reducción de errores de medicación en pediatria

Quasi-experimental study which aimed to verify the influence of nursing activities redesign in the reduction of medication errors in three pediatrics wards of a university hospital. Types and frequencies of medication errors identified in a study carried through the wards guided the redesign and exerted the function of dependent variable in the assessment of the intervention. To errs identification 556 documents on 77 children's medical charts were analyzed. In 8550 medication doses analyzed, in 1498 (17,5%) errors were evidenced, an inferior ratio (21,1%) of the control study. Globally the intervention generated small changes in medication errors ratio and type, being effective to reduce dose omission (p< 0.0001), medication suspended by physicians and not registered as suspended for the nurses (p<0.0001) and wrong hour (p= 0,0002).Estudio casi-experimental que verificó influencia de rediseño de actividades de enfermería en la reducción de errores de medicación en tres unidades de pediatría de un hospital universitario. Los tipos y frecuencias de errores de medicación identificados en estudio realizado en las unidades fundamentaran lo rediseño y ejercieron función de variables dependientes en el estudio de la intervención propuesta. Fueron analizadas 556 prescripciones médicas en los documientos hospitalares de 77 niños. Se verificaron 8550 dosis, en 1498(17,5%) se constataron errores, proporción inferior (21,1%) a del estudio control. Globalmente la intervención generó poco cambio en la proporción y en la tipología de los errores de medicación, siendo efectiva para reducir omisión de la dosis (p< 0,0001), medicación suspensa por el médico y no registrada como suspensa por la enfermería (p < 0,0001) y hora errada (p = 0,0002).Estudo quase-experimental que verificou a influência do redesenho de atividades de enfermagem para a redução de erros de medicação em três unidades de pediatria de um hospital universitário. Os tipos e freqüências de erros de medicação identificados em estudo realizado nas unidades nortearam o redesenho e exerceram função de variáveis dependentes no estudo da intervenção proposta. Foram analisadas 556 prescrições médicas nos prontuários de 77 crianças. Verificaram-se 8550 doses, em 1498 (17,5%) constataram-se erros, proporção inferior (21,1%) a do estudo controle. Globalmente a intervenção gerou pouca mudança na proporção e na tipologia dos erros de medicação, sendo efetiva para reduzir omissão da dose (p<0,0001), medicação suspensa pelo médico e não registrada como suspensa pela enfermagem (p<0,0001) e hora errada (p=0,0002).UNIFESP Departamento de EnfermagemCNPqUNIFESP, Depto. de EnfermagemSciEL

Análise dos registros de entrevista inicial fonoaudiológica em sujeitos com diagnóstico de gagueira

Este estudo visa a investigar a gagueira na clínica fonoaudiológica e os registros da anamnese, em pacientes diagnosticados como gagos. A análise foi realizada a partir do estudo das pastas de 40 pacientes. Procurou-se identificar o perfil desses sujeitos e discuti-lo a partir das categorias: etiologia da gagueira; auto-imagem; ativação emocional; contato visual e o uso de estratégias. Os resultados obtidos revelaram que 17,5% dos participantes relacionam a causa da gagueira ao uso dos discursos autoritários dos adultos; 15%  à  hipótese genética;  7,5% a algum trauma sofrido na infância; 45% apresentam imagem estigmatizada de falante; 40% apresentam piora da gagueira em situações de estresse; 35% apresentam alteração no contato visual e 32,5% revelaram fazer uso de estratégias para adiar sua gagueira. PALAVRAS-CHAVE: Gagueira; Discurso; Anamnes

Biological risks in professionals working in the mobile urgency service

This descriptive, cross-sectional study aims to evaluate the biological risks among professionals who work in the Mobile Emergency Service of the Metropolitan Region of São Luís - MA. The data were collected from 177 professionals from basic and advanced support units between February and April 2018, using a structured questionnaire.  While a high prevalence of exposure to biological risks was observed among all the subjects, men were found to be at a higher risk. The main source of contamination was blood, mainly affecting the whole skin during the procedure of immobilization. It was evidenced that most of the subjects did not complete the accident report and did not adhere to any post-exposure protocols. It is believed that the development of educational, safety and health measures can minimize the occupational hazards and accidents among the SAMU professionals, who are providers of indispensable service to society, even if susceptible to various environmental risks

long-term follow-up (CIMbA-LT)

