Thesis (D.P.H.)--University of Oklahoma. / Bibliography: leaves 52-53.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2672. Adviser: Wendell C. Taylor. Includes bibliographical references.

Home hospice care - applicability of Australian Standards on patient admission This master thesis inspects topic of home hospice care in the context of the Czech Republic. It aims to provide the reader with consistent overview regarding home hospice and palliative care as dealt with by particular organization, understanding of the topic in a broader context, and further information about the system and practical information. The thesis consists of a theoretical and practical section. The former introduces the general topic, mapping its history from initial thoughts up until the current day home and residential hospices while defining numerous terms applied in the latter. The empirical section then focuses on examining the process of admission of terminally ill patients into home hospice care. Firstly, the approach taken by concerned organization is examined, selecting appropriate Australian Standards for implementation. A three-month implementation period follows, which is reflected on through interviews with team members. The conclusion offers suggestions for improvements in the ways of working and hence the provided care on the whole, applicable across all home hospice teams. The text is targeted at an adult reader. Keywords: Home hospice. Palliative care. Patient admission. Standards. Australian...

Introdução - As leis de restrição ao fumo têm sido amplamente difundidas pelo mundo principalmente na última década. Estudos prévios e meta análises têm demonstrado uma redução nas taxas de infarto do miocárdio após a vigência dessas leis. Entretanto, para a população latino-americana, as informações ainda são escassas. Na primeira fase deste estudo foi demonstrada a implementação bem sucedida da lei anti fumo na cidade de São Paulo, com uma redução expressiva nos níveis de monóxido de carbono em restaurantes, bares e casas noturnas. Objetivo - Avaliar se a implementação da lei anti fumo na cidade de São Paulo em 2009 foi associada a uma redução nas taxas de mortalidade e internação hospitalar por infarto do miocárdio e acidente vascular cerebral. Métodos - Foi realizado um estudo de séries temporais mensais entre janeiro de 2005 e dezembro de 2010. Os dados foram provenientes do DATASUS, o principal sistema de informação pública de saúde disponível no Brasil e do Sistema de Informação sobre Mortalidade (SIM). A análise foi realizada utilizando o método Auto-regressivo, Integrado e de Médias Móveis com variáveis exógenas (ARIMAX), modelado por variáveis ambientais e poluentes atmosféricos para avaliar as taxas de mortalidade e internação hospitalar antes da lei e prever os eventos após a lei. Também foi realizada análise utilizando o método de Análise de Séries Temporais Interrompida (ITSA), em conjunto com o ARIMAX, para comparar o período anterior à lei, o momento em que entrou em vigor e o período após a lei. Resultados - Foi observada uma redução nas taxas de internação hospitalar (-5.4% nos primeiros 3 meses após a lei) e mortalidade (-11.9% nos primeiros 17 meses após a lei) por infarto do miocárdio com o método ARIMAX e uma redução na taxa de internação hospitalar (-7,4% entre o 7º e o 12º mês após a lei) e mortalidade (-5,3% nos primeiros 17 meses após a lei) por acidente vascular cerebral, com a mesma metodologia. Conclusão - As taxas de internação hospitalar e mortalidade por infarto do miocárdio e acidente vascular cerebral foram reduzidas após o início da vigência da lei anti fumo / Background - Smoking restriction laws have spread worldwide during the last decade. Previous studies and meta-analyses have shown a decline in the community rates of myocardial infarction and/or heart attack after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in places like restaurants, bars, and nightclubs. Objective - To evaluate whether the 2009 implementation of a smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction and stroke. Methods - We performed a