Creación de una simulación para el desarrollo de competencias en un hospital

Este artigo descreve a criação, aplicação e análise da eficácia de uma simulação por computador para a identificação e o desenvolvimento de competências de gestão de conflitos e feedback. Foi realizado um estudo exploratório descritivo de abordagem quantitativa em um hospital de Porto Alegre, RS, com 29 enfermeiros, com o objetivo de analisar a eficácia da simulação utilizada em EaD na identificação e desenvolvimento de competências de gestão de conflitos e dar e receber feedback em lideranças enfermeiras de um hospital pediátrico. Foram utilizados três instrumentos: a) questionário de avaliação de liderança, b) simulação sobre gestão de conflitos e feedback, baseado na teoria do Grid Gerencial, e c) avaliação de reação. A comparação entre as respostas do questionário e da simulação demonstram alteração no estilo gerencial dos participantes nas duas dimensões relativas às competências estudadas. A avaliação de reação foi positiva, com satisfação de 89,66% dos usuários. A simulação criada neste estudo se mostrou eficaz para a identificação de competências de gestão de conflitos e dar e receber feedback. Porém, são necessários novos estudos com amostras maiores e métodos de controle para afirmar a eficácia no desenvolvimento de competências.This article describes the creation, application, and analysis of the effectiveness of a computer simulation for the identification and development of conflict management and feedback skills. A descriptive exploratory study of quantitative approach was realized in a hospital in Porto Alegre, RS, Brazil, with 29 nurses, with the objective of analyzing the efficacy of the simulation used in Distance Education in the identification and development of conflict management skills and of giving and receiving feedback in leading nurses of a pediatric hospital. Three instruments were used: a) leadership assessment questionnaire, b) simulation on conflict management and feedback, based on the managerial grid theory, and c) reaction evaluation. The comparison between the answers of the questionnaire and the simulation shows a change in the managerial style of the participants in the two dimensions. The reaction evaluation was positive, with a satisfaction of 89.66% of users. The simulation created in this study proved to be effective to identify conflict management skills and to give and receive feedback; however, new studies with larger samples and control methods are necessary to assert efficacy in the development of competencies.En este artículo se describe la creación, aplicación y análisis de la eficacia de una simulación por computadora para la identificación y el desarrollo de competencias de gestión de conflictos y retroalimentación. Se realizó un estudio exploratorio descriptivo de abordaje cuantitativo en un hospital de Porto Alegre, RS, con 29 enfermeros, con el objetivo de analizar la eficacia de la simulación utilizada en EaD en la identificación y desarrollo de competencias de gestión de conflictos y dar y recibir feedback en líderes enfermeros de un hospital pediátrico. Se utilizaron tres instrumentos: a) cuestionario de evaluación de liderazgo, b) simulación sobre gestión de conflictos y feedback, basado en la teoría del Grid Gerencial, y c) evaluación de reacción. La comparación entre las respuestas del cuestionario y la simulación demuestran cambios en el estilo gerencial de los participantes en las dos dimensiones relativas a las competencias estudiadas. La evaluación de reacción fue positiva, con satisfacción del 89,66% de los usuarios. La simulación creada en este estudio se mostró eficaz para la identificación de competencias de gestión de conflictos y dar y recibir feedback. Sin embargo, son necesarios nuevos estudios con muestras mayores y métodos de control para afirmar la eficacia en el desarrollo de competencias

Poor glycaemic control in Brazilian patients with type 2 diabetes attending the public healthcare system a cross-sectional study

Objectives: To describe the clinical profile of Brazilian patients with type 2 diabetes attending the public healthcare system and identify factors associated with poor glycaemic control.Design: Cross-sectional study.Setting: 14 centres in five regions of Brazil, including primary care units and outpatient clinics of University Hospitals.Participants: Patients with type 2 diabetes attending outpatient clinics of public healthcare system.Main outcome measured: Glycated haemoglobin (HbA1c), centrally measured by high-performance liquid chromatography (National Glycohemoglobin Standardization Program certified).Results: A total of 5750 patients aged 61 10 years, with 11 8 years of diabetes duration (66% women, 56% nonwhite, body mass index: 28.0 5.3 kg/m(2)) were analysed. Mean HbA1c was 8.6 +/- 2.2%, and median HbA1c was 8.1% (6.9% to 9.9%). HbA1c 8%.Conclusions: the majority of Brazilian patients with type 2 diabetes attending the public healthcare system had HbA1c levels above recommended targets. the recognition of Northeast residents and non-white patients as vulnerable populations should guide future policies and actions to prevent and control diabetes.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundo de Incentivo a Pesquisa (FIPE) of Hospital de Clinicas de Porto Alegre (HCPA)Pfizer PharmaceuticalHosp Clin Porto Alegre, Endocrine Div, Porto Alegre, RS, BrazilUniv Fed Rio Grande do Sul, Porto Alegre, RS, BrazilHosp Getulio Vargas, Endocrine Div, Manaus, Amazonas, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilFed Univ Para, BR-66059 Belem, Para, BrazilUniversidade Federal de São Paulo, Endocrine Div, São Paulo, BrazilUniversidade Federal de São Paulo, Endocrine Div, São Paulo, BrazilWeb of Scienc