Funding Information: Collaborators of the CIMBA-LT study: Hospital Vila Franca de Xira: André Oliveira; João Gonçalves-Pereira; Joaquim Lima. Centro Hospitalar de Médio Tejo (Abrantes): Rui Assis; Joana Monteiro. Hospital Nélio Mendonça (Funchal): André Simões; Catarina Lume. Centro Hospitalar de Trás-os-Montes e Alto Douro (Vila Real): Maria João Pinto. Centro Hospitalar de Vila Nova de Gaia: Sara Pipa. Hospital de Braga: Laura Costa. Hospital de Bragança: Cristina Nunes. Hospital do Divino Espírito Santo (S. Miguel): Manuela Henriques; Luís Tavares. Hospital de Leiria: Filipa Sequeira. Centro Hospitalar Universitário de S.João (Porto): José-Artur Paiva; Tatiana Santos Vieira; Núria Jorge. Centro Hospital Universitário de Lisboa Norte (Lisboa): Ana Bento Rodrigues; Susana Fernandes; João Ribeiro. Hospital S.Francisco Xavier (Lisboa): Rui Morais; Pedro Póvoa; Luís Coelho. Centro Hospitalar Universitário de Coimbra: Ana Martinho; Iolanda Santos. Hospital Egas Moniz (Lisboa): Gabriela Almeida. Hospital de Beja: Alexandra Paula; Filipe Morais de Almeida. Centro Hospitalar Universitário do Algarve (Faro): Sofia Ribeiro. Publisher Copyright: © 2023, The Author(s).Background: The past years have witnessed dramatic changes in the population admitted to the intensive care unit (ICU). Older and sicker patients are now commonly treated in this setting due to the newly available sophisticated life support. However, the short- and long-term benefit of this strategy is scarcely studied. Methods: The Critically Ill patients’ mortality by age: Long-Term follow-up (CIMbA-LT) was a multicentric, nationwide, retrospective, observational study addressing short- and long-term prognosis of patients admitted to Portuguese multipurpose ICUs, during 4 years, according to their age and disease severity. Patients were followed for two years after ICU admission. The standardized hospital mortality ratio (SMR) was calculated according to the Simplified Acute Physiology Score (SAPS) II and the follow-up risk, for patients discharged alive from the hospital, according to official demographic national data for age and gender. Survival curves were plotted according to age group. Results: We included 37.118 patients, including 15.8% over 80 years old. The mean SAPS II score was 42.8 ± 19.4. The ICU all-cause mortality was 16.1% and 76% of all patients survive until hospital discharge. The SAPS II score overestimated hospital mortality [SMR at hospital discharge 0.7; 95% confidence interval (CI) 0.63–0.76] but accurately predicted one-year all-cause mortality [1-year SMR 1.01; (95% CI 0.98–1.08)]. Survival curves showed a peak in mortality, during the first 30 days, followed by a much slower survival decline thereafter. Older patients had higher short- and long-term mortality and their hospital SMR was also slightly higher (0.76 vs. 0.69). Patients discharged alive from the hospital had a 1-year relative mortality risk of 6.3; [95% CI 5.8–6.7]. This increased risk was higher for younger patients [21.1; (95% CI 15.1–39.6) vs. 2.4; (95% CI 2.2–2.7) for older patients]. Conclusions: Critically ill patients’ mortality peaked in the first 30 days after ICU admission. Older critically ill patients had higher all-cause mortality, including a higher hospital SMR. A long-term increased relative mortality risk was noted in patients discharged alive from the hospital, but this was more noticeable in younger patients.publishersversionpublishe