time series study of monthly rates of mortality and hospital admissions for acute myocardial infarction and stroke from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modeled by environmental variables and atmospheric pollutants to evaluate the mortality and hospital admission rate before the law and forecast events after the law. We also used Interrupted Time Series Analysis (ITSA) in conjunction with ARIMAX to compare the period before the law, the moment of implementation of the law, and the period after the law. Results - We observed a reduction in hospital admission rate (-5.4% in the first 3 months after the law) and mortality rate (-11.9% in the first 17 months after the law) for myocardial infarction with ARIMAX method. We observed a reduction in hospital admission rate (-7,4% between the 7th and the 12th month after the law) and mortality rate (-5,3% in the first 17 months after the law) for stroke with ARIMAX method. Conclusions - Hospital admission rate and mortality rate for myocardial infarction and stroke were reduced after the smoking ban law was implemented

Thesis (MScEng)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Predictive analytics in healthcare has become one of the major focus areas in healthcare delivery worldwide. Due to the massive amount of healthcare data being captured, healthcare providers and health insurers are investing in predictive analytics and its enabling technologies to provide valuable insight into a large variety of healthcare outcomes. One of the latest developments in the field of healthcare predictive modelling (PM) was the launch of the Heritage Health Prize; a competition that challenges individuals from across the world to develop a predictive model that successfully identifies the patients at risk of admission to hospital from a given patient population. The patient-admission predictive algorithm (PAPA) is aimed at reducing the number of unnecessary hospitalisations that needlessly constrain healthcare service delivery worldwide. The aim of the research presented is to determine the feasibility and value of applying PAPAs in the South African healthcare system as part of a preventive care intervention strategy. A preventive care intervention strategy is a term used to describe an out-patient hospital service, aimed at providing preventive care in an effort to avoid unnecessary hospitalisations from occurring. The thesis utilises quantitative and qualitative techniques. This included a review of the current and historic PM applications in healthcare to determine the major expected shortfalls and barriers to implementation of PAPAs, as well as the institutional and operational requirements of these predictive algorithms. The literature study is concluded with a review of the current state of affairs in the South African healthcare system to, firstly, articulate the need for PAPAs and, secondly, to determine whether the public and private sectors provide a suitable platform for implementation (evaluated based on the operational and institutional requirements of PAPAs). Furthermore, a methodology to measure and analyse the potential value-add of a PAPA care intervention strategy was designed and developed. The methodology required a survey of the industry leaders in the private healthcare sector of South Africa to identify, firstly, the current performance foci and, secondly, the factors that compromise the performance of these organisations to deliver high quality, resource-effective care. A quantitative model was developed and applied to an industry leader in the private healthcare sector of South Africa, in order to gauge the resultant impact of a PAPA care intervention strategy on healthcare provider performance. Lastly, in an effort to ensure the seamless implementation and operation of PAPAs, an implementation framework was developed to address the strategic, tactical, and operational challenges of applying predictive analytics and preventive care strategies similar to PAPAs. The research found that the application of PAPAs in the public healthcare sector of South Africa is infeasible. The