Programas de Controle de Infecção Relacionada à Assistência à Saúde (PCIRAS) são importantes na melhoria da qualidade dessa assistência, interligada hoje com o programa de segurança do paciente, por meio do controle e prevenção dos eventos adversos indesejáveis. O escopo deste estudo é analisar o desempenho dos PCIRAS dos hospitais da cidade de Manaus, Estado do Amazonas, assim como possíveis fatores intervenientes. Estudo transversal, de avaliação, desenvolvido em 2015, nos hospitais da cidade de Manaus, Estado do Amazonas, a partir de 50 leitos, junto a profissionais que atuam no PCIRAS.Dois instrumentos foram utilizados na coleta dos dados. O primeiro, para buscar uma caracterização geral dos hospitais e dos PCIRAS. O segundo se refere a quatro indicadores clínicos de avaliação de PCIRAS, previamente construídos e validados, sendo dois de estrutura e dois de processo: 1) (PCET) Estrutura técnicooperacional do programa de prevenção e controle de IRAS; 2) (PCDO) Diretrizes operacionais de controle e prevenção de IRAS; 3) (PCVE) Sistema de vigilância epidemiológica de IRAS; 4) (PCCP) Atividades de controle de prevenção de IRAS. Foram realizadas associações entre características das unidades hospitalares e dos PCIRAS com os resultados da avaliação. A amostra foi constituída de 25 hospitais, representando 89,3% da totalidade de acesso. A conformidade geral de todos os indicadores foi 69%. O PCET obteve a melhor conformidade (81,9%), seguido pelo PCVE (73,2%), PCDO (72,3%) e PCCP (48,6%). Pela verificação da conformidade mediana, os PCET e PCVE alcançaram 90%, indicando que metade dos hospitais apresentaram resultados próximos da totalidade do atendimento às diretrizes recomendadas nesses indicadores. Já, o PCCP, ambas as medidas se localizaram próximas de 50%, ou seja, é o indicador com pior desempenho entre as instituições avaliadas. Todos os indicadores resultaram em grandes dispersões e os valores de máximo e mínimo corroboram com a variabilidade relativamente alta que os PCIRAS desses hospitais apresentaram. Para os indicadores PCVE e PCCP foram observados hospitais em que nenhum de seus componentes foi atendido. Um hospital teve baixo desempenho em todos os indicadores e em 4 deles o desempenho foi superior a 80% em todos os indicadores. Obteve-se indícios de melhor conformidade dos indicadores, em geral, relacionados a: entidades mantenedoras privadas; existência de algum tipo de certificação/acreditação; composição da equipe do SCIH formada por enfermeiro, médico e outros (técnico de enfermagem e/ou bioquímico e/ou administrativo); vínculo empregatício institucionalizado do enfermeiro e médico do PCIRAS; carga horária exclusiva dos enfermeiros e médicos que atuam no SCIH, sendo acima de 6 horas para enfermeiro e acima de 4 horas para médico; tempo de experiência dos enfermeiros atuando no SCIH a partir de 5 anos e médicos entre 5 a 10 anos; capacitação em controle e prevenção de IRAS na admissão de recursos humanos (com exceção do indicador PCVE). Não houve indícios de melhor desempenho dos indicadores em relação à realização de auditorias internas e conhecimento prévio do enfermeiro para atuar no SCIH.Em razão da alta acessibilidade do universo de hospitais a partir de 50 leitos (89,3%) é possível considerar que os resultados refletem um diagnóstico geral dos PCIRAS dos hospitais de Manaus e, desse modo, com condição de contribuir para a gestão das unidades hospitalares desse município, no que ser refere à organização de seus PCIRAS, na busca constante do atendimento das diretrizes nacionais e a qualidade da assistência à saúde. A contínua aplicação dos indicadores de avaliação do PCIRAS em outros cenários trará um conhecimento do seu desempenho nas regiões do país e possibilitará não somente análises comparativas, como também contribuirão para tomadas de decisões políticas de controle e prevenção de IRAS, de acordo com as realidades especificas de seus PCIRAS. / Infections Relating the Medical Care Prevention and Control (IRMCPC) are important to improve such an assistance quality as it is nowadays interlinked with the patient security program through