The effectiveness of pilates training interventions on older adults’ balance: a systematic review and meta-analysis of randomized controlled trials

Pilates training intervention programs have gained attention as a potential approach to enhancing balance in older adults, thereby reducing the risk of falls. In light of these considerations, this systematic review and meta-analysis aimed to critically evaluate the existing evidence and determine the effect of Pilates training intervention programs on older adults’ balance. Materials and Methods: The literature was searched through the PubMed, Web of Science, and Scopus databases from inception until July 2023. The primary keywords used for the literature search included “elderly” or “older adults” and “pilates training” and “balance”. Results: The systematic review through qualitative analysis showed robust evidence about the efficacy of Pilates intervention programs in improving older adults’ balance. The pooled meta-analysis of static and dynamic balance showed that eight (53%) out of a total fifteen analyzed interventions presented a significant effect of Pilates in improving the participants’ balance, without between-study heterogeneity. In addition, the meta-analysis regarding dynamic balance showed that six (67%) out of nine analyzed interventions presented a significant effect of Pilates in improving the participants’ balance, without heterogeneity between studies. Similarly, the meta-analysis regarding static balance showed that four (50%) out of eight analyzed studies presented significant effects on the older adults’ balance, where moderate between-study heterogeneity was found. Sensitivity analysis showed that three studies reduced the between-study heterogeneity (19, 17.6, and 17%), regressing from moderate to low heterogeneity, p < 0.05. Conclusions: This systematic review and meta-analysis underscores the potential of Pilates training as a valuable intervention to enhance balance in the elderly populationThis work is supported by national funding through the Portuguese Foundation for Science and Technology, I.P., under the project UIDB/04045/2020.info:eu-repo/semantics/publishedVersio

The Portfolio as an Evaluation Tool: an Analysis of its Use in an Undergraduate Nursing Program

This qualitative study was carried out between April and August 2007. It analyzed the use of portfolios in the academic community. A total of nine full-time professors and 119 students enrolled in their third semester were interviewed through a semi-structured interview. Content analysis was used to analyze data. Learning evaluations are seen as a verification of knowledge and efficacy of pedagogical method, and also as an incentive to study. Evaluations are procedural, that is, evaluation is continuous, or one-time, e.g. semester end tests. The portfolio is defined as a gradual and continuous evaluation tool. The faculty members and students need to accept the use of portfolios and evaluate the possibilities of this resource. This study is a first attempt to appraise the evaluation process of an undergraduate program, and the use of portfolios and other strategies needs to be consolidated in order to improve the educational process in undergraduate nursing programs.

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association

OBJECTIVE: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. METHOD: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. RESULTS: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). CONCLUSIONS: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection

Multi-organ NMR metabolomics to assess in vivo overall metabolic impact of cisplatin in mice

This work describes, to our knowledge, the first NMR metabolomics analysis of mice kidney, liver, and breast tissue in response to cisplatin exposure, in search of early metabolic signatures of cisplatin biotoxicity. Balb/c mice were exposed to a single 3.5 mg/kg dose of cisplatin and then euthanized; organs (kidney, liver, breast tissue) were collected at 1, 12, and 48 h. Polar tissue extracts were analyzed by NMR spectroscopy, and the resulting spectra were studied by multivariate and univariate analyses. The results enabled the identification of the most significant deviant metabolite levels at each time point, and for each tissue type, and showed that the largest metabolic impact occurs for kidney, as early as 1 h post-injection. Kidney tissue showed a marked depletion in several amino acids, comprised in an overall 13-metabolites signature. The highest number of changes in all tissues was noted at 12 h, although many of those recovered to control levels at 48 h, with the exception of some persistently deviant tissue-specific metabolites, thus enabling the identification of relatively longer-term effects of cDDP. This work reports, for the first time, early (1-48 h) concomitant effects of cDDP in kidney, liver, and breast tissue metabolism, thus contributing to the understanding of multi-organ cDDP biotoxicity.publishe