private healthcare sector, however, was considered a suitable platform to implement PAPAs, as this sector satisfies the institutional and operational requirements of PAPAs. The value-add model found that a PAPA intervention strategy will add significant value to the performance of healthcare providers in the private healthcare sector of South Africa. Noteworthy improvements are expected in the ability of healthcare provider’s to coordinate patient care, patient-practitioner relationships, inventory service levels, and staffing level efficiency and effectiveness. A slight decrease in the financial operating margin, however, was documented. The value-add methodology and implementation support framework provides a suitable platform for future researchers to explore the collaboration of preventive care and PM in an effort to improve healthcare resource management in hospitals. In conclusion, patient-admission predictive algorithms provide improved evidence-based decision making for preventive care intervention strategies. An efficient and effective preventive care intervention strategy improves healthcare provider performance and, therefore, adds significant value to these organisations. With the proper planning and implementation support, the application of PAPA care intervention strategies will change the way healthcare is delivered worldwide. / AFRIKAANSE OPSOMMING: Vooruitskattingsanalises in gesondheidsorg het ontwikkel in een van die mees belangrike fokusareas in die lewering van kwaliteit gesondheidsorg in ontwikkelde lande. Gesondheidsorgverskaffers en lewensversekeraars belê in vooruitskattingsanalise en ooreenstemmende tegnologieë om groot hoeveelhede gesondheidsorg pasiënt-data vas te lê, wat waardevolle insigte bied ten opsigte van ʼn groot verskeidenheid van gesondheidsorg-uitkomstes. Een van die nuutste ontwikkelinge in die veld van gesondheidsorg vooruitskattingsanalises, was die bekendstelling van die “Heritage Health Prize”, 'n kompetisie wat individue regoor die wêreld uitdaag om 'n vooruitskattingsalgoritme te ontwikkel wat pasiënte identifiseer wat hoogs waarskynlik gehospitaliseer gaan word in die volgende jaar en as bron-intensief beskou word as gevolg van die beraamde tyd wat hierdie individue in die hospitaal sal deurbring. Die pasiënt-toelating vooruitskattingsalgoritme (PTVA) het ten doel om onnodige hospitaliserings te identifiseer en te voorkom tem einde verbeterde hulpbronbestuur in gesondheidsorg wêreldwyd te bewerkstellig. Die doel van die hierdie projek is om die uitvoerbaarheid en waarde van die toepassing van PTVAs, as 'n voorkomende sorg intervensiestrategie, in die Suid-Afrikaanse gesondheidsorgstelsel te bepaal. 'n Voorkomende sorg intervensiestrategie poog om onnodige hospitaliserings te verhoed deur die nodige sorgmaatreëls te verskaf aan hoë-riskio pasiënte, sonder om hierdie individue noodwendig te hospitaliseer. Die tesis maak gebruik van kwantitatiewe en kwalitatiewe tegnieke. Dit sluit in 'n hersiening van die huidige en historiese vooruitskattings modelle in die gesondheidsorgsektor om die verwagte struikelblokke in die implementering van PTVAs te identifiseer, asook die institusionele en operasionele vereistes van hierdie vooruitskattingsalgoritmes te bepaal. Die literatuurstudie word afgesluit met 'n oorsig van die huidige stand van sake in die Suid-Afrikaanse gesondheidsorgstelsel om, eerstens, die behoefte vir PTVAs te identifiseer en, tweedens, om te bepaal of die openbare en private sektore 'n geskikte platform vir implementering bied (gebaseer op die operasionele en institusionele vereistes van PTVAs). Verder word 'n metodologie ontwerp en ontwikkel om die potensiële waarde-toevoeging van 'n PTVA sorg intervensiestrategie te bepaal. Die metode vereis 'n steekproef van die industrieleiers in die private gesondheidsorgsektor van Suid-Afrika om die volgende te identifiseer: die huidige hoë-prioriteit sleutel prestasie aanwysers (SPAs), en die faktore wat die prestasie van hierdie organisasies komprimeer om hoë gehalte, hulpbron-effektiewe sorg te lewer. 