the control and prevention of the undesirable adverse events. The scope of this study is to recognize Manaus City, Amazonas States Hospitals IRMCPCs performance as well as possible intervenient factors. Assessment transversal studies developed in 2015 in Manaus City, Amazonas State hospitals starting with fifty (50) hospital beds along with the professionals who act in IRMCPCs. Two (2) instruments have been utilized for the data collection. The first seeks a general characterization of both the hospital and IRMCPCs. The second refers to the four (4) clinical indicators for IRMCPCs assessment previously built up and valid being two (2) for the structure and two (2) for the process: 1. Infections Relating the Medical Care IRMC, Prevention and Control Technical-Operational Structure PCTOS; 2. IRMC Control And Prevention Operational Directresses CPOD; 3. IRMC Epidemiological Vigilance System EVS; 4. IRMC Control and Prevention Activities CPA. Some associations among the hospital unities characteristics and IRMCPCs have been carried out with their relevant assessment results. The sample has been constituted of twentyfive (25) hospitals representing eight-nine dot three percent (89.3%) of the total access. The general conformity of all indicators has been sixty-nine percent (69%). The PCTOS has obtained a better conformity of eight-one dot nine percent (81.9%), followed by EVS seventy-three dot 2 percent (73.2%), CPOD seventy-two dot three percent (72.3%), and CPA forty-eight dot six (48.6%). Through the average conformity ascertainment both PCTOS and EVS have reached ninety percent (90%) indicating that half of the hospitals have shown results of their attendance totality close to the directresses recommend in these indicators. As regard CPA both measures lies close to fifty percent (50%), namely, it is the indicator with the worse performance amongst the assessed institutions. All indicators have resulted in big dispersions and the maximum and minimum values corroborate with the relatively high variety these hospital IRMPCPs have produced. For the EVS and CPA indicators it has been observed hospital where none of their components has been satisfied. One hospital had law performance in all indicators and in four (4) of them the performance was higher than eighty percent (80%) in all indicators. It has been observed evidences of better conformity of the indicators in a general sense relating to: private sponsoring entities; the existence of some type of certification/accreditation; the composition of the HICS team comprised of nurse, physician and others (nursery technician and/or biochemist and/or administrative person); IRMPCP nurse and physician labor entailment duly institutionalized; exclusive hour charge for the nurses and physicians acting in the Hospital Infections Control System HICS being over six (6) hours for the nurses and over four (4) hours for the physicians; the skill period of the nurses acting in HICS is as of five (5) years and that of the physicians lies between five (5) and ten (10) years; IRMC control and prevention capacitation in the human resources admission (excepting the EVS indicators). There was not any evidence of better performance of the indicators relating the carrying out of internal audit and the nurse previous skill to act in HICS. On account of the high accessibility to the hospital universe as of fifty (50) hospital beds equal eighty-nine dot three percent (89.3%) it is possible to consider that the results reflect a IRMPCP general diagnosis of Manaus hospitals and, thus, in a condition to contribute to this municipality unities management in which refers the IRMPCP organization in seeking a constant satisfaction to the national directresses and the health care quality. The continuous application of IRMPCP assessment indicators in other sceneries will bring up knowledge of its performance in other regions within the country and will make possible not only the comparative analysis but it will also contribute for the political decision making for the IRMC control and prevention according to the specific realities of their IRMPCPs.