Ediacaran metazoan fossil record from South America and its implications in the studies about origin and complexification of animal life

O Período Ediacarano marca o aparecimento dos primeiros organismos macroscópicos complexos no registro fóssil. Evidências atuais indicam que a biota de Ediacara é composta tanto por animais quanto por grupos de protistas gigantes extintos, além de algas e outros organismos sem afinidades comprovadas com representantes modernos. Fósseis dessa biota foram documentados em pelo menos 40 localidades no mundo. Na América do Sul, fósseis de metazoários ediacaranos são encontrados no Brasil, Paraguai, Uruguai e Argentina. Na maioria dessas localidades, são encontrados fósseis do último momento evolutivo da biota ediacarana, capazes de realizar esqueletogênese, tais como Cloudina e Corumbella, correlatos a assembleia Nama. Essa novidade evolutiva surgiu, provavelmente, em resposta a pressões de predação e mudanças químicas nos oceanos. Recentemente, foram encontrados fósseis de organismos de corpo mole, típicos de outra assembleia ediacarana (White Sea), em Santa Catarina (Brasil). Essa ocorrência é de grande relevância, uma vez que representa a única descoberta na América do Sul que apresenta organismos dessa assembleia. Este trabalho tem por objetivo compilar as ocorrências da biota de Ediacara na América do Sul, bem como discutir a importância da inserção e dos estudos dessas ocorrências no cenário mundial no escopo de uma das mais importantes questões da Paleobiologia: a origem e a evolução dos animais na Terra.The Ediacaran Period marks the first appearance of complex macroscopic organisms in the fossil record. Current evidence indicates that Ediacara biota is composed of animals, groups of extinct giant protists, algae and other organisms without proven affinities with modern groups. Fossils of this biota have been documented in at least 40 locations worldwide. In South America, ediacaran metazoan fossils are found in Brazil, Paraguay, Uruguay and Argentina. In most of these locations, are found fossils of the last moment of evolutionary ediacaran biota, capable of performing skeletogenesis, such as Cloudina and Corumbella, related to Nama assemblage. This evolutionary novelty arose probably in response to predation pressures and chemical changes in the oceans. Newly, fossils of soft-bodied organisms were found, typical of other ediacaran assembly (White Sea), in Santa Catarina (Brazil). This occurrence is of great importance since it represents the only discovery about its assemblage in South America. This work aims to compile the occurrences of the Ediacara biota in South America, as well as discussing the importance of inclusion and study these events on the world scene in the scope of one of the most important issues of Paleobiology: the origin and evolution animals on Earth

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

Background\ud To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.\ud \ud Methods\ud This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).\ud \ud Results\ud Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).\ud \ud Conclusions\ud A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.We thank Mrs. Karianne Aroeira Davidson, Mrs. Anna Maria Ferreira, Mrs. Elisangela Santos and Sandro Sperandei for their technical assistance.This work was supported by grants from Farmanguinhos/Fundação Oswaldo Cruz/National Health Ministry, the Brazilian Diabetes Society, Fundação do Amparo à Pesquisa do Estado do Rio de Janeiro, and Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil

Tipos e motivos de desligamento dos trabalhadores de enfermagem em um hospital da região de Porto Alegre - RS

Este trabalho apresenta um levantamento dos tipos e motivos de desligamentos dos trabalhadores de enfermagem ocorridos no período de outubro de 2010 a setembro de 2011 em um hospital da Grande Porto Alegre, RS. Os tipos de desligamento foram descritos por cargo, associados com o tempo de trabalho na Instituição e o motivo do desligamento declarado pelo funcionário. Além disso, foram descritos os motivos dos desligamentos informados pelos funcionários e pela liderança. Buscou-se verificar a associação das variáveis transferência e promoção, acompanhamento psicológico e intenção de retorno à Instituição com o tipo de desligamento. O estudo foi realizado a partir das listagens dos 568 desligados neste período, fichas de entrevista de desligamento e um campo específico da avaliação de desempenho no qual a liderança informa o motivo da saída. Os resultados indicam a maior parte dos desligamentos ocorrendo por iniciativa dos empregados, sendo os tipos de desligamento mais frequentes o pedido de demissão e pedido de demissão em período de contrato, com 63,7% dos casos somados. Os motivos dos desligamentos foram bastante diversificados. Dentre eles, justificativas relacionadas a outro emprego obtiveram grande destaque, com 28,7% dos desligados informando esta motivação. Enfim, as causas da rotatividade em hospitais são diversas e complexas. Este estudo, no entanto, buscou apoiar a gestão de pessoas no sentido de identificar estas causas para poder trabalhar cada uma delas, seja de forma individual ou em conjunto, quando necessário. Sugere-se desenvolver novos estudos sobre o tema, visto ser ainda pouco estudado