'n Kwantitatiewe model is ontwikkel en toegepas op een industrieleier in die private Stellenbosch gesondheidsorgsektor van Suid-Afrika, om die gevolglike impak van 'n PTVA sorg intervensiestrategie op prestasieverbetering te meet. Ten slotte, in 'n poging om te verseker dat die implementering en werking van PTVAs glad verloop, is 'n implementeringsraamwerk ontwikkel om die strategiese, taktiese en operasionele uitdagings aan te spreek in die toepassing van vooruitskattings analises en voorkomende sorg strategieë soortgelyk aan PTVAs. Die navorsing het bevind dat die toepassing van PTVAS in die openbare gesondheidsorgsektor van Suid-Afrika nie lewensvatbaar is nie. Die private gesondheidsorgsektor word egter beskou as 'n geskikte platform om PTVAs te implementeer, weens die bevrediging van die institusionele en operasionele vereistes van PTVAs. Die waarde-toevoegings model het bevind dat 'n PTVA intervensiestrategie beduidende waarde kan toevoeg tot die prestasieverbetering van gesondheidsorgverskaffers in die private gesondheidsorgsektor van Suid-Afrika. Die grootste verbetering word in die volgende SPAs verwag; sorg koördinasie, dokter-pasiënt verhoudings, voorraad diensvlakke, en personeel doeltreffendheid en effektiwiteit. 'n Effense afname in die finansiële bedryfsmarge word egter gedokumenteer. 'n Implementering-ondersteuningsraamwerk is ontwikkel in 'n poging om die sleutel strategiese, taktiese en operasionele faktore in die implementering en uitvoering van 'n PTVA sorg intervensiestrategie uit te lig. Die waarde-toevoegings metodologie en implementering ondersteuning raamwerk bied 'n geskikte platform vir toekomstige navorsers om die rol van vooruitskattings modelle in voorkomende sorg te ondersoek, in 'n poging om hulpbronbestuur in hospitale te verbeter. Ten slotte, PTVAs verbeter bewysgebaseerde besluitneming vir voorkomende sorg intervensiestrategieë. 'n Doeltreffende en effektiewe voorkomende sorg intervensiestrategie voeg aansienlike waarde tot die algehele prestasieverbetering van gesondheidsorgverskaffers. Met behoorlike beplanning en ondersteuning met implementering, sal PTVA sorg intervensiestrategieë die manier waarop gesondheidsorg gelewer word, wêreldwyd verander.

Introdução - As leis de restrição ao fumo têm sido amplamente difundidas pelo mundo principalmente na última década. Estudos prévios e meta análises têm demonstrado uma redução nas taxas de infarto do miocárdio após a vigência dessas leis. Entretanto, para a população latino-americana, as informações ainda são escassas. Na primeira fase deste estudo foi demonstrada a implementação bem sucedida da lei anti fumo na cidade de São Paulo, com uma redução expressiva nos níveis de monóxido de carbono em restaurantes, bares e casas noturnas. Objetivo - Avaliar se a implementação da lei anti fumo na cidade de São Paulo em 2009 foi associada a uma redução nas taxas de mortalidade e internação hospitalar por infarto do miocárdio e acidente vascular cerebral. Métodos - Foi realizado um estudo de séries temporais mensais entre janeiro de 2005 e dezembro de 2010. Os dados foram provenientes do DATASUS, o principal sistema de informação pública de saúde disponível no Brasil e do Sistema de Informação sobre Mortalidade (SIM). A análise foi realizada utilizando o método Auto-regressivo, Integrado e de Médias Móveis com variáveis exógenas (ARIMAX), modelado por variáveis ambientais e poluentes atmosféricos para avaliar as taxas de mortalidade e internação hospitalar antes da lei e prever os eventos após a lei. Também foi realizada análise utilizando o método de Análise de Séries Temporais Interrompida (ITSA), em conjunto com o ARIMAX, para comparar o período anterior à lei, o momento em que entrou em vigor e o período após a lei. Resultados - Foi observada uma redução nas taxas de internação hospitalar (-5.4% nos primeiros 3 meses após a lei) e mortalidade (-11.9% nos primeiros 17 meses após a lei) por infarto do miocárdio com o método ARIMAX e uma redução na taxa de internação hospitalar (-7,4% entre o 7º e o 12º mês após a lei) e mortalidade (-5,3% nos primeiros 17 meses após a lei) por acidente vascular cerebral, com a mesma