A autoavaliação por parte das Equipes de Atenção Básica à Saúde (EAB) é um dos componentes da fase de desenvolvimento do Programa de Melhoria do Acesso e da Qualidade na Atenção Básica (PMAQ-AB). Motivado pela experiência de participação como pesquisador no processo de avaliação externa do programa, este estudo buscou identificar avanços e dificuldades auto referidos pelas EAB do DRS III - Araraquara que aderiram ao segundo ciclo do PMAQ-AB. Trata-se de uma pesquisa descritiva, de corte transversal no tempo, que se valeu de dados primários obtidos a partir de um questionário construído pelo pesquisador similar à matriz de intervenção do instrumento Auto Avaliação para Melhoria do Acesso e Qualidade (AMAQ), a fim de identificar os Objetivos/Metas (O/M) alcançados, considerados como avanços, e os não alcançados ou parcialmente alcançados, tomados como dificuldades. As entrevistas foram feitas com profissionais componentes das EAB que participaram da autoavaliação e da construção da Matriz de intervenção. Participaram do estudo 47 equipes de 16 municípios distribuídos pelas quatro regiões de saúde do DRS III. Os O/M relatados pelos entrevistados foram avaliados segundo o número de avanços e dificuldades, por região de saúde, por município e pelas subdimensões existentes nas dimensões 3 - Unidade Básica de Saúde e 4 - Educação Permanente, Processo de Trabalho e Atenção integral à Saúde. Constatou-se a existência de 236 O/M definidas nas matrizes de intervenção das equipes participantes. Destes, 156 (66%) foram avanços e 80 (34%) foram dificuldades - sete (3%) parcialmente alcançados e 73 (31%) não alcançados. Dos 156 O/M alcançados, 83% correspondem a duas subdimensões da dimensão 4: Atenção Integral à Saúde, com 67 (43%) e Organização do Processo de Trabalho com 63 O/M alcançados (40%). Considerando que os achados evidenciam o predomínio de avanços na melhoria do acesso e da qualidade, reforça-se a importância da auto avaliação das equipes, da ampliação e consolidação da cultura avaliativa no sentido do aprimoramento dos processos de produção do cuidado em saúde e do PMAQ como parte de uma política indutora de mudanças nas práticas na Atenção Básica, contribuindo para a melhor assistência e ampliação do acesso dos usuários aos serviços de saúde. / Self-assessment by the Primary Care Teams is one of the components of the development phase of the Program for Improving Access and Quality in Primary Care (PMAQ-AB). Motivated by the experience of the researcher\'s participation in the external evaluation process of the program, this study sought to identify advances and self-reported difficulties by the Basic Attention Teams-EAB of DRS III - Araraquara who joined the cycle one of PMAQ-AB. From a descriptive and crosssectional approach in time, we used primary data obtained from a questionnaire previously constructed by the researcher, based on the intervention matrix of the instrument Self-Assessment for Improving Access and Quality (AMAQ), in order to capture Objectives / Targets -O / M achieved (advances) and not achieved or partially achieved (difficulties), according to answers from a professional of the team that represented it. A total of 47 teams from 16 municipalities of the four health regions of DRS III participated in the study. The O / M reported by the interviewees were evaluated according to the number and percentage of advances and difficulties, by health region, by municipality and by subdimension of dimensions 3 - Basic Health Unit and 4 - Permanent Education, Work Process and Comprehensive Care. 236 O/M were elaborated by the participating teams. Of these, 156 (66%) were reached; seven (3%) partially achieved, and 73 (31%) of all O / M elaborated were not reached. Of the 156 O / M achieved, 83% of them correspond to two subdimensions of dimension 4: Comprehensive Health Care with 67 O / M (43%) and Work Process Organization with 63 achieved (40%). Considering the findings, the importance of PMAQ-AB as an initiative that promotes changes in health practice in AB is reinforced, reflecting better care and broadening access to health services by its users.