metodologia. Conclusão - As taxas de internação hospitalar e mortalidade por infarto do miocárdio e acidente vascular cerebral foram reduzidas após o início da vigência da lei anti fumo / Background - Smoking restriction laws have spread worldwide during the last decade. Previous studies and meta-analyses have shown a decline in the community rates of myocardial infarction and/or heart attack after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in places like restaurants, bars, and nightclubs. Objective - To evaluate whether the 2009 implementation of a smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction and stroke. Methods - We performed a time series study of monthly rates of mortality and hospital admissions for acute myocardial infarction and stroke from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modeled by environmental variables and atmospheric pollutants to evaluate the mortality and hospital admission rate before the law and forecast events after the law. We also used Interrupted Time Series Analysis (ITSA) in conjunction with ARIMAX to compare the period before the law, the moment of implementation of the law, and the period after the law. Results - We observed a reduction in hospital admission rate (-5.4% in the first 3 months after the law) and mortality rate (-11.9% in the first 17 months after the law) for myocardial infarction with ARIMAX method. We observed a reduction in hospital admission rate (-7,4% between the 7th and the 12th month after the law) and mortality rate (-5,3% in the first 17 months after the law) for stroke with ARIMAX method. Conclusions - Hospital admission rate and mortality rate for myocardial infarction and stroke were reduced after the smoking ban law was implemented

Positive associations between short-term exposure to ambient particulate matter (PM) pollution and cardio-respiratory morbidity and mortality have been established in epidemiologic studies. However, scientific uncertainties remain regarding which PM constituents and sources are most harmful to the exposed population. While tentative evidence of positive links between certain PM constituents and sources with specific health outcomes exists, significant heterogeneity in study findings remains. The chemical composition and emission source of air pollution vary not only temporally, but also geographically. Thus, substantial research on these characteristics under different atmospheres (e.g., Asian atmosphere) is warranted to enhance our understanding of PM-related health effects. / In Hong Kong, air pollution levels often exceed the World Health Organization’s air quality guidelines, posing serious public health threat. Although two decades of active research have associated PM mass (weights) concentration in Hong Kong with elevated risk of daily mortality and emergency hospital admissions, individual chemical constituents and sources responsible for the adverse health effects associated with PM mass have rarely been examined. This thesis attempted to reduce the current scientific uncertainty by making use of the speciation data for PM with aerodynamic diameter ≤ 10 μm (PM₁₀) to examine the associations between chemical constituents and daily cardio-respiratory emergency hospital admissions in Hong Kong between 2001 and 2008. It also capitalized on Positive Matrix Factorization (PMF) source apportionment model to create an alternative measure of PM concentrations that quantified the relative contribution of PM₁₀ sources. This enabled the assessment of health risks associated with exposure to particle mixture from specific sources. / Time-series analyses conducted in this work showed evidence of positive links of emergency hospitalizations with multiple PM₁₀ constituents for various exposure lags examined. In multipollutant models adjusting for gaseous co-pollutants, three groups of constituents were significantly associated with increased risk of cause-specific hospitalizations. They included: combustion-related constituents (i.e., elemental carbon, organic matter, potassium ion, manganese, nitrate ion, arsenic, lead), sea salt-related constituents (i.e., sodium ion, chloride ion, magnesium), and constituents related to soil/road dust (i.e., aluminum, iron). Significant associations were most evident between November to April. PMF model identified eight PM₁₀ sources: 1) vehicle exhaust, 2) soil/road dust, 3) regional combustion, 4) residual oil, 5) fresh sea salt, 6) aged sea salt, 7) secondary nitrate, and 8) secondary sulfate. Health effect analysis demonstrated that all PM₁₀ sources, except fresh sea salt, were positively associated with emergency hospitalizations. Combustion-related sources were positively associated with risk of cardiovascular hospitalizations at shorter cumulative lags than with respiratory hospitalization. Sources that primarily generate coarser particles (i.e., soil/road dust and aged sea salt) were linked to respiratory hospitalizations at shorter cumulative lags than combustion sources that emit fine particles, which were associated with respiratory hospitalization at delayed cumulative lags. / This work may help prioritize future toxicological research on the biologic mechanisms linking PM pollution to cardio-respiratory health. It also stresses the importance of regulation and reduction of traffic and other combustion-related emissions, reconfiguration of urban environment to reduce personal exposure to traffic emissions, as well as establishment of a coordinated and robust regional-scale air quality management plan. Constituent- and source-based air quality standards and policy strategies should be considered, supplementary to standards for total PM mass (e.g., PM₁₀ and PM₂.₅), to effectively protect the population from air pollution mixture. For example, policy measures aiming at controlling anthropogenic sources of coarse particles (e.g., soil/road dust, precursor gases for atmospheric conversion of aged sea salt) should be advisable. / 以往流行病學研究已經建立大氣懸浮顆粒（PM）污染短期暴露和心血管﹑呼吸系統疾病的發病率以及死亡率之間的關聯，但仍然不能確定究竟那種PM化學成分和排放源對暴露人群最有害。初步證據已經顯示了個別PM化學成分和排放源與某些疾病的相關聯，但是，現今研究結果之間依然存在顯著差異。此外，顆粒污染物的化學成分和排放源會隨地理空間不同而變化，因此有必要在不同地域的大氣環境下（如亞洲）進行研究，從而提高我們對PM影響健康的認識。 / 香港的空氣質量常超過世界衛生組織規定的可接受空氣質量標準，空氣污染已經成為一個嚴重的公共衛生問題。香港二十年的空氣污染研究已顯示PM質量濃度會增加死亡率和緊急入院的風險，然而仍然缺乏PM化學成分和排放源對健康影響的研究。本港環境保護署擁有十多年連續測量的可吸入懸浮粒子（PM₁₀）成分數據，因此本論文利用這數據與公共衛生數據來填補這個學術空白。具體的，本論文探索香港2001年至2008年間的PM化學成分與期間每日心血管和呼吸系統緊急入院的關聯。本論文還利用正交矩陣因子分解法（PMF），即大氣顆粒物的源解析技術，進行顆粒源分離，已建立替代單元以分別代表PM₁₀不同排放源的相對貢獻建立一個替代措施量化PM₁₀的成分中不同來源相對的貢獻，最終評估暴露於特定來源的PM₁₀混合成分的健康風險。 / 本文中的時間序列分析研究結果表明緊急入院率與多個PM化學成分在不同的暴露滯後時間上均存在正關聯。本論文的多種污染物時間序列的模型對氣體的共污染性進行了控制，研究發現以下三种顆粒物對某些具體疾病的緊急入院風險有顯著增加︰燃燒有關的顆粒（即︰碳元素，有機物，鉀離子，錳，硝酸根離子，砷，鉛），與海鹽有關的顆粒（即︰鈉離子，氯離子，鎂），以及與土壤/道路粉塵有關的顆粒（即︰鋁，鐵），這種相關性在寒冷的季節更為明顯（即每年的11月至4月）。PMF鑑定了八個PM₁₀的排放源或排放組合，包括︰1）汽車排氣，2）土壤/道路粉塵，3）區域燃燒產物，4）渣油，5）鮮海鹽，6）陳海鹽，7）二次硝酸鹽，和8）二次硫酸鹽。分析發現，除鮮海鹽外，其他PM₁₀的排放源與緊急入院呈正關係。研究顯示與燃燒有關的排放源能增加即時因心血管疾病緊急入院的風險，而主要含有粗顆粒的排放源能增加即時呼吸系統疾病緊急入院的風險，且在作用時間上比燃燒排放源（主要含有細顆粒）的危害更快。 / 本論文所提供的研究成果有助於重新定位未來有關空氣污染與心肺健康的生物學機制毒理學研究方向。研究結果強調監管和降低交通以及其他有關燃燒排放的重要性，利用合理城市環境結構及配置來減少居民暴露交通空氣污染的風險，以及建立區域性的空氣質量管理計劃。此外，本研究還建議除了PM質量濃度（如PM₁₀和PM₂.₅）的空氣質量標準以外，針對PM化學成分和排放源的空氣質量標準也應加以考慮，以有效地保護居民免受空氣污染的危害，例如，應考慮有關粗顆粒（如土壤/道路麈和前驅氣體）的人為來源的政策措施。 / Pun, Chit. / Thesis Ph.D. Chinese University of Hong Kong 2014. / Includes bibliographical references (leaves 108-133). / Abstracts also in Chinese. / Title from PDF title page (viewed on 18, October, 2016). / Pun, Chit. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-11-03T11:54:04Z No. of bitstreams: 1 Murillo da Silveira Grübler_.pdf: 3027339 bytes, checksum: 2fdb175c76ab90e275bf8ba04792e452 (MD5) / Made available in DSpace on 2016-11-03T11:54:04Z (GMT). No. of bitstreams: 1 Murillo da Silveira Grübler_.pdf: 3027339 bytes, checksum: 2fdb175c76ab90e275bf8ba04792e452 (MD5) Previous issue date: 2016-08-19 / CNPQ – Conselho Nacional de Desenvolvimento Científico e Tecnológico / O Gerenciamento de Leitos é uma importante área de planejamento e controle hospitalar. Sua função é garantir o equilíbrio entre os pacientes que chegam através do setor de emergência, os eletivos que possuem algum tratamento agendado e aqueles que saem do hospital. Dessa forma, esse gerenciamento possibilita manter alta a taxa de ocupação dos