Thesis (Ph.D. (Zoology)) --University of Limpopo (Turfloop Campus), 2011 / South Africa's water resources are limited and scarce in global terms, due to the fact that the country's climate varies from desert to semi-desert in the west to sub-humid along the coastal area. The country is also expected to experience further variability in rainfall, reduced precipitation and increased evaporation as a result of climate change. At the projected population growth and economic development rates, it is unlikely that the projected demand on water resources in South Africa will be sustainable. An additional concern is the declining water quality due to domestic, mining and industrial pollution, and eutrophication as well as salinisation due to agricultural pollution. Thus, aquatic ecosystems must be protected, monitored and managed to ensure sustainable resource use. The aim of the study was to evaluate and compare possible environmental deterioration by analysing fish health and parasite diversity in three dams within the Limpopo and Olifants River Systems by using the fish Health Assessment Index (HAI) and the Inverted Parasite Index (IPI). The intention of the study was to substantiate the theories behind the HAI and IPI in a bid to augment strategies to manage water quality, fish health and aquatic biodiversity. Seasonal surveys were carried out between April 2008 and April 2010 at three localities. The Luphephe-Nwanedi Dams are in a Nature Reserve located in a rural catchment, the Flag Boshielo Dam in an industrualised and mining catchment whereas the Return Water Dam is located on a platinum mining premise. Clarias gariepinus (Burchell, 1822) and Oreochromis mossambicus (Peters, 1852) were collected with the aid of gill nets and used as indicator fish species. Fish were examined for external parasites after which they were weighed and measured. Blood was drawn and skin smears were made. The skin smears were examined with a dissecting microscope for the presence of parasites. Fish were killed, dissected and then examined as prescribed in the fish HAI. From the ecto- and endoparasite data collected, infection statistics and ecological parameters were calculated. The HAI values were calculated for each fish species at each sampling site. To verify the results of the HAI, water quality was included in the studyThe nutrients and mining related pollutants of the three dams differed to a great extent and showed a similar increasing trend in the order: Luphephe-Nwanedi Dams < Flag Boshielo Dam < Return water Dam. Our results were consistent with previous work describing Luphephe-Nwanedi Dams as essentially unimpacted and Flag Boshielo Dam as impacted with a combination of mining and agricultural effluents. The results have shown that the Return Water Dam is an extremely polluted site with high levels of nutrients and metals. Fish health of both species responded similarly to polluted sites although mean population HAI results showed that C. gariepinus was more affected in terms of haematocrit necropsy-related alterations. The top six metrics that correlated most to fish health scores were nearly the same for both species (i.e. haematocrit values, inverted ectoparasite index, condition of the kidney, liver, gills and skin). The parasite community of C. gariepinus comprised 19 metazoan species. Seventeen parasite species were recovered from fish sampled from Luphephe-Nwanedi Dams compared to 11 at Flag Boshielo Dam and four at the Return Water Dam. The parasite community of O. mossambicus comprised 20 metazoan species. A total of 19 species, 17 species, and 4 species of metazoan parasites from O. mossambicus were obtained from Luphephe-Nwanedi Dams, Flag Boshielo Dam and the Return Water Dam, respectively. In both fish species, the Shannon Wiener Index, the inverse Simpson Index, equitability and the number of metazoan parasite individuals were highest in fish from Luphephe-Nwanedi Dams. The results of this study emphasized the negative impacts of urbanization, agricultural and mining activities on the environment. The fish hosts collected in the mining premise supported the poorest and least diverse parasite communities of all sampled sites, with virtual depletion of both heteroxenous and monoxenous species. The Return Water Dam may therefore be regarded as a simulation model for a severely environmentally deteriorated, impoverished habitat, in which all or part of the intermediate hosts have been depleted, enabling the survival of hardy parasite species only. Further studies should address the identification of parasite life stages that are more sensitive to pollutants / The National Research Foundation,the Flemish Interuniversity Council(VLIR-UOS),and the Division for Research Administration and Development,University of Limpopo

The Field Study reports on the research and development of a Health Assessment Program (HAP) for secondary school students over a period of three years in the ACT. The 'original' HAP is described, and its early implementation methods discussed. Changes are proposed and trialled, and further refinements made, then trialled again. Through this process a new HAP is developed. The 'Research and Development Cycle' (Borg and Gall 1983) provides the theoretical framework for the planning of the field study. (See 1.4). The 'new' HAP exhibits the characteristics of an 'education' program. The physical components have been developed to enable them to be administered by the teachers who are responsible for the organisation of the HAP in their school, and health professionals are only used for those components which require confidential counselling. This is in contrast to the 'original' HAP which was organised and conducted by health professionals. The process by which the changes took place has determined the quality of the new HAP. The developments have been based on the views of the teachers who used the HAP, the students who were tested, and the health professionals who participated. The literature has also been used to provide the direction for, and nature of, the changes. This process has ensured a program which is highly suitable for use in the school environment. It is not envisaged that the HAP has reached its final stage of development. Each school who uses the program is encouraged to modify and adapt it to suit the needs of their own teachers and students.