quartos, mas sem realmente lotá-los, além de prever qualquer situação não planejada. A gestão eficaz de leitos hospitalares como recurso sempre foi um desafio para os gestores. Nas décadas de 80 e 90, por exemplo, milhares de pacientes tiveram operações canceladas em virtude de razões não médicas. Como há necessidade de um melhor controle do fluxo, a área de Gerenciamento de Leitos começou, então, a receber mais atenção acadêmica e também políticas nacionais para a sua gestão. O processo de admissão e posicionamento de enfermos, a partir do Gerenciamento de Leitos, vem se desenvolvendo nos últimos anos através de diversas técnicas de pesquisa operacional, tais como simulação, teoria de filas, análise estatística, entre outras. Devido às constantes incertezas vividas pelos hospitais atualmente, o uso do modelo cognitivo Ciência de Situação em pesquisas científicas na área da saúde vem crescendo cada vez mais. A Ciência de Situação é uma área de estudo que busca compreender o contexto dos ambientes e projetar ações futura. Em suma, é uma técnica que vai além do tradicional processamento de informações, visto que procura explicar o comportamento humano na operação de sistemas complexos. Nessa assertiva, este trabalho tem como objetivo utilizar a Ciência de Situação na área de Gerenciamento de Leitos, usando um modelo híbrido que une a técnica de Rede Neural Artificial Multilayer Perceptron com a Teoria do Valor Multiatributo para tomada de decisão, auxiliando gestores no processo de atribuição de pacientes em leitos adequados ao seu tratamento. Através da implementação de um protótipo baseado neste modelo híbrido de apoio à decisão, nomeado de IMBEDS, foram avaliados 50 pacientes em um total de 266 leitos gerenciados pela Central de Leitos, no Hospital Mãe de Deus, localizado em Porto Alegre. O resultado final dos testes foi de 93,5% de similaridade entre o leito apto apresentado pelo modelo e o processo real de alocação dos enfermos. / The Bed Management is an important area of planning and control hospital. It’s function is to ensure the balance between the patients who come through the emergency department, elective that have some scheduled treatment and those leaving the hospital. Thus, the Bed Management enables the hospital keep high occupancy rate of rooms, but without fill all the beds, in addition to providing any unplanned situation. Effective management of hospital beds as a resource has always been a challenge for managers. In the 80s and 90s, for example, thousands of patients have operations canceled due to non-medical reasons. As there is need for better control of the flow, Bed Management area then began to receive more academic attention and also policies national for the Bed Management. The process of admission and positioning the patients, from the management of beds, has been developing in recent years through of operational research, such as simulation, queuing theory, statistical analysis, among others. Due to the uncertainties experienced by hospitals nowadays, the use of model Situation Awareness in research in the health field is growing increasingly. Situation Awareness is a field of study that seeks to understand the context of the environment and designing future actions. In short, it is a technique that goes beyond the traditional information processing, as it seeks to explain human behavior in the operation of complex systems. In this statement, this work aims to use the Situation Awareness in Bed Management area, using a hybrid model that combines the technique Artificial Neural Network Multilayer Perceptron with the Multi-Attribute Value Theory for decision making, assisting managers in process of patient's allocation to the bed suitable in his treatment. Through the implementation of a prototype based on this hybrid model of decision support, named of IMBEDS, were evaluated 50 patients in a total of 266 beds managed by Beds Center, in the Hospital Mãe de Deus, located in Porto Alegre. The final result of the tests was 93.5% similarity between the bed apt selected by the model and the allocation process of the patients.