<p>This phenomenological study explored the lived experiences of undergraduate community health nursing students at the University of the Western Cape&nbsp / who conducted a family health assessment learning task in communities during their clinical fieldwork placement.The population included the 2008&nbsp / semester two, third year undergraduate baccalaureus nursing students. These students completed their community health nursing modules at the end of the first semester. A total of nine (9) out of the eighty- nine (89) semester two students participated in this qualitative research study. The purposive and&nbsp / convenient sample consisted of those students who agreed to voluntarily participate in the research study. In-depth interviews were conducted with seven&nbsp / (7) female and two (2) male students to collect data. Field notes were taken and utilized to capture non-verbal communication of the participants. The focus&nbsp / f the researcher was to explore the lived experiences of students and not that of the family whom they interviewed. All interviews were audio recorded&nbsp / nd validated by participants after transcription, before any of the data was used for the data analysis process. The data collected was categorized into themes as guided by the systematic data analyses process according to Tesch&rsquo / s (1990) method, as cited in Creswell (2003). Saturation was tested&nbsp / after nine interviews and the researcher found that no new data emerged. The importance of the research study was to reflect on the exploration of the&nbsp / self-reported lived experiences of the third year community&nbsp / ealth nursing students while conducting the family health assessment learning task.&nbsp / </p>

A review of diagnostic methods shows that new techniques are required that quantify system degradation from measured response. Information theory, developed by Claude E. Shannon, involves the quantification of information defining limits in signal processing for reliable data communication. One such technique considers information theory fundamentals forming an analogy between a machine and a communication channel to modify Shannon`s channel capacity concept and apply it to measured machine system response. The technique considers the residual signal (difference between a measured signal induced by faults from a baseline signal) to quantify degradation, perform system health assessment, and diagnose faults. Similar to noise hampering data transmission, mechanical faults hinder power transmission through the system. This residual signal can be viewed as noise within the context of information theory, to permit application of information theory to machines to construct a health measure for assessment of machine health. The goal of this dissertation is to create and study metrics for assessment of machine health. This dissertation explores channel capacity which is grounded and supported by proven theorems of information theory, studies different ways to apply and calculate channel capacity in practical industry settings, and creates methods to assess and pinpoint degradation by applying the channel capacity based measures to signals. Channel capacity is the maximum rate of information that can be sent and received over a channel having a known level of noise. A measured signal from a machine consists of a baseline signal exemplary of health, intrinsic that contaminates all measurements, and signals generated by the faults. Noise, the difference between the measured signal and the baseline signal, consists of intrinsic noise and "fault noise". Separation between fault and intrinsic (embedded in the measurement) noise shows channel capacity calculations for the machine require minimal computational efforts, and calculations are consistent in the presence of intrinsic white noise. Considering the response average or DC component of a signal in the channel capacity calculations adds robustness to diagnostic results. The method successfully predicted robot failures. Important to system health assessment is having a good baseline response as reference. The technique is favorable for industry because it applies to measurement data and calculations are done in the time domain. The technique can be used in semi-conducting industry as a tool monitoring system performance and lowering fab operating cost by extending component use and scheduling maintenance as needed. With a window running average channel capacity the technique is able to locate the fault in time. / text

<p>This phenomenological study explored the lived experiences of undergraduate community health nursing students at the University of the Western Cape&nbsp / who conducted a family health assessment learning task in communities during their clinical fieldwork placement.The population included the 2008&nbsp / semester two, third year undergraduate baccalaureus nursing students. These students completed their community health nursing modules at the end of the first semester. A total of nine (9) out of the eighty- nine (89) semester two students participated in this qualitative research study. The purposive and&nbsp / convenient sample consisted of those students who agreed to voluntarily participate in the research study. In-depth interviews were conducted with seven&nbsp / (7) female and two (2) male students to collect data. Field notes were taken and utilized to capture non-verbal communication of the participants. The focus&nbsp / f the researcher was to explore the lived experiences of students and not that of the family whom they interviewed. All interviews were audio recorded&nbsp / nd validated by participants after transcription, before any of the data was used for the data analysis process. The data collected was categorized into themes as guided by the systematic data analyses process according to Tesch&rsquo / s (1990) method, as cited in Creswell (2003). Saturation was tested&nbsp / after nine interviews and the researcher found that no new data emerged. The importance of the research study was to reflect on the exploration of the&nbsp / self-reported lived experiences of the third year community&nbsp / ealth nursing students while conducting the family health assessment learning task.&nbsp / </p>

SAMMANFATTNING                                                                                             Syftet med interventionsstudien var att undersöka om ROAG (revised oral assessment guide) munbedömningsinstrument förbättrade sjuksköterskor bedömning av cancerpatienters munhälsa på en palliativ vårdenhet. Metoden hade en kvasiexperimentell design med en journalgranskning före och efter en intervention. Interventionen bestod av en kortare utbildning av munhälsa samt införandet av ROAG munbedömningsinstrumentet. Resultatet visade att både bedömningar och åtgärder av munhälsan har ökat statistiskt signifikant jämfört med före interventionen på den palliativa vårdenheten, resultatet visar också att det inte alltid finns rätt koppling mellan symtom och åtgärd. Slutsats ROAG munbedömningsinstrument är ett bra verktyg för sjuksköterskor att använda för att bedöma munhälsan på en palliativ vårdenhet, men det räcker inte bara med ROAG munbedömningsinstrument utan det behövs kontinuerlig utbildning för att förbättra bedömningar och åtgärder . / ABSTRACT The purpose of the intervention study was to investigate whether ROAG (Revised oral assessment guide) improved nurses’ estimation of cancer patients’ oral health at a palliative care unit. The method was of a quantitative design with a quasi-experimental survey. Medical records were studied before and after an intervention, which consisted of a brief lecture on oral health and an introduction of ROAG. The results show significant increase in both assessment and measure of oral health after the intervention at the palliative care unit compared to before the intervention. The result also shows that the link between symptom and action does not always correspond to each other.   In conclusion, ROAG oral assessment is a great instrument for nurses to evaluate oral health at a palliative care unit, although it is not enough. Continuous education is required to improve evaluation and intervention.

Background Many trials in the USA, Canada, Europe and Australia have attempted to evaluate the effectiveness of preventive in-home health assessment and home care programs for older people. Trials have differed widely in their processes, including the dependence levels of subjects, assessment components and locations (clinic/home), intensity of case management (frequency of contact, length of follow-up period, scope of interventions) and methods of case management (telephone/visits). Preventive programs use valuable health resources and, although there has been inconclusive evidence of their effectiveness, programs combining preventive in-home health assessment and home care for older people have been introduced into public policy in Australia and internationally. Ongoing research is therefore essential in order to identify the positive benefits for older people, and establish their effectiveness with regard to health resource utilisation. Purpose The purpose of the study was to maintain the health status of older people living alone in the community by implementing a preventive health assessment and follow-up home care program. Research Design An experimental group was compared with a control group using a cluster randomised controlled trial methodology. Health outcomes were measured pre and post intervention, including health perception, functional ability, psychosocial status, client satisfaction, and health resource utilisation. Population and Sample The population for this study consisted of people aged 75 years and over who lived alone in Independent Living Units within managed retirement facilities, and who were highly independent in their activities of daily living. The final sample totalled 124, comprising of an experimental group (n=61) and a control group (n=63). The sample resided in South East Queensland. Intervention The intervention for the study "A Community Preventive Health Model for over 75s Living Alone" comprised of five major elements: 1) targeting before health and/or social crisis, and while community care needs were low; 2) linking clients with a community nurse; 3) comprehensive health assessments and identification of needs; 4) introduction of basic health care and community services and referrals if required; and 5) case management by three-monthly telephone contact. Assessments and case management were carried out by experienced community care registered nurses, and case management was performed for a one year period. The control group received health assessments and phone calls similar to the experimental group for data collection purposes, and to balance the risk of a Hawthorne effect due to regular contacts with participants. However all aspects of case management were omitted from all episodes of contact with the control group. For ethical reasons control group participants were supplied with a summary of their health assessment results to share with their GP if they wished. Data Collection and Instruments Measures of health perception, functional ability and psychosocial status occurred at two points (baseline and after 12 months). Measures of health resource utilisation, mortality and client satisfaction were measured after twelve months. A combination of several