To assess the validity of case mix adjustment methods used to derive standardised mortality ratios for hospitals, by examining the consistency of relations between risk factors and mortality across hospitals. DESIGN: Retrospective analysis of routinely collected hospital data comparing observed deaths with deaths predicted by the Dr Foster Unit case mix method. SETTING: Four acute National Health Service hospitals in the West Midlands (England) with case mix adjusted standardised mortality ratios ranging from 88 to 140. PARTICIPANTS: 96 948 (April 2005 to March 2006), 126 695 (April 2006 to March 2007), and 62 639 (April to October 2007) admissions to the four hospitals. MAIN OUTCOME MEASURES: Presence of large interaction effects between case mix variable and hospital in a logistic regression model indicating non-constant risk relations, and plausible mechanisms that could give rise to these effects. RESULTS: Large significant (P<or=0.0001) interaction effects were seen with several case mix adjustment variables. For two of these variables-the Charlson (comorbidity) index and emergency admission-interaction effects could be explained credibly by differences in clinical coding and admission practices across hospitals. CONCLUSIONS: The Dr Foster Unit hospital standardised mortality ratio is derived from an internationally adopted/adapted method, which uses at least two variables (the Charlson comorbidity index and emergency admission) that are unsafe for case mix adjustment because their inclusion may actually increase the very bias that case mix adjustment is intended to reduce. Claims that variations in hospital standardised mortality ratios from Dr Foster Unit reflect differences in quality of care are less than credible.

No / To build an early warning score (EWS) based exclusively on routinely undertaken laboratory tests that might provide early discrimination of in-hospital death and could be easily implemented on paper. Using a database of combined haematology and biochemistry results for 86,472 discharged adult patients for whom the admission specialty was Medicine, we used decision tree (DT) analysis to generate a laboratory decision tree early warning score (LDT-EWS) for each gender. LDT-EWS was developed for a single set (n=3496) (Q1) and validated in 22 other discrete sets each of three months long (Q2, Q3...Q23) (total n=82,976; range of n=3428 to 4093) by testing its ability to discriminate in-hospital death using the area under the receiver-operating characteristic (AUROC) curve. The data generated slightly different models for male and female patients. The ranges of AUROC values (95% CI) for LDT-EWS with in-hospital death as the outcome for the validation sets Q2-Q23 were: 0.755 (0.727-0.783) (Q16) to 0.801 (0.776-0.826) [all patients combined, n=82,976]; 0.744 (0.704-0.784, Q16) to 0.824 (0.792-0.856, Q2) [39,591 males]; and 0.742 (0.707-0.777, Q10) to 0.826 (0.796-0.856, Q12) [43,385 females]. CONCLUSIONS: This study provides evidence that the results of commonly measured laboratory tests collected soon after hospital admission can be represented in a simple, paper-based EWS (LDT-EWS) to discriminate in-hospital mortality. We hypothesise that, with appropriate modification, it might be possible to extend the use of LDT-EWS throughout the patient's hospital stay.