widely-used, valid and reliable instruments, as well as some newly developed data collection tools, were used to measure health outcomes. Data Analysis Independent group t-tests and Chi-square tests were used to examine for baseline differences between the experimental and control groups, and also to analyse health resource utilisation data at Time 2. A series of ANCOVA tests were applied to test the remaining hypotheses, so that the effects of Time 1 scores and potential confounding variables could be incorporated into the analyses. Results The experimental group and control group were homogenous at baseline for all demographic variables and all major outcome variables. The intervention model was applied for one year, with 66% (n = 40) in the experimental group having at least one unmet need identified and appropriate interventions undertaken. Only a small proportion of interventions (16%) were recorded as not being followed through by clients, and the majority (59%) resulted in needs being met or problems resolved. Results showed no benefits were gained from the program after one year for experimental group participants for the outcomes of health perception, functional ability, psychosocial status, health resource utilisation and mortality. However, the experimental group did show a statistically significantly higher level of satisfaction with care. Conclusions Comprehensive assessments performed by Registered Nurses with expertise in gerontology resulted in the identification of previously undetected unmet needs. When comprehensive assessment was combined with low intensity case management for a one year period, higher levels of client satisfaction with care were achieved. Therefore a model involving Registered Nurses with advanced knowledge and experience in aged care, working in collaboration with General Practitioners and community service organisations, could have considerable benefits in identifying unmet needs and improving client satisfaction. However, no client benefit was detected for quality of life outcomes, nor was a reduction in health resource utilisation found. This result from an Australian cohort is consistent with findings from many other international trials (Van Haastregt et al., 2000). It is possible that methodological issues are masking the effect of the intervention. Are we measuring appropriate outcomes? Are we expecting long-term outcomes in short time frames? Are we applying the model appropriately across a diverse older population? Further research to explore these questions is recommended for the future.

Orientador: Marli Teresinha Cassamassimo Duarte / Resumo: Introdução: O Subsistema Nacional de Vigilância Epidemiológica em Âmbito Hospitalar visa aumentar a sensibilidade e oportunidade na detecção de doenças de notificação compulsória (DNC) e, assim, possibilitar a adoção, oportuna, de medidas de controle, possibilitando a interrupção da cadeia de transmissão de doenças entre a população. Tendo-se em vista a importância de estudos avaliativos para o aprimoramento do sistema e a escassez de estudos nesta área, propôs-se a presente pesquisa que teve por objetivo descrever e avaliar a rede dos NHE do Estado de São Paulo, do ponto de vista de estrutura, com enfoque nos recursos humanos, e de processo. Método: Trata-se de estudo transversal, que incluiu 34 dos 41 NHE do Estado de São Paulo. Os dados foram obtidos de julho de 2017 a janeiro de 2018 por meio de questionário eletrônico e analisados com base nas Portarias 183/2014 GM/MS e 204/2016 GM/MS e no Guia de Vigilância Epidemiológica, segundo referencial de avaliação de Donabedian (1980), considerando-se estrutura e processo. Para a avaliação de estrutura foram selecionados 4 indicadores relacionados à composição e capacitação das equipes e para o processo, 4 indicadores relativos à organização e gestão do processo de trabalho e 7 referentes às atribuições previstas nas legislações. Os dados foram analisados por meio de estatística descritiva. Resultado: A maioria (73,5%) dos coordenadores eram mulheres, tinham 30 a 59 anos (64,7%) e a totalidade ensino superior completo. Dentre os... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Hospital - based Epidemiological Surveillance Subsystem aims t o increase sensitivity and opportunity in the detection of notifiable diseases through the timely adoption of control measures, enabling the interruption of the chain of transmission of diseases among the population. Considering the importance of evaluati ve studies for the improvement of the System and the scarcity of studies in this area , the purpose of the present study was to describe and evaluate the network of the NHE of the State of São Paulo, from the point of view of structure, focusing on human re sources, and process. Method: This is a cross - sectional study, which included 34 of the 41 NHE's in the State of São Paulo. The data were obtained from July 2017 to January 2018 by means of an electronic questionnaire and analyzed based on Ordinances 183/2 014 GM/MS and 204/2016 GM/MS and on the Guide of Epidemiological Surveillance, according to the Donabedian evaluation referential (1980), considering structure and process. For the evaluation of the structure, 4 indicators related to the composition and qu alification of the teams and for the process 4 indicators related to the organization and management of the work process and 7 related to the attributions provided in the legislations were selected. Data were analyzed using descriptive statistics. Outcome: The majority (73.5%) of the coordinators were women, were between 30 and 59 years old (64.7%) and the entirety of them had complete higher educati... (Complete abstract click electronic access below) / Mestre